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Q) What is not an indication of surgery over Radio active Iodine (RAI) therapy in Grave's disease?
Ans c
Indications of Surgery over RAI:
a) confirmed cancer or suspicious thyroid nodules
b) young
c) desire to conceive soon (<6 months) after treatment
d) have had severe reactions to antithyroid medications
e) have large goiters (>80 g) causing compressive symptoms
f) are reluctant to undergo RAI therapy.
Schwartz page 1637
Indications of Surgery over RAI:
a) confirmed cancer or suspicious thyroid nodules
b) young
c) desire to conceive soon (<6 months) after treatment
d) have had severe reactions to antithyroid medications
e) have large goiters (>80 g) causing compressive symptoms
f) are reluctant to undergo RAI therapy.
Schwartz page 1637
Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks. She presented in emergency with high grade fever and hypotension. What is not a part of further management?
Ans c
This is Thyroid storm.
Predisposing factors:
- Cessation of antithyroid medications
- Infection
- Thyroid or non-thyroid surgery in untreated thyrotoxicosis
- Trauma in untreated thyrotoxicosis
- Amiodarone
- Iodinated contrast agents
- RAI therapy
Management:
- Beta blockers
- Oxygen and hemodynamic support
- IV Lugol iodine
- PTU
- Corticosteroids
Schwartz page 1638
This is Thyroid storm.
Predisposing factors:
- Cessation of antithyroid medications
- Infection
- Thyroid or non-thyroid surgery in untreated thyrotoxicosis
- Trauma in untreated thyrotoxicosis
- Amiodarone
- Iodinated contrast agents
- RAI therapy
Management:
- Beta blockers
- Oxygen and hemodynamic support
- IV Lugol iodine
- PTU
- Corticosteroids
Schwartz page 1638
Q1. Which of the following is not true for Hashimoto thyroiditis?
1. c
Hashimoto's thyroiditis is an autoimmune process initiated by CD4+T lymphocytes with specificity for thyroid antigens.
Hypothyroidism is due to cytotoxic cells and autoantibodies.
Primary treatment is Thyroxine; surgery only for cosmetic reasons.
More common in women (1:10–20) between ages 30–50.
May present with enlarged firm gland, hypothyroidism (20%), or hashitoxicosis (5%).
Increases risk of thyroid lymphoma.
Hashimoto's thyroiditis is an autoimmune process initiated by CD4+T lymphocytes with specificity for thyroid antigens.
Hypothyroidism is due to cytotoxic cells and autoantibodies.
Primary treatment is Thyroxine; surgery only for cosmetic reasons.
More common in women (1:10–20) between ages 30–50.
May present with enlarged firm gland, hypothyroidism (20%), or hashitoxicosis (5%).
Increases risk of thyroid lymphoma.
Q2. In which of the following conditions anti thyroid antibody may not be elevated?
2. d
Antibodies include anti-Tg, anti-TPO, and TSI.
~80% of Hashimoto's patients have elevated antibodies; also seen in Graves', multinodular goiter, and some neoplasms.
In Graves', antibodies target thyroid hormone receptors (TRAbs).
Iodine Metabolism:
Daily need ~0.1 mg.
Absorbed as iodide, transported into follicles, oxidized, and coupled to form T3/T4.
Most T3 from peripheral T4 deiodination.
Thyroid autoregulates — low iodine → more T3; excess iodine → inhibition of synthesis/secretion.
Antibodies include anti-Tg, anti-TPO, and TSI.
~80% of Hashimoto's patients have elevated antibodies; also seen in Graves', multinodular goiter, and some neoplasms.
In Graves', antibodies target thyroid hormone receptors (TRAbs).
Iodine Metabolism:
Daily need ~0.1 mg.
Absorbed as iodide, transported into follicles, oxidized, and coupled to form T3/T4.
Most T3 from peripheral T4 deiodination.
Thyroid autoregulates — low iodine → more T3; excess iodine → inhibition of synthesis/secretion.
Q3. Regarding thyroid and parathyroid neoplasms
3. b
Q4. A complication of thyroidectomy which can be prevented by prophylaxis is
4. c
Thyroid storm, a manifestation of severe thyrotoxicosis, is avoided by prophylactic treatment with propylthiouracil or methimazole prior to surgery.
Thyroid storm, a manifestation of severe thyrotoxicosis, is avoided by prophylactic treatment with propylthiouracil or methimazole prior to surgery.
Q5) What is the next step in investigating a 26 year old male with solitary thyroid nodule 1 cm in size?
5. b
Initial investigation is thyroid function tests to assess for hypo/hyperthyroidism.
Low TSH → hyperthyroidism, evaluate with isotope scan (lower malignancy risk).
High TSH → hypothyroidism, most likely Hashimoto's thyroiditis.
Initial investigation is thyroid function tests to assess for hypo/hyperthyroidism.
Low TSH → hyperthyroidism, evaluate with isotope scan (lower malignancy risk).
High TSH → hypothyroidism, most likely Hashimoto's thyroiditis.