Hypothyroidism

Question 1

Management of Hypothyroidism

Answer 1

Levothyroxine 25-50microg PO OD adjust every 4-8 weeks.

Question 2

Factors affecting efficacy of Thyroxine Replacement

Answer 2

• Not taken on empty stomach
  30-60mins before breakfast or 120mins after dinner
• Other medications affecting absorption (Bile acid resins, calcium carbonate, ferrous sulphate)
• Malabsorption co-morbidity (Coeliac disease, IBD, short gut syndrome, bariatric surgery, CF)

Question 3

When to refer patients to specialist in cases of hypothyroidism

Answer 3

• Age <= 18
• Unresponsive to therapy
• Pregnant
• Cardiac patients
• Presence of goitre, nodule or other structural change in thyroid gland
• Presence of other endocrine diseases

Question 4

Indications for pre-conception screening of thyroid disorder

Answer 4

• Personal history of thyroid disorder
• Family history of thyroid disorder
• T1DM or another autoimmune disorder
• Prior or current +’ve thyroid antibodies
• History of infertility, recurrent pregnancy loss or preterm delivery.
• Goitre on examination
• Prior head and neck irradiation.

Test at first antenatal visit. If abnormal, repeat tests 4-6 weekly in first trimester.

If normal, repeat test at 30/40

Question 5

Treatment of hypothyroidism during pregnancy

Answer 5

• Increase dose by 25% as soon as mother falls pregnant
• 4-6 weekly TFTs during early pregnancy.