Goitre

Question 1

What is the definition of GOITRE?

Answer 1

Generalized enlargement of the thyroid gland

The term GOITRE is derived from the Latin word “guttur” meaning throat.

Question 2

What is an isolated (or solitary) thyroid swelling?

Answer 2

A discrete swelling (nodule) in one lobe with no palpable abnormality elsewhere.

Question 3

What is a dominant nodule in thyroid swellings?

Answer 3

A discrete swelling (nodule) with evidence of abnormality elsewhere in the gland.

Question 4

List the classifications of thyroid swellings.

Answer 4

• Simple Goitre (Euthyroid)
• Toxic
• Neoplastic (Primary)
• Inflammatory
• Infective

Question 5

What are the types of simple goitre?

Answer 5

• Diffuse
• Multinodular

Question 6

What are the types of toxic thyroid swellings?

Answer 6

• Diffuse (Graves’ Disease)
• Multinodular
• Toxic Adenoma

Question 7

What are the benign and malignant neoplastic thyroid swellings?

Answer 7

• Benign: Follicular Adenoma
• Malignant: Follicular Carcinoma, Papillary Carcinoma, Medullary Carcinoma, Anaplastic Carcinoma

Question 8

What are the autoimmune inflammatory thyroid conditions?

Answer 8

• Chronic Lymphocytic Thyroiditis
• Hashimoto’s Disease

Question 9

What are the types of granulomatous inflammatory thyroiditis?

Answer 9

• De Quervain’s Thyroiditis
• Riedel’s Thyroiditis

Question 10

What can cause dietary iodine deficiency leading to endemic goitre?

Answer 10

Low iodine content in water and foods, particularly in mountainous areas.

Question 11

What is dyshormonogenesis?

Answer 11

Defective hormone synthesis that can lead to sporadic goitre due to genetic or familial causes.

Question 12

What are goitrogens?

Answer 12

• Vegetables of the brassica family (e.g., cabbage, kale)
• Anti-thyroid drugs (e.g., Carbimazole, PTU)
• Para-amino salicylic acid (PAS)

Question 13

What are the clinical assessment components for giant multinodular goitre?

Answer 13

• History
• Physical Examination
• Clinical Diagnosis

Question 14

What investigations are used for thyroid swellings?

Answer 14

• Thyroid ultrasound scan
• FNAC
• Serum TSH, T3, T4
• X-Rays
• Indirect Laryngoscopy
• Scintigraphy

Question 15

What is the risk factor for cancer in discrete thyroid swellings?

Answer 15

80% of discrete swellings are ‘Cold’ with 15% of these being cancers.

Question 16

What are the indications for surgical treatment of thyroid conditions?

Answer 16

• Cosmetic grounds
• Patient anxiety
• Pressure symptoms
• Solitary or Dominant thyroid nodule
• Toxicity

Question 17

What are the types of thyroid operations?

Answer 17

• Total lobectomy
• Subtotal lobectomy
• Isthmusectomy
• Total thyroidectomy
• Subtotal thyroidectomy
• Near-total thyroidectomy
• Lobectomy

Question 18

Define thyrotoxicosis.

Answer 18

Clinical state resulting from inappropriately high thyroid hormone action in tissues.

Question 19

What is hyperthyroidism?

Answer 19

A form of thyrotoxicosis due to inappropriately high synthesis and secretion of thyroid hormone(s) by the thyroid gland.

Question 20

What is the prevalence of thyrotoxicosis?

Answer 20

1.2% (0.5% overt, 0.7% subclinical)

Question 21

List the clinical types of thyrotoxicosis.

Answer 21

• Diffuse Toxic Goitre (Graves’ disease)
• Toxic Multinodular Goitre
• Toxic Nodule/Adenoma
• Subacute thyroiditis

Question 22

What are common symptoms of thyrotoxicosis?

Answer 22

• Nervousness
• Increased sweating
• Palpitations
• Heat intolerance
• Fatigue
• Excessive appetite
• Weight loss
• Emotional lability

Question 23

What are the signs of hyperthyroidism?

