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Endocrine > 376 Hypothyroidism > Flashcards

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
Q

tyrosine kinase inhibitor that can induce thyroid autoimmunity via their effects on T cell regulation

A

alemtuzumab

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26
Q

clinically useful markers of thyroid autoimmunmity

A

antibodies to TPO and thyroglobulin (Tg)

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27
Q

True or false. Transplacental passage of Tg or TPO anitbodies has no effect on the fetal thryoid

A

True.

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28
Q

True or false. 20% of patient have autoimmune hypothyroidism have antibodies to TSH-R esp among Asians.

A

True

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29
Q

True or false. Patients with Hashimoto’s thyroiditis may present because of goiter rather than symptoms of hypothyroidism

A

True.

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30
Q

Evaluation of hypothyroidism. TSH elevated. What to do next?

A

Measure FT4

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31
Q

Evaluation of hypothyroidism. TSH normal. Pituitary disease suspected What to do next?

A

Measure FT4

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32
Q

Evaluation of hypothyroidism. TSH normal. Pituitary disease suspected FT4 normal.

A

No further tests

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33
Q

Evaluation of hypothyroidism. TSH normal. Pituitary disease suspected FT4 low

A

Rule out sick euthyroid, drug effect then evaluate anterior pituitary function

34
Q

Evaluation of hypothyroidism. TSH elevated. FT4 normal. What to do next

A

Mild hypothyroidism.

35
Q

Evaluation of hypothyroidism. TSH elevated. FT4 normal. TPOAb positive and symptomatic

A

Treat with T4

36
Q

Evaluation of hypothyroidism. TSH elevated. FT4 normal. TPOAb negative, no symptomatic

A

Annual follow up

37
Q

Evaluation of hypothyroidism. TSH elevated. FT4 low.

A

Primay hypothyroidism.

38
Q

Evaluation of hypothyroidism. TSH elevated. FT4 low. TPOAb positive

A

Autoimmune hypothyroidism

39
Q

Evaluation of hypothyroidism. TSH elevated. FT4 low. TPOAb negative

A

Rule out other causes of hypothyroidism

40
Q

True or false. Normal TSH excludes primary but not secondary hypothyroidism

A

True.

41
Q

True or false.FT4 is inferior to TSH as screening as it will not detect subclinical hypothyroidism

A

True.

42
Q

True or false. Asymmetric goiter in Hashimot’s thyroiditis may be confused with a mulitnodular goiter

A

True.

43
Q

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

A

True.

44
Q

better measurement of thyroid function following radioiodine treatment

A

FT4

45
Q

True or false. Lithium may cause hypothyroidism

A

True.

46
Q

goal of treatment in secondary hypothyroidism

A

maintain T4 levels in the upper half of the reference interval

47
Q

why can’t TSH be used to monitor therapy in secondary hypothyroidism

A

TSH is secreted but in its bioinactive form

48
Q

dose of levothyroxine in adult patients under 60 yrs old without evidence of heart disease

A

50- 100 ug levothyroxine with goal of normal TSH levels

49
Q

Why is there no place for liothyronin alone as long term replacement

A

short half life necessitates 3-4 daily doses and associated with fluctuating T3 levels

50
Q

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

A

True.

51
Q

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

A

subclinical hypothyroidism

52
Q

treatment of subclinical hypothyroidism

A

low dose of levothyroxine 25-50 ug/day with goal of normalizing TSH

53
Q

how is levothyroxine dose adjusted during pregnancy

A

as much as 45%

54
Q

how is thyroid function evaluated during pregnancy

A

thyroid function should be evaluated immediately after pregnancy is confirmed and every 4 weeks during the first half of pregnancy

55
Q

what is the goal of TSH in pregnancy,

A

low half of the normal range or less than 2.5 mIU/L

56
Q

True or false. Elderly patients may require 20% less thyroxine than younger patients

A

True.

57
Q

what is the dosing of levothyroxine in elderly patients

A

12.5-25 ug/day with similar increments every 2-3 months until TSH is normalized

58
Q

True or false. Myxedema coma has a 20-40% mortality

A

True.

59
Q

how is levothyroxine administered in myxedema coma

A

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
Q

Can T3 be given in myxedema coma

A

Yes because T4 to T3 conversion is impaired, it can be added

61
Q

side effect of liothyroxine

A

cardiac arrhythmias

62
Q

what is the dose of liothyroxine in patient no cardiovascular risk

A

5-20 ug liothyronine followed by 2.5- 10 ug 8 hourly

63
Q

True or false. Parenteral hydrocortisone 50 mg every 6 hrs should be administered because there is impaired adrenal reserve in profound hypothyroidism

A

True.

64
Q

hypertonic or hypotonic saline in myxedema

A

hypotonic IV fluids avoided as it may exacerbate water retention

65
Q

Effects of hypothyroidism to CNS

A

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
Q

Effects of hypothyroidism to respiratory system

A

Depression of both hypoxic and hypercapnic ventilatory drive leading to CO2 retention

67
Q

ECG effects of hypothyroidism

A

Prolonged PR interval low amplitude of P wave…

68
Q

Causes of transient hypothyroidism

A

Silent thyroiditis including postpartum thyroiditis; Subacute thyroiditis; Withdrawal of supraphysiologic thyroxine; After treatment or subtotal thyroidectomy for Graves disease

69
Q

Causes of secondary tertiary hypothyroidism

A

Hypopituitarism, Hypothalamic disease; Bexarotene treatment

70
Q

Equivalent of primary hypothyroidism in hyperthyroidism. Needed test? Treatment?

A

Equivalent: Graves disease. Anti TPO antibodies. Treatment: levothyroxine(+/-) antibodies

71
Q

True or false. In secondary hypothyroidism, TSH normal or low but FT3 and FT4 are low

A

True

72
Q

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

A

True.

73
Q

Should subclinical hypothyroidism be treated?

A

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
Q

Manifestation of myxedema coma

A

Hypothyroidism, Hyponatremia, Adrenocorticoid eficiency Hypothermia

75
Q

Causes of primary hypothyroidism

A 
Autoimmune hypothyroidism
Iatrogenic
Drugs
Congenital hypothyroidism
Infiltrative disorders
Goitrogens
76
Q

Elective surgery. Target TSH

Emergency surgery. Target TSH. If abnormal, what to do?

A

Elective: TSH less than 10
Emergency: TSH less than 20
If abnormal, load with levothyroxine

77
Q

Special instruction in taking levothyroxine. Medications that affect levothyroxine absorption

A

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
Q

Thyroid cancer. 3-4 weeks after surgery what can be done? Conditions?

A

Radioiodine. But off hormone

If not for radioiodine, start levothyroxine immediately postop

79
Q

Thyroid cancer. What can be done next after surgery?

A

RAI 3-4 weeks after surgery. Off hormone

If RAI not planned yet, start levothyroxine immediately after surgery

80
Q

initial treatment of myxedema coma

A

Levothyroxine 500 ug per IV/NGT bolus followed by 50-100 ug/day

81
Q

alternative initial treatment for myxedema coma

A

Liothyronin 10-25 ug q8hrs-12 IV/NGT or levothyroxine + liothyronine combination

82
Q

when to do external warming in patient with myxedema coma

A

temp less than 30 degress Celsius

Endocrine (15 decks)

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