Thyroid Gland Diseases Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Thyroid Gland Diseases. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Thyroid Gland Diseases Indian Medical PG Question 1: Metastases from follicular carcinoma should be treated by:
- A. Radioiodine (Correct Answer)
- B. Surgery
- C. Thyroxine
- D. Observation
Thyroid Gland Diseases Explanation: ***Radioiodine***
- **Differentiated thyroid cancers**, including **follicular carcinoma**, retain the ability to uptake iodine, making **radioiodine (I-131) therapy** highly effective for treating metastases [1].
- This therapy targets and destroys thyroid cancer cells wherever they are located in the body, including distant metastatic sites.
*Surgery*
- While surgery (e.g., **thyroidectomy**) is the primary treatment for localized thyroid cancer and can be used to resect some metastases, it is **not always feasible** for all metastatic sites, especially widely disseminated disease.
- Surgery for widespread metastases carries significant risks and may not be curative if all tumor burden cannot be removed.
*Thyroxine*
- **Thyroxine (T4)** replacement therapy is crucial after thyroidectomy to replace missing hormones and to **suppress TSH** production, which can stimulate residual cancer growth [1].
- However, thyroxine itself does **not directly destroy** existing metastases; it's a supportive and suppressive therapy, not a primary treatment for metastases.
*Observation*
- **Observation** is generally not appropriate for treating metastases from **follicular carcinoma**, as these metastases have the potential to grow and lead to significant morbidity and mortality if left untreated.
- Active treatment is usually indicated to improve prognosis and quality of life.
Thyroid Gland Diseases Indian Medical PG Question 2: Radiation exposure can lead to which type of thyroid carcinoma?
- A. Lymphoma
- B. Papillary carcinoma (Correct Answer)
- C. Medullary carcinoma
- D. Follicular carcinoma
Thyroid Gland Diseases Explanation: ***Papillary carcinoma***
- Papillary thyroid carcinoma is strongly associated with **radiation exposure**, particularly during childhood [1].
- It is the most prevalent type of thyroid cancer and typically has a **good prognosis** [1].
*Lymphoma*
- Thyroid lymphoma is rare and generally not linked to **radiation exposure**; it often presents as a **rapidly enlarging goiter**.
- It is more commonly associated with **autoimmune thyroiditis**, not primary radiation effects.
*Follicular carcinoma*
- Follicular carcinoma shows a correlation with **iodine deficiency** rather than radiation exposure [1].
- Its presentation is more subtle, compared to the classical association of **radiation with papillary carcinoma**.
*Medullary carcinoma*
- Medullary thyroid carcinoma is primarily linked to **familial syndromes** like MEN 2 and not radiation exposure.
- It arises from **parafollicular C cells**, making it clinically distinct from radiation-related types.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099.
Thyroid Gland Diseases Indian Medical PG Question 3: A female presents with a 1 × 1 cm thyroid swelling. What is the next best step in management?
- A. I-131
- B. TSH (Correct Answer)
- C. TSH & T4
- D. T3 & T4
- E. FNAC
Thyroid Gland Diseases Explanation: ***Correct Option: TSH***
- **Thyroid-stimulating hormone (TSH)** is the most sensitive initial test to assess thyroid function when a thyroid nodule is discovered.
- An abnormal TSH level (either high or low) can guide further investigation into whether the nodule is associated with a functional thyroid disorder.
- **TSH should be the first test** according to American Thyroid Association guidelines for thyroid nodule evaluation.
*Incorrect Option: I-131*
- **I-131 (radioactive iodine therapy)** is a treatment modality for hyperthyroidism or thyroid cancer, not a diagnostic step for initial thyroid swelling evaluation.
- Administering I-131 before assessing thyroid function would be inappropriate and could lead to unnecessary or harmful intervention.
*Incorrect Option: TSH & T4*
- While TSH is crucial, adding **T4 (thyroxine)** as an initial step is often not necessary if TSH is normal, as TSH alone effectively screens for primary thyroid dysfunction.
- Measuring both TSH and T4 is typically reserved for situations where TSH is abnormal or when central hypothyroidism is suspected.
*Incorrect Option: T3 & T4*
- Measuring **T3 (triiodothyronine)** along with T4 as an initial screening for a thyroid nodule is generally not recommended.
