Internal Medicine revision questions with answers on thyroid disorders.

INTERNAL MEDICINE: THYROID DISORDER QUESTIONS

BY SULEIMAN NDORO JNR (DR AUDI)

1. Regarding hyperthyroidism; which statement is false?

A. Multinodular toxic goitre is the most common cause

B. Serum TSH is the initial test of choice

C. Radioactive T₃ uptake gives information regarding status of Thyroid Binding Globulin (TBG)

D. Consider pregnancy when there is high TBG
ANSWER
A: Multinodular toxic goitre (Plummer’s Disease0 contributes to 15% of all cases. Grave’s disease (diffuse toxic goitre) is the most common cause contributing to 80% of all cases. 

2. Which statement is incorrect concerning multinodular toxic goitre?

A. It is more common in pregnant mothers
B. It is characterised by hyperfunctioning areas that produce high T4 and T3 levels
C. Thyroid atrophy occurs due to decreased TSH
D. Patchy uptake appears on the thyroid scan
ANSWER
A: Multinodular toxic goitre is more common in elderly patients and not in pregnant mothers

3. Which of the following is not specific to Graves’ disease?

A. Exophthalmos
B. Pretibial myexedema
C. Thyroid bruit
D. Lid lag
ANSWER
D: There are 3 signs of hyperthyroidism specific to Graves’ disease. These include: Exophthalmos, Pretibial myexedema and thyroid bruit.

4. Regarding Graves’ disease; which statement is false?

A. Radioiodine 131 is the most common therapy in the USA for Graves’ hyperthyroidism
B. Proptosis is always present
C. It is commonly associated with other autoimmune disorders
D. Pretibial myexedema is due to dermal accumulation of mucopolysaccharides
ANSWER
B: Proptosis-edema of the extraocular muscles and retro-orbital tissue is a hallmark of Graves’ disease but is not always present.

 5. About treatment of hyperthyroidism; which statement is false?

A. Propylthiouracil (PTU) is preferred for pregnant patients with Graves’ disease
B. Sodium ipodate is used for acute management of some palpitations, tremors, anxiety etc
C. Agranulocytosis is a serious side effect of thionamides
D. PTU inhibits conversion of T4 to T3
ANSWER
B: Sodium ipodate or iopanoic acid lowers serum T3 and T4 levels and causes rapid improvement of hyperthyroidism and is appropriate for acute management of severe hyperthyroidism that is not responding to conventional therapy.
Beta blockers are the drugs that are used for acute management of some symptoms such as palpitations, tremors, anxiety, tachycardia, and sweating and muscle weakness.