Hypothyroidism

Question 1

What are the symptoms of Hypothyroidism?

Answer 1

Wt gain
Lethargy
Cold intolerance
Decreased appetite
Constipation
Low mood
Menorrhagia

Question 2

What are the signs of Hypothyroidism?

Answer 2

Dry skin + hair
Reduced reflexes
Bradycardia
Cold hands
Ascites
May have a goitre
Myxoedema (SC tissue swelling around eyes and dorsum of hand)

Question 3

What are some of the causes of Hypothyroidism?

Answer 3

Hashimoto's disease
Atrophic thyroiditis
Thyroid agenesis
Iodine deficiency
Iatrogenic - Carbimazole, Thyroidectomy, Radioactive iodine

Question 4

What is the pathophysiology of Atrophic thyroiditis?

Answer 4

Thyroid antibodies - anti TSH, anti TPO
Lymphocytic infiltrate causes atropy (no goitre)
Associated with Pernicious anaemia, vitiligo

Question 5

What is the pathophysiology of Hashimoto’s disease?

Answer 5

Antibodies cause atrophy of thyroid
Regeneration occurs causing a goitre
High TSH, low T3/T4
High MCV, may have normocytic anaemia

Question 6

How do you treat Hypothyroidism?

Answer 6

Levothyroxine - titrated to normalise TSH

Check for other autoimmune disorders eg Addisons

Question 7

What is a Myxoedema coma/crisis?

Answer 7

Severe hypothyroidism with physiological decompensation
Usually patients who have had undiagnosed hypothyroidism for several years
Precipitated by stress or infection eg MI, Stroke

Question 8

What is the management of Myxoedema coma/crisis?

Answer 8

Bloods - TFTs, FBC, U+Es, Glucose, Cortisol
T3/T4 IV slowly (as may precipitate myocardial ischaemia)
100mg Hydrocortisone IV