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Year 6 Endocrinology > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

What is Hashimoto’s thyroiditis?

A

Hashimoto’s thyroiditis is an autoimmune disorder of the thyroid gland, typically associated with hypothyroidism.

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2
Q

What is a notable characteristic of Hashimoto’s thyroiditis?

A

It is 10 times more common in women.

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3
Q

What are the features of hypothyroidism in Hashimoto’s thyroiditis?

A

Features include a firm, non-tender goitre and the presence of anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibodies.

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4
Q

What other conditions are associated with Hashimoto’s thyroiditis?

A

It is associated with other autoimmune conditions such as coeliac disease, type 1 diabetes mellitus, and vitiligo.

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5
Q

What type of lymphoma is associated with Hashimoto’s thyroiditis?

A

Hashimoto’s thyroiditis is associated with the development of MALT lymphoma.

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6
Q

Can Hashimoto’s thyroiditis present with thyrotoxicosis?

A

Yes, there may be a transient thyrotoxicosis in the acute phase.

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7
Q

What percentage of women in the UK are affected by hypothyroidism?

A

Hypothyroidism affects around 1-2% of women in the UK.

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8
Q

How much more common is hypothyroidism in females than males?

A

Hypothyroidism is around 5-10 times more common in females than males.

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9
Q

What is the most common cause of primary hypothyroidism?

A

Hashimoto’s thyroiditis is the most common cause of primary hypothyroidism.

Hashimoto’s thyroiditis is an autoimmune disease associated with IDDM, Addison’s, or pernicious anaemia.

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10
Q

What may occur in the acute phase of Hashimoto’s thyroiditis?

A

Hashimoto’s thyroiditis may cause transient thyrotoxicosis in the acute phase.

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11
Q

What are other causes of primary hypothyroidism?

A

Other causes include subacute thyroiditis (de Quervain’s), Riedel thyroiditis, after thyroidectomy or radioiodine treatment, drug therapy (e.g. lithium, amiodarone, or anti-thyroid drugs such as carbimazole), and dietary iodine deficiency.

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12
Q

What is secondary hypothyroidism?

A

Secondary hypothyroidism is rare and results from pituitary failure.

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13
Q

What are some conditions associated with secondary hypothyroidism?

A

Associated conditions include Down’s syndrome, Turner’s syndrome, and coeliac disease.

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14
Q

What are general features of hypothyroidism?

A

Weight gain, lethargy, cold intolerance.

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15
Q

What skin features are associated with hypothyroidism?

A

Dry (anhydrosis), cold, yellowish skin; non-pitting oedema (e.g. hands, face); dry, coarse scalp hair, loss of lateral aspect of eyebrows.

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16
Q

What gastrointestinal feature is common in hypothyroidism?

A

Constipation.

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17
Q

What gynaecological feature is associated with hypothyroidism?

A

Menorrhagia.

18
Q

What neurological features are seen in hypothyroidism?

A

Decreased deep tendon reflexes; carpal tunnel syndrome.

19
Q

What vocal feature may be noted in hypothyroidism?

A

A hoarse voice is also occasionally noted.

20
Q

What is the initial starting dose of levothyroxine for elderly patients and those with ischaemic heart disease?

A

The initial starting dose should be 25mcg od for patients with cardiac disease, severe hypothyroidism, or patients over 50 years. Other patients should be started on a dose of 50-100mcg od.

21
Q

When should thyroid function tests be checked after a change in thyroxine dose?

A

Thyroid function tests should be checked after 8-12 weeks.

22
Q

What is the therapeutic goal for TSH levels in hypothyroidism treatment?

A

The therapeutic goal is ‘normalisation’ of the TSH level, preferably aiming for a TSH in the range of 0.5-2.5 mU/l.

23
Q

How should the levothyroxine dose be adjusted for women with established hypothyroidism who become pregnant?

A

The dose should be increased by at least 25-50 micrograms due to the increased demands of pregnancy, with careful monitoring of TSH aiming for a low-normal value.

24
Q

Is there evidence to support combination therapy with levothyroxine and liothyronine?

A

There is no evidence to support combination therapy with levothyroxine and liothyronine.

25
Q

What are the side effects of thyroxine therapy?

A

Side effects include hyperthyroidism due to over-treatment, reduced bone mineral density, worsening of angina, and atrial fibrillation.

26
Q

What substances can interact with levothyroxine absorption?

A

Iron and calcium carbonate can reduce the absorption of levothyroxine; they should be given at least 4 hours apart.

27
Q

What is subacute thyroiditis also known as?

A

Subacute thyroiditis is also known as De Quervain’s thyroiditis and subacute granulomatous thyroiditis.

28
Q

What typically triggers subacute thyroiditis?

A

Subacute thyroiditis is thought to occur following a viral infection.

29
Q

What is the typical initial presentation of subacute thyroiditis?

A

It typically presents with hyperthyroidism.

30
Q

What are the four phases of subacute thyroiditis?

A
  1. Phase 1 (3-6 weeks): hyperthyroidism, painful goitre, raised ESR.
  2. Phase 2 (1-3 weeks): euthyroid.
  3. Phase 3 (weeks - months): hypothyroidism.
  4. Phase 4: thyroid structure and function returns to normal.
31
Q

What does thyroid scintigraphy reveal in subacute thyroiditis?

A

Thyroid scintigraphy shows globally reduced uptake of iodine-131.

32
Q

What is the management approach for subacute thyroiditis?

A

Management is usually self-limiting; most patients do not require treatment.

33
Q

How can thyroid pain be managed in subacute thyroiditis?

A

Thyroid pain may respond to aspirin or other NSAIDs.

34
Q

What treatment is used in more severe cases of subacute thyroiditis?

A

In more severe cases, steroids are used, particularly if hypothyroidism develops.

35
Q

What is subclinical hypothyroidism?

A

TSH raised but T3, T4 normal with no obvious symptoms.

36
Q

What is the risk of progressing to overt hypothyroidism?

A

The risk is 2-5% per year, higher in men.

37
Q

What increases the risk of progressing to overt hypothyroidism?

A

The presence of thyroid autoantibodies.

38
Q

Do all patients with subclinical hypothyroidism require treatment?

A

Not all patients require treatment; NICE has produced guidelines.

39
Q

What is the management for TSH > 10 mU/L?

A

Consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart.

40
Q

What is the management for TSH between 5.5 - 10 mU/L in patients < 65 years?

A

Consider offering a 6-month trial of levothyroxine if TSH is 5.5 - 10 mU/L on 2 separate occasions 3 months apart and there are symptoms of hypothyroidism.

41
Q

What is the management for older patients (especially over 80 years) with TSH between 5.5 - 10 mU/L?

A

Follow a ‘watch and wait’ strategy; if asymptomatic, observe and repeat thyroid function in 6 months.

Year 6 Endocrinology (27 decks)

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