Autoimmune Thyroid Disease Overview
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Questions and Answers

What is the recommended investigation for thyroid nodules that are suspicious for malignancy or radiologically indeterminate?

  • Molecular techniques
  • Thyroid ultrasound
  • Fine needle aspiration cytology (correct)
  • Thyroid scintigraphy

    • What is the role of thyroid scintigraphy in evaluating thyroid nodules when TSH is normal?

  • It can readily determine the size and number of nodules within the thyroid
  • It is not routinely used in the evaluation of thyroid nodules when TSH is normal (correct)
  • It is used routinely to determine the nature of the thyroid swelling
  • It is the key investigation in defining the risk of malignancy in a nodule

    • What ultrasound characteristics are associated with a higher likelihood of malignancy in a nodule?

  • Presence of microcalcification and regular margins
  • Generalized hypoechogenicity and increased vascularity
  • Spongiform appearance and intranodular vascularity
  • Hypoechogenicity, intranodular vascularity, microcalcification, and irregular or lobulated margins (correct)

    • What does the presence of thyroid autoantibodies support the diagnosis of?

    <p>Graves’ disease</p> Signup and view all the answers

    What is the significance of a 'spongiform' appearance in a thyroid nodule on ultrasound?

    <p>Highly predictive of a benign aetiology</p> Signup and view all the answers

    What treatment is recommended for nodules that are suspicious for malignancy?

    <p>surgical excision</p> Signup and view all the answers

    What is the recommended therapy for patients with subclinical thyrotoxicosis?

    <p>Low dose thionamide or 131I therapy</p> Signup and view all the answers

    What is the conversion rate to overt thyrotoxicosis for patients with subclinical thyrotoxicosis?

    <p>5% each year</p> Signup and view all the answers

    What is the recommended approach for patients with subclinical hypothyroidism and non-specific symptoms?

    <p>Levothyroxine therapy</p> Signup and view all the answers

    When is it better to treat thyroid failure early in patients with subclinical hypothyroidism?

    <p>When TSH rises above 10mIU/L</p> Signup and view all the answers

    What should be the goal of levothyroxine therapy in patients with subclinical hypothyroidism?

    <p>To restore serum TSH concentration to normal</p> Signup and view all the answers

    What is the most common adverse effect of antithyroid drugs mentioned in the text?

    <p>Rash</p> Signup and view all the answers

    What is the recommended surgical approach for thyroid surgery according to the text?

    <p>Near-total thyroidectomy</p> Signup and view all the answers

    What is the primary action of antithyroid drugs like carbimazole and propylthiouracil?

    <p>Inhibiting iodination of tyrosine</p> Signup and view all the answers

    What is one of the risk factors for relapse of Graves' disease after stopping antithyroid therapy?

    <p>Presence of a goitre</p> Signup and view all the answers

    What is the purpose of adding oral potassium iodide before thyroid surgery?

    <p>To reduce the size and vascularity of the gland</p> Signup and view all the answers

    What effect does therapeutic 131I have on the incidence of malignancies according to the text?

    <p>Increases incidence of thyroid and gastrointestinal malignancies</p> Signup and view all the answers

    What is the typical presentation of non-thyroidal illness (sick euthyroidism)?

    <p>Low serum TSH, raised T4, and normal or low T3</p> Signup and view all the answers

    What causes the abnormalities in thyroid function tests in non-thyroidal illness?

    <p>All of the above</p> Signup and view all the answers

    What is the primary reason for avoiding thyroid function tests unless there is clinical evidence of concomitant thyroid disease in non-thyroidal illness?

    <p>Difficult interpretation of test results</p> Signup and view all the answers

    What is the approximate percentage of thyroid nodules that are malignant?

    <p>5%–10%</p> Signup and view all the answers

    When should suspicion of a primary thyroid malignancy be heightened in the case of a thyroid nodule?

    <p>If it presents in childhood or adolescence</p> Signup and view all the answers

    What investigation should be performed urgently if there is any doubt about the etiology of an anterior neck swelling?

    <p>Ultrasound scan</p> Signup and view all the answers

    What is the most common manifestation of Graves’ disease?

    <p>Thyrotoxicosis with or without a diffuse goitre</p> Signup and view all the answers

    What percentage of patients with Graves’ disease have thyroid-stimulating immunoglobulins (TRAb) detected in their serum?

    <p>Over 95%</p> Signup and view all the answers

    What is the presumed role of fluctuating TRAb concentration in the serum of patients with Graves’ thyrotoxicosis?

