Hyperthyroidism

Question 1

Which cardiovascular drug can cause hyperthyroidism?

Answer 1

Amiodarone is a class IIIantiarrhythmicdrug that can causehyper-andhypothyroidism

Question 2

What is used to treat hyperthyroidism?

Answer 2

Beta blockers for symptomatic relief

Carbimazole however there is a risk of AGRANULOCYTOSIS and hepatotoxicity. Patients on this medication should ensure there is effective contraception during first and second trimester of pregnancy.

Question 3

What is the first line definitve management of grave’s disease?

Answer 3

Anti-thyroid drug therapy with carbimazole for 12-18 months but this has 50% success

Question 4

What is 2nd line for grave’s?

Answer 4

Radioactive iodine ablation but this may becontraindicatedinGrave’s diseaseif the patient hasthyroid eye disease because it will exacerbate this

Question 5

What is thyroid eye disease?

Answer 5

Autoimmune destruction of periorbital muscle and orbital fat, causing diplopia, bulging eyes and vision loss, strongly assoicated with Grave’s

Question 6

What is thyroid gland pain associated with?

Answer 6

subacute granulomatous thyroiditis (De Quervain’s)

may improve with aspirin or other NSAIDs

Question 7

What is the management of toxic mutinodular goitre?

Answer 7

First-line:Radioactive iodine abalation
Second-line: Thyroidectomy (total in TMG/lobectomy in toxic adenoma))

Question 8

What is toxic mutinodual goitre?

Answer 8

Toxic multinodular goitre is a condition characterised by chronichyperthyroidismandmultinodular goitre which can be caused bychronic idodine deficiency or radiation to the neck

Question 9

What is a key compaction with hyperthyroidism/

Answer 9

Thyroid stormpresents withhyperthermia, tachycardia and hypertension

+ N&V, diarrhoea, altered mental state, arrhythmias

Hypertension has a wide pulse pressure and atrial fibrillation causing irrregularly irregular pulse

Question 10

A patient has a long-standingthyroid nodulethat moves superiorly whenever theystick out their tongue. What is the most likely diagnosis?

Answer 10

Thyroglobulin cyst that forms from a persistent congenital reminant of the thyroglossal duct

Question 11

What is a risk with thyroidectomy?

Answer 11

Wound haematoma with swelling in the neck 4-6 hours after surgery. This will abuse clear Inspiratory stridor and tense welling in the neck. It should be managed with removing the wound sutures

Question 12

What is the treatment of thyroid eye disease?

Answer 12

Selenium supplements
Topical lubricant eye droplets

Question 13

How does carbimazole work?

Answer 13

blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

Question 14

How does porphythioruacil work?

Answer 14

inhibiting 5’-deiodinase which reduces peripheral conversion of T4 to T3

Question 15

What are the benign duels of the thyroid gland?

Answer 15

Multinodular goitre, Thyroid adenoma, Hashimoto’s thyroiditis, Cysts (colloid, simple, or hemorrhagic)

These are common conditions affecting the thyroid gland.

Question 16

What is the first line imaging of choice for thyroid nodules?

Answer 16

Ultrasonography

This imaging technique helps assess the characteristics of thyroid nodules.

Question 17

What does toxic multinodular goitre describe?

Answer 17

A thyroid gland containing autonomously functioning thyroid nodules resulting in hyperthyroidism

This condition leads to overproduction of thyroid hormones.

Question 18

What is the treatment of choice for toxic multinodular goitre?

Answer 18

Radioiodine therapy

This treatment helps to reduce thyroid hormone production.

Question 19

What does nuclear scintigraphy reveal in toxic multinodular goitre?

Answer 19

Patchy uptake

This indicates the presence of functioning nodules.

Question 20

What is Graves’ disease?

Answer 20

An autoimmune thyroid disease where the body produces IgG antibodies to the TSH receptor

It is the most common cause of thyrotoxicosis.

Question 21

What are the typical features of Graves’ disease?

Answer 21

• Eye signs (30% of patients)
• Exophthalmos
• Ophthalmoplegia
• Pretibial myxoedema
• Thyroid acropachy (digital clubbing, soft tissue swelling, periosteal new bone formation)

These features help differentiate Graves’ disease from other causes of thyrotoxicosis.

Question 22

What is the initial treatment to control symptoms of Graves’ disease?

Answer 22

Propranolol

This medication blocks adrenergic effects associated with hyperthyroidism.

Question 23

What are the contraindications for radioiodine treatment?

Answer 23

• Pregnancy (should be avoided for 4-6 months after treatment)
• Age < 16 years
• Thyroid eye disease (relative contraindication)

These contraindications help prevent complications.

Question 24

How does pregnancy affect thyroxine-binding globulin levels?

Answer 24

Increases levels of thyroxine-binding globulin (TBG)

This leads to an increase in total thyroxine levels without affecting free thyroxine.

Question 25

What is transient gestational hyperthyroidism?

Answer 25

Activation of the TSH receptor by HCG during pregnancy ## Footnote HCG levels decline in the second and third trimesters.

Question 26

What is the traditional antithyroid drug of choice?

Answer 26

Propylthiouracil ## Footnote It is used in the first trimester of pregnancy to avoid risks associated with carbimazole.

