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Hypothyroidism Flashcards

1
Q

Causes of hypothyrodisims

A

Iodine deficiency
Goitre
Hashimotos - aitoimmune thyroiditis
Iatrogenic - srugery/medications
Transient thryoiditis
Thyroid infiltrative disorders
Congential

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2
Q

Medications that cna cuase hypothryodisim

A

Amiodarone - acute
Carbimazole - overtreamtent for hyper
Lithium
Radioactive iodine

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3
Q

Symptoms of hypothyrodism

A

Tired
Weak
Cold
Constipation
Depression
Menstrual irregularities
Thyrpid pain

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4
Q

Signs of hypothryoidism

A

Hari loss
Dyr skin
Weight gain
Puffy eyes - oedema general aswell
Slow refleces
Bradycardia + diastolic HPTN
Pericardial effusion
HF
Hoarseness of voice - goitre
Paraesthesia - carpal tunnel syndrome or peripheral neuropahty

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5
Q

How does hypothryoidism cause HF

A

reduced level of thyroid hormone causes the decreased contractility + heart muscle cannot fully relax -> decreased CO-> diastolic dysfunction

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6
Q

What triggers the release of T3 and T4?

A

TSH

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7
Q

Where is TSH released from?

A

Anterior pituitary

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8
Q

Where is TRH released from?

A

Hypothalamus

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9
Q

Pathwya of thyroid hormones

A

TRH -> TSH -> T3 + T4

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10
Q

What thyroid hormone condition occurs in peripheral tissues?

A

T4 to more biologically active T3

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11
Q

Primary vs secondary hypothyroidims

A

Primary - thyroid gland unable to produce T3 and T4
Secondary/central hypothyroidism - insufficient thryoid stimulation due to pituitary or hypothalamic disorder

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12
Q

What are hormone levels ranges in subclincial hypothyroidism?

A

TSH levels increased
T3/T4 IN NORMAL range

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13
Q

Thyroid levels in overt hypothyroidism

A

TSH levels above normal reference range
Freee T4 below normal reference range

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14
Q

What are causes of transient thyroiditis?

A

Viral infection causing subacute (de Quervians) thyroiditis - painful swelling
Post partum - painless inflam autoimmune condition for up to a year

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15
Q

What gene is ass with hashimotos?

A

HLA DR5

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16
Q

THyroid infiltrative disorders

A

Amyloidosis
Sarcoidosis
TB
Malignant - lymphoma, thyroid, mets

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17
Q

What is congential hypothyrpoidism?

A

Absence or underdevleopment of thyroid fland
Ectopuc hypoplastic gland
Absence of enzymes required for hormone synthesis and iodide transfer

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18
Q

Causes of secondary hypothyroidism

A

Tumours = pituitary adenomas or gliomas
Surgery, radiotherapy, trauma
Pituitary infarction
Sheehand syndrome
INfiltrative disorders - + haemoachromatomas
Isolated TSH deficinecy or inactivity
Idiopathic
Drugs -

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19
Q

Drugs that cause secodnary hypothyroidism

A

cocaine, dopamine, glucocorticosteroids, metformin

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20
Q

Complications of hypothyroidims - groups

A

Cardiovascular
Reproductive
Neurological and cognitive

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21
Q

Cardiovascular complciations of hypothyroidism

A

Dyslipidemia
Metabolic syndrome - insulin resisitance
Coronary heart disease + stroke
Heart failure

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22
Q

Reproducitve/ pregnancy complciations of hypothyroidism

A

Increased risk of subfertility/infertility
IN pregnenayc:
INcreased risk of miscarriage, anaemia, pre eclampsia, placental abruption, pp haemorrhage, stillbirth
Adverse neonatal outcomes - prem, low birthweiht, resp distress, congenital abnormalities, hypothyrodism, impaired foetal neurocognitive development

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23
Q

Neurological and cognitive complciations of hypothyroidism

A

Decreased taste, vision, hearing
Impaired attention, concentration, memory, language, executive function, psychomotor speed

23
Q

Neurological and cognitive complciations of hypothyroidism

A

Decreased taste, vision, hearing
Impaired attention, concentration, memory, language, executive function, psychomotor speed

