Clinical Thyroid Disease

Question 1

What are the symptoms of hypothyroidism ?

Answer 1

Weight gain 
Lethargy 
Feeling cold 
Constipation
Heavy periods
Dry skin 
Hair fall out 
Bradcardia 
Slow reflexes 
Goitre

Question 2

What are the TSH and FT4/FT3 levels in primary hypothyroidism?

Answer 2

Raised TSH

Low T3 and T4

Question 3

What are the TSH and T3/T4 levels in subclincal hypothyroidism?

Answer 3

High TSH
Low or normal T3 T4
The TSH has managed to compensated for the reduced secretion of T3 T4

Question 4

What are the TSH and T3/4 levels in secondary hypothyroidism?

Answer 4

Low TSH

Low T3/4

Question 5

What is the commonest endocrine condition after DM?

Answer 5

Hypothyroidism

Question 6

Are males or females more affected in hypothyroidism?

Answer 6

Females

Question 7

How does risk of hypothyroidism change with age?

Answer 7

Increased risk with age

Question 8

Why is everyone screened at birth for hypothyroidism?

Answer 8

Because if missed it can lead to inproper development

Question 9

What are some causes of primary hypothyroidism?

Answer 9

Autoimmune thyroid disease (Hashmitos)
Iatrogenic
Chronic iodine deficiency
Drug induced

Question 10

What are some causes of secondary hypothyroidism?

Answer 10

Pituitary/hypothalamic damage:
Pituitary tumour 
Post PG surgery 
Sheehan's syndrome 
Isolated TRH deficiency

Question 11

What are the investigations for hypothyroidism?

Answer 11

TSH
FT4/FT3
Autoantibodies (TPO)

Question 12

What is the treatment for hypothyroidism?

Answer 12

Levothyroxine

Question 13

Is there any benefit to combining FT3 and FT4 treatment?

Answer 13

No

Question 14

What is the initial dose of levothyroxine?

Answer 14

50 mcg/day

Question 15

For how long do you increase the dose of lvevothyroxine?

Answer 15

Until TSH is normal

Question 16

After stabilisation how often is hypothyroidism checked?

Answer 16

Annual

Question 17

When should levothyroxine be taken?

Answer 17

Same time everyday on an empty stomach

Question 18

When would you be more cautious about levothyroxine dose?

Answer 18

IHD - angina
Pregnancy - increase dose by 25%
Potpartum thyroiditis
Myxedema coma

Question 19

What is the treatment for myxedema coma?

Answer 19

IV T3 (steroid)

Question 20

What is myxedema hypothyroidism?

Answer 20

Coma due to hypothyroidism

Question 21

When should treatment of subclinical hypothyroidism be considered?

Answer 21

TSH>10
TSH>5 with positive thyroid antibodies
TSH elevated with symptoms

Question 22

What is goitre?

Answer 22

Swelling of the neck resulting from enlargement of the TG

Question 23

What causes goitre?

Answer 23

Puberty 
Pregnancy 
Grave's disease
Hashmoto's disease 
Thyroiditis 
Iodine deficiency

Question 24

What are the type of goitre?

Answer 24

Multinodular 
Diffuse 
Cysts 
tumours 
Miscellaneous

Question 25

What tumours can cause goitre?

Answer 25

Adenomas Carcinomas Lymphomas

Question 26

What are the investigations for a solitary nodule?

Answer 26

Thyroid function tests Isotope scanning if low TSH USS FNA

Question 27

What is the commonest type of thyroid cancer?

Answer 27

Papillary

Question 28

What is the prognosis for follicular and papillary thyroid cancer?

Answer 28

Good prognosis

Question 29

Who is papillary thyroid cancer common in?

Answer 29

younger females

Question 30

Where does follicular thyroid carcinoma typically spread to?

Answer 30

Lungs | Bone

Question 31

Rx for thyroid cancer?

Answer 31

Near total thyroidectomy High does radioiodine Long term suppressive doses of thyroxine Follow up

Question 32

What are other types of thyroid cancer?

Answer 32

Anaplastic Lymphoma Medullary

Question 33

What is the prognosis for anaplastic thyroid cancer?

Answer 33

Very poor | Due to it being so aggressive and locally invasive

Question 34

Where do medullary thyroid cancers arise from?

Answer 34

Parafollicular C cells

Question 35

What are the signs of hyperthyroidism?

Answer 35

``` ¥ Weight Loss ¥ Anxiety/Irritability ¥ Heat Intolerance ¥ Bowel frequency increases ¥ Light periods ¥ Sweaty palms ¥ Palpitations ¥ Hyperreflexia/Tremors ¥ Goitre ¥ Thyroid eye symptoms/signs ```

Question 36

What are the causes of primary hyperthyroidism?

Answer 36

Grave's disease Toxic multinodular goitre Toxic adenoma

Question 37

What is the main cause of secondary thyrotoxicosis?

Answer 37

Pituitary adenoma secreting TSH

Question 38

What causes thyrotoxicosis without hyperthyroidism?

Answer 38

Destructive thyroiditis | Excessive thyroxine administration

Question 39

Who is more affected with Grave's disease m or f?

Answer 39

F>M

Question 40

What is a common goitre presentation of grave's disease?

Answer 40

Diffuse goitre

Question 41

Which antibodies drive grave's disease?

Answer 41

Thyroid peroxidase antibodies | TSH receptor antibodies

Question 42

What is the treatment for hyperthyroidism?

Answer 42

ATD - carbimazole BB Radioiodine Thyroidectomy

Question 43

What is the draw back to radioiodine treatment?

Answer 43

High chance of hypothyroidism

Question 44

What are the anti thyroid drugs?

Answer 44

Carbimazole Propylthiouracil

Question 45

Who cant radioiodine patients come into contact with for 4 weeks?

Answer 45

<18 | Pregnant women

Question 46

TSH: 15 (0.3-3.3) FT4: 9 (10-25) What is the diagnosis?

Answer 46

Primary hypothyroidism

Question 47

TSH: 2 (0.3-3.3) - low end of normal FT4: 9 (10-25) What is the diagnosis?

Answer 47

Secondary hypothyroidism

Question 48

TSH: 15 (0.3-3.3) FT4: 12 (10-25) What is the diagnosis?

Answer 48

Subclinical hypothyroidism

Question 49

Why is FT4 normal and TSH elevated in subclinical hypothyroidism?

Answer 49

Because the PG rises TSH levels to compensate for the low FT4 levels

Question 50

Why is TSH high but FT4 low in primary hypothyroidism?

Answer 50

TSH tried to produce more FT4 but the thyroid isn't working so will not physically produce any more FT4

Question 51

What are the investigations for hyper and hypothyroidism?

Answer 51

TSH T4 T3 Thyroid antibodies

Question 52

What are the draw backs to thyroidectomy in hyperparathyroidism?

Answer 52

Will need thyroid replacement therapy for life Risk of hypoparathyroidism Risk of damage to recurrent laryngeal n. – hoarseness