Thyroid

Question 1

Diagnostic of autoimmune hypothyroidism (Hashimoto’s disease)

Answer 1

Anti-TPO (thyroid peroxidase antibodies) ( can be positive in Graves but not diagnostic)

Question 2

Diagnostic of Graves’ Disease sens. & spec. >95%

Answer 2

TSH receptor antibodies (TRABs – thyrotropin receptor antibodies

Question 3

Frequently positive in autoimmune thyroid diseases

Answer 3

Thyroglobulin antibodies, Moinitored w thyroid cancer to detect recurrance

Question 4

symptoms of hyperthroidisim ?

Answer 4

menstural irregularity, subfertility, hypotrophy of muscles(tremors general), osteoporosis, tachycardia, thirst, excess urination

Question 5

symptomps of Hypothyroidism

Answer 5

chills, increased fatigue, hair loss, dry skin, constipation, longer menstural irregularity, foetal loss, weight gain, high BP and cholestrol

Question 6

rare complications of autoimmune Thyroid Disease

Answer 6

Thyroid Dermopathy & Acropachy

Question 7

Side effects of anti-thyroid drugs

Answer 7

1-Agranulocytosis – leukopaenia, neutropaenia) risk is 1/500. urgent FBC if they develop sore throat or fevers
2-Rash
3-GI upset
4-Joint pain

Question 8

Complications of Hyperthyroidism

Answer 8

• Atrial fibrillation
• Osteoporosis
• Heart failure
• Increased mortality rate
• Pregnancy related ccomplications

Question 9

Causes of hyperthyroidism

Answer 9

• Graves Disease (i.e. autoimmune thyroid disease)
• Thyroiditis – subacute/De Quervain’s, post-partum
• Toxic Multinodular Goitre
• Solitary Toxic Adenoma
• Pituitary tumor- TSHoma
• Medications – amiodarone, excessive thyroxine

Question 10

Radioiodine uptake scan I-123 high & low in?

Answer 10

Graves
TMNG
Toxic adenoma
Pituitary tumour

Reduced in:
Thyroiditis
Iodine induced (amiodarone)

Question 11

Management of thyrotoxicosis

Answer 11

Carbimazole ( risk of agranulocytosis) (for Graves only 12-18months use? Remission

PTU
similar to carbimazole but liver toxic & fulminant liver failure, only 1st trimester / if intolerant to carbimazole

Propanolol
improve symptomps of sweat and tremor

Radioiodine therapy (I-131)
Treatment of choice in TMNG, adenoma and
relapsed Graves disease. pregnancy C/I for 4/12, causes flare of graves eye, and leads to Fibrosis

Surgery ( defentive )
Complications;damage to recurrent laryngeal nerve,
hypoparathyroidism

Question 12

Sick euthyroid

Answer 12

usu adaptive response to illness, Low-normal TSH, low fT4 and fT
Repeat TFT in 6 weeks when patient is well

Question 13

low/ normal TSH + low fT4

Answer 13

Secondary hypothyroidism, Hypopituitarism
Deficiency of ACTH, LH+ FSH, TSH, GH
Requires pituitary screen and MRI pitu

Question 14

Pitutary Hormone replacement therapy

Answer 14

1-treat cortisol deficiency with hydrocortisone.
once cortisol replaced commence thyroxine

Question 15

Causes of hypothyroidism

Answer 15

• Autoimmune hypothyroidism (Hashimoto’s thyroiditis)
• Post thyroidectomy, post radioiodine
• Drugs: Lithium, Carbimazole
• Iodine deficiency (endemic goitre)
• Hypopituitarism

Question 16

Levothyroxine dosage

Answer 16

starting dose : 50 mcg / 25mcg for CVD & Elderly
increasing dose by : 25mcg

Check TFTs in 6-8 weeks, and annual measurement

Avg. Dose: 1.6mcg/kg

In Pregnancy :
Increase dose by 50
Tft’s each trimester
TSH should be 1-2.5 mU/L

ALWAYS 1ST THING MORNING 20 MINS BEFORE ANYTHING. NO COFFEE,NO WITHIN 4 Hrs of multivitamin or iron calcuim, dont take before tft blood test