20 - Thyroid Disease

Question 1

What is a goitre and what can it be caused by?

Answer 1

- Iodine deficiency

• Selenium deficiency
• Tumours
• Thyroid disease

Question 2

What is Hashimoto’s diesease and how is it treated?

Answer 2

• Antibody blocks TSH receptor on follicle cells preventing them responding to TSH
• Treated with oral thyroxine and dose is adjusted based on patients signs, symptoms and levels of TSH

Question 3

What are some causes of Hypothyroidism and what are the general symptoms?

Answer 3

• Weight gain
• Tiredness and lethargy
• Weakness, muscle cramps and cerebellar ataxia
• Dry flaky skin
• Deep husky voice
• Cold intolerance

Question 4

What are some signs of cretinism?

Answer 4

Question 5

What is myxedma?

Answer 5

• Severe hypothyroidism in adults

Symptoms:

• Thick puffy skin
• Muscle weakness
• Slow speech
• Mental deterioration
• Intolerance to cold

Question 6

What are some causes and symptoms of hyperthyroidism?

Answer 6

• Heat intolerance, increased oxygen consumption and increased BMR
• Weight loss
• Physical and mental hyperactivity
• Tachycardia
• Intestinal hyper-mobility
• Skeletal and cardiac myopathy so tired, weak and breathless
• Osteoporosis due to increased bone turnover

Question 7

What is Grave’s disease?

Answer 7

• TSI antibodies prodcued that stimulate TSH receptors on follicle cells

Question 8

How can you treat Grave’s disease?

Answer 8

- Carbimazole (or propylthiouracil) : inhibits thyroid peroxidase so iodination and coupling of tyrosine residues on thyroglobulin doesn’t work

• Beta blockers for symptom control
• Surgery for cosmetics
• Radioactive iodine (not in pregnancy)

Question 9

What examination can you use to look at the thyroid function?

Answer 9

More colour there is the more active it is so in hypothyroidism will be very faint

Question 10

Answer 10

C

Question 11

What are some causes of hyperprolactinaemia apart from pituitary adenoma?

Answer 11

Question 12

What drug is used to treat hyperprolactinaemia?

Answer 12

Question 13

What is an issue that can be encountered when measuring prolactin levels in the blood with a macroprolactinoma?

Answer 13

Question 14

How can you distinguish between hyperthyroidism and anxiety?

Answer 14

Hands are warm and moist in hyperthyroidism but in anxiety they are cold

Question 15

What are some tests you could do to rule out a pituitary adenoma over hyperthyroidism?

Answer 15

• Neck exam
• Hand tremors
• Visual field test

Question 16

A patient has the following symptoms, what differential diagnoses should you be thinking about?

Answer 16

• Chronic fatigue
• Hypothyroidism
• Anaemia
• Depression

Question 17

How do you treat hypothyroidism and what are the dangers of treatment?

Answer 17

• Daily levothyroxine
• Can cause hyperthyroidism and cardiac effects if not poorly controlled

Question 18

Why might this patient be struggling to concieve?

Answer 18

Prolactin negatively feedsback on GnRH so FSH and LH not released so cannot ovulate

Question 19

What are some physical examinations of the thyroid gland that you can carry out?

Answer 19

Question 20

What are some of the symptoms and signs of hypothyroidism?

Answer 20

Question 21

What are some signs and symptoms of hyperthyroidism?

Answer 21

Question 22

What are some red flag symptoms of thyroid cancer?

Answer 22

Question 23

A 44 year old female patient is shown to have normal free plasma T3 and T4 but undetectable TSH. Which condition best describes this scenario

Answer 23

Subclinical hyperthyroidism is characterized by a low or undetectable concentration of serum TSH with free triiodothyronine and free thyroxine levels within laboratory reference ranges

Question 24

What effect can amiodarone have on the thyroid?

Answer 24

The antiarrhythmic drug amiodarone is structurally similar to thyroxine and so can disrupt thyroid function (both hypo- and hperthyroid effects have been reported with this drug