Disease Profiles: Thyroid Disorders Flashcards
(194 cards)
1
Q
How would you manage hyperthyroidism in pregnancy?
A
Graves may settle as pregnancy suppresses autoimmunity
β-blockers if needed
LOW DOSE antithyroid drugs (wait as late as possible due to side effects on foetus) - propylthiouracil 1st trimester, carbimazole 2/3rd trimester
2
Q
Describe the genetic factors linked to Graves disease
A
Increased incidence in family members
Susceptibility associated with certain HLA haplotypes, as well as polymorphisms in genes associated with immune regulation
3
Q
Describe the management of acute severe hypercalcaemia
A
Fluids - rehydrate with 0.9% saline 4-6L in 24 hours
Consider loop diuretics once rehydrated (avoid thiazides)
Bisphosphonates - single dose will lower Ca2+ over 2-3 days, max. effect at 1 week
4
Q
Describe the histology of minimally invasive follicular carcinoma
A
Follicular architecture well differentiated, may have part surrounding capsule, difficult to distinguish from adenoma
5
Q
How would you differentiate between hyperemesis gravidarim and hyperthyroidism in pregnancy?
A
Hyperemesis gravidarim - ↑hCG, ↓TSH, no antibodies
HG should resolve by 20 weeks gestation
6
Q
Which genetic syndrome results in patients who almost always develop a parathyroid adenoma with hypercalcaemia at a young age?
A
MEN1 and 2
7
Q
Which forms of hyperparathyroidism can result in hypercalcaemia?
A
Primary and tertiary
8
Q
Why is smoking cessation very important in a patient with Graves disease?
A
Graves eye disease is associated with smoking
9
Q
Which type of differentiated thyroid cancer has a propensity for haematogenous spread?
A
Follicular carcinoma
10
Q
What is pretibial myxoedema?
A
Infiltrative dermopathy caused by the accumulation of excess mucopolysaccharides, associated with Graves disease and occasionally seen in Hashimoto’s thyroiditis
11
Q
Describe the management of thyroid lymphoma
A
Chemotherapy (R-CHOP), radiotherapy or steroids
(Does not respond to RAI)
12
Q
Describe the pathophysiology of Graves disease
A
Involves auto-antibodies to TSH receptor, thyroid peroxisomes and thyroglobulin
The anti-TSH receptor antibodies stimulate the thyroid resulting in increased function
Some antibodies can inhibit function - may explain paradoxical episodes of hypofunction which can occur
13
Q
Describe the clinical presentation of medullary thyroid carcinoma
A
Neck mass with local effects - dysphagia, hoarseness, airway compromise
Paraneoplastic syndromes - diarrhoea, Cushing’s
14
Q
When would you treat subclinical hyperthyroidism?
A
If TSH <0.1%, or if co-existing osteoporosis/fracture or AF
15
Q
What are β-blockers used for in the management of Graves disease?
A
Useful for immediate symptomatic relief of thyrotoxic symptoms
16
Q
PTH increases urinary _____ excretion
A
Phosphate
17
Q
Name 3 causes of hypocalcaemia
A
Chronic kidney disease, congenital absence (DiGeorge syndrome), destruction (surgery, radiotherapy, malignancy)
18
Q
___ production by a medullary thyroid carcinoma causes diarrhoea
A
VIP
19
Q
______ cases of medullary thyroid carcinoma result in a solitary nodule
A
Sporadic
20
Q
Describe the management of hypercalcaemia secondary to malignancy
A
Treat underlying malignancy
Chemotherapy may reduce calcium in e.g. myeloma
21
Q
Name two drugs which can cause hypercalcaemia
A
Vit. D, thiazides
22
Q
Describe the management of advanced medullary thyroid carcinoma
A
May involve tyrosine kinase inhibitors
23
Q
Why are patients with differentiated thyroid cancer after initial treatment given suppressive doses of levothroxane?
