hypothyroidism Flashcards
Hypothyroidism
What are S&S of hypothyroidism:
Neuropsych Neuromuscular Skin/Hair Voice Weight CVS Goitre Hot/Cold/diaphoresis Eyes GI Pituitary fntn
Neuropsych - depression - decreased mental function Neuromuscular - physical tiredness - paresthesia - hypokinesis - hyporeflexia Skin/Hair - coarse, dry skin - coarse, brital hair Voice - hoarseness Weight - weight gain (not in ped's) CVS - bradycardia - isolated DBP Goitre - yes Hot/Cold/diaphoresis - lack sweating - cold intolerance Eyes - periorbital edema GI - constipation Pituitary fntn - menorrhagia
Hypothyroidism
When testing for hypothyroidism, if TSH is high, and fT4 is normal, next step is to check fT3. True/False
False
If fT4 is normal consider subclinical hypothyroidism
Hypothyroidism
What will TSH/T3T4 be in sick euthyroid (although testing not normally indicated for this condition)
all low, as the patient recovers, TSH may become elevated
Hypothyroidism
What are causes of central hypothyroidism?
- injuries & infections
- vascular accidents
- pituitary tumours, invasive or compressive lesions
- autoimmune
- infiltrative disease (of the pituitary gland)
- congenital (most common cause intellectual disability –> thyroid screening newborns)
Hypothyroidism
After initiating synthroid, what do you monitor to titrate dose and when do you recheck BW?
TSH, 6 weeks?
Hypothyroidism
What is the most common cause of hypothyroidism?
Hashimoto’s
Hypothyroidism
What blood test confirms autoimmune thyroiditis?
anti-TPO
Hypothyroidism
If someone has a goitre, check Tg and antiTg for ( thyroglobulin/antithyroglobulin) to rule out thyroid carcinoma
True/False
false
Tg/anti-Tg are tumor markers for patients who have undergone previous tx for thyroid CA. Generally not indicated for intact thyroid.
Hypothyroidism
What is primary, secondary and tertiary etiologies for hypothyroidism?
primary - thyroid
secondary - pituitary
tertiary - hypothalamus
Hypothyroidism
What is another word for hypothyroidism that refers to periorbital/facilal edema?
myxedema
Hypothyroidism
Risk factors for thyroid disease
• men: age ≥ 60 years
• women: age ≥ 50 years
• personal history or strong family history of thyroid disease
• diagnosis of other autoimmune diseases
• past history of neck irradiation
• previous thyroidectomy or radioactive iodine ablation
• drug therapies such as lithium and amiodarone
• dietary factors (iodine excess and iodine deficiency)
• certain chromosomal or genetic disorders (e.g., Turner syndrome, Down syndrome and mitochondrial disease)
- hypothyroidism females are 5-8 X higher prevalence
Hypothyroidism
When would you treat subclinical hypothyroidism?
TSH > 10, or TSH < 10 + symptomatic (less common)
Hypothyroidism
How often do you screen TSH if patient is taking lithium or amiodarone?
Q3-6months
Hypothyroidism
How often do you recheck TSH for patients with subclinical hypothyroidism or those or are not taking pharmocologic tx?
Q6-12 months
Hypothyroidism
When synthroid dose is stabilized, how often do you monitor TSH?
Q6-12 months
