Thyroid disorders

Question 1

what are the symptoms of hypothyroidism?

Answer 1

weight gain
cold intolerance 
slow reflexes 
slow speech 
constipation
heavy periods
dry skin/hair
bradycardia
goitre 
if severe- puffy eyes, swollen tongue, hoarseness, coma

Question 2

what are the symptoms of hyperthyroidism?

Answer 2

weight loss
heat intolerance 
anxiety/irritability 
bowel infrequency 
sweaty palms
light periods
hyperreflexia / tremor
goitre 
thyroid eye disease

Question 3

if there is raised TSH and low T3, T4 what is this?

Answer 3

primary hypothyroidism

Question 4

if there is low TSH and normal T4,T3 what is this?

Answer 4

subclinical (compensated) hypothyroidism

Question 5

if there is low TSH and low T3, T4, what is this?

Answer 5

secondary hypothyroidism

Question 6

what are causes of acquired hypothyroidism?

Answer 6

hashimotos autoimmune
iatrogenic;
- post radioactive iodine (treatment for hyperthyroidism)
- radioactive iodine for H & N cancers
chronic iodine deficiency
post partum thyroiditis

Question 7

what are the causes of secondary hypothyroidism?

Answer 7

pituitary tumour
craniopharyngioma 
post pituitary surgery or radiotherapy
sheehans syndrome
isolated TSH deficiency

Question 8

if you suspected hyperthyroidism, what investigations would you carry out?

Answer 8

TSH
Thyroxine
autoantibodies

FBC
lipids
hyponatraemia 
increased muscle enzymes
hyperprolactinaemia

Question 9

what is the treatment for hypothyroidism?

Answer 9

levothyroxine tablets

Question 10

when would you treat subclinical hypothyroidism?

Answer 10

if TSH >10
of if TSH >5 with positive thyroid antibodies
or TSH elevated with symptoms

Question 11

what are the risks with over treatment of thyroxine?

Answer 11

osteopenia

AF

Question 12

what are physiological causes of goitre?

Answer 12

puberty

pregnancy

Question 13

what are the different types of goitre?

Answer 13

diffuse goitre
multi nodular 
solitary nodule 
cyst
adenoma, carcinoma, lymphoma 
miscellaneous i.e. sarcoidosis

Question 14

how would you investigate a solitary nodular goitre?

Answer 14

TFT’s
USS
FNA
isotope scanning of low TSH

Question 15

what are differentiated thyroid cancers?

Answer 15

papillary
follicular
lymphoma

Question 16

what are the non differentiated thyroid cancers?

Answer 16

medullary

anaplastic

Question 17

what thyroid cancer spreads via lymphatics?

Answer 17

papillary

Question 18

where does follicular thyroid cancer spread to?

Answer 18

bone

lung

Question 19

what is the treatment for differentiated thyroid cancers?

Answer 19

radioiodine

near total thyroidectomy

Question 20

what is the thyroid cancer marker?

Answer 20

thyroglobulin

Question 21

what is the treatment for medullary thyroid cancer?

Answer 21

prophylactic thyroidectomy

Question 22

what is the treatment for anapaestic thyroid cancer?

Answer 22

external radiotherapy

Question 23

what thyroid cancer arises from parafollicular C cells?

Answer 23

medullary

Question 24

what thyroid cancer is associated with MEN 2 and what is this associated with?

Answer 24

medullary

phaechromocytoma & hyperparathyroidism

Question 25

in what thyroid cancer is the serum Ca level raised and why?

Answer 25

medullary | because it is associated with MEN 2 which can cause hyperparathyroidism

Question 26

does thyrotoxicosis result in hyper or hypothyroidism?

Answer 26

hyper

Question 27

what are the primary causes of hyperthyroidism?

Answer 27

autoimmune hashimotos toxic multi nodular goitre toxic adenoma

Question 28

what are the causes of thyrotoxicosis without hyperthyroidism?

Answer 28

excessive thyroxine administration | destructive thyroiditis - post partum, amiadorone induced, subacute

Question 29

what is the presentation of sub acute (de Quervain's) thyroiditis?

Answer 29

presents with hyperthyroidism for 3-6 weeks then hypothyroidism occurs for the following 3-6 months often recall having painful goitre +- fever, malaise, myalgia

Question 30

what is the treatment for hyperthyroidism?

Answer 30

anti thyroid drugs; - carbimazole & propylthiouracil (titration regimen) steroids radioiodine betablockers

Question 31

what are the side effects of anti thyroid drugs?

Answer 31

rash | agranulocytosis

Question 32

what is the difference in the initial treatment of someone with hypothyroidism and also ischaemic heart disease?

Answer 32

start initial dose at 25mcg/day and slowly titrate up every 2-4 weeks until it reaches 75-100mc/day (normally would start at 50mcg/day)

Question 33

when would you treat subclinical hypothyroidism?

Answer 33

if TSH > 10 even with no symptoms if TSH > 5 if positive thyroid antibodies always treat if they have definitive symptoms always treat if they become pregnant

Question 34

what is the change in treatment of hypothyroidism in pregnancy?

Answer 34

double levothyroxine dose

Question 35

is thyroxine treatment for post part thyroiditis life-long?

Answer 35

no | trial withdrawal within 6-12 months

Question 36

what is myxedema coma and how do you treat it?

Answer 36

severe hypothyroidism resulting in a coma | treat with IV T3 and IV steroid

Question 37

What drugs can cause hypothyroidism?

Answer 37

Amiadorone Lithium Interferon

Question 38

What precipitates sub acute thyroiditis (De Quervains syndrome)

Answer 38

Viral infection

Question 39

What is the cause(s) of secondary hyperthyroidism?

Answer 39

TSH secreting pituitary adenoma

Question 40

What can cause thyrotoxicosis without hyperthyroidism?

Answer 40

post partum thyrotoxicosis sub acute syndrome Drug induced I.e. amiadorone Excessive thyroxine administration

Question 41

what is the action of goitrogens?

Answer 41

goitrogens disrupt the thyroid's ability to produce thyroid hormones by interfering with iodine uptake in the thyroid gland this results in the pituitary producing more TSH due to reduced negative feedback

Question 42

what causes thyrotoxicosis without hyperthyroidism?

Answer 42

post partum thyroiditis sub acute (De Quervains syndrome) amiadorone induced excessive thyroxine administration

Question 43

what does sheehan's syndrome cause?

Answer 43

secondary hypothyroidism | post partum haemorrhage or hypotension damages the pituitary

Question 44

what triggers sub acute (de Quavairns) syndrome and how do you treat it?

Answer 44

triggered by virus i.e. enteroviruses - coxsackie | May require short term steroids NSAIDS