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Common Thyroid status examination exam questions for medical finals, OSCEs and MRCP PACES

Click on the the example questions below to reveal the answers


Question 1.

What thyroid examination signs are specific to Graves’ Disease?

  • Exopthalmos
  • Chemosis
  • Opthalmoplegia
  • Thyroid acropachy
  • Pretibial myxoedema

Question 2.

How can the severity of thyroid eye disease be graded?

  • American Thyroid Association NO SPECS system
    • No signs
    • Only signs (upper lid retraction ± lid lag)
    • Soft tissue involvement (chemosis)
    • Proptosis
    • Extraocular muscle involvement (usually with diplopia)
    • Corneal involvement
    • Sight loss (due to optic nerve involvement)

Question 3.

What is the differential diagnosis of thyroid enlargement?

  • Smooth
    • Simple Goitre
    • Graves
    • Hashimoto’s thyroiditis
    • Thyroiditis
      • Acute tenderness, pain and swelling.
      • May be hyperthyroid.
  • Multinodular goitre (MNG)
    • Usually benign, but in MNG with a dominant single nodule, 5% chance of malignancy.
  • Fibrotic goitre (Riedel’s Thyroiditis)
    • Irregular, hard, ‘woody’ thyroid gland
    • Impossible to clinically distinguish from carcinoma
  • Solitary nodule
    • Thyroid adenoma
    • Solitary toxic adenoma can occur (giving T3 toxicosis) but are uncommon
    • Thyroid cysts
    • Single nodule in multinodular goitre
    • Carcinomas

Question 4.

What is the differential diagnosis of a painful thyroid?

  • De Quervains
    • Hyperthyroid, then hypo. Probably post-viral.
  • Infectious thyroiditis
    • Euthyroid
  • Radiation thyroiditis

Question 5.

What are the possible complications of large goitres?

  • Upper airway obstruction
  • Dysphagia
  • Recurrent laryngeal palsy
  • Jugular compression
  • Horner’s syndrome

Question 6.

What’s the differential diagnosis of proptosis?

  • Grave’s disease
  • Cavernous sinus thrombosis
  • Carotico-cavernous fistula
  • Orbital cellulitis
  • Retro-orbital malignancy

Question 7.

What are the initial investigations of a neck lump?

  • Bloods
    • Thyroid function tests
    • Thyroid peroxidase antibodies (TPO Abs)
    • TSH receptor antibodies (TR Abs)
  • Ultrasound (USS)
  • Fine needle aspiration (FNA)

Question 8.

What are the complications of hypothyroidism?

  • Depression
  • Bradycardia and associated symptoms
  • Hyperlipidaemia
  • Carpal tunnel syndrome
  • Heart failure
  • Coma eventually

Question 9.

What are the possible treatments for hyperthyroidism?

  • Symptoms
    • Beta-block
  • Disease control
    • Carbimazole
      • NB. If pregnant, do not give carbimazole in high doses (use propothiuracil). Also do not use block and replace as thyroxine does not cross the placenta
    • Radioactive Iodine
      • Contraindicated in pregnancy and lactation, must avoid close contact with children under 11 for two weeks, and pregnancy for four months
    • Subtotal thyroidectomy
      • Only done once patient has been rendered medically euthyroid


Click here for all the clinical examinations: how to examine, what to look for and how to present your findings