A
Aim is to suppress TSH below the normal range to minimise risk of recurrence
24
Q
Describe the clinical presentation of thyroid lymphoma
A
Rapid onset mass in thyroid
25
Which genetic syndrome results in patients who develop an adenoma resulting in primary hyperparathyroidism?
Familial isolated hyperparathyroidism
26
Describe the clinical presentation of a differentiated thyroid cancer
Majority present with palpable nodules
Small percentage are chance findings on histological section of thyroidectomy tissue
Approx. 5% present with local or disseminated metastases
Local effects e.g. hoarseness, dysphagia, cough suggest advanced disease
27
What is fibrosa cystica?
Osteoporosis, brown tumours and osteitis caused by overproduction of PTH and continued osteoclasis in hyperparathyroidism
28
Why should you alert neonatologist if you find TRAb antibodies in a pregnant woman?
TRAb antibodies can cross the placenta and cause neonatal transient hyperthyroidism
29
Which investigations would you perform in suspected differentiated thyroid cancer?
US scan, TSH
Confirm with US-FNA, may need excisional biopsy of lymph node
Pre-operative laryngoscopy if vocal cord palsy suspected clinically
30
Describe the pathophysiology of a goitre
Reduced T3/T3 production causes a rise in TSH, stimulating gland enlargement
May maintain euthyroid state or if compensation fails there will be goitrous hypothyroidism
31
What is scintiscan used for in investigating a patient with hyperthyroidism?
Used in patients who are antibody negative to look for toxic nodular disease
32
How would you manage a 'low risk' thyroid cancer?
Thyroid lobectomy + biopsy, thyroidectomy following biopsy results if needed
33
What is pseudo-pseudohypoparathyroidism?
Describes the phenotypic defects of pseudohypoparathyroidism (Albright's herditary osteodystrophy) but without any abnormalities in calcium metabolism
34
Describe the chronic clinical features of hypercalcaemia
Myopathy
Fractures
Osteopenia
Depression
Pancreatitis
Duodenal ulcers
Hypertension
Renal calculi
35
Which differentiated thyroid cancer has been associated with activation of the MAP kinase pathway, rearrangements of RET or NTKR1, activating point mutation in BRAF and ras mutations?
Papillary carcinoma
36
How would you be able to tell if a nodule on the throat is in the thyroid?
Moves on swallowing - invested in pretracheal fascia
37
\_\_\_ production by a medullary thyroid carcinoma causes Cushing's
ACTH
38
Name three causes of medullary thyroid carcinoma
Adults - sporadic, familial non-MEN
Children - MEN2a
39
Name 3 causes of thyrotoxicosis not associated with hyperthyroidism
Thyroiditis e.g. drug-induced
Exogenous thyroid hormones
Ectopic thyroid tissue
40
Name the three components of fibrosa cystica
Osteoporosis, brown tumours and osteitis
41
How would you investigate a follicular adenoma?
US scan, FNA, serum TSH, thyroid surgery + biopsy
42
How would you monitor a patient with differentiated thyroid cancer after initial treatment?
Measure TSH and Tg every 6 months for first 5 years, then annually for next 5 years, consider discharge after 5 years if low risk
43
What is a diffuse goitre?
Diffusely enlarged thyroid
44
Describe the clinical presentation of post-partum thyroiditis
Small, diffuse, nontender goitre
Hyperthyroid then hypothyroid
45
Describe histology of papillary carcinoma
Can be multifocal
Often cystic
May be calcified - psammoma bodies
46
What is a follicular adenoma?
Benign encapsulated tumour of the thyroid gland that is surrounded by a thin fibrous capsule
47
What causes primary hyperparathyroidism?
Due to a benign adenoma, hyperplasia or rarely a malignant neoplasia within the parathyroid glands
48
How can hypomagnesaemia cause hypocalcaemia?
Calcium release from cells is dependent on magnesium - in magnesium deficiency intracellular calcium is high so PTH release will be inhibited
49
Describe the management of primary hyperparathyroidism
Parathyroidectomy if indicated
Cinacalcet (calcium mimetic) - can be useful if need treatment but unfit for surgery
50
What is a multi-nodular goitre?
