Hypothyroidism

Question 1

Prevalence of ?-?% in the general population.

Much more common in ?(10:1).

Answer 1

1-2%

females

Question 2

Common causes;
o Autoimmune.
—• ? thyroiditis: associated with a goitre.
————• ? common cause of hypothyroidism.
————• T-cell ? of the gland, plus B-cell secretion of ? TSH-receptor antibodies.
————• There is often an ? ? phase.
————• There is a ?, ? goitre.
—• ? thyroiditis: not associated with a goitre.
o Previous treatment for ?.

Answer 2

hashimotos
most
destruction
inhibitory
initial hyperthyroid
symmetrical
bosselated
atrophic
hyperthyroidism

Question 3

Less common causes;
o Drugs: ?, ? excess, ?.
o ? deficiency: most common cause worldwide.
o ?: often transient.
o Secondary causes;
---• ? disorders.
---• ? disorders.
Rare causes;
o Congenital agenesis / ? infiltration.

Answer 3

amiodarone
iodine
lithium
iodine
thyroiditis
hypothalamic
pituitary
neoplastic

Question 4

Symptoms;

?.
?/ Psychosis.
? intolerance.
Weight ?.
? (GI).
?.
? coma.
o Rare.

Answer 4

fatigue
depression
cold
gain
constipation
menorrhagia
myxoedema

Question 5

Signs;

? loss.
Loss of outer third of ?.
?.
? voice.
Goitre.
?-cardia.
? skin.
Hypo-?

Answer 5

hair
eyebrow
anaemia
hoarse
brady
dry
reflexia

Question 6

Investigations;

FBC: anaemia
o Macrocytic due to co-morbid ? anaemia.
o Microcytic due to ?

TFTs: ? TSH, ? free T4 in primary causes.
o Low TSH in ?/? disease, or ‘sick thyroid
syndrome’ due to non-? illness.

? antibodies: ? in Hashimoto’s.
?: can be raised due to hepatic hypothyroidism.
?: raised due to muscle hypothyroidism.

Answer 6

pernicious
menorrhagia
raised
low
pituitary/hypothalamic
thyroid
TPO
raised
cholesterol
CK

Question 7

Management;

? (L-T4).
o ? starting doses, titrated ? to clinical effect.
o Reassess every ?-? weeks, until ? is in the ? half of the reference range in primary disease.
• TSH unreliable if ? cause, titrate with ?levels and clinical ?

Answer 7

levo
low
up
4-6
tsh
lower
secondary
t4
symptoms

Question 8

Acute thyroiditis;
Relatively uncommon, but may follow an ?.
Presents with ? and ?, plus thyroid ? and tenderness.
Initially there are ? features as stored hormone is ?.
After this, the patient develops ?, which is usually ? but can occasionally be ?.

Answer 8

urti
fever
malaise
swelling
hyperthyroid
released
hypo
transient
permanent

Question 9

Acute thyroiditis;
There is classically ?/? uptake on ? scanning.
Treatment is with ? in the ? phase, and then ? analgesia.
Occasionally ? 30mg/day is used.

Answer 9

low/absent
technetium
propranolol
thyrotoxic
simple
prednisolone