- T3 levels are primarily used to diagnose **hyperthyroidism** or to evaluate the severity of thyrotoxicosis after an abnormal TSH and T4 have been identified.
*Incorrect Option: FNAC*
- While **Fine Needle Aspiration Cytology (FNAC)** is an essential diagnostic tool for thyroid nodules, it is typically performed after TSH assessment.
- FNAC is indicated for nodules >1 cm with suspicious ultrasound features, but **functional assessment with TSH comes first** to rule out hyperfunctioning nodules.
Thyroid Gland Diseases Indian Medical PG Question 4: A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
- A. 48%
- B. 12%
- C. 24%
- D. 3% (Correct Answer)
Thyroid Gland Diseases Explanation: ***3%***
- **Purely cystic thyroid nodules** (as described in this case with "isolated cystic swelling") have a **very low risk of malignancy**, typically **2-3%** or less.
- According to **ATA guidelines** and **TIRADS classification**, purely cystic nodules are considered **low suspicion** lesions.
- The cystic nature suggests a **benign process** such as a degenerated adenoma, colloid cyst, or simple cyst.
- **Fine needle aspiration (FNA)** may still be considered if the nodule is >2 cm or has any suspicious solid components, but is often not required for purely cystic lesions.
*48%*
- This percentage is **significantly higher** than the actual malignancy risk for a purely cystic thyroid swelling.
- Such a **high risk** would typically be associated with **solid nodules** exhibiting highly suspicious ultrasound features such as:
- Microcalcifications
- Irregular or spiculated margins
- Taller-than-wide shape
- Marked hypoechogenicity
- Extrathyroidal extension
*24%*
- This percentage represents a **moderate to high risk** of malignancy, which is **not characteristic** of an isolated purely cystic thyroid swelling.
- A risk in this range might be seen with:
- **Mixed solid-cystic nodules** with predominantly solid components
- Solid nodules with **intermediate suspicious features** on ultrasound
*12%*
- While lower than 24% or 48%, 12% is still **considerably higher** than the generally accepted malignancy risk for purely cystic thyroid nodules.
- This risk level could be plausible for:
- **Predominantly cystic nodules** with some eccentric solid components
- Solid nodules with **mildly suspicious** features on ultrasound
Thyroid Gland Diseases Indian Medical PG Question 5: A 40F presents with double vision, headaches, and a progressively enlarging thyroid mass. She has proptosis and limited eye movement. TSH is suppressed. Likely cause of her symptoms?
- A. Pituitary adenoma
- B. Orbital cellulitis
- C. Graves' orbitopathy (Correct Answer)
- D. Thyroid carcinoma
Thyroid Gland Diseases Explanation: Graves' orbitopathy
- The combination of **proptosis**, **limited eye movement (ophthalmoplegia)** causing double vision, and a suppressed TSH (indicating hyperthyroidism) is highly characteristic of **Graves' disease** with orbital involvement [1].
- An **enlarging thyroid mass** further supports Graves' disease, as it often presents with goiter and hyperthyroidism, leading to the autoimmune sequelae in the orbit [1].
*Pituitary adenoma*
- While it can cause **headaches** and **double vision** due to oculomotor nerve compression, a pituitary adenoma would not typically cause a progressively **enlarging thyroid mass** or **proptosis** with suppressed TSH.
- Hypersecreting pituitary adenomas (e.g., ACTH, GH) affect other endocrine axes, and non-secreting ones primarily cause mass effect.
*Orbital cellulitis*
- This is an **acute infection** of the orbital tissues, usually presenting with **pain, fever, rapidly progressing proptosis**, and erythema, which is not suggested by the chronic and progressive nature of this patient's symptoms.
- It would not be associated with a suppressed TSH or an enlarged thyroid gland.
*Thyroid carcinoma*
- A thyroid carcinoma can present as an **enlarging thyroid mass** and may cause local symptoms like dysphagia or hoarseness if advanced, but it does not directly cause **proptosis**, **double vision**, or suppressed TSH.
- Although some rare thyroid cancers can metastasize to the orbit, primary presentation with bilateral proptosis and ophthalmoplegia is not typical.