Irregular enlarged thyroid due to nodule formation
51
Which patient group is most likely to develop a sporadic diffuse goitre?
Females, usually occurs in puberty/YA
52
What is the first line antithyroid drug in the management of Graves disease?
Carbimazole
53
How would a brown tumour appear on x-ray?
Lytic lesion
54
Name two conditions associated with subclinical hyperthyroidism
Osteoporosis and atrial fibrillation
55
Describe the clinical presentation of pseudohypoparathyroidism
Bone abnormalities (McCune Albright)
Obesity
Subcutaneous calcification
Learning disability
Brachydactyly (shortened 4th metacarpal)
56
What is subclinical hyperthyroidism?
↓TSH, normal fT4/3
57
Describe the clinical presentation of a multi-nodular goitre
Multiple nodules - thyroid feels bumpy on palpation
Mass effects
Can be inactive or toxic
58
If a patient has a solitary thyroid nodule which is firm, hard and immobile with cervical lymphadenopathy and associated hoarseness, is it more likely to be benign or malignant?
Malignant
59
Describe the management of anaplastic thyroid carcinoma
Total thyroidectomy if resectable +/- adjuvant radiochemotherapy as needed
(Do not respond to RAI)
60
Describe the management of a diffuse goitre
Treat underlying cause if appropriate
Usually no further treatment needed (unless causing obstructive symptoms - surgery)
61
How are thyroid nodules which have undergone USS-FNA classified?
FNA Bethesda classification - Thy1-5
62
How would you manage a hypothyroid patient who becomes pregnant?
Increase thyroxine dose by 25mcg as soon as pregnancy suspected, check TFTs regularly and increase thyroxine appropriately
63
Name two classes of disease which can cause hyperparathyroidism
Granulomatous disease e.g. sarcoid, TB
Disease of high turnover e.g. thyrotoxic, Pagets (especially if bedridden)
64
How would you investigate a multi-nodular goitre?
As for thyroid nodule - thyroid function test, US, FNA, thyroid isotope scan
CT scan may detect retrosternal extension and tracheal compression in patients with a very large goitre or clinical symptoms
Flow volume loops if considering other potential causes of breathlessness
65
What is a toxic thyroid nodule?
Thyroid gland contains autonomously functioning thyroid nodule(s), with resulting hyperthyroidism
66
Describe the prognosis of anaplastic thyroid carcinoma
Rapid growth and involvement of neck structures and death
67
What causes a sporadic diffuse goitre?
Most cases have no clear cause
Some associated with ingestion of substances limiting T3/T4 production or dyshormonogenesis
68
Describe the biochemistry usually seen in primary hyperparathyroidism
High calcium, usually high serum PTH, normal or low phosphate
69
Name an autoimmune disease associated with the development of papillary carcinoma
Hashimotos
70
Describe the clinical presentation of primary hyperparathyroidism
Hypercalcaemia - fatigue, depression, bone pain, myalgia, nausea, thirst, polyuria, renal stones, osteoporosis
71
Describe the management of a thyroid storm
High dose carbimazole
β-blockers (propranolol)
Potassium iodide
Hydrocortisone
IV fluids +/- inotropes
Treat precipitating cause e.g. MI, infection, PE
72
What is pseudohypoparathyroidism?
Genetic defect of the Gs⍺-protein causing end organ resistance to PTH → hypocalcaemia
73
Which patient group is most likely to develop follicular carcinoma?
