Hypothyroidism

Question 1

What causes hypothyroidism?

Answer 1

PRIMARY ATROPHIC HYPOTHYROIDISM - lymphocytic infiltration of thyroid
HASHIMOTO’S THYROIDITIS - lymphocytic and plasma cell infiltration leading to goitre, high levels of autoantibodies
IODINE DEFICIENCY - post-thyroidectomy / radioiodine treatment, drug induced eg lithium, carbimazole, amiodarone

Question 2

How does hypothyroidism present?

Answer 2

-Fatigue, lethargy
-Low mood
-Cold intolerance
-Weight gain
-Constipation
-Menorrhagia
-Hoarse voice
-Reduced memory / cognition
-Myalgia, cramps, weakness

Question 3

What signs might someone with hypothyroidism have?

Answer 3

BRADYCARDIC
Bradycardia
Reflexes relax slowly
Ataxia
Dry thin hair /skin
Yawning / drowsy
Cold hands
Ascites
Round puffy face
Defeated demeanour
Immobile
CCF

Question 4

How would you investigate someone with hypothyroidism?

Answer 4

-TFTs (raised TSH, low T4)
-Lipids (raised cholesterol and triglycerides)

Question 5

How would you treat hypothyroidism?

Answer 5

HEALTHY + YOUNG - levothyroxine 100mcg, monitor 6-weekly
ELDERLY / IHD - levothyroxine, start at 25mcg and increase slowly as can precipitate angina / MI