clinical thyroid disease - hypothyroidism Flashcards

1
Q

What are the three main parts of the thyroid gland

A

Right lobe, left lobe and the isthmus

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2
Q

How is the release of T3 and T4 stimulated

A

TRH is released from the hypothalamus and travels to the anterior pituitary where it stimulates the release of TSH which then goes to the thyroid gland and stimulates the release of T3 and T4

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3
Q

What causes the negative feedback in the release of T3 and T4

A

T3 and T4 on the anterior pituitary and the hypothalamus

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4
Q

What is the normal TSH level

A

0.35-4.5

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5
Q

What are the symptoms of hypothyroidism

A

Fatigue/lethargy
Cold intolerance
weight gain
weakness, arthralgia and myalgia
constipation
irregularities in menstruation
depression
dry skin and reduced hair
thyroid pain

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6
Q

What are the signs of hypothyroidism that are seen on examination

A

Course dry skin/ hair and hair loss
Oedema including swelling of the eye balls and puffy face
Hoarseness in the voice or deepening
Goitre
Bradycardia and diastolic hypertension
Delayed relaxation of deep tendon reflexes
Paraesthesia caused by carpal tunnel

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7
Q

What is carpal tunnel syndrome

A

Pressure on the nerves in the wrist that can cause paraesthesia and numbness in the hands and fingertips

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8
Q

What tests are done for hypothyroidism suspicion

A

Bloods :
TFT - thyroid function tests - T4 and TSH
Full blood count
HbA1c - to check for diabetes

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9
Q

Which gender is hypothyroidism more common in

A

Women

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10
Q

What are the congenital causes of of hypithyroidism

A

Agenesis / maldevelopment

Issues with production of hormones

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11
Q

What is the most common cause of primary hypothyroidism

A

Hashimatos autoimmune thyroid disease

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12
Q

What drugs can cause primary hypothyroidism

A

Antithyroid drugs, amiodarone, lithium and interferon

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13
Q

What is the link between iodine and hypothyroidism

A

Chronic iodine deficiency can cause hypothyroidism - iodine is required for the production of T3 and T4

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14
Q

What are causes of secondary.tertiary hypothyroidism

A

Pituitary tumour
Craniopharyngioma
Post pituitary surgery or radiotheraoy

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15
Q

What is the treatment for hypothyroidism in adults less than 65

A

Start levothyroxine at 1.6micrograms per kg per day

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16
Q

What is the treatment for adults more than 65 years of age or with pre-existing cardiac disease

A

Levothyroxine - 25-50 micrograms a day

17
Q

What presents with High TSH and a normal T4

A

Subclinical hypothyroidism

18
Q

What presents with a high TSH and a low T3/T4

A

Hypothyroidism

19
Q

What is the treatment fir subclinical hypothyroidism

A

If there is raised TSH, treat as if it is hypothyroidism

20
Q
A