Thyroid - clinical

Question 1

Specific clinical manifestations of hypothyroidism?

Answer 1

Coarse hair
Coarse skin
Puffy facies
Macroglossia
Hoarse voice

Question 2

What is macroglossia?

Answer 2

Unusually large tongue

Question 3

Non-specific clinical manifestations of hypothyroidism

Answer 3

Bradycardia
Constipation
Cold intolerance
Weight gain
Tired

Question 4

Hypothyroidism is usually…

Answer 4

Primary autoimmune

Question 5

Primary AI causes of hypothyroidism?

Answer 5

Atrophic thyroiditis

Hashimoto’s thyroiditis

Question 6

What blood test result do both atrophic thyroiditis and Hashimoto’s thyroiditis share?

Answer 6

Presence of thyroid peroxidase antibodies (TPO abs)

Question 7

Differential diagnosis between atrophic thyroiditis and Hashimoto’s thyroiditis?

Answer 7

Hashimoto’s causes enlargement of the thyroid

Question 8

Cause of primary hypothyroidism?

Answer 8

Lack of thyroid hormones causing a slowing of metabolic processes

Question 9

Features of atrophic thyroiditis?

Answer 9

Fibrosis of thyroid gland and myxoedema

Question 10

What is central hypothyroidism?

Answer 10

Hypothyroidism arising from a lack of TSH

Question 11

What other investigations should be done in the case of central hypothyroidism?

Answer 11

Measure other pituitary hormones as well as testosterone
MRI/CT of the head (pituitary and hypothalamus)
Gene analysis

Question 12

Treatment for hypothyroidism?

Answer 12

Levothyroxine

Question 13

Thyrotoxicosis is…

Answer 13

Hyperthyroidism

Question 14

Symptoms of thyrotoxicosis

Answer 14

Restlessness
Warmth intolerance
Diarrhoea
Sweating
Palpitations and breathlessness
Mood and behaviour change
Muscle stiffness and weakness

Question 15

Clinical signs of hyperthyroidism?

Answer 15

Lid retraction

Lid lag

Question 16

Causes of hyperthyroidism?

Answer 16

Grave’s disease

Toxic thyroid nodule

Question 17

Cause of Grave’s disease?

Answer 17

Stimulating antibodies to the TSH receptor

Question 18

Associated findings in Grave’s disease?

Answer 18

Orbitopathy (25%)
Dermopathy (orange peel) and acropachy (rare)
Elephantitis
Myxoedema

Question 19

Why does the thyroid enlarge in Hashimoto’s?

Answer 19

Lymphocytic infiltration and destruction of thyroid tissue with secondary antibodies to TPO

Question 20

Treatment for hyperthyroidism?

Answer 20

Carbimazole and Propylthiouracil
Radio-iodine (avoid in thyroid eye disease)
Surgery

Question 21

Painless thyroiditis:

Answer 21

Hashimoto’s
Lymphocytic (post-partum)
Reidel’s (fibrous)

Question 22

Painful thyroiditis:

Answer 22

Granulomatous (De Quervain’s)

Radiation-induced thyroiditis

Question 23

Lump but TFTs normal and Abs not found?

Answer 23

Nodule: cytology and Ultrasound scan

Question 24

Thyroid cancers

Answer 24

Papillary (PTC) - 85%
Medullary (linked with MEN2) - tumour marker is calcitonin
Anaplastic (lymphoma) - very aggressive

Question 25

Hormone profile of primary hyperparathyroidism?

Answer 25

PTH: elevated Ca: elevated Phosphate: low Urine Ca:Creatinine clearance > 0.01

Question 26

Hormone profile of secondary hyperparathyroidism?

Answer 26

PTH: elevated Ca: low or normal Phosphate: elevated Vitamin D: low

Question 27

Hormone profile of tertiary hyperparathyroidism?

Answer 27

``` PTH: elevated Ca: normal or high Phosphate: low or normal Vitamin D: low or normal Alkaline phosphatase: elevated ```

Question 28

What causes primary hyperparathyroidism?

Answer 28

Adenoma (mainly solitary) | Carcinoma

Question 29

What causes secondary hyperparathyroidism?

Answer 29

Parathyroid hyperplasia due to low calcium almost always in the context of chronic renal failure

Question 30

What causes tertiary hyperparathyroidism?

Answer 30

Continual hyperplasia (all 4 glands) despite correction of the underlying renal problem

Question 31

Clinical signs of primary hyperparathyroidism?

Answer 31

Can be subtle or asymptomatic Recurrent abdominal pain (renal colic, pancreatitis) Changes in cognition/emotional state

Question 32

Clinical signs of secondary hyperparathyroidism?

Answer 32

``` Few symptoms Eventually may develop: Bone disease Osteitis fibrosa cystica Soft tissue calcifications ```

Question 33

Clinical signs of tertiary hyperparathyroidism?

Answer 33

Metastatic calcification Bone pain and/or fracture Nephrolithiasis Pancreatitis

Question 34

Finding of calcium:creatinine clearance < 0.01

Answer 34

Benign familial hypocalciuric hypercalcaemia

Question 35

Histological finding in muscle cells of Thyroid disease myopathy

Answer 35

Checkerboard appearance due to areas of necrosis and regeneration

Question 36

Causes of hypothyroidism:

Answer 36

``` Hashimoto's de Quevain's Postpartum thyroiditis Riedel's Iodine deficiency Lithum (Amiodarone - both) ```

Question 37

Causes of hyperthyroidism:

Answer 37

Grave's disease Toxic multi nodular goitre (Amiodarone - both) (Postpartum and de Quervain's both have an initial hyperthyroid phase before becoming hypo)

Question 38

Investigation of thyrotoxicosis will reveal...

Answer 38

``` TSH down T3 and T4 up Thyroid autoAbs (Can do isotope scan) ```

Question 39

Major active thyroid hormone:

Answer 39

T3

Question 40

Plasma thyroid hormone (less potent):

Answer 40

T4

Question 41

Lowers plasma calcium:

Answer 41

Calcitonin

Question 42

What is associated with Hashimoto's?

Answer 42

MALT lymphoma

Question 43

High TSH Low T3, T4 Anti-TPO +ve Anti-Tg +ve

Answer 43

Hashimoto's

Question 44

Hashimoto's increases your risk of:

Answer 44

Other AI conditions: | e.g. Addison's, LE, Grave's, T1DM, pernicious anaemia, RA, thrombocytopenic purpura, vitiligo

Question 45

Features of Hashimoto's thyroiditis?

Answer 45

Hypothyroid features Firm, non-tender goitre Anti-TPO and anti-Tg +ve

Question 46

Signs of hypoparathyroidism:

Answer 46

Tetany: muscle cramping, twitching and spasm Perioral paraesthesia Trosseau's sign: carpal spasm if brachial artery occluded by raising and holding pressure over systolic Chvostek's sign: tapping over the parotid causes facial muscle twitching Chronic: depression, cataracts ECG: prolonged QT interval

Question 47

Treatment for primary hypoparathyroidism:

Answer 47

alfacalcidol