    <p>Accounting for the natural history of Graves’ thyrotoxicosis</p> Signup and view all the answers

    What may result in thyroid failure in some patients with Graves’ disease?

    <p>Tissue destruction by cytotoxic antibodies and cell-mediated immunity</p> Signup and view all the answers

    What has a strong genetic component in the case of Graves’ disease?

    <p>HLA-DRß-Arg74, CTLA4, PTPN22, TSHR1, CD25 and CD40</p> Signup and view all the answers

    What is associated with the development of ophthalmopathy in Graves’ thyrotoxicosis?

    <p>Smoking</p> Signup and view all the answers

    What is the approximate range of 131I dose administered in most centers?

    <p>400–600 MBq</p> Signup and view all the answers

    During the lag period after 131I administration, what can be used to control symptoms?

    <p>β-blocker</p> Signup and view all the answers

    What is the disadvantage of 131I treatment according to the text?

    <p>Majority of patients develop hypothyroidism</p> Signup and view all the answers

    What does carbimazole do that reduces the efficacy of 131I therapy?

    <p>Prevents organification of 131I in the gland</p> Signup and view all the answers

    In which condition should 131I be avoided according to the text?

    <p>Graves’ ophthalmopathy</p> Signup and view all the answers

    What is recommended for women of reproductive age before and after administration of 131I?

    <p>Avoidance of pregnancy for at least 6 months before and after</p> Signup and view all the answers

    When should men use strict contraceptive measures after receiving 131I?

    <p>For at least 6 months</p> Signup and view all the answers

    What effect does 131I have on survival and replication of follicular cells?

    <p>It inhibits survival and replication</p> Signup and view all the answers

    How long should thyrotoxicosis persist after administration of a further dose of 131I before a further dose can be given?

    <p>6 months</p> Signup and view all the answers

    What is the recommended treatment for mild Graves' ophthalmopathy?

    <p>Oral selenium</p> Signup and view all the answers

    What is the optimal management for moderate to severe Graves' ophthalmopathy?

    <p>Glucocorticoids and orbital radiotherapy</p> Signup and view all the answers

    What is the primary characteristic of Pretibial myxoedema?

    <p>Pink-colored or purplish plaques on the anterior aspect of the leg</p> Signup and view all the answers

    What is the treatment for severe cases of Pretibial myxoedema?

    <p>Topical glucocorticoids</p> Signup and view all the answers

    What is indicated as a treatment for hypothyroidism in Hashimoto’s thyroiditis?

    <p>Levothyroxine therapy</p> Signup and view all the answers

    What antibodies are present in the serum in more than 90% of patients with Hashimoto’s thyroiditis?

    <p>Thyroid peroxidase antibodies</p> Signup and view all the answers

    What is the typical duration of hypothyroidism before normal thyroid function is restored in transient thyroiditis?

    <p>4-6 months</p> Signup and view all the answers

    What is the effect of the damaged follicular cells on iodine uptake in the thyrotoxic phase?

    <p>Iodine uptake is low because damaged cells are unable to trap iodine</p> Signup and view all the answers

    What is the effect of post-partum thyroiditis on subsequent pregnancies?

    <p>It tends to recur after subsequent pregnancies</p> Signup and view all the answers

    What is the recommended daily intake of iodine for adult men and women according to the World Health Organization (WHO)?

    <p>150µg/day</p> Signup and view all the answers

    What is the approximate percentage of the world population living in areas of iodine insufficiency?

    <p>Roughly one-third</p> Signup and view all the answers

    What is a major dietary source of iodine according to the text?

    <p>Dairy products</p> Signup and view all the answers

    What is the main autoantigen identified in Graves’ ophthalmopathy?

    <p>TSH receptor</p> Signup and view all the answers

    Which factor causes marked swelling and fibrosis of the extraocular muscles in Graves’ ophthalmopathy?

    <p>Interstitial fluid content</p> Signup and view all the answers

    What is the effect of active ocular inflammation in exophthalmic Graves’ disease?

    <p>Periorbital edema and conjunctival inflammation with changing orbital signs</p> Signup and view all the answers

    What is more common in men and cigarette smokers as a risk factor for Graves’ ophthalmopathy?

    <p>Eye displacement (proptosis, exophthalmos)</p> Signup and view all the answers

    What may exacerbate ophthalmopathy in Graves’ thyrotoxicosis?

    <p>Radioiodine therapy</p> Signup and view all the answers

    What is the most frequent presenting symptom related to increased exposure of the cornea in Graves’ ophthalmopathy?

