Thyroid Disorders

Question 1

This form of hyperthyroidism is caused by too much over production of TSH by the Thyroid gland

Answer 1

1. Primary hyperthyroidism

Question 2

This form of hyperthyroidism is caused by over production of TSH as a result of over stimulation of the TSH

Answer 2

1. Secondary hyperthyroidism

Question 3

TSH receptor antibodies are producing too much TSH. An autoimmune disease, mimic TSH and stimulate the TSH receptors in the thyroid gland

Answer 3

1. Graves disease most common cause

Question 4

Nodules that develop in the thyroid gland and act independently of the thyroid gland and continuously produce TSH.

Answer 4

1. Toxic multinodular goitre

Question 5

Bulging of the eyeball, as a result of inflammation, swelling and hypertrophy behind the eyeball

Answer 5

1. Exopthalmos

Question 6

Deposit of mucin under the skin on the anterior leg, specific to graves disease as a result of a reaction to the skin from the thyroid antibodies

Answer 6

1. Pretibial myxoedema

Question 7

What are symptoms of hyperthyroidism?

Answer 7

1. Sweating and heat intolerance 2. Weight loss 3. Frequent stools 4. Anxiety and irritability 5. Tachycardia 6. Sexual dysfunction 7. Fatigue

Question 8

These conditions are specific to Graves Disease?

Answer 8

1. Diffuse goitre 2. exothalmos 3. thyroid eye disease 4. pretibial myxoedema

Question 9

What would the clinician feel when palpating a thyroid with nodules?

Answer 9

1. Firm nodules

Question 10

What is the second most common cause of thyroid toxicosis?

Answer 10

1. Thyroid nodules

Question 11

Single abnormal thyroid nodule that is benign acting on its own secreting TSH?

Answer 11

1. Benign adenoma

Question 12

Viral infection with fever neck pain, tenderness, dysphagia, hyperthyroidism phase, hypothyroid phase, in which the thyroid levels return to normal.

Answer 12

1. De Quervain’s Thyroiditis

Question 13

How is De Quervain’s Thyroiditis treated

Answer 13

1. Steroids if needed 2. supportive care NSAIDs

Question 14

Rare presentation acute severe presentation of hyperthyroidism with symptoms of pyrexia, tachycardia, delirium. May require admission to the hospital for fluid resuscitation, anti-arrhythmic drugs and beta blockers

Answer 14

1. Thyroid storm

Question 15

How is hyperthyroidism treated? First line medication

Answer 15

1. Carbimazole-Graves disease 4-8 weeks then maintenance dose when normal, can titrate. Given a high enough dose to block TSH and then replace with levothyroxine.

Question 16

What is the second line treatment for hyperthyroidism?

Answer 16

1. PTU-small risk of liver reactions

Question 17

A treatment option for management of hyperthyroid that is not a pill is?

Answer 17

1. Radioactive iodine, taken up by gland and radiation emitted destroys a portion of the thyroid cells, by decreasing amount of TSH, can take up to 6 months and requires thyroid replacement.

Question 18

What are the precautions that must be taken when giving Radioactive iodine to patients?

Answer 18

1. Pregnancy for 6 months 2. limit contact with children 3. limit contact with anyone

Question 19

Why are beta blockers used in the treatment of hyperthyroidism?

Answer 19

1. Beta blockers block adrenalin related symptoms.

Question 20

What does Propranolol do in patients with hyperthyroidism?

Answer 20

1. Non selective blocks activity/useful in patients with thyroid storm.

Question 21

Most common cause of hypothyroidism?

Answer 21

1. Hashimoto thyroiditis

Question 22

What is hashimoto’s thyroiditis?

Answer 22

1. Autoimmune inflammation of the thyroid gland, bodies immune system attacking the thyroid gland.

Question 23

What occurs in Hashimoto’s Thyroiditis?

Answer 23

1. Anti-thyroid peroxidase (Anti TPO antibodies) Antithyroglobulin, first their is goiter and then atrophy of the thyroid gland.

Question 24

What medications can cause hypothyroidism?

Answer 24

1. Lithium 2. Amiodarone

Question 25

A condition that results in the pituitary gland failing to produce enough TSH?

Answer 25

1. Central hypothyroidism/hypopituitarism

Question 26

What are causes of hypopituitarism?

Answer 26

1. tumors 2. infections 3.vascular (sheehan syndrome) 4, radiation

Question 27

What are symptoms of hypothyroidism?

Answer 27

1. Coarse hair/hair loss 2. weight gain 3. amenorrhea 4. fluid retention-edema-ascites-pleural effusion 5. fatigue 6. constipation 7. dry ski

Question 28

How would a clinician diagnose hypothyroidism?

Answer 28

1. TSH 2. T3 and T4

Question 29

This type of hypothyroidism, the T3 and T4 levels are low and the TSH is elevated? There is no negative feedback so the pituitary produces lots of TSH to get the thyroid working again.

Answer 29

1. Primary hypothyroidism

Question 30

Low production of TSH, related to the pituitary. TSH low and T3 and T 4 low

Answer 30

2. Secondary hypothyroidism

Question 31

What is Levothyroxine?

Answer 31

1. Synthetic T4 that metabolizes to T3

Question 32

When starting Levothyroxine, how often is the TSH level measured?

Answer 32

1. Monthly until stable

Question 33

If TSH level is high, then what does that mean regarding the Levothyroxine dose?

Answer 33

1. Too low needs to be increased

Question 34

If TSH is low, what does that mean in relation to the dosing of levothyroxine?

Answer 34

1. The dose is too high and needs to be decreased.