Thyroid Disease

Question 1

What are the blood findings in hyperthyroidism?

Answer 1

T3/4 High, TSH low

Question 2

What are the blood findings in HYPOthyroidism

Answer 2

T3/4 low, TSH high

Question 3

What are the RF for hyperthyroidism?

Answer 3

FH
High iodine intake
Smoking
Trauma to thyroid inc surgery
Childbirth
HAART (HIV treatment)

Question 4

What is weight loss. Sweating, insomnia, restlessness, AF, cardiac failure and psychiatric symptoms a sign of?

Answer 4

Thyrotoxicosis

Question 5

What are the two main systems in a thyroid storm?

Answer 5

Hyperthermia and mental disturbance

Question 6

What can be used in women of childbearing age with hyperthyroidism?

Answer 6

Propothyuracil

Question 7

What is the risk with carbimazole?

Answer 7

Agranulocytosis and hepatotoxicity

Question 8

What what be the bloods in subclinical hyperthyroidism?

Answer 8

T3/4 normal but low TSH

Question 9

What is the most common cause of hyperthyroidism?

Answer 9

Graves disease (80% of cases)

Question 10

What are other causes of hyperthyroidism besides Graves?

Answer 10

Thyroiditis (10%), toxic adenoma, multinodular goitre (>60 years)

Question 11

What age and gender is hyperthyroidism most common in?

Answer 11

Ages 30-50, more common in women

Question 12

What are risk factors for hyperthyroidism?

Answer 12

Family history, high iodine intake, smoking, thyroid trauma, childbirth, HAART

Question 13

What is the biochemical profile of primary hyperthyroidism?

Answer 13

Low TSH, high T3/T4

Question 14

What drugs can cause exogenous hyperthyroidism?

Answer 14

Amiodarone, Lithium, Interferon A, OTC weight loss meds (e.g., kelp)

Question 15

What autoantibody is most specific for Graves disease?

Answer 15

TRAbs (98% sensitive, 99% specific)

Question 16

What are specific signs of Graves disease?

Answer 16

Exophthalmos, pretibial myxoedema, lymphoid hyperplasia (e.g., splenomegaly)

Question 17

What are symptoms of thyrotoxicosis?

Answer 17

Weight loss, sweating, AF, heart failure, insomnia, psychiatric symptoms

Question 18

What is a thyroid storm and how is it identified?

Answer 18

1-2% cases; hyperthermia + mental disturbance. Use Birch-Wartosky score.

Question 19

What is the first step in management of hyperthyroidism?

Answer 19

Refer to endocrinologist

Question 20

What should women of childbearing age be advised in hyperthyroidism?

Answer 20

Avoid pregnancy, offer contraception, consider propylthiouracil

Question 21

What is the role of beta-blockers in hyperthyroidism?

Answer 21

Manage palpitations and anxiety

Question 22

What are side effects of carbimazole?

Answer 22

Agranulocytosis and hepatotoxicity

Question 23

What is subclinical hyperthyroidism?

Answer 23

Normal T3/T4, low TSH. Often caused by toxic nodular goitre.

Question 24

What are the risks associated with subclinical hyperthyroidism?

Answer 24

Increased CHD mortality, AF, hip fractures

Question 25

What is the most common cause of hypothyroidism worldwide?

Answer 25

Iodine deficiency

Question 26

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

Answer 26

Autoimmune thyroiditis (e.g., Hashimoto’s)

Question 27

Who is most affected by hypothyroidism?

Answer 27

Women, especially over 60 years

Question 28

What are risk factors for hypothyroidism?

Answer 28

T1DM, Addison’s, lithium, amiodarone, thyroid surgery, Down/Turner syndrome

Question 29

What foods contain iodine?

Answer 29

Fish, dairy, grains

Question 30

What is secondary hypothyroidism?

Answer 30

Caused by TSH deficiency from pituitary disease

Question 31

What antibody is seen in autoimmune thyroiditis?

Answer 31

Anti-TPO (found in 90–95%)

Question 32

What are lab abnormalities in untreated hypothyroidism?

Answer 32

Raised CK, cholesterol, triglycerides, normo/macrocytic anaemia

Question 33

How is hypothyroidism treated?

Answer 33

Levothyroxine (T4) – 50–200 mcg daily, lower dose in elderly or cardiac disease

Question 34

How should levothyroxine be taken?

Answer 34

Empty stomach, with water, 30 minutes before food

Question 35

What is the target TSH range in treated hypothyroidism?

Answer 35

0.4–5 mU/L

Question 36

What is the monitoring frequency for TSH on stable treatment?

Answer 36

Annually

Question 37

What drugs affect T4 absorption?

Answer 37

Ferrous sulphate, calcium, rifampicin, amiodarone

Question 38

What are risks of overtreatment with T4 or T3?

Answer 38

Osteoporosis and cardiac arrhythmias

Question 39

What is subclinical hypothyroidism?

Answer 39

TSH above normal, normal T4. Seen in 18% elderly, 2–4% progress to full.

Question 40

When is treatment considered in subclinical hypothyroidism?

Answer 40

If symptomatic, positive anti-TPO, history of radioiodine or treated Graves

Question 41

How often should subclinical hypothyroidism be monitored?

Answer 41

Every 6–12 months

Question 42

If low TSH and low T4/T3 what you thinking?

Answer 42

Compression of anterior pituitary

Question 43

If high TSH and T3/4 what you thinking?

Answer 43

Pituitary adenoma