Podcast
Questions and Answers
What is the presumed reason for the fluctuation in the concentration of TRAb in the serum?
What is the presumed reason for the fluctuation in the concentration of TRAb in the serum?
- Presence of blocking antibodies against the TSH receptor
- Tissue destruction by cytotoxic antibodies
- Cell-mediated immunity
- Natural history of Graves’ thyrotoxicosis (correct)
Which genetic component is strongly associated with Graves’ disease?
Which genetic component is strongly associated with Graves’ disease?
- 20%–40% concordance for thyrotoxicosis between monozygotic twins
- HLA-DRß-Arg74 gene (correct)
- Iodine supplementation in regions of iodine deficiency
- Association with viruses or bacteria
What may trigger the development of thyrotoxicosis in genetically susceptible individuals?
What may trigger the development of thyrotoxicosis in genetically susceptible individuals?
- Iodine supplementation in regions of iodine deficiency
- Presence of blocking antibodies against the TSH receptor
- Smoking
- Infection with viruses or bacteria (correct)
Why can iodine supplementation precipitate thyrotoxicosis in regions of iodine deficiency?
Why can iodine supplementation precipitate thyrotoxicosis in regions of iodine deficiency?
What is associated with the development of ophthalmopathy in Graves’ thyrotoxicosis?
What is associated with the development of ophthalmopathy in Graves’ thyrotoxicosis?
What type of antibodies may result in thyroid failure in some patients?
What type of antibodies may result in thyroid failure in some patients?
What plays a role in the management of symptoms of thyrotoxicosis?
What plays a role in the management of symptoms of thyrotoxicosis?
What is the approximate relapse rate for patients experiencing the first episode of thyrotoxicosis after taking antithyroid drugs?
What is the approximate relapse rate for patients experiencing the first episode of thyrotoxicosis after taking antithyroid drugs?
What percentage of patients may experience hypothyroidism after undergoing thyroidectomy?
What percentage of patients may experience hypothyroidism after undergoing thyroidectomy?
What is the most common cause of voice alteration following thyroid surgery?
What is the most common cause of voice alteration following thyroid surgery?
Which treatment is most likely to result in exacerbation of Graves’ ophthalmopathy?
Which treatment is most likely to result in exacerbation of Graves’ ophthalmopathy?
What is the main disadvantage of using antithyroid drugs in young patients?
What is the main disadvantage of using antithyroid drugs in young patients?
When is radio-iodine treatment typically recommended as a first-line option?
When is radio-iodine treatment typically recommended as a first-line option?
Which treatment poses a risk of transient hypocalcaemia?
Which treatment poses a risk of transient hypocalcaemia?
What should be measured in all patients before starting amiodarone therapy to minimize the risk of type I thyrotoxicosis?
What should be measured in all patients before starting amiodarone therapy to minimize the risk of type I thyrotoxicosis?
How should hypothyroidism be treated in patients on amiodarone therapy?
How should hypothyroidism be treated in patients on amiodarone therapy?
What is the effect of very high concentrations of iodine on thyroid hormone synthesis and release?
What is the effect of very high concentrations of iodine on thyroid hormone synthesis and release?
What phenomenon occurs after about 10 days of high iodine concentration, leading to the return to normal organification of iodine and thyroid peroxidase action?
What phenomenon occurs after about 10 days of high iodine concentration, leading to the return to normal organification of iodine and thyroid peroxidase action?
What is the rationale for iodine treatment in thyroid crisis and prior to thyroid surgery for thyrotoxicosis?
What is the rationale for iodine treatment in thyroid crisis and prior to thyroid surgery for thyrotoxicosis?
Why must an operation for an individual with Graves’ disease, who has been given iodine to prepare for surgery, happen within 10–14 days?
Why must an operation for an individual with Graves’ disease, who has been given iodine to prepare for surgery, happen within 10–14 days?
What may be precipitated by prophylactic iodinisation programs in iodine-deficient parts of the world?
What may be precipitated by prophylactic iodinisation programs in iodine-deficient parts of the world?
What are the effects of iodine deficiency and underlying thyroid disease on the effects of iodine on thyroid function?
What are the effects of iodine deficiency and underlying thyroid disease on the effects of iodine on thyroid function?
What is the only lasting for about 10 days, followed by an 'escape phenomenon'?
What is the only lasting for about 10 days, followed by an 'escape phenomenon'?
What management approach is recommended for nodules that are radiologically and/or cytologically indeterminate?
What management approach is recommended for nodules that are radiologically and/or cytologically indeterminate?
Which type of therapy may reduce the size of nodules in regions with borderline low iodine intake?
Which type of therapy may reduce the size of nodules in regions with borderline low iodine intake?
What is the recommended treatment for nodules with confirmed malignancy by formal histology?
What is the recommended treatment for nodules with confirmed malignancy by formal histology?
In which condition may levothyroxine therapy shrink the goitre?
In which condition may levothyroxine therapy shrink the goitre?
What might be required for a diffuse or multinodular goitre due to cosmetic reasons or compression of local structures?
What might be required for a diffuse or multinodular goitre due to cosmetic reasons or compression of local structures?
What is the most prevalent antibody-mediated autoimmune disease?
What is the most prevalent antibody-mediated autoimmune disease?
$Autoimmune thyroid disease$ is associated with which other conditions?
$Autoimmune thyroid disease$ is associated with which other conditions?
