Thyroid

Question 1

initial treatment for Graves for symptomatic relief

Answer 1

beta blocker: propranolol

Question 2

if Graves patients not controlled with beta blocker, give…

Answer 2

carbimazole

Question 3

adverse affects of radio iodine therapy

Answer 3

hypothyroidism
precipitation of thyroid eye disease

Question 4

major complication of carbimazole

Answer 4

agranulocytosis

Question 5

Graves investigations
TSH
T4

Answer 5

TSH: low
T4: high

Question 6

what medication can reduce absorption of levothyroxine and induce hypothyroidism?

Answer 6

ferrous sulphate (iron / calcium carbonate tablets)

Question 7

target TSH while on thyroxine treatment

Answer 7

0.5-2.5

Question 8

over-replacement of levothyroxine leading to overshot TSH can lead to

Answer 8

osteoporosis

Question 9

when and how should levothyroxine be taken

Answer 9

30 mins before breakfast, caffeine and other medications

Question 10

how far apart should iron and levothyxoine be taken

Answer 10

4 hours

Question 11

pregnant women with hypothyroidism levothyroxine dose changes

Answer 11

should be increased by 25-50micrograms

Question 12

if TSH up but >10, and T4 normal and patient
-asymptomatic
-symptomatic <65
-symptomatic >65

Answer 12

-observe and repeat in 6 months
-trial levothyroxine
-watch and wait, avoid hormones

Question 13

if TSH is high its always

Answer 13

primary hypothyroidism

Question 14

Graves disease pathophys

Answer 14

TSHR autoantibodies binds to TSH receptor -> T3 and T4 stimulated -> negative feedback loop decreases production of TSH -> T3 and T4 continue to rise

Question 15

hypothyroidism treatment in elderly

Answer 15

25mg titrated up

Question 16

long term amiodarone side effects

Answer 16

hypothyroidism and thyrotoxicosis

Question 17

common features of primary hyperparathyroidism

Answer 17

thirsty elderly female with sore bones

‘bones, stones, abdo groans and psychic moans.

Question 18

most common cause and pathophys of primary hyperparathyroidism

Answer 18

solitary adenoma - > increased PTH -> hypercalcaemia

Question 19

primary hyperparathyroidism investigations

Answer 19

PTH raised or normal
Ca raised
Phosphate raised

Question 20

secondary hyperparathyroidism cause

Answer 20

chronic kidney disease or vit D-> hypocalceamia -> raised PTH

Question 21

secondary hyperparathyroidism investigations

Answer 21

PTH raised
Ca low

Question 22

tertiary hyperparathyroidism cause

Answer 22

caused by chronic secondary HPTism hyperplasia

Question 23

tertiary hyperparathyroidism investigations

Answer 23

PTH increased significantly
Ca low

Question 24

subacute thyroiditis symptoms

Answer 24

painful tender goitre
raised ESR
hyperthyroidism
globally reduced iodine uptake

Question 25

myxoedema coma treatment

Answer 25

IV thyroid hormone and IV hydrocortisone

Question 26

primary hyperparathyroid cause

Answer 26

parathyroid adenoma

Question 27

hyperthyroid medication in pregnancy

Answer 27

first trimester use propylthiouracil, switched to carbimazole in 2/3rd trimester (severe hepatic injury)

Question 28

definitive management of primary hyperparathyroidism

Answer 28

total parathyroidectomy