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Endocrine > 1(E): Hypothyroidism > Flashcards

1(E): Hypothyroidism Flashcards

1
Q

What is myxoedema

A

Clinical manifestation of thyroid hormone deficiency

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2
Q

What is the stereotype for hypothyroidism

A

Women over-40

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3
Q

What is primary hypothyroidism

A

Defect in thyroid gland: low T3, T4

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4
Q

What is secondary hypothyroidism

A

Defect in pituitary gland: low TSH

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5
Q

What is tertiary hypothyroidism

A

Defect in hypothalamus: low TRH

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6
Q

What are the two aetiological categories of hypothyroidism

A

Autoimmune

Acquired

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7
Q

What are two autoimmune conditions causing hypothyroidism

A
  • Hashimoto’s

- Primary atrophic hypothyroidism

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8
Q

What is primary atrophic hypothyroidism

A

Diffuse lymphocytic infiltration of the thyroid gland causing atrophy

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9
Q

What is a feature of primary atrophic hypothyroidism

A

No goitre

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10
Q

What is the most common cause of hypothyroidism in wester civilisation

A

Hashimoto’s disease

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11
Q

when is Hashimoto’s more common

A

Women over-60

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12
Q

what is the most common cause of Hashimoto’s in developing countries

A

iodine deficiency

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13
Q

what are 4 acquired causes of hypothyroidism

A
  • post thyroidectomy
  • radio-iodine treatment
  • drug induced
  • de quervains subacute thyroiditis
  • post-partum thyroiditis
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14
Q

what medications can cause hypothyroidism

A

amiodarone
carbimazole
lithium

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15
Q

explain hypothyroidism in de quervains thyroiditis

A

after period hyperthyroidism, can lead to hypothyroidism

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16
Q

explain postpartum thyroiditis

A

after pregnancy can have period of hypothyroidism

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17
Q

what can cause secondary hypothyroidism

A

pituitary adenoma

18
Q

what are signs of hypothyroidism

A 
Bradycardia 
Reflexes diminished
Ataxia
Defeated demeanour 
Yawning
Cold hands
Ascites and non-pitting oedema, pericardial effusion 
Round puff face
Dry hair and skin 
Immobile/ileus 
CCF
19
Q

when does sick euthyroid syndrome occur

A

In patients who are critically unwell or severe stress

20
Q

when does sick euthyroid syndrome occur more

A

ITU patients

21
Q

explain thyroid function in sick euthyroid

A

Normal thyroid function - no symptoms of hyper or hypothyroidism, however, cytokines alter circulating thyroid hormone

22
Q

What is first line investigation for hypothyroidism disease

A

TFTs

23
Q

How do TFTs present in primary hypothyroidism

A
  • Low T3, T4

- High TSH

24
Q

How do TFTs present in secondary hypothyroidism

A
  • Low T3, T4

- Low TSH

25
Q

How do TFTs present in sick euthyroid syndrome

A
  • Low TSH

- Low T3, T4

26
Q

How do TFTs present in subclinical hypothyroidism

A
  • High TSH

- Normal T3, T4

27
Q

How do TFTs present if poor compliance with thyroxine

A
  • High TSH

- Normal T3, T4

28
Q

Why is lipid profile ordered in hypothyroidism

A

Untreated hypothyroidism can increase VLDL and Ldl

29
Q

What autoantibodies are present in hypothyroidism

A
  • anti-TPO (thyroid peroxidase)
30
Q

What is given to manage hypothyroidism

A

Thyroxine

31
Q

How long is waited after giving thyroxine to measure TFTs

A

4 Weeks

32
Q

What is risk with thyroxine

A

Can precipitate angina, MI

33
Q

What are 3 risks of hypothyroidism

A
  • Carpal tunnel
  • Myxoedema coma
  • CVD
34
Q

What are 4 risks of hypothyroidism in pregnancy

A
  • Pre-eclampsia
  • Anaemia
  • Pre mature
  • PPH
35
Q

What is myoexdema coma

A

Acute exacerbation of hypothyroidism

36
Q

What age does myxoedema coma occur

A

Over 65 year-olds

37
Q

What are 5 causes of myxoedema coma

A
  • MI
  • Infection
  • Trauma
  • Stroke
  • Post thyroidectomy
38
Q

Explain how myxoedema coma presents

A

Altered mental status
Seizures

Bradycardia
Hyporeflexia
Hypothermia
Hypoglycaemia

39
Q

Where should myoexdema patients be managed

A

ICU

40
Q

What is given in myoexedma coma

A

If suspect pituitary disorder give hydrocortisone first. Then Liothyronine (T3) [If do not suspect pituitary - just give liothyronine]

Endocrine (20 decks)

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