THYROTOXICOSIS

Question 1

CLINICAL FEATURES
• HYPERMETABOLISM
– _________
– INCREASED __________
–________ INTOLERANCE
•_______ SIGNS
• CARDIAC
• OTHERS
– DIARRHOEA
– MENSTRUAL
– IRRITABILITY

Answer 1

WEIGHT LOSS

APPETITE; HEAT

EYE

Question 2

Scenarios:

TWO
• TSH - LOW
• T3 - HIGH
• T4 - HIGH

Answer 2

Primary hyperthyroidism

Question 3

Scenarios:

THREE
• TSH - LOW
• T3 - HIGH
• T4 - NORMAL

Answer 3

Isolated T3 toxicosis

Question 4

Scenarios:

FOUR
• TSH - LOW
• T3 - NORMAL
• T4 - HIGH

Answer 4

Isolated T4 toxicosis

Question 5

Scenarios:

FIVE
• TSH - LOW
• T3 - NORMAL
• T4 - NORMAL

Answer 5

1) lab error
2) sub clinical hyperthyroidism
3) on going treated hyperthyroidism

Question 6

Scenarios:

SIX
• TSH - HIGH
• T3 - NORMAL
• T4 - NORMAL

Answer 6

1) lab error
2) sub clinical hypothyroidism
3) on going treated hypothyroidism

Question 7

Scenarios:

SEVEN
• TSH - HIGH
• T3 - HIGH
• T4 - HIGH

Answer 7

Secondary hyperthyroidism

Question 8

Scenarios:

EIGHT
• TSH - HIGH
• T3 - LOW
• T4 - LOW

Answer 8

Hypothyroidism

Question 9

Scenarios:

NINE
• TSH - LOW
• T3 - LOW
• T4 - LOW

Answer 9

Secondary hypothyroidism

Question 10

INVESTIGATIONS
• NECK USS
• NECK X-RAY
–________
–___________
–______________
• FNAC
• FBC
• SCINTIGRAPHY

Answer 10

A-P; LATERAL

THORACIC INLET

Question 11

TREATMENT
• MEDICAL
•___________
•______________
•______________
• SURGERY

Answer 11

β-BLOCKERS

ANTI-THYROID DRUGS

RADIO-IODINE

Question 12

COMPLICATIONS OF SURGERY
•_________________________ INJURY
• _______________________ NERVE
• HAEMATOMA
• WOUND INFECTION
• KELOIDS
• RECURRENCE

Answer 12

RECURRENT LARYNGEAL NERVE

EXT BRANCH OF SUPERIOR
LARYNGEAL

Question 13

*_____________– prohormone, majority secreted
*__________________ – active hormone

Answer 13

T4 (thyroxine)

T3 (triiodothyronine)

Question 14

T3

• ~_____% is gotten from peripheral conversion (T4 → T3 via 5′-deiodinase)
  
  • ~_____% secreted directly

Answer 14

80

20

Question 15

Transport
* Bound to:
*________________________ (most important)
*_______________
*____________

Answer 15

Thyroxine-binding globulin (TBG)

Transthyretin; Albumin

Question 16

Which is active

Bound or Free Hormome

Answer 16

Only free hormone is active

Question 17

Clinical features

Cardiovascular
* Tachycardia
*————— (esp elderly)
*———————-
* High-output heart failure

Answer 17

Tachycardia

Atrial fibrillation

Widened pulse pressure

Question 18

Clinical features
Neuromuscular
*—————
*_________ muscle weakness (thyrotoxic myopathy)
* Hyperreflexia

CNS / Psychiatric
* Anxiety
* Irritability
*_________
*____________ (rare but dramatic)

Answer 18

Tremor (fine) ; Proximal

Insomnia; Psychosis

Question 19

Clinical features

GI
*___________ bowel movements
* Diarrhea
*____________

Reproductive
*___________/___________
*___________
* Gynecomastia (↑_________ )

Skin & Hair
* ________ , _______ skin
* Fine hair
* Hair ______
*__________ (Plummer nails)

Answer 19

Increased; Hyperdefecation

Oligomenorrhea / amenorrhea

Infertility; SHBG

Warm, Moist

loss; Onycholysis

Question 20

Graves’ disease
Extra-thyroidal manifestations
1. Ophthalmopathy
*__________
* __________
* __________
* __________

Answer 20

Exophthalmos
Lid lag
Lid retraction

Question 21

Eye disease is dependent on thyroid hormone level

T/F

Answer 21

F

Eye disease is independent of thyroid hormone level

Question 22

Graves’ disease

Extra - THYROIDAL manifestation

2. _________ ________
   * _____________ edema
   * location: __________
   * Due to dermal _____________________________

Answer 22

Pretibial myxedema

Non-pitting

Anterior shin

mucopolysaccharide deposition

Question 23

Thyroid storm (life-threatening)
Definition

???

Answer 23

Acute, severe exacerbation of thyrotoxicosis

Question 24

Thyroid storm

Triggers
*___________
*___________
* Trauma
* Childbirth
* Stopping ______________

Answer 24

Infection

Surgery

antithyroid drugs

Question 25

Features of thyroid storm * Hyper________ * Severe __________ *__________ * Vomiting * Heart failure

Answer 25

pyrexia; tachycardia Delirium

Question 26

Management of thyroid storm (memorize order) 1. 2. 3. 4. 5. Supportive care

Answer 26

Beta-blocker (Propranolol) Thionamide (PTU preferred initially) Iodine (after thionamide) Steroids

Question 27

Investigations First-line * ________ (most sensitive) *________ in thyrotoxicosis Confirmatory *_________ *________

Answer 27

TSH; ↓↓↓ ↑ Free T4 ↑ T3

Question 28

Special tests: Radioactive iodine uptake (RAIU) Condition Graves Toxic nodules Thyroiditis

Answer 28

High , diffuse Low Low

Question 29

Special tests: Antibodies *_____________________ → Graves *_____________ → autoimmune thyroid disease

Answer 29

TSH receptor antibody Anti-TPO

Question 30

Antithyroid drugs List 2

Answer 30

* Methimazole * Propylthiouracil (PTU)

Question 31

Radioactive iodine (I-131) *__________ thyroid tissue * Contraindicated in: *___________ *______________

Answer 31

Destroys Pregnancy; Breastfeeding

Question 32

Treatment: Special situations Pregnancy *_______ in 1st trimester *_____________ later * Avoid ____________

Answer 32

PTU Methimazole radioactive iodine

Question 33

Graves VS thyroiditis Pain RAIU Antibodies Eye signs Treatment

Answer 33

No; yes High; low Yea; no Yes; no Anti thyroid; Beta blockers

Question 34

_________ is the most sensitive test for thyrotoxicosis”

Answer 34

TSH

Question 35

Eye disease severity does not correlate with thyroid hormone levels T/F

Answer 35

T

Question 36

Low RAI uptake suggests __________________ , not ____________”

Answer 36

hormone release synthesis