Question 27

What are the risks of propylthiouracil?

Answer 27

Increased risk of severe hepatic injury ## Footnote This risk necessitates careful monitoring.

Question 28

What is subclinical hyperthyroidism?

Answer 28

Normal serum free thyroxine and triiodothyronine levels with TSH below normal range (< 0.1 mu/l) ## Footnote This condition is increasingly recognized in clinical practice.

Question 29

What are the causes of subclinical hyperthyroidism?

Answer 29

* Multinodular goitre (especially in elderly females) * Excessive thyroxine ## Footnote These causes lead to biochemical changes without overt symptoms.

Question 30

What cardiovascular risk is associated with subclinical hyperthyroidism?

Answer 30

Atrial fibrillation ## Footnote This condition can have significant implications for cardiovascular health.

Question 31

What is the management strategy for subclinical hyperthyroidism?

Answer 31

Therapeutic trial of low-dose antithyroid agents for approximately 6 months ## Footnote This can help induce remission if TSH levels remain persistently low.

Question 32

What are the phases of thyroiditis?

Answer 32

* Phase 1: Hyperthyroidism, painful goitre, raised ESR (3-6 weeks) * Phase 2: Euthyroid (1-3 weeks) * Phase 3: Hypothyroidism (weeks to months) * Phase 4: Normal thyroid structure and function ## Footnote Understanding these phases helps in managing thyroiditis effectively.

Question 33

What does thyroid scintigraphy show in thyroiditis?

Answer 33

Globally reduced uptake of iodine-131 ## Footnote This finding indicates decreased thyroid function.

Question 34

What percentage of Graves' disease patients are affected by thyroid eye disease?

Answer 34

25-50% ## Footnote This condition can significantly impact the quality of life.

Question 35

What is the proposed cause of thyroid eye disease?

Answer 35

Autoimmune response against an autoantigen, possibly the TSH receptor ## Footnote This leads to retro-orbital inflammation.

Question 36

What is the most important modifiable risk factor for thyroid eye disease?

Answer 36

Smoking ## Footnote Cessation can significantly reduce the risk.

Question 37

What are common features of thyroid eye disease?

Answer 37

* Exophthalmos * Conjunctival oedema * Optic disc swelling * Ophthalmoplegia * Inability to close eyelids ## Footnote These features can lead to complications such as exposure keratopathy.

Question 38

What is the most common complication of thyroid eye disease?

Answer 38

Exposure keratopathy ## Footnote Caused by eyelid retraction and proptosis.

Question 39

What serious complication can occur due to optic neuropathy in thyroid eye disease?

Answer 39

Reduction in visual acuity, color vision deficits, visual field defect ## Footnote This requires urgent medical intervention to prevent permanent vision loss.

Question 40

What is thyroid storm?

Answer 40

A rare but life-threatening complication of thyrotoxicosis ## Footnote Typically seen in patients with established thyrotoxicosis.

Question 41

What are some precipitating events for thyroid storm?

Answer 41

* Thyroid or non-thyroidal surgery * Trauma * Infection * Acute iodine load (e.g., CT contrast media) ## Footnote These events can trigger an acute exacerbation of symptoms.

Question 42

What are the clinical features of thyroid storm?

Answer 42

* Fever > 38.5ºC * Tachycardia * Confusion and agitation * Nausea and vomiting * Hypertension * Heart failure * Abnormal liver function tests ## Footnote Recognizing these features is crucial for prompt management.

Question 43

What is included in the management of thyroid storm?

Answer 43

* Symptomatic treatment (e.g., paracetamol) * Treatment of underlying precipitating event * Beta-blockers (IV propranolol) * Anti-thyroid drugs (methimazole or propylthiouracil) * Lugol's iodine * Dexamethasone ## Footnote This comprehensive approach addresses both symptoms and underlying causes.

Question 44

What are the common causes of thyrotoxicosis?

Answer 44

* Graves' disease * Toxic nodular goitre * Acute phase of subacute (de Quervain's) thyroiditis * Acute phase of post-partum thyroiditis * Acute phase of Hashimoto's thyroiditis * Amiodarone therapy * Contrast media ## Footnote These conditions can lead to increased thyroid hormone levels.

Question 45

What are the blood test findings in thyrotoxicosis?

Answer 45

* TSH down * T4 and T3 up * Thyroid autoantibodies ## Footnote These findings assist in diagnosing thyrotoxicosis.

Question 46

What to give for De Quervain’s thyorid is?

Answer 46

Simple analgesia like naproxen

Question 47

What are the features of subacute thyorid it’s?

Answer 47

history of following a viral illness, raised ESR, tender goitre and initial hyperthyroid phase. Euthyoridi fase Hypothyoridism phase after few weeks-months Normal function

Question 48

What is dthe difference between sick euthyoird sndrome and De Quervain’s thyoriditis?

Answer 48

Sick Euthyroid Syndrome: Caused by systemic illness (e.g., sepsis, trauma, surgery), not by thyroid pathology. Hypothyoridism is acute with illness De Quervain's Thyroiditis: Often follows a viral upper respirattory infection and causes hypothyoridism which is gradual

Question 49

What is the diagnostic feature of sick euthyoriid syndrome

Answer 49

Occurs with acute illness: Low T3/T4 and normal TSH