Answer 23

• Tachycardia
• Hot, moist palm
• Goitre
• Agitation
• Tremor
• Exophthalmos

Question 24

What is the treatment goal for thyrotoxicosis?

Answer 24

Normalize serum TSH levels and reverse/correct clinical signs & symptoms.

Question 25

What medications are used in the treatment of thyrotoxicosis?

Answer 25

* Beta-blockers (e.g., Propranolol) * Antithyroid medication * Radioactive Iodine Therapy (I-131) * Surgery

Question 26

What are the side effects of antithyroid medications?

Answer 26

* Rash * Arthralgias * Nausea * Vasculitis * Liver function test abnormalities * Agranulocytosis * Embryopathy

Question 27

What is the role of methimazole in treating thyrotoxicosis?

Answer 27

It is primarily used as first-line in Graves' disease and can lead to remission.

Question 28

What is the purpose of pre-operative preparation with super-saturated potassium iodine?

Answer 28

To decrease vascularity of the gland before surgery.

Question 29

What are common post-operative complications of thyroid surgery?

Answer 29

* Haemorrhage * Tracheal Compression * R. L. Nerve damage * Hypoparathyroidism

Question 30

What is SSKI used for?

Answer 30

To decrease vascularity of gland in Graves' disease and large goiters.

Question 31

What is the recommended pre-surgery treatment for patients with Graves' disease?

Answer 31

Lugol’s Iodine solution (10 drops tid x 10 days prior to surgery).

Question 32

What are the common post-operative complications of thyroid surgery?

Answer 32

* Haemorrhage * Tracheal Compression * R. L. Nerve damage * Hypoparathyroidism * Wound Infection * Recurrence

Question 33

What percentage of patients with Graves' disease may have eye involvement?

Answer 33

Up to 50%.

Question 34

What are the potential thyroid storm triggers?

Answer 34

* Unrecognized or inadequately treated thyrotoxicosis * Infection * Trauma * Radioiodine therapy

Question 35

What is the cardinal manifestation of Thyroid Storm?

Answer 35

Fever >102° F.

Question 36

What are some symptoms of Thyroid Storm?

Answer 36

* Tachycardia * Tachypnea * Nausea/vomiting * Diarrhea * CNS manifestations * Anemia * Hyperglycemia

Question 37

What are the components of the Thyroid Storm Scoring System?

Answer 37

* Fever * CNS agitation * Cardiac pulse * GI signs * Precipitant history

Question 38

How is the treatment of Thyroid Storm initiated?

Answer 38

1. Decrease thyroid hormone synthesis with Propylthiouracil or methimazole. 2. Inhibit thyroid hormone release with sodium iodide (IV) or potassium iodide (oral).

Question 39

What is the role of beta-blockers in Thyroid Storm treatment?

Answer 39

To reduce heart rate.

Question 40

What are the goals of treatment in Thyroid Storm?

Answer 40

* Decrease thyroid hormone synthesis * Inhibit thyroid hormone release * Reduce heart rate * Support circulation * Treat precipitating cause

Question 41

What is the prognosis of Thyroid Storm with aggressive therapy?

Answer 41

Approximately 20% mortality.

Question 42

When should hospitalization be considered in Thyroid Storm?

Answer 42

When thyroid storm is present, impending, or suspected.

Question 43

What should be done regarding TSH levels in suspected Thyroid Storm?

Answer 43

Do not wait for test results: delays potentially lifesaving therapy.

Question 44

What conditions may require an endocrinologist's consultation?

Answer 44

* Developing optimal management plan * Significant Graves eye disease present * Patient is pregnant * Thyroid storm present, impending, or suspected

Question 45

What is the treatment approach for Graves' disease?

Answer 45

* Antithyroid medications * I-131 * Thyroidectomy

Question 46

What treatment options are available for toxic multinodular goiter?

Answer 46

* I-131 * Thyroidectomy

Question 47

What should be done before definitive treatment for toxic adenoma?

Answer 47

Use antithyroid medications to improve thyroid hormone levels.

Question 48

What is the recommended action if RAIU is low?

Answer 48

Treat underlying cause or monitor as the condition may be transient.