Hypothyroidism

Question 1

What is the most common secondary cause of hypothyroidism?

Answer 1

• Radiotherapy or surgery for hypertyroidism

Question 2

What symptoms are seen in hypothyroidism?

Answer 2

• Depression
• Pyschosis
• Apathy
• Sleepiness
• Weight gain
• Deafness
• Dry skin
• Paraesthesia
• Constipation
• Menorrhagia
• Cold intolerance

Question 3

What are the signs of hypothyroidism?

Answer 3

• Thin, dry, lifeless hair
• Puffy face
• Thinned eyebrows (with loss of outer third)
• Goitre
• Bradycardia
• Pleural effusions
• Ascities
• Carpal tunnel syndrome
• Obesity
• Slow relaxing ankle reflexes

Question 4

What are the investigations carried out to diagnose and investigate hypothyroidism?

Answer 4

Serum thyroxine (decreased)
TSH (Increased in primary causes, normal or decreased in secondary causes)
FBC - associated with normocytic/macrocytic anaemia
If pt has stridor/other evidence of tracheal compression - radiograph of thoracic inlet and CT neck

Question 5

What is the management strategy for hypothyroidism?

Answer 5

• Replace with levothyroxine

Question 6

Why should caution be taken when giving levothyroxine?

Answer 6

Patients with longer history and more severe symptoms should be approached more cautiously with levothyroxine therapy as hypothyroidism can lead to hypercholesterolaemia and coronary artery disease. Speeding up metabolism and increasing demand with levothyroxine can precipitate MI and death.

Question 7

What is a serious complication of severe hypothyroidism?

Answer 7

Myxoedema coma - rare - caused by hypothyroidism.

Presents with coma and usually hypothermia