Thyroid Osce

Question 1

Ddx of a neck lump in the midline?

Answer 1

o Goitre

o Thyroglossal cyst

Question 2

Ddx of a neck lump in the anterior triangle?

Answer 2

o Branchial cyst - under the top of SCM o Carotid body tumour
o Lymph node [See Appendix A]

Question 3

Ddx of a neck lump in the posterior triangle?

Answer 3

o Cystic hygroma (above clavicle)

o Lymph node

Question 4

Safe answers for any neck lump?

Answer 4

o Sebaceous cyst

o Lipoma

Question 5

Causes of Goitre

Answer 5

• Multinodular goitre
• Grave’s disease
• Solitary nodule (adenoma I carcinoma)
• Hashimoto’s thyroiditis
• Subacute thyroiditis

Question 6

Multinodular goitre (MNG)

Answer 6

• Most common large goitre
• Can be smooth rather than multinodular to feel
• Patient usually euthyroid = non-toxic MNG
• Hyperthyroid = toxic MNG
• Indications for surgery in non-toxic MNG
o Cosmetic
o Local compression effect

Question 7

Grave’s disease

• Classic features

Answer 7

o	Goitre
o	Thyrotoxicosis
o	Eye disease (50%)
•	Exopthalmos	}   Unique to Graves
•	Ophthalmoplegia		
        Pretibial  myxoedema	
o	Thyroid acropachy

Question 8

Factors differentiating Graves from toxic MNG

Answer 8

o Smooth goitre (MNG rarely smooth)
o Grave’s-unique features as above
o TSH-receptor antibodies

Question 9

Indications for surgery for goiter

Answer 9

o Cosmetic
o Local compression o Failed medical Rx
o Intolerant of medication

Question 10

Any cause of hyperthyroidism would cause?

Answer 10

Lid retraction

lid lag

Question 11

Signs specific to graves disease

Answer 11

Exopthalmos

Ophthalmoplegia

Question 12

Rx for hyper thyroidism?

Answer 12

• Medical
o Symptomatic control: J3-blockers
o Anti-thyroid therapy: Carbimazole
Radioiodine
• Surgical (cosmetic, compression, malignancy) o Total thyroidectomy
o Subtotal thyroidectomy

Question 13

Causes of Hypothyroidism

Answer 13

• Autoimmune
o Primary atrophic thyroiditis (no goitre) o Hashimoto’s initially

•	Acquired
      o	Iodine deficiency
(number one cause worldwide) 
      o	Subacute thyroiditis
      o	Iatrogenic

• Surgery
• Radioiodine
• Carbimazole
• Lithium
• Amiodarone

•	Secondary
      o	Panhypopituitarism (very rare)

Question 14

Ddx of Hyperthyroidism

Answer 14

• Grave’s
• Toxic MNG
• Toxic nodule (usually adenoma)

• Thyroiditis in the initial phase
o Hashimoto’s
o Subacute

• Secondary (rare)
o TSHoma
o Hydatidiform mole o Choriocarcinoma

Question 15

Ddx of Parotid swelling

Answer 15

•	Bilateral		
      0	Viral I bacterial parolilis	
      0	TB	
      0	Alcohol	
      0	Pleomorphic adenoma	
      0	Sjogren's	
      0	Sarcoidosis

• Unilateral
0 Duct blockage
0 Unilateral pleomorphic adenoma

Question 16

Contraindications to radioiodine

Answer 16

• Young children at home

* Incontinent (eliminated in urine)

Question 17

Complications of thyroidectomy

Answer 17

•	Early
        0	Anaesthetic I haemorrhage I infection
	0	Damage to surrounding structures
	•	Recurrent laryngeal nerve
	•	Trachea
	•	Oesophagus
	•	Neck musculature
	0	Transient hypoparathyroidism
•	Late
	0	Hypoparathyroidism
	0	Recurrent  hyperthyroidism
                Hypothyroidism