THYROID DISEASES

Question 1

what antibodies are found in almost all patients with autoimmune hypothyroidism

Answer 1

Thyroglobulin and Thyroid peroxidase (TPO)

Question 2

what antibodies are the cause of graves diseaes

Answer 2

Thyroid stimulating antibodies

Question 3

What is the greatest risk factor for Predisposition to thyroid autoimmunity

Answer 3

being Female

-also post partum

Question 4

what gene could predispose you to thyroid autoimmunity

Answer 4

HLA-DR3

Question 5

what are the 3 group factors that cause thyroid autoimmunity

Answer 5

Genes
Endogenous
Environment

Question 6

what are some Autoimmune diseases associated with thyroid autoimmunity (name 5)

Answer 6

** Type 1 diabetes mellitus
** Addison’s disease
* Pernicious anaemia
** Vitiligo
** Alopecia areata
* Coeliac disease/ dermatitis herpetiformis
* Chronic active hepatitis
* Rheumatoid arthritis/ SLE/ Sjogren’s syndrome
* Myasthenia gravis (Graves’ disease)

Question 7

what causes Thyroid associated ophthalmopathy in graves disease

Answer 7

-**Swelling in extraocular muscles **is likely due to an autoantigen in the extraocular muscle that cross reacts with, or is identical to, a thyroid autoantigen

Question 8

what is a Goiter

Answer 8

lump or swelling at the front of the neck caused by a swollen thyroid

Question 9

Define HYPERTHYROIDISM and list 3 mechanisms for increased levels:

Answer 9

• Excess of thyroid hormones in blooda. overproduction thyroid hormone
  b. leakage of preformed hormone from
  thyroid
  c. ingestion of excess thyroid hormone

Question 10

What are common causes of hyperthyroidism

Answer 10

• Graves’ disease (75- 80% of all cases)
• Toxic multinodular goitre
• Toxic adenoma

Question 11

List some drugs that could induce hyperthyroidism

Answer 11

• Iodine
• Amiodarone
• Lithium
• Radiocontrast agents (contains large doises of iodine)

Question 12

List CLINICAL FEATURES of hyperthyroidism

Answer 12

Weight loss
Tachycardia
Anxiety
Tremor
Hyperphagia
Heat intolerance
sweating
Diarrhoea
Lid lag + stare
Menstrual disturbance

Question 13

what condition matches the following** clinical features:**

• Diffuse goitre
• Thyroid eye disease (infiltrative)
• Pretibial myxoedema
• Acropachy

Answer 13

Graves

Question 14

Which antibodies are responsible for graves

Answer 14

**Thyroid-stimulating autoantibodies **(TSAb’s) that activate the thyrotropin receptor (TSHR).

Question 15

what is the name of these symptoms and the hyperthyyroid condition
Image

Answer 15

Thyroid eye disease - Graves

(some will have forwards protrusion and others posterior (compressing optic nerve))

Question 16

how would you investigate hyperthyroidism

Answer 16

Thyroid function tests = suppressed TSG, Increased free T3 and T4

-supporting tests - Thyroid antibodies: TPO, Tg, TRAb
Isotope uptake scan

Question 17

what is the treatment for graves

Answer 17

• carbimazol
• surgery
• Radioiodin 131I
• propythiouracil used in perngnacy as carbimazolis highly tetragenic

Question 18

what is a possible side effect of carbimazol (Thionamides)

Answer 18

agranulocytosis

Question 20

what is hypothyroidism and the different types

Answer 20

• **abnormally low thyroid hormones
• **3 typesPRIMARY (>99%)
  - absence / dysfunction thyroid gland
  - most cases due to Hashimoto’s thyroiditisSECONDARY / TERTIARY
  - pituitary / hypothalamic dysfunction

Question 21

what are the common symptoms of hypothyroidism

Answer 21

Fatigue
Weight gain /difficulty loosing weight
cold
bradychardic
dry skin
muscles cramps
odemema
preorbital oedema
constipation

Question 24

How would you investigate secondary **hypothyroidism**

Answer 24

Reduced TSH, T3 and T4

Question 25

How is hypothyroidism treated

Answer 25

Treatment of choice - **synthetic L-thyroxine (T4)**

Question 26

what is a complication of graves

Answer 26

thyroid sorm/thyrotoxosis

Question 27

what treatment for hypothyroidism

Answer 27

levothyroxine