Thyroid

Question 1

Increased TSH and low T4?

Answer 1

Hypothyroidism :
Atrophic
Hashimoto’s
De Quervains
Post partum
Riedel thyroiditis

Question 2

Increased TSH and normal T4?

Answer 2

Treated hypothyroidism or subclinical hypothyroidism

Question 3

High TSH and high T4?

Answer 3

TSH secreting tumour or thyroid hormone resistance

Question 4

Low TSH and increased t4?

Answer 4

Hyperthyroidism:
Grave’s disease
Toxic multinodular goitre
toxic adenoma
drugs
ectopic

Question 5

Low TSH and normal T3?

Answer 5

Subclinical hyperthyroidism

This can progress to primary hypothyroidism

Question 6

Increasing then decreasing TSH, low T3?

Answer 6

Sick euthyroidism

Question 7

Low TSH and Low t4?

Answer 7

Secondary hypothyroidism

Question 8

Symptom relief for hyperthyroid?

Answer 8

Beta blockers
Topical steroids for dermopathy
Eye drops for patients with eye disease

Question 9

Which antithyroid medications are used for medical management of hyperthyroidism?

Answer 9

Carbimazole

• titrate to normal T3 or block and replace

Question 10

Carbimazole side effects?

Answer 10

Agranulocytosis

Rashes

Question 11

When is radio-iodine used?

Answer 11

Sometimes after medical therapy has failed, can use for hyperthyroidism

Risk of permanent hypothyroidism

Contraindicated in pregnancy and lactating women

Question 12

Indications for surgical thyroidectomy?

Answer 12

• Women intending to become pregnant in the next 6 months
• Local compression due to goitre
• Cosmetic
• Suspected cancer
• Co-existing hyperparathyroidism
• Refractory to medical therapy

Question 13

How to prepare patients for thyroidectomy?

Answer 13

Patient must be euthyroid prior to surgery

Question 14

How does a thyroid storm present?

Answer 14

Shock
Pyrexia
Confusion
Vomiting

Question 15

Radio iodine uptake in Graves disease?

Answer 15

High diffuse uptake

painless goitre

anti-TSH receptor antibodies

Question 16

isotope scan uptake in toxic multinodular goitre?

Answer 16

High uptake hot nodules

painless nodules

(also called plummers)

Question 17

isotope uptake in toxic adenoma?

Answer 17

solitary ‘hot nodule’ = 1 area of uptakr

Question 18

Which types of thyroidneoplasia are there? (5)

Answer 18

Papillary

Follicular

Medullary

Anaplastic

Lymphoma

Question 19

What isotope uptake is seen in postpartum thyroiditis?

Answer 19

Low uptake

Question 20

What is the most common cause of hypothyroidism in the UK?

Answer 20

Primary atrophic hypothyroid

• diffuse lymphocytic infiltration causing atrophy

No goitre, no known antibodies

Associated with perniceous anaemia, vitiligo

Question 21

What is hashimotos thyroiditis?

Answer 21

Plasma cell infiltration and goitre

• hypothyroidism

Seen in elderly females

++ auto antibody tites (anti TPO/TTG)

Question 22

What is the most common cause worldwide of hypothyroidism?

Answer 22

Iodine deficiency

Question 23

Which drugs can cause hypothyroidism?

Answer 23

Amiodarone

Antithyroid drugs

Lithium

Question 24

What is Riedel’s thyroiditis

Answer 24

dense fibrosis replacing normal parenchyma

stony hard

• hypothyroid

Question 26

Who gets Papillary thyroid carcinoma?

Answer 26

20-40 female Associated with irradiation Very good prognosis Most common thyroidneoplasia

Question 27

How does papillary thyroid carcinoma spread?

Answer 27

Lymph nodes and lung

Question 28

What is seen on histology for papillary thyroid carcinoma?

Answer 28

Psammoma bodies (calcification) Orphan annie eyes (empty appearing nuclei)

Question 29

How to investigate and manage papillary thyroid carcinoma?

Answer 29

Tumour marker: thyroglobulin Mx : Surgery +/- radioiodine, thyroxine to lower TSH

Question 30

What is the most common thyroidneoplasia?

Answer 30

Papillary

Question 31

How does follicular thyroid cancer spread?

Answer 31

Though the blood -> lungs + liver, breast, adrenals

Question 32

What is Follicular thyroid cancer like on histology?

Answer 32

Uniform cells forming small follicles, looks almost like normal thyroid

Question 33

What cells are medullary neoplasms derived from?

Answer 33

Parafollicular C cells

Question 34

What tumour marker is expected in medullary thyroid cancer?

Answer 34

Secrete calcitonin tumour marker : CEA + calcitonin

Question 35

What does medullary thyroid cancer look like on histology?

Answer 35

Sheets of dark cells, amyloid deposition within tumor (amyloid is broken down calcitonin)

Question 36

Who gets medullary tumour cancer?

Answer 36

80% is sporadic 20% is linked to familial MEN2 gene AND SO need to screen for phaechromocytoma

Question 37

Which thyroid cancer is aggressive and rare?

Answer 37

Anaplastic - most patients due within 1 year - pleomorphic giant cells - spindle cells with sarcomatous appearance

Question 38

Which autosomal dominant inherited disorders cause a predisposition to developing cancers of endocrine system?

Answer 38

MEN1 (pituitary, pancreatic, parathyroid) MEN2a (parathyroid, phaeochromocytoma, medullary thyroid) MEN2b (phaeochromocytoma, medullary thyroidm mucocutaenous neuromas)

Question 39

Which cancers occur if someone has MEN1 gene?

Answer 39

3Ps (pituitary, pancreatic, parathyroid)

Question 40

Which cancers occur if someone has MEN2a gene?

Answer 40

2Ps and 1M MEN2a (parathyroid, phaeochromocytoma, medullary thyroid)

Question 41

Which cancers occur if someone has MEN2b gene?

Answer 41

1P and 2M (phaeochromocytoma, medullary thyroidm mucocutaenous neuromas)