Hypothyroidism

Question 1

Untreated can lead to

Answer 1

Dementia

Heart disease

Question 2

onset is insidious/acute

Answer 2

insidious

Question 3

Oedema =pitting/non-pitting

Answer 3

non-pitting (doenst respond to diuretics)

Question 4

TFTs you request

Answer 4

T4 and TSH (not t3)

Question 5

Name the primary autoimmune hypothyroidisms (2)

Answer 5

Hashimotos (goitre due to lymphocytic/plasma infiltrate)
Primary atrophic (lymphocytic causing atrophy - no goitre)

Question 6

Hashimotos pathophysiology

Answer 6

Autoanitbodies vs receptor/enzymes/TBG

Question 7

What is Hashitoxicosis

Answer 7

Rare intital period of hyperthyroidism

Question 8

World-wide chief cause of hypothyroidism

Answer 8

iodine deficieny

Question 9

Explain sub-acute hypothyroidism (not sub-clinical)

Answer 9

Temporary hypo after period of hyper

Question 10

MOA of Amiodarone.

Answer 10

class III antiarrhythmic agent, and prolongs phase 3 of the cardiac action potential

1) Structurally like t4, inhibits t4 release =hypo
2) Destructive thyroiditis = release of hormones = hyper

Tx - if amiodarone cannot be stopped = -ectomy

check tfts 6 monthly

Question 11

GI tract signs?

Answer 11

Ileus/immobile (=constipation)

Question 12

Associated with POEMS syndrome. What is poems? (rare)

Answer 12

Polyneuropathy
Organomegaly
Endrocrinopathy
M-protein band
Skin pigmentation

Question 13

Effect on pregnancy?

Answer 13

Eclampsia, low birth weight, still birth etc

Question 14

Tx of Hypothyroidism (young and old)

Answer 14

Young: 50-100 microg/24hrs LEVOTHYROXINE (adjust according to tfts - normalise TSH)

OLD: 24micog/24hrs and build up according to TSH

Question 15

MOA levothyroxine

Answer 15

synthetic thyroid hormone that is chemically identical to thyroxine (T4)