Higher incidence in female, higher incidence at 40-50 years
Incidence slightly higher in regions of iodine deficiency
74
Describe the clinical presentation of anaplastic thyroid carcinoma
Thyroid nodule
Features of local infiltration/compression
Cervical lymphadenopathy
Signs of distant metastases
75
Name a genetic mutation associated with medullary thyroid carcinoma
Germline RET mutations
76
Name the 4 types of benign thyroid nodule
Cyst
Colloid nodule
Benign follicular adenoma
Hyperplastic nodule
77
Define thyrotoxicosis
The clinical, physiological, and biochemical state arising when the tissues are exposed to excess thyroid hormone
78
Describe the reproductive features of hyperthyroidism
Menstrual cycle changes, including lighter beeling and less frequent periods
79
Describe the pathophysiology of a multi-nodular goitre
Variation of response of follicular cells to external stimuli - recurrent hyperplasia and involution
Mutations of TSH signalling pathway
There will be a varying degree of fibrosis, haemorrhage and calcification
80
Describe the long term management of hypocalcaemia
Calcium supplement
Vitamin D supplement or cholecalciferol depot injection
81
A patient presents with hypercalcaemia. PTH levels are undetectable. What must be investigated for?
Malignancy
82
Describe the clinical presentation of hypocalcaemia
Paraesthesia - fingers, toes, perioral
Muscle cramps, tetany
Muscle weakness
Fatigue
Bronchospasm or laryngospasm
Fit
83
Describe the clinical presentation of a diffuse goitre
Entire thyroid gland swells and is smooth to the touch
Usually euthyroid, may be S+S of hyper/hypothyroidism
Mass effects
In children dyshormonogenesis may cause cretinism
84
Which thyroid cancers are derived from follicular epithelium?
Papillary and follicular carcinoma
85
How would you investigate a diffuse goitre?
Thyroid function tests - T3/T4 normal, TSH high or upper limit of normal
86
What is rhTSH used for in whole-body iodine scanning?
Increase TSH to ensure sensitivity
87
What is familial hypocalciuric hypercalcaemia?
Autosomal dominant deactivating mutation in the calcium sensing receptor which results in decreased sensitivity of the receptor to calcium
88
Describe the hair and skin features of hyperthyroidism
Hair change (thin, brittle hair)
Rapid fingernail growth
89
How would you manage a patient with recurrent differentiated thyroid cancer?
Whole-body scan to determine ability to take up iodine with a view to RAI
If negative whole-body scan - systemic anti-cancer therapy
90
Hypo- and hyperthyroidism causes anovulatory cycles, resulting in reduced \_\_\_\_\_\_\_
Fertility
91
What thyroid hormone results would you expect in a patient with primary hyperthyroidism e.g. in Graves disease?
TSH low, free T4/T3 high
92
Which autoantibody is found in 70-100% of patients with Graves disease?
TSH receptor antibody (stimulating)
93
PTH increases the synthesis of active forms of _______ \_\_
Vitamin D
94
What causes secondary hyperparathyroidism?
Physiological response to low calcium or vitamin D resulting in overproduction of PTH, can also be caused by chronic kidney disease
95
How can malignant disease cause hypercalcaemia?
Metastatic bone destruction
PTHrp from solid tumours
Osteoclast activating factors produced by tumours
96
How would you manage a 'high risk' thyroid cancer?
Subtotal/total thyroidectomy
Consider radioactive iodine
97
How would you manage severe Graves eye disease?
Steroids, radiotherapy, surgery
98
Describe the management of a multi-nodular goitre
Most can leave alone
Antithyroid drugs if toxic
Radioactive iodine if significant hyperthyroid
Surgery if structural problem or significant retrosternal extension
99
What are differentiated thyroid cancers?
Refers to papillary and follicular variants
100
What is thyroid bruit?
Bruit when auscultating over the thyroid, associated with the formation of large goitres in Graves disease
Reflective of hypervascularity of thyroid
101
Name 5 causes of hypomagnesemia
Alcohol, drugs, GI illness with diarrhoea, pancreatitis, malaborption
102
Define hashitoxicosis
Transient hyperthyroidism caused by inflammation associated with Hashimoto's thyroiditis, patient will then develop hypothyroidism
103
What is a thyroid storm?
Rapid deterioration of hyperthyroidism with typically seen in hyperthyroid patient with an acute infection/illness or recent thyroid surgery
104
When would you treat subclinical hypothyroidism?