    <p>Proptosis and lid retraction</p> Signup and view all the answers

    What is the autoregulatory response that inhibits thyroid hormone synthesis and release due to very high iodine concentrations?

    <p>Wolff–Chaikoff effect</p> Signup and view all the answers

    In which condition may iodine supplementation increase the prevalence of subclinical hypothyroidism and autoimmune hypothyroidism?

    <p>Iodine-sufficient areas</p> Signup and view all the answers

    What is the cytotoxic effect of amiodarone on thyroid follicular cells mainly attributed to?

    <p>Inhibition of iodine uptake</p> Signup and view all the answers

    What type of thyroiditis is due to a direct cytotoxic effect of amiodarone administration?

    <p>Type II thyroiditis</p> Signup and view all the answers

    What can result in hypothyroidism as a failure to escape from the Wolff–Chaikoff effect?

    <p>Autoimmune disease</p> Signup and view all the answers

    What is the primary action of amiodarone on thyroid follicular cells?

    <p>Inhibition of iodine uptake</p> Signup and view all the answers

    What is the most effective treatment for patients with significant thyrotoxicosis?

    <p>Combination therapy with an antithyroid drug and glucocorticoid</p> Signup and view all the answers

    When should amiodarone be discontinued in patients with thyrotoxicosis?

    <p>If the cardiac state permits</p> Signup and view all the answers

    What is the typical presentation of simple diffuse goitre?

    <p>Symmetrical, soft, and noticed by friends and relatives</p> Signup and view all the answers

    What is the management approach for a small multinodular goitre?

    <p>No treatment necessary but annual thyroid function testing</p> Signup and view all the answers

    Which test is a good screening test for significant tracheal compression in patients with large goitres?

    <p>Flow-volume loop</p> Signup and view all the answers

    What is the recommended investigation to confirm the diagnosis of multinodular goitre?

    <p>Thyroid scintigraphy</p> Signup and view all the answers

    In which patients is Levothyroxine therapy of no benefit for shrinking multinodular goitres?

    <p>Older patients in iodine-sufficient countries</p> Signup and view all the answers

    What is the treatment usually for toxic multinodular goitre?

    <p>131I</p> Signup and view all the answers

    Why is the iodine uptake lower in toxic multinodular goitre compared to Graves’ disease?

    <p>Lower TSH levels</p> Signup and view all the answers

    Why is long-term treatment with antithyroid drugs not usually employed?

    <p>High relapse rate after drug withdrawal</p> Signup and view all the answers

    Why are asymptomatic patients with subclinical thyrotoxicosis increasingly being treated with 131I?

    <p>To reduce risk of atrial fibrillation and osteoporosis</p> Signup and view all the answers

    Why is long-term treatment with antithyroid drugs not usually employed?

    <p>High relapse rate after drug withdrawal</p> Signup and view all the answers

    What is the rationale for using 131I in patients with large goitres and thyrotoxicosis?

    <p>To reduce thyroid size and normalize thyroid function</p> Signup and view all the answers

    Why is long-term treatment with antithyroid drugs not usually employed?

    <p>High relapse rate after drug withdrawal</p> Signup and view all the answers

    What is the significance of a suppressed TSH level in asymptomatic patients with subclinical thyrotoxicosis?

    <p>It reduces the risk of atrial fibrillation and osteoporosis.</p> Signup and view all the answers

    Why is Levothyroxine therapy of no benefit in shrinking multinodular goitres in iodine-sufficient countries?

    <p>Due to low TSH levels</p> Signup and view all the answers

    What is the approximate incidence of congenital hypothyroidism based on routine screening of TSH levels in heel-prick blood samples obtained 5–7 days after birth?

    <p>1 in 3000</p> Signup and view all the answers

    What is the most common cause of dyshormonogenesis?

    <p>Deficiency of the intrathyroidal peroxidase enzyme</p> Signup and view all the answers

    Which gene mutation is most commonly associated with Pendred syndrome?

    <p>SLC26A4 gene</p> Signup and view all the answers

    What is the primary cause of thyroid hormone resistance?

    <p>Mutations in the thyroid hormone receptor β gene</p> Signup and view all the answers

    What is the distinguishing feature between thyroid hormone resistance and TSHoma that can help in differentiation?

    <p>Elevation of TSH with administration of TRH in thyroid hormone resistance but not in TSHoma</p> Signup and view all the answers

    What is the role of pendrin encoded by the SLC26A4 gene?

    <p>Transport iodide to the luminal surface of the follicular cell</p> Signup and view all the answers

    Which enzyme deficiency results in the most common form of dyshormonogenesis?

