thyroid disorders

Question 1

overt vs subclinical primary hypothyroidism

- how to differentiate

Answer 1

overt will have raised TSH, low T4

subclinical will have raised TSH but normal T4

Question 2

management of primary hypothyroidism

- which types should be commenced on treatment immediately (consider symptoms, overt vs subclinical)

Answer 2

treat immediately if symptomatic

if not, dither and procrastinate

Question 3

hyperthyroidism - ddx (7)

Answer 3

autoimmune
- grave’s disease

tumor

• toxic multinodular goitre
• thyroid adenoma

inflammatory

• painless sporadic thyroiditis
• subacute thyroiditis

medication related

• drug-induced hyperthyroidism -(amiodarone)
• exogenous hormone replacement

Question 4

hyperthyroidism

• indications for imaging
• what imaging to do

Answer 4

if TSH suppressed, and raised T3 or T4

do a tec-99 radionuclide scan

Question 5

hyperthyroidism - tec99 findings in

• grave’s disease
• thyroid adenoma
• toxic multinodular goitre
• subacute thyroiditis
• exogenous supplementation
• drug induced thyroiditis
• painless sporadic thyroiditis

Answer 5

graves - homogenous uptake
thyroid adenoma - single spot uptake
toxic multinodular goitre - heterogenous uptake
the rest will have no uptake

Question 6

hyperthyroidism - no uptake on tec-99

• ddx (4)
• which are painful and which are painless

Answer 6

• subacute thyroiditis (painful)
• exogenous supplementation
• drug induced thyroiditis
• painless sporadic thyroiditis