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Roomies Collab Deck 2: Endocrinology and NeuroPsych > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

What are the signs and symptoms of hypothyroidism? (8)

A
  1. Fatigue
  2. Weight gain
  3. Constitution
  4. Menstrual irregularities
  5. Depression
  6. Dry skin
  7. Intolerance to cold
  8. Reduced body and scalp hair
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2
Q

What are the complications of hypothyroidism? (7)

A
  1. Dyslipidemia
  2. Coronary HD
  3. HF
  4. Impaired fertility
  5. Pregnancy complications
  6. Impaired concentration and/or memory
  7. Rarely myxedema coma (life-threatening medical emergency)
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3
Q

Primary hypothyroidism refers to when the condition arises from the _____________

A

thyroid gland

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4
Q

What are the causes of hypothyroidism? (5)

A
  1. Iodine deficiency
  2. Autoimmune disease (Hashimoto’s thyroiditis)
  3. Radiotherapy
  4. Surgery
  5. Drugs
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5
Q

What are the causes of secondary hypothyroidism? (2)

A
  1. Pituitary disorder

2. Hypothalamic disorder

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6
Q

Primary hypothyroidism is more common in females than males and can be classified as either ________ or ________; both of which may or may not be symptomatic.

A

overt

subclinical

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7
Q

Overt hypothyroidism is characterised by thyroid stimulating hormone (TSH) levels _________ the reference range and free thyroxine (FT4) levels __________ the reference range

A

above

below

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8
Q

In subclinical hypothyroidism, TSH levels are ________ the reference range but FT4 and free tri-iodothyronine (FT3) levels are _________ the reference range

A

above

within

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9
Q

In pregnancy, hypothyroidism is defined as overt based on __________ TSH levels (using trimester-specific reference ranges) regardless of FT4 levels

A

elevated

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10
Q

What are the aims of treatment in patients with hypothyroidism? (3)

A
  1. Alleviate symptoms if present
  2. Align thyroid function tests within or close to reference range
  3. Reduce the risk of long-term complications
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11
Q

What information should be explained to patients and their family or carers regarding treatment for hypothyroidism? (Not safety information) (3)

A
  1. Some patients may feel well even when their thyroid function tests are outside the reference range
  2. Even when they have no symptoms, treatment may be advised to reduce the risk of long-term complications
  3. Symptoms may lag behind treatment changes for several weeks to months
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12
Q

What is the first-line treatment for overt hypothyroidism?

A

Levothyroxine; aim to maintain TSH levels within the reference range

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13
Q

How should management be modified in patients being treated for hypothyroidism with levothyroxine if symptoms persist even after achieving normal TSH levels?

A

consider adjusting the dose to achieve optimal well-being whilst avoiding doses that cause TSH suppression or thyrotoxicosis

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14
Q

For patients whose TSH level was very high before starting treatment or who have had a prolonged period of untreated disease, the TSH level can take up to __________ to return to the reference range

A

6 months

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15
Q

Consider measuring TSH levels every ________ until a stable level has been achieved, then yearly thereafter

A

3 months

Monitoring free thyroxine (FT4) should also be considered in those who continue to be symptomatic

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16
Q

Due to the uncertainty around the long-term adverse effects and the insufficient evidence of benefit over levothyroxine monotherapy, the use of ______________ is not recommended

A

natural thyroid extract; Liothyronine (either alone or in combination with levothyroxine) is not routinely recommended for the same reasons

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17
Q

When considering whether to start treatment for subclinical hypothyroidism, take into account features suggesting ________________

A

underlying thyroid disease

18
Q

For patients with subclinical hypothyroidism who have a TSH level of______ mIU/L or higher on 2 separate occasions 3 months apart, consider levothyroxine sodium

A

10

19
Q

In addition to monitoring of TSH, monitoring of ___________ should only be considered in hypothyroid patients who continue to be symptomatic

A

free thyroxine (FT4)

20
Q

For symptomatic patients aged under 65 years with a TSH level above the reference range, but lower than 10 mlU/L on 2 separate occasions 3 months apart, consider a ____________________

A

6-month trial of levothyroxine sodium

if symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains elevated, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine

21
Q

If ___________ hypothyroidism is suspected, refer the patient urgently to an endocrinologist to assess the underlying cause

A

secondary

22
Q

For those planning a pregnancy and whose thyroid function tests (TFTs) are not within range, advise _____________ until stabilised on levothyroxine sodium treatment

A

delaying conception;

If pregnancy is confirmed, urgently measure TFTs; discuss the initiation, or changes to levothyroxine sodium treatment and TFT monitoring with an endocrinologist whilst awaiting review, to reduce the risk of obstetric and neonatal complications

23
Q

Do females with hypothyroidism who are planning a pregnancy or are pregnant need to be referred to an endocrinologist?

