Thyroid Pathology

Question 1

what is the most common cause of hyperthyroidism

Answer 1

Graves disease

Question 2

what is graves disease

Answer 2

autoimmune destruction of the thyroid gland, commonly affects middle aged women

Question 3

which autoantibodies are positive in Graves disease

Answer 3

TRAb

Question 4

describe the goitre in Graves disease

Answer 4

smooth goitre

Question 5

list some other causes of hyperthyroidism

Answer 5

drug induced - lithium, amiodarone
nodular - TRAb -ve and asymmetrical goitre
post viral hyperthyroidism

Question 6

what is the indication that a lump in the throat is a goitre

Answer 6

moves superiorly on swallowing

Question 7

what are the symptoms and signs of hyperthyroidism

Answer 7

diarrhoea, light periods, tremor, palpitations, heat intolerance, weight loss, anxiety, visible goitre

Question 8

what are the eye manifestations of Graves disease

Answer 8

chemosis - swelling of conjunctiva
proptosis
double vision
gritty eyes

Question 9

what is pre-tibial myxoedema

Answer 9

pitting oedema found in the shins, seen with graves disease

Question 10

describe TFTs for primary, secondary and sub-clinical hyperthyroidism

Answer 10

primary - T3/T4 high and TSH low
secondary - T3/T4 high and TSH high
sub-clinical - t3/t4 normal and TSH high

Question 11

list the first and second line anti-thyroid drugs

Answer 11

carbimazole first line and propylthiouracil second line

Question 12

what other drugs are used to treat hyperthyroidism

Answer 12

symptom management eg propanolol and anti-motility drugs

Question 13

list the side effects of anti-thyroid drugs

Answer 13

carbimazole not safe during first trimester of pregnancy and risk of agranulocytosis - must stop medication if experience extreme fever and mouth ulcers

Question 14

what are the other methods of treatment for hyperthyroidism other than drugs

Answer 14

radio-ablation

thyroidectomy but risk of hypothyroidism and hypoparathyroidism

Question 15

what is thyrotoxicosis

Answer 15

severe form of hyperthyroidism

Question 16

what causes thyrotoxicosis

Answer 16

infection, MI, recent thyroid surgery

Question 17

how does thyrotoxicosis present

Answer 17

confusion, tachycardia, AF, diarrhoea, thyroid bruit and risk of circulatory collapse

Question 18

outline the management of thyrotoxicosis

Answer 18

fluids
beta-blocker or digoxin
carbimazole

Question 19

hypothyroidism has higher incidence in area of high or low iodine

Answer 19

high iodine

Question 20

list the different causes of hypothyroidism

Answer 20

Hashimotos - autoimmune

iatrogenic such as post thyroidectomy or drug induced

Question 21

what is the presentation of Hashimotos thyroiditis specifically

Answer 21

autoimmune destruction with goitre
presents in women aged 40-60
presentation of thyroid perioxidase antibodies

Question 22

list the symptoms of hypothyroidism

Answer 22

constipation, cold tolerance, depression, weight gain, bradycardia, dry skin and hair, heavy periods, peri-orbital swelling and cognitive impairment

Question 23

describe TFTs for primary, secondary and sub-clinical hypothyroidism

Answer 23

primary - T3/T4 low and TSH high
secondary - T3/T4 low and TSH low
sub-clinical - T3/T4 normal and TSH high

Question 24

what is the management for hypothyroidism

Answer 24

levothyroxine - synthetic T4

Question 25

what is the dosing of levothyroxine

Answer 25

young patient - 50-100 mcg | older patient or high risk IHD - 25-50 mcg

Question 26

what is the severe form of hypothyroidism that occurs if untreated or following surgery

Answer 26

myxoedema coma

Question 27

how does myxoedema coma present

Answer 27

psychosis seizures coma hypothermia and hypoglycaemia

Question 28

how is myxoedema coma managed

Answer 28

correct hypoglycaemia warm patient T3 infusion hydrocortisone

Question 29

what increases risk of developing thyroid cancer

Answer 29

radiation exposure

Question 30

how does thyroid cancer present

Answer 30

enlarging lump on the thyroid or goitre dysphagia or SOB facial swelling if superior vena cava obstruction

Question 31

what do TFTs look like with thyroid cancer

Answer 31

usually normal, especially if well-differentiated

Question 32

what is the gold standard investigation for diagnosing thyroid cancer

Answer 32

ultra-sound guided fine needle aspiration

Question 33

what is the most common type of thyroid cancer and how does it spread

Answer 33

papillary cancer, spreads via lymphatics | presents aged 20-30 with good prognosis

Question 34

what is the second most common type of thyroid cancer and how does it spread

Answer 34

follicular - spreads haematologically | well differentiated cancer with good prognosis

Question 35

which cancer has the poorest prognosis and how does it present

Answer 35

anaplastic thyroid cancer, hard, craggy growth on the neck usually presents in elderly very rapid growth with haematoglogical spread

Question 36

thyroid lymphoma is associated with what disease

Answer 36

autoimmune thyroid diseases such as Hasimotos thyroiditis | requires chemo/radiation to treat

Question 37

define a low risk thyroid tumour

Answer 37

<50 years old, tumour <4cm, well-differentiated and TSH low range of normal

Question 38

what is the management of thyroid tumours

Answer 38

thyroidectomy | radio-ablation if hyperthyroid

Question 39

radio-ablation increases risk of what cancer

Answer 39

acute myeloid leukaemia

Question 40

when does T3 and T4 need to be stopped for radio-ablation

Answer 40

T3 - 2 weeks prior | T4 - 4 weeks prior