TSH \> 10 or if patient is pregnant
105
Which patient group is most likely to develop thyroid lymphoma?
Background of auto-immune hypothyroidism
Females aged 70-80 years
106
Which form of differentiated thyroid cancer more commonly spreads to the lungs, bone or brain?
Follicular carcinoma
107
Serum alkaline phosphatase is raised in hypercalcaemia of \_\_\_\_\_\_\_\_\_
Malignancy
108
Describe the musculoskeletal features of hyperthyroidism
Fine tremor of the outstretched fingers
Muscle weakness, especially in thighs and upper arms
109
Which antithyroid drug is given instead of carbimazole during 1st trimester of pregnancy?
PTU
110
Describe the management of localised medullary thyroid carcinoma
Total thyroidectomy - curative
111
PTH increases reabsorption of _____ by renal tubules
Calcium
112
Describe the prognosis of post-partum thyroiditis
After delivery, the mother develops transient over-active thyroid, classically at around 6 weeks, and then at around 3 months has an underactive thyroid
Hypothyroid phase associated with neonatal depression
Can persist up to 1 year postpartum
25-50% will have persistent hypothyroidism beyond 1 year
113
How would you describe a 'high risk' differentiated thyroid cancer?
Stage Thy3 or higher on FNA (atypical)
114
Name 2 medications which can cause hypomagnesemia
Thiazide, PPIs
115
When would you perform a thyroidectomy in a hyperthyroid patient?
Relapsed Graves' disease and nodular thyroid disease when radioiodine is contraindicated e.g. pregnancy
116
Describe the acute clinical features of hypercalcaemia
Thirst
Dehydration
Confusion
Polyuria
117
Describe the ophthalmological features of hyperthyroidism
Lid retraction
Double vision
Graves ophthalmopathy in Graves disease
118
What causes Graves eye disease?
Results from autoimmune inflammation of the extra-ocular muscles as orbital fat and connective tissue have TSH receptors
119
Describe the histology of medullary thyroid carcinoma
Composed of spindle or polygonal cells arranged in nests, trabeculae or follicles
Associated amyloid deposition (abnormally folded calcitonin)
120
Which differentiated thyroid cancer has been associated with mutations in PI3K/AKT pathway, ras mutations and translocation involving Pax8 and PPAR𝛾1?
Follicular carcinoma
121
Describe the management of a follicular adenoma
Lobectomy with biopsy
122
Describe the biochemistry usually seen in tertiary hyperparathyroidism
High calcium, high PTH
123
Name the 4 types of malignant thyroid nodule
Papillary thyroid carcinoma
Medullary thyroid carcinoma
Lymphoma
Anaplastic
124
Which patient group is most likely to develop Graves disease?
Females, 20-40 years
125
Name the most common cause of hyperthyroidism (85%)
Graves disease
126
Which form of differentiated thyroid cancer more commonly spreads to cervical lymph nodes?
Papillary carcinoma
127
Describe the biochemistry usually seen in familial hypocalciuric hypercalcaemia
Mild hypercalcaemia, reduced urine calcium excretion, (marginally) elevated PTH
128
Describe the cardiovascular features of hyperthyroidism
Increased pulse rate
Palpatations, AF
Rarely cardiac failure
129
How would you investigate underlying malignancy in a patient with hypercalcaemia?
X-ray, CT, MRI, PET
Isotope bone scan
130
Name two genes implicated in \< 20% of follicular adenomas
\< 20% have a mutant ras or PIK3CA
131
What causes tertiary hyperparathyroidism?
Parathyroid becomes autonomous after many years of overactivity e.g. renal failure
132
What causes a diffuse goitre?
Physiological (e.g. pregnancy)
Autoimmune thyroid disease
Endemic (iodine deficiency)
Inflammation (de Quervain's thyroiditis
Sporadic
133
How would you describe a 'low risk' differentiated thyroid cancer?
Age \<50 years, tumour \<4 cm
134
What classification of thyroid nodule on ultrasound would prompt further investigation (USS-FNA)?
