thyroid problems

Question 1

secondary hyperthyroidism

Answer 1

pathology in the hypothalamus or pituitary

Question 2

graves disease definition

Answer 2

autoimmune condition where TSH receptor antibodies cause primary hyperthyroidism

Question 3

causes of hyperthyroidism

Answer 3

graves disease
inflammation
solitary toxic thyroid nodule
toxic multinodular goitre

Question 4

features of hyperactive thyroid

Answer 4

anxiety and irritability
sweating and heat intolerance
tachycardia
weight loss
fatigue
insomnia
frequent loose stools
sexual dysfunction
brisk reflexes

Question 5

specific features to graves disease

Answer 5

diffuse goitre
graves eye disease
pretibial myxoedema
thyroid acropachy

Question 6

3 phases of de quervain’s thyroiditis

Answer 6

thyrotoxicosis
hypothyroidism
return to normal

Question 7

what is the initial thyrotoxic phase of de quervain’s thyroiditis

Answer 7

excessive thyroid hormones
thyroid swelling and tenderness
flu like illness
raised inflammatory markers

Question 8

treatment of de quervain’s

Answer 8

mostly supportive
NSAIDs
betablockers for hyperthyroidism
levothyroxine for hypothyroidism

Question 9

presentation of thyroid storm

Answer 9

fever
tachycardia
delirium

Question 10

hyperthyroidism management

Answer 10

carbimazole
propylthiouracil- small risk of severe reactions
both can cause agranulocytosis
radioactive iodine

Question 11

TFT in primary hypothyroidism

Answer 11

low T3 and T4 high TSH

Question 12

what is hashimoto’s thyroiditis associated with

Answer 12

anti-TPO
anti-Tg

Question 13

causes of primary hypothyroidism

Answer 13

hashimoto’s: most common in developed world
iodine deficiency: most common in developing
treatments for hyperthyroidism
lithium
amiodarone

Question 14

causes of secondary hypothyroidism

Answer 14

tumours
surgery
radiotherapy
sheehan’s syndrome
trauma

Question 15

presentation of hypoactive thyroid

Answer 15

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

Question 16

management of hypoactive thyroid

Answer 16

oral levothyroxine

Question 17

management of graves disease

Answer 17

first line: ATD (carbimazole)
initial treatment of symptoms: propranolol

Question 18

contraindications for radioiodine

Answer 18

pregnancy
<16 years old
thyroid eye disease

Question 19

side effects of thyroxine treatment

Answer 19

hyperthyroidism
reduced bone mineral density
worsening of angina
AF

Question 20

drugs that interact with thyroxine

Answer 20

iron
calcium carbonate

Question 21

presentation of myxoedema coma

Answer 21

confusion and hypothyroidism

Question 22

management of myxoedema coma

Answer 22

IV thyroid replacement
IV fluids
IV corticosteroids
electrolyte imbalance correction
rewarming

Question 23

management of thyrotoxicosis in pregnancy

Answer 23

propylthiouracil: first trimester

Question 24

what is riedel’s thyroiditis

Answer 24

rare cause of hypothyroidism
dense fibrous tissue replacing normal thyroid parenchyma
on exam: hard, fixed painless goitre

Question 25

investigations in de quervain's thyroiditis

Answer 25

thyroid scintigraphy: globally reduced uptake of iodine-131

Question 26

management of thyroid eye disease

Answer 26

smoking cessation topical lubricants steroids radiotherapy surgery

Question 27

complications of thyroid eye disease

Answer 27

exposure keratopathy optic neuropathy strabismus and diplopia

Question 28

first line imaging in suspicious thyroid nodule

Answer 28

ultrasonography

Question 29

management of thyroid storm

Answer 29

symptomatic treatment (paracetamol) treat underlying precipitating event beta-blockers (IV propranolol) anti-thyroid drugs (methimazole or propylthiouracil) lugol's iodine dexamethasone

Question 30

what does patchy uptake in nuclear scintigraphy suggest

Answer 30

toxic multinodular goitre

Question 31

treatment of toxic multinodular goitre

Answer 31

radioiodine therapy

Question 32

presentation of myxoedemic coma

Answer 32

confusion and hypothermia

Question 33

management of myxoedema coma

Answer 33

IV thyroid replacement IV fluid IV corticosteroids- in case also adrenal insufficiency electrolyte imbalance correction

Question 34

management of thyrotoxicosis

Answer 34

propranolol: to control thyrotoxic tremor carbimazole