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S3 Case 4 - Endocrine > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

What is included in the thyroid gland?

A

Pyramidal lobe
Right lobe
Isthmus
Left lobe

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2
Q

What are the 2 functions of the thyroid?

A

Synthesis of thyroid hormones
Secretion of calcitonin

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3
Q

What are the thyroid hormones?

A

T3 + T4

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4
Q

H ow does the thyroid maintain calcium + phosphate levels?

A

Through secretion of parathyroid hormone (PTH)

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5
Q

What is included in hypothyroidism?
Too little

A

Primary = overt/subclinical
Secondary = pituitary-hypothalamic dysfunction
Peripheral

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6
Q

What is primary overt hypothyroidism?

A

Clinically insufficient amount

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7
Q

What is primary subclinical hypothyroidism?

A

Can’t produce it

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8
Q

What is peripheral hypothyroidism?

A

Body not using what is there

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9
Q

What is included in hyperthyroidism?
Too much

A

Thyroidal origin
Pituitary disease - most common
Extrathyroidal origin

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10
Q

What are the hypothyroidism signs + symptoms?

A

Thinning hair
Goiter = abnormally enlarged thyroid gland
Slow metabolism (weight gain)
Dry skin
Jaundice = infants born with
Bradycardia

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11
Q

What are the causes of hypothyroidism?

A

Autoimmune thyroiditis
Iodine deficiency
Post thyroidectomy/radioactive iodine treatment
Drug induced
Peripheral resistance to thyroid hormone
Congenital disease - eg. thyroid agenesis

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12
Q

What is the diagnosis for hypothyroidism?

A

Symptoms
Thyroid function test (TFTs)
- TSH
- Free T4

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13
Q

What does TFT show if primary overt hypothyroidism?

A

Levels raised + FT4 low

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14
Q

What does TFT show if primary subclinical hypothyroidism?

A

TSH slightly raised
FT4 within normal range

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15
Q

What does TFT show if secondary hypothyroidism?

A

TSH low
FT4 low

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16
Q

What does TFT show if peripheral hypothyroidism?

A

rT3 low

17
Q

How are thyroid hormones released?

A

Thyroid releasing hormone comes from hypothalamus
Stimulates TSH release
Goes to thyroid
Thyroid releases T3 + T4

18
Q

What are the treatment aims for hypothyroidism?

A

Replace thyroid hormone
Correct TSH levels + resolved clinical symptoms

19
Q

What is 1st line for hypothyroidism?

A

Levothyroxine

20
Q

What is the usual starting dose for levothyroxine?

A

1.6mcg/kg rounded to nearest 25mcg dose

21
Q

What is the dose of levothyroxine if patient >65 or pre-existing CVD?

A

Reduced starting dose of 25-50mcg OD
= due to risk of overtreatment

22
Q

How do you monitor hypothyroidism/medication?

A

Initially TFTs every 3 months
Can take up to 6 months for TSH to stabilise

23
Q

How is levothyroxine titrated?

A

In steps of 25mcg

24
Q

What happens if TSH is within normal limits BUT symptoms are still present?

A

Test FT4 to investigate secondary hypothyroidism

25
Q

When monitoring secondary hypothyroidism what should you do?

A

Only adjust dose dependent on FT4

26
Q

Which medication influence the thyroid?

A

Dopamine
Glucocorticoid
Iodine
Metal ions
Phenobarbital
Beta-blockers

27
Q

How do you take levothyroxine?

A

Take 30-60 mins before food or other medications

28
Q

What are the interactions with levothyroxine?

A

Food - eg. milk
Medicines - eg. calcium, Fe, PPIs
Disease - eg. IBD/Coeliac

29
Q

What are side effects of levothyroxine?

A

Flushing
Palpitations
Insomnia
Angina
Thyroid crisis

30
Q

How is hypothyroidism + pregnancy linked?

A

Uncontrolled hypothyroidism can impair fertility
Insufficient thyroid hormone can have teratogenic effects

31
Q

What happens if you’re pregnant + have hypothyroidism?

A

Need frequent TSH level monitoring
Increase levothyroxine dose dose by 25-50mcg

S3 Case 4 - Endocrine (17 decks)

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