Hypothyroid

Question 1

What is a firm, non tender goitre and hypothyroidism indicative of?

Answer 1

Hashimoto’s thyroiditis

Question 2

What other conditions is hashimoto’s thyroiditis associated with?

Answer 2

hashimoto’s is associated with:

1) vitiligo
2) pernicious anaemia
3) type 1 DM
4) Addison’s disease
5) premature ovarian failure

Question 3

What are the causes of hypothyroidism/

Answer 3

1) Idiopathic atrophic hypothyroid
2) Autoimmune ( hashimoto’s - pts present with firm, non tender goitre, and hypothyroidism)
3) Previous surgical or radioiodine treatment of thyroid.
4) congenital hypothyroid (inherited ezyme defects)
5) Iodine deficiency
6) Iatrogenic - long term iodine therapy, amiodarone, lithium carbonate.

Question 4

What are the symptoms of hypothyroid?

Answer 4

1) tiredness
2) weight gain
4) cold intolerance
5) hoarse voice
6) dry skin
7) constipation
8) menorrhagia

Question 5

What are the systemic effects of hypothyroidism?

Answer 5

Cardiovascular:

1) Bradycardia
2) heart failure

Neuromuscular:

3) Aches and pains
4) carpal tunnel syndrome
5) deafness
6) depression
7) delayed relaxation of reflexes

Haematological:

8) Macrocytic anaemia
9) iron deficiency anaemia (caused by heavy periods)

Derm:

10) dry skin
11) vitiligo

GI:
12) constipation

Repro:

13) infertility
14) menorrhagia

Developement:

15) growth retardation
16) mental disabilities
17) delayed puberty

Question 6

what investigations are done for hypothyroidism?

Answer 6

1) thyoroid function test shows:
- high TSH
- low T3/T4

2) Autoantibodies to thyroglobulin or thyroid peroxidase (TPO) –> HASHIMOTOS
3) raised cholesterol
4) BLOODS –> FBC —> raised MCV and anaemia
5) ECG –> bradycardia

Question 7

What is the treatment for hypothyroidism?

Answer 7

Levothyroxine

stop amiodarone if possible

Question 8

what are the clinical signs of hypothyroid?

BRADYCARDIC pneumonic

Answer 8

BRADYCARDIC pneumonic:

• Bradycardia
• Reflexes relax slowly
• Ataxia (cerebellar)
• Dry skin, thin hair
• Yawing, tired, drowsy
• Cold hands
• Ascites +/- pitting oedema
• Round face (weight gain)
• Depressed
• Immobile
• Congestive heart failure

Question 9

What is the pathophysiology of hashimotos thyroiditis?

Answer 9

Hashimotos is an autoimmune disease that causes hypothyroid.
It causes atrophy and fibrosis of the thyroid gland.
Autoantibodies may be present against thyroid peroxidase, thyroglobulin and TSH receptor.
A goitre usually develops that is smooth, firm, non tender and not toxic.