Podcast
Questions and Answers
What is the typical range of a normal thyroid gland size?
What is the typical range of a normal thyroid gland size?
Which of these is the most appropriate initial laboratory test for evaluating possible hyperthyroidism?
Which of these is the most appropriate initial laboratory test for evaluating possible hyperthyroidism?
A bruit heard over the thyroid gland suggests which of the following?
A bruit heard over the thyroid gland suggests which of the following?
What condition is indicated when there is venous distension in the neck and difficulty breathing, especially when the arms are raised?
What condition is indicated when there is venous distension in the neck and difficulty breathing, especially when the arms are raised?
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Which of the following best describes 'primary' pathology in the context of the hypothalamic-pituitary-thyroid axis?
Which of the following best describes 'primary' pathology in the context of the hypothalamic-pituitary-thyroid axis?
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Which of these is likely to be associated with a high FT4 and low TSH?
Which of these is likely to be associated with a high FT4 and low TSH?
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What is typically the size increase in a thyroid gland of a patient with Graves' disease?
What is typically the size increase in a thyroid gland of a patient with Graves' disease?
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Which of these clinical features is least likely to be associated with hyperthyroidism and Graves' disease?
Which of these clinical features is least likely to be associated with hyperthyroidism and Graves' disease?
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What is the correct range for normal TSH levels in mU/mL?
What is the correct range for normal TSH levels in mU/mL?
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Which of these is a common initial symptom of thyrotoxicosis?
Which of these is a common initial symptom of thyrotoxicosis?
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A 37-year-old obese woman with a family history of diabetes presents with recent urinary tract infections and frequent thirst. Based on the provided information, which of the following is the most appropriate initial step in assessing for potential diabetes?
A 37-year-old obese woman with a family history of diabetes presents with recent urinary tract infections and frequent thirst. Based on the provided information, which of the following is the most appropriate initial step in assessing for potential diabetes?
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Which of the following best describes the primary pathophysiological mechanisms contributing to Type 2 Diabetes Mellitus in the provided context?
Which of the following best describes the primary pathophysiological mechanisms contributing to Type 2 Diabetes Mellitus in the provided context?
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According to the ADA 2023 guidelines, at what interval should a healthy 40-year-old individual with no additional risk factors for diabetes undergo routine screening?
According to the ADA 2023 guidelines, at what interval should a healthy 40-year-old individual with no additional risk factors for diabetes undergo routine screening?
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Which of the following is NOT considered a risk factor for Type 2 Diabetes Mellitus, according to the given information?
Which of the following is NOT considered a risk factor for Type 2 Diabetes Mellitus, according to the given information?
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A patient with confirmed diabetes is noted to have a normal HbA1c level at their routine visit. From the following test results, which is the most likely reason for this unexpected result?
A patient with confirmed diabetes is noted to have a normal HbA1c level at their routine visit. From the following test results, which is the most likely reason for this unexpected result?
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Which of the following is a clinical manifestation that is explicitly mentioned as resulting from the hyperglycemia associated with diabetes?
Which of the following is a clinical manifestation that is explicitly mentioned as resulting from the hyperglycemia associated with diabetes?
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If a patient's initial screening for diabetes is inconclusive, what is the next recommended step?
If a patient's initial screening for diabetes is inconclusive, what is the next recommended step?
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Which of the following diagnostic criteria, when present, would most strongly suggest a diagnosis of Type 1 Diabetes over Type 2 Diabetes?
Which of the following diagnostic criteria, when present, would most strongly suggest a diagnosis of Type 1 Diabetes over Type 2 Diabetes?
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Study Notes
Thyroid Disorders
- Classification of BMI (kg/m²): Underweight (<18.5), Normal (18.5-24.9), Overweight (25-29.9), Obese I (30-34.9), Obese II (35-39.9), Obese III (≥40)
- Classification of BMI (kg/m²) in Asians: <18.5, 18.5-22.9, 23-24.9, 25-29.9, ≥30
- Hypertension: BP ≥130 systolic or ≥85 diastolic or use of specific medication
- Fasting Glucose: ≥100 mg/dL or previously diagnosed T2DM
- Physical Exam of Thyroid: Includes examination of the thyroid, signs of abnormal thyroid function and extra-thyroid features like ophthalmopathy and dermopathy. Examine and palpate each lobe, noting size, consistency, nodularity, tenderness, and fixation. Neck muscles should be relaxed.
- Thyroid Gland Size: Normal size is 12-20g
- Thyroid Hormones: Thyroxine (T4), Triiodothyronine (T3)
- Pemberton's Sign: Large retrosternal goiters can cause venous distention when arms are raised and difficulty breathing.
- Normal Values: FT4: 9-22 pmol/L, FT3: 3.5-6.5 pmol/L, TSH: 0.40-4.2 mU/mL
Hypothyroidism
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Drugs used to treat Dyslipidemia: Fibric acid derivatives (fibrates) like Gemfibrozil and Fenofibrate
- Mechanism: Affect LPL, VLDL synthesis and can cause dyspepsia, myalgia, gallstones, and elevated transaminases.
- Hypothyroidism Results: Low TSH, High FT4
- Hypothyroidism Differentials: Primary hypothyroidism (overt) , Mild (subclinical), Drug effects, sick euthyroid syndrome, Central hypothyroidism (pituitary disease)
- Autoimmune hypothyroidism: positive thyroid autoantibodies
- Case Summary (Hypothyroidism): A 25-year-old woman presents with hyperactivity, irritability, heat intolerance, tachyardia (120bpm), bilateral proptosis and diffusely enlarged thyroid gland. Tremors were also noted.
- Thyroid Nodules: Thyroid nodules can be identified on physical examination with characteristic signs including changes in size, consistency, nodularity, tenderness and fixation.
Hyperthyroidism
- Case Summary (Hyperthyroidism): A 25-year-old female presents with hyperactivity, irritability, and heat intolerance. Physical examination reveals tachycardia (120/bpm), proptosis (ocular), and diffuse enlargement of the thyroid gland with tremors.
- Hyperthyroidism Differentials: Primary (Graves', toxic multinodular goiter, toxic adenoma), Secondary (TSH-secreting pituitary adenoma or thyroid hormone resistance syndrome), Gestational thyrotoxicosis (HCG on TSH receptor)
- Causes (Hyperthyroidism): Graves' disease, toxic multinodular goiter, toxic adenoma, activating mutations of TSH receptor, Struma ovarii, Drugs (iodine excess).
- Thyrotoxicosis: A state of thyroid hormone excess. Sometimes not synonymous with hyperthyroidism, which is the result of excess thyroid function.
- Pathophysiology of Hyperthyroidism: Autoimmune condition that leads to excess synthesis and release of thyroid hormones.
- Signs of Thyrotoxicosis: Tachycardia (including atrial fibrillation in the elderly), tremor, goiter, warm moist skin, muscle weakness (proximal myopathy).
- Iodine Excess (Thyrotoxicosis): Jod-Basedow phenomenon, where a previously iodine-deficient thyroid becomes overly stimulated with excessive iodine intake.
- Signs and Symptoms: Dyspnea, irritability, dysphagia, heat intolerance, sweating, palpitations, weight loss, fatigue, and weakness.
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Description
This quiz covers various aspects of thyroid disorders including classification of Body Mass Index (BMI), hypertension, fasting glucose levels, and the physical examination of the thyroid. It also explores normal values of thyroid hormones and relevant signs like Pemberton's sign. Test your knowledge about these crucial aspects of thyroid health.