U3 (atypical) and above
135
Describe the clinical features of a thyroid storm
Hyperpyrexia, severe tachycardia, extreme restlessness, cardiac failure and liver dysfunction
136
Name two genetic features associated with anaplastic thyroid carcinoma
p53 and β-catenin mutations (+ genetic features associated with DTCs)
137
What thyroid hormone results would you expect in a patient with secondary hyperthyroidism?
TSH high, free T4/T3 high (or 'normal')
138
What is a thyrotropinoma?
TSH secreting pituitary adenoma, very rare cause of hyperthyroidism
139
What ECG finding is consistent with hypocalcaemia?
QT prolongation
140
Describe the management of hypomagnesemia
Magnesium supplementation, calcium supplementation if needed
141
PTH activates ________ which results in increased bone reabsorption and releases calcium
Osteoclasts
142
Describe the biochemistry usually seen in pseudohypoparathyroidism
Calcium will be low but PTH concentrations are elevated due to PTH resistance
143
How would you investigate anaplastic thyroid carcinoma?
TSH, US
Confirmation: US-FNA or biopsy
144
Which type of differentiated thyroid cancer tends to spread via lymphatics?
Papillary carcinoma
145
Describe the biochemistry usually seen in secondary hyperparathyroidism
Low calcium, high PTH
146
Define subclinical thyroid disease
Abnormal TSH with normal thyroid hormone
147
What is a goitre?
Enlarged palpable thyroid gland, which moves on swallowing
148
What is Trousseau's sign?
Sign of hypocalcaemia - inflation of the sphygmomanometer cuff above systolic pressure for 3 min induces tetanic spasm of the fingers and wrist
149
Maternal thyroxine important for neonatal development (especially \_\_\_)
CNS
150
Which patient group is most likely to develop a follicular adenoma?
Higher incidence in women, increases in incidence in increasing age
Increased incidence in regions of iodine deficiency
151
Describe the neuropsychiatric features of hyperthyroidism
Increased nervousness and excessively emotional
Sleep disturbance
Depression
Insomnia
152
What is Chovestek's sign?
Sign of hypocalcaemia - gentle tapping over the facial nerve causes twitching of the ipsilateral facial muscles
153
What is thyroid arcropachy?
Specific sign of Graves disease involving thickening of the extremities manifested by digital clubbing, soft tissue swelling of the hands and feet, and periosteal new bone formation
154
Which patient group is most likely to develop a benign thyroid nodule?
Females
155
Describe the pathophysiology of post-partum thyroiditis
In the postpartum phase there is exacerbation of all autoimmune diseases
156
\_\_\_\_\_\_ cases of medullary thyroid carcinoma result in bilateral/multicentric disease
Familial
157
Describe the clinical signs of hypomagnesemia
Positive Chvostek sign and Trousseau sign
Cardiac arrhythmias
158
Which investigations would you perform in suspected medullary thyroid carcinoma?
Neck USS and FNA
Measure serum base calcitonin - 24-hour urinary metanephrines
Further imaging to detect localised/advanced disease
Check genetics for MEN
159
Which investigations would you perform in hypomagnesemia?
Serum magnesium (low)
Measure other electrolytes, particularly K+ and Ca2+
160
Which investigation would you perform in suspected thyroid lymphoma?
Core biopsy
161
Describe the management of acute severe hypocalcaemia
IV calcium gluconate 10 ml, 10% over 10 mins (in 50ml saline or dextrose)
Calcium infusion (10ml 10% calcium gluconate in 100ml infusate, at 50 ml/h)
162
How are thyroid nodules seen on ultrascan classified?
USS classification - U2-U5
163
Describe the features of Graves eye disease
Autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, erythema, conjunctivitis, and bulging eyes (exophthalmos)
164
Which differentiated thyroid cancer is associated with ionising radiation?
Papillary carcinoma
165
When would you use a whole body iodine scanning (I-131) in a patient with differentiated thyroid cancer?
