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376 Hypothyroidism Flashcards

1
Q

What is the diagnosis of patient with elevated TSH and normal FT4?

A

Mild hypothyroidism or subclinical hypothyroidism

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2
Q

Most common symptom of hypothyroidism

A

Weakness and fatigue

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3
Q

Most common signs of hypothyroidism

A

Dry coarse skin

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4
Q

Most common cause of hypothyroidism worldwide

A

Iodine deficiency

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5
Q

Most common cause of hypothyroidism in iodine sufficient areas

A

Hashimoto thyroiditis/ autoimmune

Iatrogenic

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6
Q

Common cause of neonatal hypothyroidism

A

Thyroid gland dysgenesis

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7
Q

Accounts for half of generic susceptibility to autoimmune hypothyroidism

A

HLA Dr and CTLA 4

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8
Q

Increased glycosaminoglucan content traps water giving rise to. Skin thickening without edema

A

Myxedema

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9
Q

Causes hoarse voice and clumsy speech in hypothyroidism

A

Fluid accumulation in the vocal cords and tongue

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10
Q

Define as steroid response syndrome associated with TPO antibodies, myoclonus and slow wave activity on EEG in relation to hypothyr9

A

Hashimoto encephalopathy

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11
Q

True or false. Hashimoto thyroiditis is characterized by heterogenous enlargement of the thyroid gland

A

True

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12
Q

What is the dose of levothyroxine

A

1.6 ug/kg BW taken 30 minutes before breakfast

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13
Q

When is relief of symptoms expected and when T4 levels are back to normal? How shall adjustment be made?

A

Symptom relief is expected 3- 6 months after commencement of treatment and when T4 normalizes.
If T4 is still high, increase levothyroxine dose by 12.5 to 25 ug increments

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14
Q

What is the half life of T4

A

7 days

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15
Q

Biochemical evidence of thyroid hormone deficiency in patients who have few or no apparent clinical features of hypothyroidism

A

Subclinical hypothyroidism

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16
Q

True or false. Levothyroxine is associated with pseudotumor cerebro in children

A

True

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17
Q

Causes 10-15% of neonatal hypothyroidism

A

inborn errors of thyroid hormone synthesis

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18
Q

True or false. Congenital cardiac malformations are four times more common in congenital hypothyroidism

A

True

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19
Q

how is neonatal hypothyroidism diagnosed

A

measurement of TSH or T4 level in heel prick blood specimens

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20
Q

dosage for neonatal hypothyroidism

A

T4 at 10-15 ug/kg per day

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21
Q

represents the end stage of Hashimoto’s thyroiditis where fibrosis is more extensive and lymphocyte infiltration is less pronounced

A

atrophic thyroiditis

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22
Q

best documented genetic risk factor for autoimmune hypothyroidism

A

HLA DR polymorphism

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23
Q

True or false. Female preponderance of thyroid autoimmunity is most likely due to sex steroid effect on immune response

A

True.

