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Endocrinology > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

Where does primary hypothyroidism arise from?

A

Thyroid gland itself

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2
Q

What are the three classifications of primary hypothyroidism?

A

Goiterous
Non-goiterous
Self limiting

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3
Q

What can cause a goiterous primary hypothyroidism?

A

Hashimoto’s thyroiditis
Iodine deficiency
Maternally transmitted anti thyroid agent
Drug induced

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4
Q

What is Hashitmoto’s thyroiditis?

A

Autoimmune disease
destruction of thyroid gland
chronic inflammation

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5
Q

What is the etiology of Hashimoto’s?

A

F>M

FHx AID

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6
Q

What auto antibodies are involved in Hashimoto’s?

A

Anti TPA (thyroid peroxidase antibodies)

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7
Q

What can be seen on miscroscopy of Hashimoto’s?

A

T cells and inflammation

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8
Q

What drugs can cause a goiterous primary hypothyroidism?

A

Amiodarone
Lithium
IL-2
IFN alpha

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9
Q

What are the causes of a non goiterous primary hypothyroidism?

A

Post radiation
Atrophic thyroiditis
Post ablative/surgey
Congenital

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10
Q

What are the self limiting causes of primary hypothyroidism?

A

Withdrawal of thyroid suppressive therapy
Post partum thyroiditis
Subacute/chronic with transient hypothyroid

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11
Q

Where are the sites of secondary hypothyroidism?

A

Hypothalamus

Pituitary

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12
Q

What hypothalamic causes of secondary hypothyroidism are there?

A

infection eg encephalitis
infiltration eg sarcoidosis
neoplasm eg craniopharyngioma
congenital

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13
Q

What pituitary causes of secondary hypothyroidism are there?

A 
panhypopituitarism
TSH deficiency
infection
infiltration
neoplasm 
trauma
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14
Q

What laboratory tests can be used to show hypothyroidism?

A 
Raised TSH
Low fT4
Low fT3
Raised CK
Raised LDL
Reduced Na+ (less renal tubule water loss)
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15
Q

What test needs to be done to rule out B12 deficiency?

A

Test for macrolytes

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16
Q

What are the hormone levels in

a) primary overt hypothyroidism?
b) primary subclinical hypothyroidism?
c) secondary hypothyroidism?

A

a) Raised TSH, Low fT4, Low fT3
b) Raised TSH, normal fT4, normal fT3
c) Low/normal TSH, low fT4, normal/low fT3

17
Q

What are the hair and skin changes in hypothyroidism?

A 
Dry skin
Periorbital puffiness
Pale, cold, doughy skin
Coarse, sparse hair
Pitting oedema (fluid retention)
18
Q

What are the thermogenesis changes in hypothyroidism?

A

Cold intolerance

19
Q

What are the cardiac changes in hypothyroidism?

A

Bradycardia
Cardiac dilatation
worsening heart failure
pericardial effusion

20
Q

What are the gynaecological changes in hypothyroidism?

A

Menorraghia (heavy periods)

may lead to oligio or amenorrhoea

21
Q

What are the changes to the metabolic rate in hypothyroidism?

A

Increased appetite
Weight gain
hyperlipidaemia

22
Q

What are the GI changes in hypothyroidism?

A

constipation
megacolon
obsruction
ascites

23
Q

What are the repiratory changes in hypothyroidism?

A

deep hoarse voice

obstructive sleep apnoea

24
Q

What antibodies are found in autoimmune hypothyroidism?

A 
Anti TPO (90%)
Anti TSH receptor (10-20%) blocking effect
Anti Thyroglobulin (60%)
25
Q

How can you treat hypothyroidism?

A

Thyroxine
50-100 ug in young
25-50 ug in elderly
Take before breakfast (food often changes pH)

26
Q

How does treatment for hypothyroidism need monitored?

A

adjust every 4 weeks according to response
check TSH levels every 2 months after a dose change
once stable check TSH every 12 months

27
Q

How does rapid restoration of metabolic rate affect patient?

A

May percipatate arrythmias

28
Q

What changes to thyroxine dose need to be considered in pregnancy?

A

May need to increase dose

29
Q

What is myxoedema in the context of hypothyroidism?

A

Very severe hypothyroidism

Can lead to myxoedema coma

30
Q

What are the signs of myxoedema in a) adult

b) baby/child

A

a) puffy face, hands, feet

b) cretinism: dwarf, limited mental functioning

31
Q

What is the etiology of a myxoedema coma?

A

Elderly women

undiagnosed/untreated hypothyroidism

32
Q

What are the ECG findings in a myxoedema coma?

A

Bradycardia
pronlonged QT
Low voltage complexes
Maybe heart block

33
Q

What are the respiratory effects in a myxoedema coma?

A

Thype 2 repiratory failure
hypercabia
hypoxia
respiratory acidosis

34
Q

What happens to the adrenals in myxoedema coma?

A

co existing failure of adrenals

35
Q

What is the treatment for a myxoedema coma?

A 
intensive care
ABCDE
passively rewarm
monitor: ECG, BP, urine output, Sp02
Fluids, electrolytes
Broad spectrum antibiotics
36
Q

Why does special care have to be taken when perscribing amiodarone?

A

causes thyrotoxicosis in low iodine areas

hypothyroidism in iodine overdose

37
Q

How is management of hyothyroidism changed in pregancy?

A

increase thyroxine my 25mcg as soon as pregnancy suspected
check TFTs monthly for 20weeks then 2 monthly until term
average dose increase is by 50%
aim for TSH

38
Q

What are the risks of untreated hypothyroidism in pregnancy?

A 
abortion
preeclampsia
abruption
postpartum hge
preterm labour
39
Q

How does gestational hCG associated thyrotoxicosis happen?

A

hyperemesis gravidarum(high hCG, low TSH)
resolves in 20wks
(only treat if persists past this)

Endocrinology (17 decks)

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