Endocrinology

  • Hyperthyroidism

  • What is the approximate ratio of hyperthyroidism in women compared to men?

  • 5:1

  • What is the commonest cause of hyperthyroidism?

  • Graves’ disease

  • List 3 key clinical features of Graves’ disease

  • 1) Goitre

    2) Thyroid eye disease

    3) Pretibial myxoedema

  • Excessive intake of which element is a risk factor for Graves’ disease?

  • Iodine

  • Which serological marker confirms the diagnosis of Graves’ disease?

  • Autoantibodies to the TSH (thyroid-stimulating hormone) receptor (TRAb)

  • Approximately what percentage of patients with Hashimoto’s thyroiditis test positive for autoantibodies to the TSH (thyroid-stimulating hormone) receptor (TRAb)?

  • 10%

  • What type of receptor is the TSH (thyroid-stimulating hormone) receptor?

  • G-protein coupled receptor with 7 transmembrane-spanning domains

  • What type of goitre is usually seen in Graves’ disease?

  • Diffuse goitre

  • In Graves’ disease which cell type infiltrates the thyroid gland?

  • Lymphocyte

  • How may toxic nodular goitre be related to iodine intake?

  • More common in regions with relatively low iodine intake

  • How may thyroid adenomas be related to iodine intake?

  • Not related to iodine intake

  • In Graves’ disease what is the typical finding on a radioiodine uptake scan?

  • Normal or high uptake

  • List 3 causes of hyperthyroidism with a low radioiodine uptake scan

  • 1) Thyroiditis

    2) Exogenous thyroid hormone ingestion

    3) Ectopic thyroid hormone production

  • List 5 ocular features which may be present in hyperthyroidism

  • 1) Exophthalmos

    2) Lid retraction

    3) Lid lag

    4) Periorbital oedema

    5) Conjunctival oedema

  • How may speech be affected in hyperthyroidism?

  • Rapid

  • How may blood pressure be affected?

  • Systolic hypertension

  • How may the muscles be affected?

  • Proximal muscle weakness

  • How may reflexes be affected?

  • Hyperreflexia

  • How is the TSH (thyroid-stimulating hormone) level affected in primary hyperthyroidism?

  • Reduced

  • Which arrhythmia commonly occurs in patients with hyperthyroidism?

  • Atrial fibrillation

  • Approximately what percentage of patients with hyperthyroidism have atrial fibrillation?

  • 10-20%

  • How may the serum calcium level be affected in hyperthyroidism?

  • Increased

  • Why may hypercalcaemia occur in hyperthyroidism?

  • Increased bone resorption

  • What bone complication may arise from chronic hyperthyroidism?

  • Osteoporosis – with increased risk of fracture

  • What lifestyle factor increases the risk of ophthalmopathy in hyperthyroidism?

  • Smoking

  • What lifestyle factor increases the risk of thyroid acropachy?

  • Smoking

  • How may menstruation be affected in hyperthyroidism?

  • Oligomenorrhoea / amenorrhoea

  • What electrolyte disturbance is associated with thyrotoxic periodic paralysis?

  • Hypokalaemia

  • List 3 possible triggers of thyrotoxic periodic paralysis

  • 1) Exercise

    2) Fasting

    3) High carbohydrate intake

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Hypothyroidism