Thyroid (hypo and hyper)

Question 1

hyperthyroidism TSH

Answer 1

low

Question 2

hypothyroidism TSH

Answer 2

high

Question 3

anti-TPO antibodies

Answer 3

graves disease and hashimotos thyroiditis

antibodies against thyroid gland

Question 4

anti-thyroglobulin antibodies

Answer 4

antibodies against a protein produced and present in thyroid gland

Question 5

TSH receptor antibodies

Answer 5

autoantibodies which cause graves disease

Question 6

USS

Answer 6

thyroid nodules
cystic vs solid nodules
guide biopsy of thyroid lesion

Question 7

radioisotope scan

Answer 7

hyperthyroidism and thyroid cancers
radioactive iodine IV
gamma camera

Question 8

thyrotoxicosis

Answer 8

abnormal and excessive quantity or thyroid hormone in the body

Question 9

primary hyperthyroidism

Answer 9

thyroid pathology

Question 10

secondary hyperthyroidism

Answer 10

overstimulation by TSH

hypothalamus or pituitary

Question 11

graves disease

Answer 11

autoimmune
TSH receptor antibodies
most common cause of hyperthyroidism

Question 12

toxic multinodular goitre

Answer 12

nodules on thyroid act independently and produce excess thyroid hormone

Question 13

exopthalmos

Answer 13

bulging of eyeball out of the socket caused by graves disease
inflamamtion, swelling and hypertrophy

Question 14

pretibial myxoedema

Answer 14

mucin deposits under skin on anterior leg

discoloured, waxy, oedematous appearance

Question 15

pretibial myxoedema is specific to what?

Answer 15

graves disease

reaction to TSH receptor antibodies

Question 16

features of hyperthyroidism

Answer 16

anxiety and irritability
sweating and heat intolerance
tachycardia 
weight loss 
fatigue 
frequent loose stools

Question 17

unique features of graves disease

Answer 17

diffuse goitre
graves eye disease
bilateral exopthalmos
pretibial myxoedema

Question 18

unique features of multinodular goitre

Answer 18

goitre with firm nodules

age over 50

Question 19

solitary toxic thyroid nodule

Answer 19

usually benign adenomas

surgical removal

Question 20

De Quervains thyroiditis

Answer 20

viral infection with fever, neck pain and tenderness
dysphagia and hyperthyroidism features
then hypothyroidism

Question 21

treating de quervains thyroiditis

Answer 21

NSAIDs and beta blockers

Question 22

thyroid storm presentation

Answer 22

pyrexia
tachycardia
delirium

Question 23

treating thyroid storm

Answer 23

fluids, anti-arrhythmics and beta blockers

Question 24

Treating hyperthyroidism

Answer 24

carbimazole 
propylthiouracil
radioactive iodine 
beta blockers 
surgery

Question 25

2 treatment regimes of carbimazole

Answer 25

titration block | block and replace

Question 26

propylthiouracil risks

Answer 26

hepatic reactions

Question 27

how is radioactive iodine treatment used?

Answer 27

drink single dose of radioactive iodine | patients can be left hypothyroidism and require levothyroxine

Question 28

strict rules radioactive iodine

Answer 28

not pregnant | avoid close contact with children for 3 weeks

Question 29

beta blocker of choice

Answer 29

propanolol | blocks adrenergic activity

Question 30

surgery - hyperthyroidism

Answer 30

whole thyroid or toxic nodules | hypothyroid post thyroidectomy

Question 31

Most common cause of hypothyroidism in developed world

Answer 31

hashimotos thyroiditis

Question 32

cause of hashimotos thyroiditis

Answer 32

autoimmune inflammation of thyroid gland

Question 33

hashimotos thyroiditis antibodies

Answer 33

antithyroid peroxidase (anti-TPO) and antithyroglobulin antibodies

Question 34

change in thyroid gland hashimotos thyroiditis

Answer 34

initial goitre then atrophy

Question 35

most common cause worldwide of hypothyroidism

Answer 35

iodine deficiency

Question 36

other causes of hypothyroidism

Answer 36

anti-thyroid medications eg carbimazole, thyroid surgery lithium pituitary gland

Question 37

lithium and thyroid

Answer 37

inhibits production of thyroid hormones | goitre and hypothyroidism

Question 38

amiodarone and thyroid

Answer 38

interferes with thyroid hormone production and metabolism | can cause hypothyroidism and thyrotoxicosis

Question 39

secondary hypothyroidism

Answer 39

pituitary gland fails to produce enough TSH | hypopituitarism

Question 40

causes of secondary hypothyroidism

Answer 40

tumours infection vascular - sheehan radiation

Question 41

presentation of hypothyroidism

Answer 41

``` weight gain fatigue dry skin coarse hair and hair loss fluid retention heavy or irregular periods constipation ```

Question 42

differentiating primary and secondary hypothyroidism

Answer 42

``` primary = high tsh and low t3 and t4 secondary = low tsh and low t3 and t4 ```

Question 43

management of hypothyroidism

Answer 43

oral levothyroxine (synthetic t4 metabolised to t3)

Question 44

changing dose of levothyroxine

Answer 44

if TSH is high the dose is too low and vice versa | check bloods monthly until TSH stable