thyroid

Question 1

what cells release parathyroid hormone

Answer 1

chief cells in Parathyroid gland

Question 2

parathyroid hormone effect on calcium levels

Answer 2

raise calcium levels

Question 3

what 4 ways does PTH increase calcium

Answer 3

1) Increase osteoclast activity in bones
2) increase calcium absorption from gut
3) increase calcium absorption from kidneys
4) increasing vitamin D activtiy

Question 4

pneumonic for hypercalcaemia…

Answer 4

renal stones, painful bones, abdominal groans & psychiatric groans

• renal stones
• painful bones
• constipation, nausea & vomiting
• fatigue, depression & psychosis

Question 5

PTH & calcium levels in primary hyperparathyroidism

Answer 5

high PTH

high Calcium

Question 6

cause and managemnt of primary hyperparathyroidism

Answer 6

cause: tumour of parathryoid gland
management: surgical removal of tumour

Question 7

cause of secondary hyperparathyroidism?

Answer 7

insufficient Vitamin D or chronic renal failure

Question 8

PTH & calcium levels in secondary hyperparathryoidism

Answer 8

PTH is high

Calcium is low/normal

Question 9

management of secondary hyperparathyroidsm

Answer 9

correcting vit D deficiency or renal transplant

Question 10

untreated secondary hyperparathryodism for long periods of time leads to?

Answer 10

tertiary hyperparathyroidism

high PTH
high Calcium

Question 11

most common cause of Hyperthyroidism in UK

Answer 11

Graves disease

Question 12

2nd most common cause of hyperthyroidism in Uk

Answer 12

toxic multinodular goitre

Question 13

medication that can cause both hyper or hypothyroidism

Answer 13

amiodarone

Question 14

What is Struma ovarii

Answer 14

hyperthyroidism caused by ectopic tyroid tissue related to ovarian teratomas & dermoid tumours

Question 15

what does the thryroud gland wrap around

Answer 15

thyroid cartilage

Question 16

histology of thyroid gland?

Answer 16

made up of thyroid follicles & lined with columnar epithelium

Question 17

marker for medullary carcinoma

Answer 17

calcitonin

Question 18

painful cystic swelling in midline of neck

Answer 18

thryroglossal cyst

Question 19

neck lump that moves on protrusion of tongue

Answer 19

thyroglossal cyst

Question 20

neck lump that increases in size on swallowing

Answer 20

Pharyngeal pouch

Question 21

neck lump - patient may experience a bout of coughing & choking when lying down flat

Answer 21

pharyngeal pouch

Question 22

describing a lump/mass

Answer 22

• site
• size
• shape
• consistency
• surface
• colour
• fluid thrill
• tenderness
• pulsatility
• mobility & movement
• can you get above or below the mass

Question 23

4 graves specific features

Answer 23

• thyroid acropachy
• ophthalmoplegia
• exolpthalmos
• pretibial myxoedema

Question 24

describe pretibial myxoedema

Answer 24

raised red-purple symmetrical skin lesions over anterolateral shins

due to deposition of mucopolysaccharides in the skin

Question 25

how is severity of Graves ophthalmopathy graded?

Answer 25

NOSPECS pneumonic ``` N - No signs or symptoms O - Only signs S - Soft tissue involvement P - Proptosis E - Extra ocular involvement C - Corneal involvement S - Sight loss ```

Question 26

features of graves eye disease

Answer 26

- proptosis - periorbital oedema - lid retraction - eye pain - visual loss

Question 27

what antibody is seen in graves disease

Answer 27

TSH- receptor Ab

Question 28

3 causes of hyperthyroidism

Answer 28

- graves disease - Toxic multinodular goitre - Toxic adenoma

Question 29

1st line medications for hyperthryoidosm

Answer 29

- Carbimazole | - Propylthiouracil

Question 30

symptomatic medx for hyperthyroidism

Answer 30

- Propranolol | - CCB

Question 31

CI for radioactive iodine

Answer 31

- pregnancy | - breastfeeding

Question 32

1st line definitive trx for toxic multinodular goitre

Answer 32

- radioactive iodine | it is taken up by the thyroid causing destruction & reduced thyroid hormone release

Question 33

when is Propythiouracil used 1st line instead of carbimazole?

Answer 33

- patient in 1st trimester of pregnancy | - in a thyroid storm

Question 34

severe side effect of Carbimazole & Propylthiouracil

Answer 34

Agranulocytosis

Question 35

what does block & replace treatment involve?

Answer 35

Carbimazole started and patient started on levothyroxine when the patient is euthyroid

Question 36

complications post hemithyroidectomy surgery (2)

Answer 36

recurrent laryngeal nerve injury hypocalcaemia

Question 37

treatment for more severe graves eye disease (3)

Answer 37

Referral to ophthalmologist is required if there is evidence of optic nerve compression, corneal opacity, inability to close eye - steroids - irradiation - surgical decompression

Question 38

presentation of Thryotoxic crisis

Answer 38

- agitation seizure - abdominal pain - v & d - hyperreflexia - tachycardia - arrhythmia - heart failure

Question 39

most common thyroid cancer

Answer 39

papillary

Question 40

what cells do medullary thyroid carcinoma derive from

Answer 40

Calcitonin C cells

Question 41

most common cause of primary hypothyroidism in the western world?

Answer 41

Autoimmune disease - Hashimoto's thyroiditis

Question 42

what 2 genetic conditions are associated with Hashimotos

Answer 42

Turner's & down's syndrome

Question 43

worldwide leading cause of hypothyroidism

Answer 43

iodine deficiency

Question 44

post viral infection?

Answer 44

Subacute de quervans thyroiditis

Question 45

goitre features in hashimotos

Answer 45

firm & non tender

Question 46

TFT in patient with poor compliance with thyroxine

Answer 46

High TSH | & normal free T4

Question 47

steroid therapy affect on TFT

Answer 47

TSH low

Question 48

autoantibodies seen in hashimotos (2)

Answer 48

Anti TPO & antithyroglobulin antibodies