Hypothyroidism

Question 1

Symptoms and Signs of Hypothyroidism (Myxoedema)

BRADYCARDIC

Answer 1

B – bradycardic
R – reflexes slow 
A – Ataxia 
D – dry hair/skin 
Y – yawning/drowsy/coma
C – Cold hands/Cold intolerance  
A – ascites + non-pitting oedema 
R – round, puffy face/obese
D – Defeated demeanour 
I – Immobile 
C – CCF

Question 2

how do you diagnose primary and secondary hypothyroidism with regards to:

TSH
T4

primary or secondary more rare?

if you have a normal TSH do you have primary or secondary hypothyroidism?

Answer 2

primary hypothyroidism
TSH = high (above normal)
T4 = low

secondary hypothyroidism
TSH = low
T4 = low

secondary is rare

neither as TSH is very sensitive so DON’T give medication if TSH is normal

Question 3

an example of an autoimmune hypothyroidism?

Answer 3

Hashimoto’s

Question 4

chief cause of primary hypothyroidism

particularly common in which type of patients?

Answer 4

iodine deficiency

women and diabetics

Question 5

causes of secondary hypothyroidism?

Answer 5

pituitary disease

Question 6

What problems does hypothyroidism cause with pregnancy?

Answer 6

eclampsia
stillbirth
prematurity

Question 7

Tx of Hypothyroidism

1) what is the regimen for fit + healthy young patients?
2) what is the regimen for elderly and IHD patients?
3) what happens if you over-replace?
4) When increasing doses in either patient - ensuring TSH doesn’t drop below?

Answer 7

1) levothyroxine (upto 100mcg)
2) start with 25 mcg levothyroxine and increase dose every 4 weeks by 25 mcg
3) AF
4) 0.5