Hypothyroidism

Question 1

What is hypothyroidism?

Answer 1

Insufficient production of the thyroid hormone by the thyroid gland

Question 2

What is the most common cause of hypothyroidism in the developing world?

Answer 2

Iodine deficiency

Question 3

What is the most common cause of hypothyroidism in the developed world?

Answer 3

Hashimoto’s thyroiditis

Question 4

What is Hashimoto’s thyroiditis?

Answer 4

Autoimmune inflammation of the thyroid gland

Question 5

What are drug causes of hypothyroidism?

Answer 5

Amiodarone

Lithium

Question 6

What are possible RF for hypothyroidism?

Answer 6

Down’s syndrome
Coeliac
Turner’s syndrome

Question 7

How does hypothyroidism present?

Answer 7

Weight gain
Lethargy
Cold intolerance 
Dry skin
Constipation 
Hoarse voice

Question 8

What can happen to hair in hypothyroidism?

Answer 8

Dry, coarse scalp hair

Loss of lateral aspect of eyebrows

Question 9

What antibodies are present with Hashimoto’s?

Answer 9

Anti-thyroid peroxidase antibodies

Anti-thyroglobulin antibodies

Question 10

What is the TSH and T3, T4 level in Primary hypothyroidism?

Answer 10

High TSH

Low T3 and T4

Question 11

What is the TSH and T3, T4 level in subclinical hypothyroidism?

Answer 11

High TSH, normal T3 and T4

Question 12

What is the medical management of hypothyroidism?

Answer 12

Levothyroxine

Question 13

How would you change the dose of levothyroxine if the patient was elderly?

Answer 13

Reduce the dose

Question 14

What should you after changing the dose of levothyroxine?

Answer 14

Check TFT’s in 8-12 weeks

Question 15

How would you change the dose of levothyroxine in someone who was pregnant?

Answer 15

Increase dose by 25-50mg

Question 16

What is a side effect of over-treatment with levothyroxine?

Answer 16

hyperthyroidism

Question 17

What can reduce the absorption of levothyroxine?

Answer 17

Iron tablets
Calcium carbonate tablets

(give 4 hours apart)

Question 18

What is the therapeutic goal of levothyroxine?

Answer 18

A normal TSH

Question 19

What is secondary hypothyroidism?

Answer 19

Pituitary gland doesn’t produce enough TSH

Question 20

What are possible causes of secondary hypothyroidism?

Answer 20

Tumours
Infection
Vascular- Sheehan’s

Question 21

What is a complication of undiagnosed hypothyroidism or poor compliance to medication?

Answer 21

Myxoedemic coma

Question 22

How does a myxoedema coma present?

Answer 22

Unconscious 
Overweight 
Dry skin 
Hypotensive
Thin and brittle hair
Periorbital oedema

Question 23

What is the management of myxoedemic coma

Answer 23

IV thyroxine
IV fluid
IV hydrocortisone (until adrenal insufficiency has been excluded)

Question 24

What is the TSH, T3 and T4 level in subclinical hypothyrodism?

Answer 24

TSH raised

T3 and T4 are normal

Question 25

What is there the risk of developing in subclinical hypothyroidism?

Answer 25

Hypothyroidism

Question 26

What would you do with someone with subclinical hypothyroidism and asymptomatic?

Answer 26

Observe and repeat thyroid function in 6 months

Question 27

In who would the starting dose of levothyroxine be lower?

Answer 27

Elderly Ischaemic Heart Disease

Question 28

What should the initial starting dose be for people with cardiac disease or over 50 be?

Answer 28

25mcg od with dose slowly titrated

Question 29

What is the normal starting dose of levothyroxine be in other patients?

Answer 29

50-100mcg od

Question 30

What are the other potential side effects of levothyroxine?

Answer 30

hyperthyroidism: due to over treatment reduced bone mineral density worsening of angina atrial fibrillation

Question 31

What gynaecological problem can hypothyroidism cause?

Answer 31

Menorrhagia

Question 32

What neurological probelms can hypothyroidism cause?

Answer 32

Decreased deep tendon reflexes Carpal tunnel syndrome

Question 33

What can occur in the hands and face in someone with hypothyroidism?

Answer 33

Non-pitting oedema (puffy face)

Question 34

What cardiac symptoms can hypothyroidism cause?

Answer 34

Bradycardia Cardiomegaly​

Question 35

What cancer is hasimoto's thyroiditis associated with?

Answer 35

Thyroid lymphoma

Question 36

How can a thyroid lymphoma present?

Answer 36

solitary, painless, hard, immobile nodule at the front of her neck- Doesn't move on tongue protrusion.