Podcast
Questions and Answers
What is the primary purpose of administering potassium iodide before surgery?
What is the primary purpose of administering potassium iodide before surgery?
What is a critical contraindication for administering radioactive iodine?
What is a critical contraindication for administering radioactive iodine?
What percentage of patients remain permanently hypothyroid after subtotal thyroidectomy?
What percentage of patients remain permanently hypothyroid after subtotal thyroidectomy?
What is the annual conversion rate to overt thyrotoxicosis in patients with subclinical thyrotoxicosis?
What is the annual conversion rate to overt thyrotoxicosis in patients with subclinical thyrotoxicosis?
Signup and view all the answers
What should be avoided in patients until 48 hours after receiving 131I?
What should be avoided in patients until 48 hours after receiving 131I?
Signup and view all the answers
How long should pregnancy be avoided after the administration of radioactive iodine?
How long should pregnancy be avoided after the administration of radioactive iodine?
Signup and view all the answers
What is the success rate of the 131I treatment within 4–12 weeks?
What is the success rate of the 131I treatment within 4–12 weeks?
Signup and view all the answers
Which treatment is usually administered to control symptoms during the lag period after 131I administration?
Which treatment is usually administered to control symptoms during the lag period after 131I administration?
Signup and view all the answers
What is a potential consequence of subtotal thyroidectomy?
What is a potential consequence of subtotal thyroidectomy?
Signup and view all the answers
What is the recommended dosage range for antithyroid drugs like carbimazole?
What is the recommended dosage range for antithyroid drugs like carbimazole?
Signup and view all the answers
Which of the following is a common issue faced by young patients with hypothyroidism?
Which of the following is a common issue faced by young patients with hypothyroidism?
Signup and view all the answers
What percentage of patients experiences transient hypocalcaemia after thyroid surgery?
What percentage of patients experiences transient hypocalcaemia after thyroid surgery?
Signup and view all the answers
What is the recurrence rate of hypothyroidism after surgery in patients over 40 years of age within 15 years?
What is the recurrence rate of hypothyroidism after surgery in patients over 40 years of age within 15 years?
Signup and view all the answers
What exacerbates Graves' ophthalmopathy in patients undergoing treatment?
What exacerbates Graves' ophthalmopathy in patients undergoing treatment?
Signup and view all the answers
Which patient demographic is most likely to experience recurrent thyrotoxicosis after antithyroid drug treatment?
Which patient demographic is most likely to experience recurrent thyrotoxicosis after antithyroid drug treatment?
Signup and view all the answers
What is a common side effect of near-total thyroidectomy that affects voice?
What is a common side effect of near-total thyroidectomy that affects voice?
Signup and view all the answers
What condition is characterized by swelling and thickening of the skin and soft tissues of the hands and feet?
What condition is characterized by swelling and thickening of the skin and soft tissues of the hands and feet?
Signup and view all the answers
What is the primary physiological change that occurs in pretibial myxedema?
What is the primary physiological change that occurs in pretibial myxedema?
Signup and view all the answers
Which antibodies are associated with Graves' disease?
Which antibodies are associated with Graves' disease?
Signup and view all the answers
What is the genetic concordance rate for thyrotoxicosis in monozygotic twins?
What is the genetic concordance rate for thyrotoxicosis in monozygotic twins?
Signup and view all the answers
What complication is most commonly associated with autoimmune thyroid diseases?
What complication is most commonly associated with autoimmune thyroid diseases?
Signup and view all the answers
What is a potential effect of TRAb acting as an antagonist?
What is a potential effect of TRAb acting as an antagonist?
Signup and view all the answers
Which of these conditions is least likely to be caused by hyperactivity of the thyroid gland?
Which of these conditions is least likely to be caused by hyperactivity of the thyroid gland?
Signup and view all the answers
Which of the following is NOT a symptom of thyroid acropachy?
Which of the following is NOT a symptom of thyroid acropachy?
Signup and view all the answers
What is a common cause of subacute (de Quervain’s) thyroiditis?
What is a common cause of subacute (de Quervain’s) thyroiditis?
Signup and view all the answers
What symptom is typically associated with subacute thyroiditis?
What symptom is typically associated with subacute thyroiditis?
Signup and view all the answers
Which demographic is primarily affected by subacute thyroiditis?
Which demographic is primarily affected by subacute thyroiditis?
Signup and view all the answers
What is a typical treatment approach for managing pain associated with subacute thyroiditis?
What is a typical treatment approach for managing pain associated with subacute thyroiditis?
Signup and view all the answers
What laboratory finding is typically elevated in cases of subacute thyroiditis?
What laboratory finding is typically elevated in cases of subacute thyroiditis?
Signup and view all the answers
Which of the following is NOT an acknowledged symptom of subacute (de Quervain’s) thyroiditis?
Which of the following is NOT an acknowledged symptom of subacute (de Quervain’s) thyroiditis?
Signup and view all the answers
How long may T4 and T3 levels remain elevated after the onset of subacute thyroiditis?
How long may T4 and T3 levels remain elevated after the onset of subacute thyroiditis?
Signup and view all the answers
What medication may be prescribed if NSAIDs are insufficient for pain management in subacute thyroiditis?
