MCQs on Thyroid – AMC Wise

Written by Dr. James Whitfield (MBBS, FRACGP) – General Practitioner

Question 1

Which one of the following is least likely to be found on clinical examination of patient with thyrotoxicosis?

A) Insomnia.
B) Fine tremors.
C) Painful hip.
D) Atrophy of interosseous muscles.
E) Wide pulse pressure.

Correct Answer: C) Painful hip.

Explanation:
Thyrotoxicosis is a clinical syndrome resulting from excess circulating thyroid hormones, which stimulate metabolic activity and the sympathetic nervous system, leading to a range of systemic effects.

Common features include insomnia (A), fine tremor (B), widened pulse pressure (E), and even atrophy of interosseous muscles (D) due to thyrotoxic myopathy. Muscle wasting, particularly of proximal muscles, is frequently seen in severe or long-standing cases.

However, painful joints like a painful hip (C) are not a recognized feature of thyrotoxicosis. Instead, arthralgia or joint pain—especially of the hips and large joints—is more often associated with hypothyroidism, not hyperthyroidism. In hypothyroidism, fluid accumulation in joints and surrounding tissues contributes to the discomfort.

Therefore, painful hip is the least likely clinical finding in a patient with thyrotoxicosis.

Question 2

A 54-year-old woman presents with a swelling in the neck which has progressively enlarged for the past few months. Investigations reveal the mass to be goiter. Which one of the following symptoms, if present, should make you think of urgent surgery?

A) Retrosternal extension.
B) Hoarseness.
C) Dysphagia.
D) Dyspepsia.
E) Puffiness of her face on raising her arms above the shoulder.

Correct Answer: E) Puffiness of her face on raising her arms above the shoulder.

Explanation:
A goiter refers to an enlarged thyroid gland, and while it often grows slowly and remains asymptomatic, it may sometimes cause compressive symptoms requiring surgical intervention.

Puffiness of the face on raising the arms above the head is a positive Pemberton sign, which occurs due to compression of the thoracic inlet, leading to venous congestion. This suggests that the goiter has grown retrosternally and is now obstructing venous return, a potentially dangerous complication requiring urgent surgery.

Although retrosternal extension (A) is concerning, it is not an indication for urgent surgery unless it leads to compressive symptoms, such as a positive Pemberton sign.
Hoarseness (B) and dysphagia (C) may indicate recurrent laryngeal nerve or esophageal involvement, but these do not on their own justify emergency intervention.
Dyspepsia (D) is unrelated and not a typical symptom of goiter.

Question 3

A 55-year-old woman presents to your clinic with a swelling in the left lower part of her neck. The swelling has developed over the past 4 months, is painless, and feels rubbery and regular on palpation with no tenderness. She is otherwise healthy and asymptomatic. Ultrasound confirms the presence of a thyroid nodule; therefore, you perform a fine needle aspiration (FNA) sampling and send it for pathology assessment. The pathology result reports only the presence of follicular cells. Which one of the following would be the most appropriate next step in management?

A) CT scan of the neck.
B) Direct laryngoscopy.
C) MRI of the neck.
D) Repeat the FNA.
E) Excisional biopsy of the lump.

Correct Answer: E) Excisional biopsy of the lump.

Explanation:
Thyroid nodules containing follicular cells on FNA cytology are classified as indeterminate or suspicious for follicular neoplasm. Cytology alone cannot distinguish between a benign follicular adenoma and a malignant follicular carcinoma, as the diagnosis of malignancy depends on identifying capsular or vascular invasion, which requires histopathological examination of the entire lesion.

Therefore, the next appropriate step is excisional biopsy (often a lobectomy), allowing full histological assessment to establish a definitive diagnosis.

Option D (Repeat FNA) is reserved for non-diagnostic FNA samples, not for indeterminate results like follicular cells.
Options A and C (CT/MRI) are not routinely used to evaluate thyroid nodules unless assessing retrosternal extension or compressive symptoms.
Option B (Direct laryngoscopy) is useful only when there is hoarseness or vocal cord involvement, not in an otherwise asymptomatic patient.

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5. Endocrine Module

5.1 Diabetes

5.2 Thyroid

5.3 Breast

5.4 Adrenals

5.5 Osteoporosis

5.6 Other Endocrine Disorders