Thyroid

Question 1

Thyrotoxicosis definition

Answer 1

Clinical effect of ↑T4

Usually from gland hyperfunction

Question 2

Sx of thyrotoxicosis

Answer 2

• Diarrhoea
• ↑ appetite but ↓ wt.
• Sweats, heat intolerance
• Palpitations
• Tremor
• Irritability
• Oligomenorrhoea ± infertility

Question 3

Signs of thyrotoxicosis in the hands

Answer 3

• Fast / irregular pulse
• Warm, moist skin
• Fine tremor
• Palmer erythema

Question 4

Signs of thyrotoxicosis in the face

Answer 4

• thin hair
• lid lag
• lid retraction

Question 5

Signs of thyrotoxicosis in the neck

Answer 5

goitre or nodules

Question 6

Signs specific to Graves

Answer 6

1. Exophthalmos
2. Pre-tibial myxoedema
3. Thyroid acropachy

Question 7

Thyroid acropachy definition

Answer 7

Clubbin and swelling of digits

Question 8

Ix for thyrotoxicosis

Answer 8

High T4

Low TSH

Autoantibodies

Question 9

Most common cause of thyrotoxicosis?

Answer 9

Graves’ disease

Question 10

Triggers of Graves disease

Answer 10

• stress
• infection
• child-birth

Question 11

Conditions associated to Graves disease

Answer 11

T1DM

Vitiligo

Addison’s

Question 12

Other causes of thyrotoxicosis

Answer 12

Toxic multinodular goitre
Toxic adenoma
Thyrotoxic phase of thyroiditis
Drugs

Question 13

Drugs causing thyrotoxicosis

Answer 13

Thyroxine

Amiodarone

Question 14

Medical treatment for thyrotoxicosis

Answer 14

Beta blocker - sx relief
Carbimazole

Question 15

Action of carbimazole

Answer 15

Anti-thyroid

Inhibits TPO

Question 16

Use of carbimazole in Graves’ disease

Answer 16

Rx 12-18 mo

Then withdraw

~ 50% relapse (→ surgery or radioiodine)

Question 17

SE of carbimazole

Answer 17

Agranulocytosis

Question 18

Radiological treatment for thyrotoxicosis

CI

Answer 18

Radioactive iodine

CI in pregnancy

Question 19

Surgical treatment for thyrotoxicosis

Answer 19

Thyroidectomy

Question 20

Thyroid storm definition

Answer 20

Thyrotoxic crisis

Acute life-threatening hypermetabolic state

Induced by excessive release of thyroid hormones

Question 21

Features of thyroid storm

Answer 21

• ↑ temp
• Agitation, confusion, coma
• Tachycardia, AF
• Acute abdomen
• Heart failure

Question 22

Precipitants to thyroid storm

Answer 22

Recent thyroid surgery

Radioactive iodine

Infection

MI

Trauma

Question 23

Mx of thyroid storm

Answer 23

1. Fluid resuscitation + NGT
2. Bloods: TFTs + cultures
3. Propranolol
4. Digoxin may be needed
5. Carbimazole
6. Hydrocortisone
7. Rx cause

Question 24

Sx of hypothyroidism

Answer 24

• Lethargy
• Cold intolerance
• ↓ appetite but ↑wt.
• Constipation
• Menorrhagia
• ↓ mood

Question 25

Signs of hypothyroidism

Answer 25

- Cold hands - Bradycardic - Slow-relaxing reflexes - Dry hair and skin - Goitre - Myxoedema

Question 26

Myxoedema definition

Answer 26

- SC tissue swelling in severe hypothyroidism - Typically around eyes and dorsum of hand

Question 27

Causes of hypothyroidism

Answer 27

- Atrophic thyroiditis - Hashimoto’s thyroiditis - Post De Quervain’s thyroiditis - Iodine deficiency - Drugs - Congenital thyroid agenesis - Hypopituitarism

Question 28

Drugs causing hypothyroidism

Answer 28

Carbimazole Amiodarone Lithium

Question 29

Most common cause of hypothyroidism in UK

Answer 29

Atrophic thyroiditis

Question 30

Most common couse of hypothyroidism worldwide

Answer 30

Iodine deficiency

Question 31

Ix for atrophic thyroiditis

Answer 31

Anti-TSH antibody positive

Question 32

Features of atrophic thyroiditis

Answer 32

Lymphocytic infiltrate → atrophy No goitre

Question 33

Ix for Hashimoto's thyroiditis

Answer 33

TPO positive | (Thyroid peroxidase antibody)

Question 34

Features of Hashimoto's thyroiditis

Answer 34

- Atrophy + regeneration → goitre - May go through initial thyrotoxicosis phase - May be euthyroid or hypothyoid

Question 35

Ix for hypothyroidism

Answer 35

High MCV High TSH Low T4 Antibodies

Question 36

Mx of hypothyroidism

Answer 36

Levothyroxine Follow up for other autoimmune diseases

Question 37

Features of myxoedema coma

Answer 37

- Looks hypothyroid - Hypothermia - Hypoglycaemia - Heart failure: bradycardia and ↓BP - Coma and seizures

Question 38

Precipitants to myxoedema coma

Answer 38

- Radioiodine - Thyroidectomy - Pituitary surgery - Infection, trauma, MI, stroke

Question 39

Mx of myxoedema coma

Answer 39

Bloods Correct any hypoglycaemia T3/T4 IV slowly Hydrocortisone Rx hypothermia and heart failure

Question 40

Why give T3/T4 slowly in myxoedema coma?

Answer 40

May precipitate MI