Thyroid disease

Question 1

symptoms of thyrotoxicosis

Answer 1

diarrhoea, weight loss, appetite increase,sweats, heat intolerance, palps, tremor, irritable. rare- pyschosis, chorea

Question 2

signs of thyrotoxicosis

Answer 2

pulse fast/irregular, warm moist skin, fine tremor, palmar erythema, lid lag, lid retraction, goitre, thyroid nodules, bruits

Question 3

what is Graves disease, typical age and male to female ratio

Answer 3

hyperthyroidism, 40-60 years, 9:1 female:male

Question 4

signs of Graves disease

Answer 4

exophthalmos, opthalmoplegia, pretibial myxoedema, clubbing, painful finger and toe swelling, periosteal reaction in limb bones

Question 5

tests for thyrotoxicosis

Answer 5

TSH down, T4 and T3 up. mild normocytic anaemia, mild neutropenia, ESR up, Ca up, LFT up

Question 6

cause of Graves

Answer 6

circulating IgG autoantibodies bind to and activate GPCR thyrotropin receptors- smooth thyroid enlargement and increased hormone production

Question 7

triggers of Graves

Answer 7

stress, infection, childbirth

Question 8

what are the causes of thyrotoxicosis

Answer 8

Graves, toxic multinodular goitre, toxic adenoma, ectopic thyroid tissue, exogenous (iodine excess, levothyroxine excess).

Question 9

what are the diffuse causes of goitre

Answer 9

physiological, Graves, Hashimotos thyroiditis, subacute (de Quervain’s) thyroiditis

Question 10

what are the nodular causes of goitre

Answer 10

multinodular goitre, adenoma, carcinoma

Question 11

how can you treat thyrotoxicosis

Answer 11

drugs- b blockers, carbimazole; radioiodine (CI- pregnancy, lactation); thyroidectomy

Question 12

complications of thyrotoxicosis

Answer 12

heart failure (thyrotoxic cardiomyopathy), angina, AF, osteoporosis

Question 13

how many Graves patients present with thyroid eye disease and what is the main known risk factor

Answer 13

25-50%. smoking

Question 14

what is the medical emergency associated with hyperthyroidism

Answer 14

thyroid storm

Question 15

what are the manifestations of Graves- heart

Answer 15

incr rate, incr contractility

Question 16

what are the manifestations of Graves- liver

Answer 16

incr peripheral T3, decr LDL

Question 17

what are the manifestations of Graves- bone

Answer 17

incr bone turnover, osteoporosis

Question 18

what are the manifestations of Graves- genital

Answer 18

male- decr libido and erectile dysfunction, female- irregular menses

Question 19

what are the manifestations of Graves- metabolic, fat

Answer 19

thermogenesis, incr O2 use; decr fat mass

Question 20

what are the manifestations of Graves- CNS

Answer 20

stiff person syndrome

Question 21

what are the manifestations of Graves- muscle

Answer 21

proximal myopathy

Question 22

what are the manifestations of Graves- thyroid

Answer 22

incr secretion T3 and T4

Question 23

more common age and gender of hypothyroidism

Answer 23

> 40 years, female 6:1

Question 24

symptoms of hypothyroidism

Answer 24

tired, sleepy, lethargic, mood decr, cold disliking, weight incr, constipation, hoarse voice, decr memory, dementia, myalgia, weakness

Question 25

signs of hypothyroidism

Answer 25

BRADYCARDIC- Reflexes relax slowly, Ataxia, Dry thin hair/ skin, Yawning/drowsy/coma, Cold hands, Ascites +/- non pitting oedema, Round puffy face, Defeated demeanour, Immobile, CCF. neuropathy, myopathy, goitre

Question 26

diagnosis of hypothyroidism

Answer 26

TSH incr T4 decr

Question 27

causes of primary autoimmune hypothyroidism

Answer 27

primary atrophic hypothyroidism; Hashimotos thyroiditis

Question 28

what is Hashimotos thyroiditis

Answer 28

goitre due to lymphocytic and plasma cell infiltration

Question 29

what is the main cause of hypothyroidism worldwide

Answer 29

iodine deficiency

Question 30

what are the causes of primary hypothyroidism

Answer 30

iodine deficiency, post thyroidectomy or radioiodine treatment, drug induced, subacute thyroiditis

Question 31

what occurs in secondary hypothyroidism

Answer 31

not enough TSH, rare, hypopituitarism

Question 32

what are the pregnancy problems associated with hypothyroidism

Answer 32

eclampsia, anaemia, prematurity, decr birthweight, stillbirth, PPH

Question 33

what are the associated conditions with hypothyroidism

Answer 33

Turners, Downs, CF, primary biliary cirrhosis

Question 34

what is the treatment for hypothyroidism

Answer 34

levothyroxine (T4).