Patients who have undergone sub-total or total thyroidectomy to determine incomplete incision or present of occult metastases
166
Which nerve is most at risk of damage during a thyroidectomy?
Recurrent laryngeal nerve
167
Describe the clinical presentation of a follicular adenoma
Discrete solitary mass in an otherwise normal thyroid gland
May be incidental finding
Patients with larger tumours may present with local symptoms e.g. dysphagia
168
Most differentiated thyroid cancers take up _____ and secrete \_\_\_\_\_\_\_
Iodine, thyroglobulin
169
If a patient has a solitary thyroid nodule that is tender, soft, smooth, and mobile with associated hormonal disturbance is it more likely to be benign or malignant?
Benign
170
What percentage of solitary thyroid nodules are benign?
95%
171
'Bones, stones, moans, and groans' refers to what?
General S+S of hypercalcaemia - bone pain, gallstones, abdominal pain and psychiatric disturbances
172
Describe the histology of widely invasive follicular carcinoma
More solid architecture, less follicular architecture, more mitotic activity
173
How does a multi-nodular goitre develop?
Develops from a long-standing simple sporadic goitre
174
What is the 1st choice treatment for relapsed Graves' disease and for nodular thyroid disease?
Radioactive iodine
175
What are brown tumours?
Osteoporotic bone prone to fracture - associated haemorrage elicits macrophage reaction and processes of organisation and repair which results in a mass of reactive tissue
176
When would you use RAI ablation in a patient with differentiated thyroid cancer?
To destroy occult microfoci left behind after thyroidectomy, and to remove residual thyroid tissue which may be a source of Tg and therefore confound the levels during follow-up
177
What is a medullary thyroid carcinoma?
Tumour of the parafollicular cells which secrete calcitonin (C-cells)
178
Why is thyroid surgery with biopsy is required for treatment and definitive diagnosis of a follicular adenoma?
FNA cannot distinguish between follicular adenoma and follicular carcinoma
179
Functioning follicular adenomas have an activating mutation in which signalling pathway?
TSHR
180
Describe clinical presentation of familial hypocalciuric hypercalcaemia
Usually benign/asymptomatic
181
Define hyperthyroidism
Refers to conditions in which overactivity of the thyroid gland leads to thyrotoxicosis
182
Which patient group is most likely to develop a papillary/follicular carcinoma?
Can affect any age group
In females, rates increase from 15-40 then plateaus
In males rates steadily increase with age
183
Describe the management of post-partum thyroiditis
No treatment for hyperthyroid phase, if symptomatic hypothyroid treat with thyroxine
Should eventually be able to stop thyroxine but if the patient is still on thyroxine after a year it is likely they will need it long term
184
Which investigations would you perform in diagnosing a solitary thyroid nodule?
Thyroid function tests
US scan
USS-FNA
Thyroid scan (scintigraphy)?
185
Describe the symptoms of hypomagnesemia
Anorexia
N+V
Muscle weakness, lethargy
Fits
186
What percentage of follicular adenomas are toxic (functioning)?
1%
187
What is anaplastic thyroid carcinoma?
Undifferentiated and aggressive tumours derived from follicular epithelium
188
Name the three thyroid autoantibodies associated with Graves disease
Anti-TPO antibody, anti-thyroglobulin antibody, TSH receptor antibody (stimulating)
189
Which patient group is most likely to develop an anaplastic thyroid carcinoma?
Usually older patients, may occur in people with a history of differentiated thyroid cancer
190
What is subclinical hypothyroidism?
↑TSH, normal fT4/3
191
Which hormone drives the development of differentiated thyroid cancers?
TSH
192
Describe the general symptoms associated with hyperthyroidism
Weight loss despite increased appetite
Frequent, loose bowel movements
Sweating and heat intolerance
Goitre
193
What medication can be used for immediate symptomatic relief of thyrotoxic symptoms when β-blockers are contraindicated?
CCBs
194
How would you manage mild Graves eye disease?
Topically e.g. lubricants