A

Yes, all of them

24
Q

If pregnancy is confirmed in a patient with hypothyroidism, what steps should be taken urgently to reduce the risk of obstetric and neonatal complications? (3)

A
  1. Urgently measure TFTs
  2. Discuss the initiation or changes to levothyroxine treatment
  3. Initiate TFT monitoring with an endocrinologist whilst awaiting review
25
Q

What are the indications for levothyroxine? (2)

A
  1. Primary hypothyroidism

2. Hyperthyroidism (block and replace regimen) in combination with carbimazole

26
Q

Healthcare professionals are advised that if a patient reports symptoms after changing to a different tablet of levothyroxine, a _________ should be considered

A

thyroid function test

27
Q

What is the main contraindication to levothyroxine?

A

Thyrotoxicosis

28
Q

What are the main cautions regarding prescription of levothyroxine? (7)

A
  1. Cardiovascular disorders
  2. DM or DI
  3. HTN
  4. Elderly
  5. Long-standing hypothyroidism
  6. Panhypopituitarism
  7. Predisposition to adrenal insufficiency
29
Q

What precautions should be taken when prescribing levothyroxine in a patient with CVD?

A

Baseline ECG because changes induced by hypothyroidism can be confused with ischemia

30
Q

What precautions should be taken when prescribing levothyroxine in a patient with DM?

A

Dose of antidiabetic drugs including insulin may need to be increased

31
Q

What precautions should be taken when prescribing levothyroxine in a patient with panhypopituitarims?

A

Initiate corticosteroid therapy before starting levothyroxine

32
Q

What precautions should be taken when prescribing levothyroxine in a patient with predisposition to adrenal insufficiency?

A

Initiate corticosteroid therapy before starting levothyroxine

33
Q

When treating patients with levothyroxine, how should dosage be altered if metabolism increases too rapidly (causing diarrhoea, nervousness, rapid pulse, insomnia, tremors and sometimes anginal pain where there is latent myocardial ischaemia)?

A

reduce dose or withhold for 1–2 days and start again at a lower dose

34
Q

How do levothyroxine requirements change during pregnancy?

A

Increase

35
Q

How do levels of maternal thyroid hormone affect fetal development?

A

Excessive or insufficient maternal thyroid hormones can be detrimental to fetus;

Assess maternal thyroid function before conception (if possible), at diagnosis of pregnancy, at antenatal booking, during both the second and third trimesters, and after delivery (more frequent monitoring required on initiation or adjustment of levothyroxine)

36
Q

Is levothyroxine safe during breastfeeding?

A

Yes, amount too small to affect tests for neonatal hypothyroidism

37
Q

What are the side effects of levothyroxine? (22)

A

(Think symptoms of hyperthyroidism)

Frequency not known

  1. Angina pectoris
  2. Anxiety
  3. Arrhythmias
  4. Arthralgia
  5. Diarrhea
  6. Dyspnea
  7. Fever
  8. Flushing
  9. Headache
  10. Hyperhidrosis
  11. Insomnia
  12. Malaise
  13. Menstrual irregularities
  14. Muscle spasm
  15. Muscle weakness
  16. Edema
  17. Palpitations
  18. Skin reactions
  19. Thyrotoxic crisis
  20. Tremor
  21. Vomiting
  22. Weight decreased
38
Q

Can oral iron and levothyroxine be taken together?

A

No, iron decreases absorption of levothyroxine; administer at least 4 hours appart

(Also antacids, sucralfate, and calcium-containing supplements eg calcium gluconate, calcium lactate, calcium phosphate, calcium chloride, calcium carbonate)

39
Q

What are the food items that potentially decrease absorption of levothyroxine and should therefore not be taken together? (4)

A
  1. Dietary fiber
  2. Milk
  3. Soy products
  4. Coffee
40
Q

When is the ideal time of day to take levothyroxine?

A

Preferably 30-60 min before breakfast, caffein-containing liquids (eg coffee or tea) or other medication

Roomies Collab Deck 2: Endocrinology and NeuroPsych (49 decks)

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