What medication may be prescribed if NSAIDs are insufficient for pain management in subacute thyroiditis?
Signup and view all the answers
What percentage of cases typically experiences complete suppression of TSH?
What percentage of cases typically experiences complete suppression of TSH?
Signup and view all the answers
What is the typical presentation for a patient with multinodular goitre?
What is the typical presentation for a patient with multinodular goitre?
Signup and view all the answers
What symptom can occur due to recurrent laryngeal nerve palsy in large goitres?
What symptom can occur due to recurrent laryngeal nerve palsy in large goitres?
Signup and view all the answers
How can the diagnosis of multinodular goitre be confirmed?
How can the diagnosis of multinodular goitre be confirmed?
Signup and view all the answers
What age range is typically associated with simple diffuse goitre presentation?
What age range is typically associated with simple diffuse goitre presentation?
Signup and view all the answers
What is the usual treatment approach for patients with toxic multinodular goitre?
What is the usual treatment approach for patients with toxic multinodular goitre?
Signup and view all the answers
What is a common characteristic of simple diffuse goitre upon examination?
What is a common characteristic of simple diffuse goitre upon examination?
Signup and view all the answers
What condition can lead to mediastinal compression in patients with very large goitres?
What condition can lead to mediastinal compression in patients with very large goitres?
Signup and view all the answers
Study Notes
Subtotal Thyroidectomy
- First line treatment for large goitres in some countries
- Usually near total thyroidectomy
- Results in hypothyroidism, patients will require lifelong levothyroxine
- Potential complications include:
- Hypothyroidism (~25%)
- Transient hypocalcaemia (10%)
- Permanent hypoparathyroidism (1%)
- Recurrent laryngeal nerve palsy (1%)
Radioactive Iodine Ablation (RAI)
- Alternative treatment for large goitres
- Administered orally and trapped in the thyroid
- Effective in 75% of patients within 4-12 weeks
- Potential complications:
- Hypothyroidism - most likely outcome
- Exacerbation of Graves' ophthalmopathy
Antithyroid Drug Therapy
- High doses of Carbimazole or Propylthiouracil are used
- Used as a bridge for patients receiving RAI
- Can result in recurrence of thyrotoxicosis, especially in young patients
Graves' Disease
- Autoimmune thyroid disease
- Characterised by:
- Thyrotoxicosis
- Goitre
- Ophthalmopathy
- Dermopathy
- Thyroid-stimulating immunoglobulins (TSI) or TSH receptor antibodies (TRAb) are found in 80-95% of patients
- Strong genetic component with 50% concordance in monozygotic twins and only 5% in dizygotic twins
Thyroid Acropachy
- Rare complication of Graves' disease
- Characterized by swelling and thickening of the hands and feet
- Results from fibroblast activation in the areas which leads to increased connective tissue production
Subclinical Thyrotoxicosis
- Serum TSH is undetectable
- Serum T3 and T4 are elevated
- Patients have increased risk of atrial fibrillation and osteoporosis
- Requires treatment, usually with RAI
- 5% chance of developing overt thyrotoxicosis (elevated T4 and/or T3) annually
Transient Thyroiditis
- Inflammation of the thyroid gland, usually after viral infection
- Two forms:
- Subacute (de Quervain’s) thyroiditis
- Postpartum thyroiditis
Subacute (de Quervain’s) thyroiditis
- Characterised by:
- Pain in the thyroid region that is worsened by swallowing, coughing, and neck movement
- Palpable and tender thyroid gland
- Systemic upset is common
- Usually affects women aged 20-40
- Responds to anti-inflammatory medication (NSAIDs)
- Release of stored thyroid hormones is followed by damaged thyroid cells and impaired hormone synthesis
- Ultimately, TSH suppression occurs in 25% of cases, with T4 and T3 levels in the reference range or elevated
Multinodular Goiter (MNG)
- Usually diagnosed in patients presenting with thyrotoxicosis, a large goitre with or without tracheal compression, or sudden painful swelling caused by haemorrhage into a nodule or cyst
- Goitre is nodular or lobulated and palpable
- Can cause mediastinal compression leading to stridor, dysphagia and superior vena cava obstruction
- Hoarseness can occur due to recurrent laryngeal nerve palsy
- Diagnosis is confirmed with ultrasonography and/or thyroid scintigraphy
- Treatment usually with RAI or antithyroid drugs (higher relapse rate with drugs)
- Thyroid surgery may be indicated in thyrotoxic patients with a large goitre
Simple Diffuse Goitre
- Presents between 15-25 years, often during pregnancy
- Characterised by:
- Soft and symmetrical goitre
- Thyroid enlargement to 2-3 times normal size
- No tenderness or lymphadenopathy
- Normal T3, T4, and TSH levels
- No thyroid autoantibodies
- No treatment is necessary and the goitre usually regresses
- May become multinodular with areas of autonomous function due to recurrent episodes of hyperplasia and involution
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz explores various treatment options for large goitres, including subtotal thyroidectomy, radioactive iodine ablation, and antithyroid drug therapy. It also covers the implications of these treatments, such as complications and the management of Graves' disease. Test your knowledge on these essential endocrine topics.