24
Rare, life threatenting complciation of hypothyroidism?
Myxoedema coma
25
Sings of myxodoema coma
Lethargy, bradycardia, hypothermia, seizures and.or coma
26
What additional features can present with secondary hypothyroidism?
Caused by abnormal pituritary hormone production - skin depigmentation, atrophic breasts, galactorrhea, amenorrhea, erectile dysfunction, loss of body hair, cushings syndrome, acromegaly
27
Hypothyroidism sus history
Typical symptoms of hypothyroisim Current or recurrent pregnancy Current or recent non thyroidal illness Drug treatment Risk facotrs
28
Risk factors for hypothyroidism
FH of thyroid or autoimmune disease or hypothalamuc pituitary disease Personal history autommune disorders History of turners or DOwns syndromes Prev radiotherapy to head or neck, radioiodine treatment, thryoid or neck surgery History of iodine defucuency Secondary causes: Brain or metastatic cancer Infiltrative disease Head trauma Surgery Radiotheraoy Disease affecting pituitary or hypothalamus
28
Risk factors for hypothyroidism
FH of thyroid or autoimmune disease or hypothalamuc pituitary disease Personal history autommune disorders History of turners or DOwns syndromes Prev radiotherapy to head or neck, radioiodine treatment, thryoid or neck surgery History of iodine defucuency Brain or metastatic cancer Infiltrative disease Head trauma Surgery Radiotheraoy Disease affecting pituitary or hypothalamus
29
Examples of autoimmune diseases that increase risk of hypothyroidism
Addisons disease Alopecia areata Pernicious anaemia Coeliac disease T1DM vitiligo Rheumatoid arthritis
30
INvestigations for hypothyroidsim
History and exam Check TSH level with TFT blood test free T4 FBC and serum B12 level HbA1c Coeliac serology Serum lipids Serum thyroid peroxidase antibodies - TPOAb if autoimmune cause sus Ultrasound of neck
31
What is a neck ultrasound looking for in hypothyroidism
= thyroid enlargement or focal nodularity
32
When test for TPOAb
When autoimmune cause of hypothyroidism susepected
33
What can alter thyroid hormone blood test reuslts - misleading
Treatment for hyperthryoidism Diurnal variation - night shift workers, irregular sleeping patterns, vigorous exercise, mood disorders Sick euthyroid syndrome Adrenal insufficeinct Obesuty - HPT acis affected, TSH raised Age Drugs
34
TSH levels in adrenal insuffiiency and what fixes
Elevated TSH Reverse with glucocorticoid replacement Addisons disease
35
Why is pernisicous anaemia linked to hypothyroidism?
It is also classified as an autoimmune disease - due to lack of internal factor in stomach
36
Differnetial diagnosis hypothryoidism
Non thyroidal illness - sick euthyroid syndrome, range conditions, starveation and trauma can cause abnormal TFTs Endocrine/autoimmune conditions Haemotological conditions - anaemia, multipl myeloma End organ damage Metabolcia abdnormlaities eg hypercalcermia Vitamin and miineral deficinciences Stress, poor sleep, aclohol misuse, anxiety, depression Dementia Post virla and chronic fatigue sundromes Polymyagua rheumatica, fibromyalgia Obesity Menopause Carbon monoxide poisonning
37
When screen for hypothyrodism?
Pregnant/planning pregnanyc with history, risk factors, T1DM or other autoimmune condition, prev problems eg miscarriage, morbidity Goitre Dyslipidemia Sus dementia Radioidine therapy prev neck radiotherapy or surgery fo head and neck cancer Other autoimmune diseases Turners or Downs syndromes Hisotry pregnancy problems Drug treatment eg amiodarone or lithium Postnatal depression
38
When do you treat subclinical hypothyroidism?
TSH >10 FT4 within reference range
39
Treatment for primary hypothyrodisimi
Levothyrozine (LT4)
40
Treatment for primary hypothyrodisimi
Levothyrozine (LT4)
41
When to repeat thryoid function tests after start T4
Few weeks
42
TSH and free T4 in throtoxicosis/Graves disease?
TSH = low Free T4 - High
43
What conditions affect TSH but not T4?
Subclinical hypothyroidism Poor compliance with thyroxine Steroid therapy
44
When are both TSH and T4 low?
Sick euthyroid syndrome Secondary hypothyroidism
44
When are both TSH and T4 low?
Sick euthyroid syndrome Secondary hypothyroidism
45
What are TSH and T4 levels in primary hypothyroidism?
High TSH Low T4
46
What is riedel thyrodiits
fibrous tissue replacing the normal thyroid parenchyma causes a painless goitre
47
What diseases is hashiotos thyroditis ass with
type 1 diabetes mellitus, Addison's or pernicious anaemia
48
Treatment levothyroxine when change
initial starting dose of levothyroxine should be lower in elderly patients and those with ischaemic heart disease. The BNF recommends that for patients with cardiac disease, severe hypothyroidism or patients over 50 years the initial starting dose should be 25mcg od with dose slowly titrated. Other patients should be started on a dose of 50-100mcg od women with established hypothyroidism who become pregnant should have their dose increased 'by at least 25-50 micrograms levothyroxine'* due to the increased demands of pregnancy. The TSH should be monitored carefully, aiming for a low-normal value
49
When should TFTs be checked after changing levothyroxine dose
thyroid function tests should be checked after 8-12 weeks
50
Therapeutic goal of levothyroxiine
the therapeutic goal is 'normalisation' of the thyroid stimulating hormone (TSH) level. As the majority of unaffected people have a TSH value 0.5-2.5 mU/l it is now thought preferable to aim for a TSH in this range
51
What need to do when taking iron and levothyroxine
AT LEAST 2 hours apart - iron causes decreased absorption
52
Side effects levothyroxine
hyperthyroidism: due to over treatment reduced bone mineral density worsening of angina atrial fibrillation

GI, liver, kidney (50 decks)

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