Thyroid Pathology

Question 1

thyroid pathology is either 1y or 2y- what does this mean?

Answer 1

1y= disease affecting the thyroid gland
2y= hypothalamic/ pituitary disease so no gland pathology

Question 2

difference between hyperthyroidism and thyrotoxicosis

Answer 2

hyperthyroidism= when there is overproduction of thyroid hormone

thyrotoxicosis= abnormal quantities of thyroid hormone in body

Question 3

aetiology of hyperthyroidism

Answer 3

excess thyroid stimulation: Grvae’s, hashitoxicosis, tumours, choriocarcinoma

thyroid nodules with autonomous function: toxic nodular goitre, adenoma

rare aetiology: thyroiditis, ectopic thyroid tissue, exogenous (levothryoxine)

Question 4

s/s of hyperthyroidism

Answer 4

metabolism if OVERactive
- palpitation, anxiety, wt loss/ inc appetite, eye disease (proptosis, lid retraction), thin hair, heat intolerance, sexual dysfunction

Question 5

ix findings for hyperthyroidism

Answer 5

1y: free T3/T4 inc, low TSH (compensation)
2y: inc T3/T4, normal/high TSH

Question 6

subclinical finding for hyperthyroidism

Answer 6

dec TSH (<0.1)

Question 7

mx for hyperthyroidism

Answer 7

antithyroid drugs- carbimazole, PTU (PTU is 1st line in 1st trimester of pregnancy)

BBs, radioiodine therapy (RAI)

Question 8

main risk with antithyroid drugs?

Answer 8

agranulocytosis- bone marrow suppression causing leukopenia

Question 9

main risk posed with surgery for thyroid disease

Answer 9

recurrent laryngeal nerve paralysis

Question 10

thyroid storm is…

Answer 10

emergency of severe hyperthyroidism- resp/cardiac distress, hyperthermia, exaggerated reflex.
mx- ABCs, iodine, PTU, BBs

Question 11

aetiology of hypothyroidism

Answer 11

1y: goitrous (hashimoto’s, drugs (Lithium/ amiodarone)), non-goitrous (atrophic thyroiditis- poster chemo, congenital etc)
2y: hypothalamus/ pituitary disease, where not enough TSH produced

Question 12

s/s of hypothyroidism

Answer 12

metabolism is UNDERactive
- coarse hair, dull face, pale/dry skin, fluid retention, cold intolerance, constipation, wt gain/reduced appetite, menorrhagia

Question 13

ix findings for hypothyroidism

Answer 13

1y: free T3/T4 low, TSH high
2y: free T3/T4 low, TSH normal/low

Question 14

subclinical clinical findings for hypothyroidism

Answer 14

low TSH

Question 15

mx for hypothyroidism

Answer 15

levothyroxine (synthetic T4), in elderly give lower 25mg dose

Question 16

complications of hypothyroidism

Answer 16

myxoedema: severe hypothyroidism
- T2 resp failure, adrenal failure. ECG has signs of arrhythmias
- mx: ABCs, thyroxine, cardiac monitoring

Question 17

aetiology of thyroiditis

Answer 17

viral, hashimotos

Question 18

types of thyroditiis

Answer 18

De Quervain’s Thyroiditis, postpartum thyroiditis, drug induced (amiodarone), acute suppurative thyroiditis

Question 19

s/s of thyroiditis & mx

Answer 19

neck tenderness, fever, viral

mx- BBs, NSAIDs

Question 20

scintigraphy scan is used for..

Answer 20

thyroiditis- shows low T4 uptake

Question 21

euthyroid sick syndrome is…

Answer 21

abnormal thyroid function results with no thyroidal illness/ or hypo-pit dysfunction

Question 22

what is the usually thyroid function test reading for euthyroid

Answer 22

low TSH, low T3/T4

Question 23

what is Grave’s Disease

Answer 23

AI condition where there are antibodies against TSHr causing hyperthyroidism

Question 24

T/F: thyroid is 10:1 in females

Answer 24

T !!!

Question 25

what is the classic triad of Grave's

Answer 25

goitre + hyperthyroidism, exophthalmos, pretibial myxoedema

Question 26

Grave's/ hyperthyroidism often has...

Answer 26

eye disease | - exophthalmos, lid lag

Question 27

T/F: Grave's eye disease often associated with alcohol

Answer 27

F: smoking

Question 28

ix for Grave's

Answer 28

low TSH, high T3/T4 | ABs: TSHr AB*, anti-thyroid peroxidase,

Question 29

what is hashimotos

Answer 29

leads to gradual failure of thyroid function due to AI destruction of tissue

Question 30

pathophysiology of Hashi

Answer 30

anti-thyroid ABs > activated CD8+ cells > cytokine mediated cell death

Question 31

T/F: hashimotos may have a period of transient hyper function of the thyroid

Answer 31

T- known as hashimotos thyrotoxicosis

Question 32

which ABs would be seen on ix

Answer 32

anti-thyroid peroxidase, antithyroglobulin antibodies

Question 33

T/F: hashimotos thyroiditis is initially small then grows

Answer 33

F: initially diffusely large > becomes atrophic

Question 34

a goitre is a...

Answer 34

midline thyroid mass

Question 35

what are the 2 main types of goitre

Answer 35

diffuse: usually iodine deficiency, T3/T4 normal, TSH high multi-nodular: evolution from longstanding solitary goitre. may be toxic multi nodular goitre

Question 36

what is toxic multi nodular goitre?

Answer 36

autonomous nodules producing continuous excessive thyroid hormone causing hyperthyroidism

Question 37

radioidoine is 1st line for...

Answer 37

relapsed Grave's or toxic multi nodular goitre