1
Q
what is Grave’s disease
A
- most common cause of primary hyperthyroidism
- production of antibodies that stimulate T3/T4 production and release in the absence of TSH
2
Q
name 6 causes of hyperthyroidism
A
- Grave’s
- nodular disease
- subacute Dequervain’s thyroiditis
- pregnancy
- drugs (e.g. amiodarone, lithium, levothyroxine)
- metastatic thyroid cancer
3
Q
what is subacute Dequervain’s thyroiditis
A
- post viral transient inflammation of the thyroid gland
- patients tend to go from hyper to hypo then back to normal
4
Q
subacute Dequervain’s thyroiditis presentation
A
- painful goitre
- pyrexia
- raised inflammatory markers
5
Q
subacute Dequervain’s thyroiditis management
A
NSAIDs
6
Q
Grave’s most common in
A
women 40-60
7
Q
Grave’s specific signs
A
- pre-tibial myxoedema
- bilateral exopthalmos
- thyroid acropachy
8
Q
hyperthyroidism general presentation
A
- heat intolerance
- sweating
- fatigue
- weight loss
- increased appetite
- reduced concentration
- swelling in the neck
- difficulty sleeping
- changes in menstrual pattern
9
Q
hyperthyroidism ophthalmology presentation
A
- gritty sensation in eye
- eye discomfort
- double vision
- photophobia
10
Q
hyperthyroidism motor presentation
A
tremor
11
Q
hyperthyroidism cardiovascular presentation
A
palpitations
12
Q
hyperthyroidism GI presentation
A
diarrhoea
13
Q
hyperthyroidism dermatology presentation
A
- moist skin or lumps on shins
- fine brittle hair
14
Q
hyperthyroidism mood presentation
A
- anxiety
- irritability
- emotional liability
- psychosis
15
Q
hyperthyroidism signs
A
- sweating
- tremor
- tachycardia
- atrial fibrillation
- moist skin
- pre-tibial myxoedema
- thyroid swelling that moves up and down with swallowing
- lid lag
- lid retraction
- chemosis
- exophthalmosis
16
Q
primary hyperthyroidism thyroid function test results
A
- high T3/T4
- low TSH
17
Q
secondary hyperthyroidism thyroid function test results
A
- high T3/T4
- high TSH
18
Q
sub-acute hyperthyroidism thyroid function test results
A
- normal T3/T4
- high TSH
19
Q
hyperthyroidism diagnosis
A
- thyroid function tests
- scintigraphy
20
Q
multi-nodular hypethyroidism scintigraphy results
A
high uptake in multiple locations
21
Q
toxic adenoma hypethyroidism scintigraphy results
A
single nodule of high uptake
22
Q
toxic adenoma hypethyroidism scintigraphy results
A
reduced uptake
23
Q
hyperthyroidism management
A
- propranolol (symptomatic control)
- carbimazole (risk of agranulocytosis and jaundice)
- propylthiourcail
- radio-ablation
- thyroidectomy
24
Q
secondary hyperthyroidism causes
A
- pituitary disease
- hypothalamic disease
25
what is a thyroid storm
* complication of hypetthyroidism
* state of severe hyperthyroidism
26
thyroid storm causes
* MI
* infection
* radio-iodine
* recent thyroid surgery
27
thyroid storm presentation
* agitation, confusion, coma
* thyroid bruit
* seizure/coma
* tachycardia, atrial fibrillation, heart failure, circulatory collapse
* acute abdomen, diarrhoea/vomiting, abdominal pain, jaundice
28
thyroid storm management
* IV beta blockers
* fluids
* cool patient
* thyroidectomy if not resolved within 24 hours
29
name 5 causes of hypothyroidism
* Hashimoto's thyroiditis
* atrophic thyroiditis
* idiodine deficiency
* post thyroiectomy/radio-ablation
* drugs (e.g. lithium, amiodarone, anti-thyroid drugs)
30
Hashimoto's most common in
women > 60
31
what cancer is Hashimoto's associatied with
B cell non-Hodgkin's lymphoma
32
hypothyroidism presentation
* weight gain
* tiredness
* fatigue
* peri-orbital swelling
* constipation
* menorrhagia, infertility
* depression, reduced memory, dementia
* dry skin, coaese hair, hair loss, loss of outer 1/3 of eyebrow
33
hypothyroidism signs
* cold peripheries
* facial puffiness
* non-pitting oedema on hands and feet
* ataxis
* slow, relaxing reflexes
* dry, thin hair and dry skin
34
hypothyroidism diagnosis
* autoantibodies (Hashimoto's = anti-thyroid peroxidase, anti-thyroglobulin and TRAB blocking)
* thyroid function tests
35
primary hypothyroidism thyroid function test results
* low T3/T4
* high TSH
36
secondary hypothyroidism thyroid function test results
* low T3/T4
* low TSH
37
subclinical hypothyroidism thyroid function test results
* normal T3/T4
* high TSH
38
hypothyroidism management
levothyroxine
39
secondary hypotyroidism causes
pituitary or hypothalamic disease
40
what is myxoedema coma
* complication of hypothyroidism
* ultimate state of hypothyroidism before death
41
myxoedema coma causes
* MI
* infection
* untreated hypothyroidism
* post-pituitary surgery/thyroidectomy
* radio-iodine
42
myxoedema coma presentation
* psychosis, coma, seizures
* hypothermia, hyporeflexia, hypoglycaemia
43
myxoedema coma diagnosis
- thyroid function test
- baseline bloods
44
myxoedema coma management
- correct hypoglycaemia
- actively warm patient
- T3 infusion
- hydrocortisone
45
most common thyroid cancer
papillary thyroid cancer
46
papillary thyroid cancer histology findings
- orphan Annie nuclei
- calcified psammoma bodies
47
best thyroid cancer prognosis
papillary
48
name 5 thyroid cancer subtypes
* papillary
* follicular
* medullary
* anaplastic
* lymhoma
49
medullary thyroid cancer pathophysiology
* malignancy of parafollicular cells
* associated with abnormal secretion of malcitonin and hypercalcaemia
50
medullary thyroid cancer associated syndrome
MEN
51
worst thyroid cancer prognosis
anaplastic
year 2 - endocrine
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