tremulousness

Discussion in 'MRCS Forum' started by Lona., Feb 4, 2008.

  1. Lona.

    Lona. Guest

    Q. A 45-year-old woman complains to her primary care physician of nervousness, sweating, tremulousness, and weight loss. The thyroid scan shown below exhibits a pattern that is most consistent with which of the following disorders?
    a- Hyper secreting adenoma
    b- Graves’ disease
    c- Lateral aberrant thyroid
    d- Papillary carcinoma of thyroid
    e- Medullary carcinoma of thyroid
  2. Lona.

    Lona. Guest

    Answer: a. (Greenfield, 2/e, pp 1672, 1680) the thyroid scan shows a single focus of increased isotope uptake, often referred to as a hot nodule; the remainder of the thyroid gland has not taken up radioactive iodine. Hyper-functioning adenomas become independent of thyroid-stimulating hormone (TSH) control and secrete thyroid hormone autonomously, which results in clinical hyperthyroidism. The elevated thyroid hormone levels ultimately diminish TSH levels severely and thus depress function of the remaining normal thyroid gland. An isolated focus of increased uptake on a thyroid scan is virtually diagnostic of a hyper-functioning adenoma. Carcinomas usually display diminished uptake and recalled cold nodules. Graves’ disease would probably manifest as a diffusely hyperactive gland without nodularity. Multinodular goiter would display many nodules with varying activity.

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