Thyroid Gland Diseases Indian Medical PG Question 6: A 30-year-old woman presents with thyroid swelling. On investigations, her TSH levels are found to be elevated. Postoperative reports showed lymphocytic infiltration and Hurthle cells. A most probable diagnosis is?
- A. Hashimoto's thyroiditis (Correct Answer)
- B. Graves' disease
- C. Follicular thyroid carcinoma
- D. Medullary thyroid carcinoma
Thyroid Gland Diseases Explanation: ***Hashimoto's thyroiditis***
- The presence of **lymphocytic infiltration** and **Hurthle cells** on postoperative pathology is characteristic of Hashimoto's thyroiditis [1,2].
- Elevated **TSH levels** indicate hypothyroidism, which aligns with the autoimmune nature of Hashimoto's affecting thyroid hormone production [1].
*Graves disease*
- Typically presents with **hyperthyroidism**, leading to suppressed TSH levels rather than elevation.
- Characterized by **thyroid enlargement** and the presence of **autoantibodies** like TSI, not lymphocytic infiltration.
*Follicular carcinoma*
- While it can cause **thyroid swelling**, it is usually associated with **malignant characteristics** rather than Hurthle cells and lymphocytic infiltration.
- TSH levels can be normal, as it does not principally engage in autoimmune thyroid destruction like Hashimoto's.
*Medullary carcinoma thyroid*
- Originates from **C cells** producing calcitonin, and typically presents with elevated calcitonin levels, not TSH.
- Characteristic findings include **C-cell hyperplasia** or **neoplastic changes**, which do not match the presented lymphocytic infiltration.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1090-1092.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 427-428.
Thyroid Gland Diseases Indian Medical PG Question 7: A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?
- A. Elevated TSH with normal thyroid hormone levels
- B. Elevated TSH with low thyroid hormone levels
- C. Normal TSH with abnormal thyroid hormone levels
- D. Suppressed TSH with elevated thyroid hormone levels (Correct Answer)
Thyroid Gland Diseases Explanation: Suppressed TSH with elevated thyroid hormone levels
- The patient's symptoms of **fatigue** (despite being warm) and **difficulty gaining weight**, coupled with her body feeling **warm**, are classic signs of **hyperthyroidism**. [1]
- In hyperthyroidism, the thyroid gland produces **excessive thyroid hormones (T3 and T4)**, which in turn **suppresses TSH** production from the pituitary gland through negative feedback. [2]
*Elevated TSH with normal thyroid hormone levels*
- This pattern is characteristic of **subclinical hypothyroidism**, where the thyroid gland is beginning to fail, leading to increased TSH to maintain normal thyroid hormone levels. [3]
- The patient's symptoms of feeling warm and difficulty gaining weight are inconsistent with hypothyroidism. [1]
*Elevated TSH with low thyroid hormone levels*
- This indicates **primary hypothyroidism**, where the thyroid gland is underactive and produces insufficient thyroid hormones, leading to a compensatory rise in TSH. [2]
- Hypothyroidism typically presents with **weight gain**, **cold intolerance**, and fatigue, which contradict the patient's presentation. [1]
*Normal TSH with abnormal thyroid hormone levels*
- This scenario usually suggests **central hypothyroidism** (pituitary or hypothalamic dysfunction affecting TSH production) or **thyroid hormone resistance**. [3]
- While possible in some rare cases, it does not fit the typical clinical picture of hyperthyroidism presented by the patient's symptoms.
Thyroid Gland Diseases Indian Medical PG Question 8: A 30-year-old came with complaints of thyroid swelling. On investigations her TSH levels were found to be elevated. Post-operative histopathological examination reports show lymphocytic infiltration and Hürthle cells. Which of the following is the most likely diagnosis?
- A. Hashimoto thyroiditis (Correct Answer)
- B. Graves disease
- C. Medullary carcinoma thyroid
- D. Follicular carcinoma
Thyroid Gland Diseases Explanation: ***Hashimoto thyroiditis***
- The classic triad of **elevated TSH** (hypothyroidism), **lymphocytic infiltration**, and **Hürthle cells** (oncocytic metaplasia) on histopathology is pathognomonic for Hashimoto thyroiditis [1].
- This autoimmune thyroiditis is characterized by immune-mediated destruction of the thyroid gland, leading to reduced thyroid hormone production and compensatory TSH elevation [1].