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24
Q

primarily medicated thyroid cell destruction

A

CD8 cytotoxic T cells

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25
tyrosine kinase inhibitor that can induce thyroid autoimmunity via their effects on T cell regulation
alemtuzumab
26
clinically useful markers of thyroid autoimmunmity
antibodies to TPO and thyroglobulin (Tg)
27
True or false. Transplacental passage of Tg or TPO anitbodies has no effect on the fetal thryoid
True.
28
True or false. 20% of patient have autoimmune hypothyroidism have antibodies to TSH-R esp among Asians.
True
29
True or false. Patients with Hashimoto's thyroiditis may present because of goiter rather than symptoms of hypothyroidism
True.
30
Evaluation of hypothyroidism. TSH elevated. What to do next?
Measure FT4
31
Evaluation of hypothyroidism. TSH normal. Pituitary disease suspected What to do next?
Measure FT4
32
Evaluation of hypothyroidism. TSH normal. Pituitary disease suspected FT4 normal.
No further tests
33
Evaluation of hypothyroidism. TSH normal. Pituitary disease suspected FT4 low
Rule out sick euthyroid, drug effect then evaluate anterior pituitary function
34
Evaluation of hypothyroidism. TSH elevated. FT4 normal. What to do next
Mild hypothyroidism.
35
Evaluation of hypothyroidism. TSH elevated. FT4 normal. TPOAb positive and symptomatic
Treat with T4
36
Evaluation of hypothyroidism. TSH elevated. FT4 normal. TPOAb negative, no symptomatic
Annual follow up
37
Evaluation of hypothyroidism. TSH elevated. FT4 low.
Primay hypothyroidism.
38
Evaluation of hypothyroidism. TSH elevated. FT4 low. TPOAb positive
Autoimmune hypothyroidism
39
Evaluation of hypothyroidism. TSH elevated. FT4 low. TPOAb negative
Rule out other causes of hypothyroidism
40
True or false. Normal TSH excludes primary but not secondary hypothyroidism
True.
41
True or false.FT4 is inferior to TSH as screening as it will not detect subclinical hypothyroidism
True.
42
True or false. Asymmetric goiter in Hashimot's thyroiditis may be confused with a mulitnodular goiter
True.
43
True or false. In the first 3-4 months after radioiodine treatment for Grave's disease, transient hypothyroidism may occur due to reversible radiation damage
True.
44
better measurement of thyroid function following radioiodine treatment
FT4
45
True or false. Lithium may cause hypothyroidism
True.
46
goal of treatment in secondary hypothyroidism
maintain T4 levels in the upper half of the reference interval
47
why can't TSH be used to monitor therapy in secondary hypothyroidism
TSH is secreted but in its bioinactive form
48
dose of levothyroxine in adult patients under 60 yrs old without evidence of heart disease
50- 100 ug levothyroxine with goal of normal TSH levels
49
Why is there no place for liothyronin alone as long term replacement
short half life necessitates 3-4 daily doses and associated with fluctuating T3 levels
50
True or false. Because T4 has long half life, patients who miss a dose can be advised to take two doses of the skipped tablets at once
True.
51
refers to biochemical evidence of thyroid hormone deficiency in patients who have few or no apparent clinical features of hypothyroidism
subclinical hypothyroidism
52
treatment of subclinical hypothyroidism
low dose of levothyroxine 25-50 ug/day with goal of normalizing TSH
53
how is levothyroxine dose adjusted during pregnancy
as much as 45%
54
how is thyroid function evaluated during pregnancy
thyroid function should be evaluated immediately after pregnancy is confirmed and every 4 weeks during the first half of pregnancy
55
what is the goal of TSH in pregnancy,
low half of the normal range or less than 2.5 mIU/L
56
True or false. Elderly patients may require 20% less thyroxine than younger patients
True.
57
what is the dosing of levothyroxine in elderly patients
12.5-25 ug/day with similar increments every 2-3 months until TSH is normalized
58
True or false. Myxedema coma has a 20-40% mortality
True.
59
how is levothyroxine administered in myxedema coma
200-400 ug which serves as loading dose followed by oral daily dose of 1.6 ug/kg/day reduced by 25% if administered IV
60
Can T3 be given in myxedema coma
Yes because T4 to T3 conversion is impaired, it can be added
61
side effect of liothyroxine
cardiac arrhythmias
62
what is the dose of liothyroxine in patient no cardiovascular risk
5-20 ug liothyronine followed by 2.5- 10 ug 8 hourly
63
True or false. Parenteral hydrocortisone 50 mg every 6 hrs should be administered because there is impaired adrenal reserve in profound hypothyroidism
True.
64
hypertonic or hypotonic saline in myxedema
hypotonic IV fluids avoided as it may exacerbate water retention
65
Effects of hypothyroidism to CNS
Glycosaminoglycans deposits leads to numbness and tingling of extremities; Decrease in the rate of muscle contraction and relaxation leading to hung up reflex; Muscle mass may be reduced or enlarged due to interstitial myxedema
66
Effects of hypothyroidism to respiratory system
Depression of both hypoxic and hypercapnic ventilatory drive leading to CO2 retention
67
ECG effects of hypothyroidism
Prolonged PR interval low amplitude of P wave...
68
Causes of transient hypothyroidism
Silent thyroiditis including postpartum thyroiditis; Subacute thyroiditis; Withdrawal of supraphysiologic thyroxine; After treatment or subtotal thyroidectomy for Graves disease
69
Causes of secondary tertiary hypothyroidism
Hypopituitarism, Hypothalamic disease; Bexarotene treatment
70
Equivalent of primary hypothyroidism in hyperthyroidism. Needed test? Treatment?
Equivalent: Graves disease. Anti TPO antibodies. Treatment: levothyroxine(+/-) antibodies
71
True or false. In secondary hypothyroidism, TSH normal or low but FT3 and FT4 are low
True
72
True or false. In patient on amiodarone, tyrosine kinase inhibitors, lithium should have baseline thyroid function test and repeated 1 month after as re check
True.
73
Should subclinical hypothyroidism be treated?
Re check esp in elderly and with CKD In young reproductive female: Treatment is administered by starting with low dose levothyroxine 25-50 ug/d with goal of normalizing TSH
74
Manifestation of myxedema coma
Hypothyroidism, Hyponatremia, Adrenocorticoid eficiency Hypothermia
75
Causes of primary hypothyroidism
``` Autoimmune hypothyroidism Iatrogenic Drugs Congenital hypothyroidism Infiltrative disorders Goitrogens ```
76
Elective surgery. Target TSH | Emergency surgery. Target TSH. If abnormal, what to do?
Elective: TSH less than 10 Emergency: TSH less than 20 If abnormal, load with levothyroxine
77
Special instruction in taking levothyroxine. Medications that affect levothyroxine absorption
30 mins prior to meals Medications: Calcium, sucralfate, PPI, salicylates, multivitamins, Ferrous sulfate 4 hrs away from levothyroxine Only 70% of levothyroxine is absorbed
78
Thyroid cancer. 3-4 weeks after surgery what can be done? Conditions?
Radioiodine. But off hormone | If not for radioiodine, start levothyroxine immediately postop
79
Thyroid cancer. What can be done next after surgery?
RAI 3-4 weeks after surgery. Off hormone | If RAI not planned yet, start levothyroxine immediately after surgery
80
initial treatment of myxedema coma
Levothyroxine 500 ug per IV/NGT bolus followed by 50-100 ug/day
81
alternative initial treatment for myxedema coma
Liothyronin 10-25 ug q8hrs-12 IV/NGT or levothyroxine + liothyronine combination
82
when to do external warming in patient with myxedema coma
temp less than 30 degress Celsius

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