Thyroid

Question 1

who is hypothyroidism seen in?

Answer 1

Females over 50 that have DM and iodine deficiency

Question 2

what group of people have Graves?

Answer 2

30-50

Question 3

What group of people have hyperthyroidism but not graves?

Answer 3

Over 50 females

Question 4

What is the change of voice in hypothyroidism?

Answer 4

Hoarseness

Question 5

what happens to concentration in both hypo/hyperthyroidism?

Answer 5

Decreased

Question 6

If someone has palpitations what is the condition that could be causing this?

Answer 6

Hyperthyroidism

Question 7

What is the change oh hair in

a) hyper
b) hypo

Answer 7

a) Sweaty skin and coarse hair

b) dry flaky skin and hair loss outer 1/3rd of eyebrow

Question 8

What is the heart changes and BP in

a) hyper
b) hypo

Answer 8

a) Tachycardia, palpitations and increase BP

b) Reduced HR and BP

Question 9

What heart conditions are associated with

a) hyper
b) hypo

Answer 9

a) AF

b) Angina

Question 10

Do you get a goitre in both hypo and hyper?

Answer 10

yes

Question 11

What happens to the menstrual cycle in both hypo and hyper?

Answer 11

Disturbed and amenorrhoea

Question 12

In which condition can you get oedema in the face and oedema in the wrist causing carpal tunnel syndrome?

Answer 12

Hyper

Question 13

What are the key differentiation questions for a thyroid history?

Answer 13

Weight change
Tolerance to heat or cold
Activity levels
Hair loss
Palpitations
Dry skin 
Bowels

Question 14

What should you ask in PMH?

Answer 14

Any previous thyroid surgery ?

Any autoimmune conditions

Question 15

What should you ask in drug history?

Answer 15

If they are taking:
Amiodarone
Lithium
Iodine 
Any changes in how you are taking them

Question 16

What social history questions should you specifically ask?

Answer 16

Diet that contains iodine

Work–> next to radation

Question 17

In FMH what should you ask?

Answer 17

Any family with thyroid problem or autoimmune disease

Question 18

On inspection in examination what are you looking for?

Answer 18

If they are hyperactive

Agitated, anxiety, fidgety (hyper)

Question 19

What signs are you looking for in the hand? What do they indicate?

Answer 19

Dry skin (hypo)
Sweaty hands (hyper)
Phalangeal bone overgrowth (Graves)
Palmar erythema (hyper)

Question 20

What is the pulse like in:

a) hypo
b) hyper

Answer 20

a) bradycardia

b) tachycardia

Question 21

If the pulse is irregular irregular what is the condition and the cause?

Answer 21

AF caused by thyrotoxicosis (hyper)

Question 22

What general signs are you looking for in the face?

a) hypo
b) hyper

Answer 22

a) dry skin, coarse hair and outer 1/3rd of hair eyebrow low

b) sweaty, coarse hair

Question 23

In the eyes what are you looking for and in what planes do you look at?

Answer 23

Exopthalmous and in all 3 planes

Front, side and back(top)

Question 24

What eye test are you doing?

Answer 24

Lid lag

Question 25

What is lid lag caused by?

Answer 25

Graves disease

Question 26

What are you inspecting in thyroid gland inspection? | What instructions are you giving and why?

Answer 26

General look at the thyroid to see if there is any obvious mass/lump Ask patient to swallow water--> movement will be either a mass or thyroglossal cyst not a lympth Then ask for them to protrude their tongue which will cause a thyroglossal cyst to move upwards

Question 27

What do you palpate? and from where?

Answer 27

First the trachea from the front Then the thyroid from the back Start at the adams apple and down to the isthmus

Question 28

What actions do you ask the patient to do on palpation?

Answer 28

Protrude their tonuge and swallow water

Question 29

What are you assessing in palpation?

Answer 29

``` Size Symettery Consistency --> smooth or nodular ( multinodular goitre) Masses Palpable thrills --> thyrotoxocosis ```

Question 30

What else do you palpate in the neck as well as the thyroid and trache?

Answer 30

Lymph ( ask the examiner if they want you to do it)

Question 31

What do you percuss in thyroid examination:?

Answer 31

Manubrium to top of the sternum | If resonant then normal but if dull indication of mass

Question 32

On auscultation what instruction do you give to the patient?

Answer 32

Hold your breath Use the bell side Any sounds indication of Graves

Question 33

What are your special tests?

Answer 33

Tibial myxedema--> Graves Patella reflex Proximal myopathy

Question 34

What are the indications of increase or decreased patella reflex?

Answer 34

Increase --> hyper | Decreased --> hypo

Question 35

How do you test for proximal myopathy?

Answer 35

Ask the patient to stand up without their hands | Indication of hyper

Question 36

What are the end pieces?

Answer 36

Thyroid function test ECG--> abnormal cardiac signs US

Question 37

Three cardinal signs of graves?

Answer 37

Exopthalmous Tibial myxedema Thyroid acropathy

Question 38

What is the affect of weight in a) hyper b) hypo

Answer 38

a) reduction in weight without meaning to | b) gain in weight

Question 39

What is the affect in appetite in a) hyper b) hypo

Answer 39

a) increased but still loss of weight | b) decreased but gain in weight

Question 40

What is the affect in bowels for a) hyper b) hypo

Answer 40

a) frequent stools | b) constipation

Question 41

What is the effect of hyper on a) energy levels b) sleep c) mood

Answer 41

a) increased b) reduced sleep c) Anxious and irritable

Question 42

What is the effect of hypo on a) energy levels b) sleep c) mood

Answer 42

a) reduced energy b) increased sleep c) lethargy and depression

Question 43

What would the blood results be for a) hyper b) hypo

Answer 43

a) Increase secretion of thyroid hormones= TSH ↓ → T4 ↑, T3 ↑ or normal. b) decrease secretion of thyroid hormones= TSH ↑ → T4 ↓, T3 ↓