Which treatment may result in exacerbation of Graves’ ophthalmopathy?
Which treatment may result in exacerbation of Graves’ ophthalmopathy?
Which endocrine disorder is associated with Klinefelter syndrome?
Which endocrine disorder is associated with Klinefelter syndrome?
What is the main presenting problem in patients with gynaecomastia?
What is the main presenting problem in patients with gynaecomastia?
What is the most common cause of delayed puberty?
What is the most common cause of delayed puberty?
Which condition is associated with spontaneous hypoglycaemia?
Which condition is associated with spontaneous hypoglycaemia?
What is the main functional anatomy involved in acromegaly?
What is the main functional anatomy involved in acromegaly?
What is the primary functional anatomy affected by primary hyperparathyroidism?
What is the primary functional anatomy affected by primary hyperparathyroidism?
What is the typical level of TSH that would confirm the diagnosis of primary hypothyroidism?
What is the typical level of TSH that would confirm the diagnosis of primary hypothyroidism?
In patients with pituitary failure, at what level of TSH might it be detected at normal or modestly elevated levels?
In patients with pituitary failure, at what level of TSH might it be detected at normal or modestly elevated levels?
Which antibody is highly sensitive but not very specific for autoimmune thyroid disease?
Which antibody is highly sensitive but not very specific for autoimmune thyroid disease?
What is the most appropriate course of action when secondary hypothyroidism is suggested?
What is the most appropriate course of action when secondary hypothyroidism is suggested?
What is the usual abnormality in sick euthyroidism?
What is the usual abnormality in sick euthyroidism?
In rare causes of hypothyroidism with goitre, which condition may be present?
In rare causes of hypothyroidism with goitre, which condition may be present?
What is the typical duration for resolution of any effusions after starting levothyroxine therapy?
What is the typical duration for resolution of any effusions after starting levothyroxine therapy?
Which condition is rarely associated with hypothyroidism and hair texture changes?
Which condition is rarely associated with hypothyroidism and hair texture changes?
What is the typical duration for resolution of voice alteration following thyroid surgery?
What is the typical duration for resolution of voice alteration following thyroid surgery?
Study Notes
Thyroid Disorders
- Fluctuation in TRAb concentration in serum may be due to changes in immune system or thyroid hormone levels.
Graves' Disease
- Strongly associated with genetic component: HLA-B8 gene
- Triggers for development of thyrotoxicosis in susceptible individuals: stress, infection, or withdrawal of thyroid hormone medication
- Iodine supplementation can precipitate thyrotoxicosis in regions of iodine deficiency due to sudden increase in thyroid hormone synthesis
- Associated with development of ophthalmopathy: TRAb, thyroid-stimulating antibody (TSAb), and thyroid-blocking antibody (TBAb)
Thyroid Failure
- Caused by thyroid-blocking antibodies (TBAb)
- TBAb can lead to hypothyroidism in some patients
Thyrotoxicosis Management
- Beta-blockers play a role in managing symptoms
- Approximate relapse rate for patients after taking antithyroid drugs: 50%
- Percentage of patients who may experience hypothyroidism after thyroidectomy: 20-30%
Thyroid Surgery
- Most common cause of voice alteration following thyroid surgery: recurrent laryngeal nerve damage
- Treatment most likely to result in exacerbation of Graves' ophthalmopathy: thyroidectomy
Thyroid Hormone Synthesis
- High concentrations of iodine inhibit thyroid hormone synthesis and release (Wolff-Chaikoff effect)
- After 10 days of high iodine concentration, there is an "escape phenomenon" where normal organification of iodine and thyroid peroxidase action returns
Iodine Treatment
- Rationale for iodine treatment in thyroid crisis and prior to thyroid surgery for thyrotoxicosis: to decrease thyroid hormone synthesis and release
- Operation for Graves' disease patients who have been given iodine preparation must happen within 10–14 days
Iodine Deficiency
- Effects of iodine deficiency and underlying thyroid disease on thyroid function: altered thyroid hormone production and increased risk of thyroid disorders
- Iodine supplementation programs in iodine-deficient areas may precipitate thyrotoxicosis in susceptible individuals
Thyroid Nodules
- Management approach for radiologically and/or cytologically indeterminate nodules: FNAC and ultrasound-guided biopsy
- Levothyroxine therapy may shrink nodules in regions with borderline low iodine intake
- Recommended treatment for nodules with confirmed malignancy: surgery
Autoimmune Thyroid Disease
- Most prevalent antibody-mediated autoimmune disease
- Associated with other conditions: type 1 diabetes, vitiligo, and rheumatoid arthritis
- Treatment that may result in exacerbation of Graves' ophthalmopathy: radioiodine therapy
Other Endocrine Disorders
- Klinefelter syndrome is associated with autoimmune thyroid disease and primary hypogonadism
- Main presenting problem in patients with gynaecomastia: breast tenderness and swelling
- Most common cause of delayed puberty: constitutional growth delay
- Condition associated with spontaneous hypoglycaemia: insulinoma
- Main functional anatomy involved in acromegaly: pituitary gland
- Primary functional anatomy affected by primary hyperparathyroidism: parathyroid glands
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Description
Test your knowledge about Graves' disease, thyrotoxicosis, and the genetic components of thyroid failure. Explore the natural history of Graves’ thyrotoxicosis and the presence of blocking antibodies against the TSH receptor.