- It is the most common cause of hypothyroidism in iodine-sufficient areas.
*Graves disease*
- Graves disease is an autoimmune condition causing **hyperthyroidism**, characterized by **low TSH** and elevated thyroid hormones (T3/T4), which contradicts the elevated TSH in this case [2].
- Histologically, it typically shows **diffuse hyperplasia** with papillary infoldings and colloidal reabsorption, without significant lymphocytic infiltration or Hürthle cells [2].
*Medullary carcinoma thyroid*
- Medullary carcinoma is a neuroendocrine tumor arising from **parafollicular C cells**, producing **calcitonin**, and is not associated with elevated TSH or Hürthle cells [3].
- Histopathology reveals **amyloid deposits** (Congo red positive) and sheets of neoplastic C cells, distinctly different from the lymphocytic infiltration described.
*Follicular carcinoma*
- Follicular carcinoma is a well-differentiated thyroid cancer where TSH levels are usually normal; elevation may occur with significant tissue destruction but is not a diagnostic feature.
- Histopathologically, diagnosis requires demonstration of **capsular or vascular invasion** by follicular cells, and does not feature extensive lymphocytic infiltration or Hürthle cells as primary findings.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1089-1091.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1092-1093.
[3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 424-426.
Thyroid Gland Diseases Indian Medical PG Question 9: The following is a histopathological image of thyroid pathology. What is the diagnosis?
- A. Papillary carcinoma of thyroid
- B. Medullary carcinoma of thyroid (Correct Answer)
- C. Follicular carcinoma of thyroid
- D. Anaplastic carcinoma of thyroid
Thyroid Gland Diseases Explanation: ***Medullary carcinoma of thyroid***
- This image shows sheets and nests of **polygonal to spindle-shaped cells**, which are characteristic of medullary thyroid carcinoma, especially when mixed with an **amyloid stroma** (seen as amorphous eosinophilic material) [2].
- The presence of **neuroendocrine features** and the production of **calcitonin** are hallmarks of these C-cell tumors [1], [2].
*Papillary carcinoma of thyroid*
- Characterized by **papillary architecture**, **ground-glass (Orphan Annie eye) nuclei**, nuclear grooves, and intranuclear cytoplasmic inclusions.
- These features are not prominently seen in the provided image.
*Follicular carcinoma of thyroid*
- Defined by an invasive growth pattern of **well-differentiated follicular cells** forming follicles, with either capsular or vascular invasion [2].
- The image does not show classic follicular architectural patterns or clear evidence of invasion in the absence of a capsule.
*Anaplastic carcinoma of thyroid*
- This is a highly aggressive and undifferentiated tumor with **marked pleomorphism**, bizarre giant cells, and high mitotic activity [2].
- While there is some pleomorphism, the overall pattern and cellular morphology in the image are more consistent with medullary carcinoma than the extreme anaplasia.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1102-1103.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-431.
Thyroid Gland Diseases Indian Medical PG Question 10: A 25-Year-old male presented with a 2cm thyroid nodule. A thyroidectomy was done. The histology picture is given below. What could be the diagnosis?
- A. Papillary thyroid carcinoma (Correct Answer)
- B. Follicular thyroid adenoma
- C. Graves' disease
- D. Adenomatous goiter
Thyroid Gland Diseases Explanation: ***Papillary carcinoma thyroid***
- Characterized by **papillary structures** and **nuclear features** such as nuclear grooves and overlapping nuclei on histology [1].
- Often presents in young adults and can show **psammoma bodies**, which are indicative of malignancy.
*Follicular adenoma*
- Generally shows well-circumscribed **follicular structures** without nuclear atypia [2,3].
- Lacks the typical **papillary architecture** and associated aggressive features found in carcinoma.
*Graves disease*
- Primarily presents with **hyperthyroidism** and diffuse goiter rather than a solitary nodule.
- Histologically, it is characterized by **hyperplastic follicles** and does not display features of malignancy.
*Adenomatous goitre*
- Refers to **nodular enlargement** of the thyroid with benign hyperplastic nodules.
- Lacks the **malignant features** present in papillary carcinoma, such as nuclear atypia and invasion.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1096-1097.
[3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429.
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