    <p>Intrathyroidal peroxidase enzyme deficiency</p> Signup and view all the answers

    What is the distinguishing feature between Pendred syndrome and thyroid hormone resistance?

    <p>Combination of dyshormonogenetic goitre and nerve deafness in Pendred syndrome but not in thyroid hormone resistance.</p> Signup and view all the answers

    What is the incidence of primary thyroid malignancy?

    <p>25 per million per annum</p> Signup and view all the answers

    What is the cause of less than 5% of all cases of thyrotoxicosis?

    <p>Toxic adenoma</p> Signup and view all the answers

    What is the typical presentation of thyrotoxicosis in almost 50% of patients with toxic adenoma?

    <p>Elevated plasma T3 alone</p> Signup and view all the answers

    What is the size of the adenoma that causes a solitary toxic nodule?

    <p>Greater than 3cm in diameter</p> Signup and view all the answers

    What is the primary treatment for a solitary toxic nodule?

    <p>$131I (400–800MBq (10–20mCi)) therapy</p> Signup and view all the answers

    What is the incidence of thyroid cancer according to the text?

    <p>$&lt;1$% of all carcinomas</p> Signup and view all the answers

    What is the effect of $131I therapy on atrophic cells surrounding the nodule?

    <p>$131I therapy has no effect on atrophic cells</p> Signup and view all the answers

    Why is permanent hypothyroidism unusual after $131I therapy for a solitary toxic nodule?

    <p>$131I therapy has no effect on surrounding cells</p> Signup and view all the answers

    What is the gender predilection for thyroid cancer, excluding medullary carcinoma?

    <p>More common in females</p> Signup and view all the answers

    What is the most common type of thyroid cancer according to its cell type of origin?

    <p>papillary carcinoma</p> Signup and view all the answers

    What is the most common type of malignant thyroid tumor?

    <p>Papillary carcinoma</p> Signup and view all the answers

    What is the main reason for the increased incidence of thyroid carcinoma?

    <p>Increased use of thyroid imaging</p> Signup and view all the answers

    What is the recommended treatment for smaller thyroid tumors with no adverse histological features?

    <p>Thyroid lobectomy</p> Signup and view all the answers

    What is the primary method used to localize local recurrence or metastatic disease in thyroid cancer?

    <p>all of above</p> Signup and view all the answers

    What is the role of sorafenib, lenvatinib, or vandetanib in the treatment of locally advanced or refractory papillary and follicular carcinoma?

    <p>To prolong progression-free survival</p> Signup and view all the answers

    What is the recommended serum TSH concentration level for 131I treatment in thyroid cancer and isotope scanning?

    <p>&gt;20 mIU/L</p> Signup and view all the answers

    What is the most common site for blood-borne metastases in follicular carcinoma?

    <p>Lungs</p> Signup and view all the answers

    What is the main long-term treatment given after total thyroidectomy to suppress TSH and inhibit growth of differentiated thyroid carcinomas?

    <p>150-200 mcg levothyroxine daily</p> Signup and view all the answers

    What does the detection of rising thyroglobulin titre across serial measurements suggest in thyroid cancer patients?

    <p>Tumor recurrence or metastases</p> Signup and view all the answers

    What are the most common adverse prognostic factors for papillary and follicular thyroid cancer?

    <p>Older age at presentation</p> Signup and view all the answers

    What is the recommended treatment for anaplastic carcinoma?

    <p>Surgery and radiotherapy</p> Signup and view all the answers

    What is the prognosis for lymphoma of the thyroid?

    <p>Median survival of 9 years</p> Signup and view all the answers

    What is the primary cause of Riedel’s thyroiditis?

    <p>Unknown aetiology</p> Signup and view all the answers

    Which hormone may be secreted by medullary carcinoma of the thyroid and lead to carcinoid syndrome?

    <p>5-hydroxytryptamine</p> Signup and view all the answers

    What is the distinguishing factor between anaplastic carcinoma and lymphoma?

    <p>Cytological and histological characteristics</p> Signup and view all the answers

    What is the role of 131I therapy in treating medullary carcinoma of the thyroid?

    <p>No role due to C cells not responding to TSH</p> Signup and view all the answers

    What is the typical presentation of Riedel’s thyroiditis?

    <p>Extensive infiltration of the thyroid with fibrous tissue</p> Signup and view all the answers

    What is the primary treatment for anaplastic carcinoma in older patients?

    <p>No effective treatment available</p> Signup and view all the answers

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