Hypothyroidism

Question 1

Define

Answer 1

Reduced production of T3 and T4 resulting in decreased metabolism and other symptoms

Question 2

Presenting symptoms (5)

Answer 2

Lethargy
cold intolerance
Decreased appetite
Weight gain
Decreased mood
Constipation
Menorrhagia

Question 3

Signs (4)

Answer 3

BRADYCARDIA
Cold hands
Slow reflexes
Myxoedema (only if severe hypo)

Question 4

Causes? (4)

Answer 4

Primary: Hashimotos, Atrophic thyroiditis, Iodine deficiency (I- is needed for the production of T3 and T4)
Secondary= hypopituitarism

Question 5

App Ix? Bloods

Answer 5

Bloods= TSH (elevated if primary hypo), T3/T4 (decreased), TPO Abs (positive), TSH Abs (positive)

Question 6

Mx

Answer 6

Levothyroxine w/ enzyme inducers to increase thyroxine metabolism and utilise the thyroxine

MAKE SURE LEVOTHYROXINE IS TITRATED TO THE RIGHT AMOUNT SO THAT TSH IS NOT SUPPRESSED

Question 7

Complications

Answer 7

myxoedema coma» hypothermia, hypoglycaemia, bradycardia, coma, heart failure

Question 8

Mx of myxoedema coma (5)

Answer 8

Oxygen
Rewarming
rehydration via IV fluids» try to increase blood volume and BP
IV T4/T3
IV hydrocortisone» to reduce subcut swelling

Question 9

What is atrophic thyroiditis?

Answer 9

There are anti TSH and TPO Abs that stop the production & release of T4/T3 and cause hypothyroidism

Question 10

What is hashimoto’s thyroiditis?

Answer 10

Anti TPO Abs

There is swelling of the neck due to a goitre» the thyroid is swollen due to the antibodies attacking

Question 11

Difference in presentation between hashimoto’s and atrophic thyroiditis?

Answer 11

Goitre in hashimotos

No goitre in atrophic thyroiditis

Question 12

Why is there no goitre in atrophic thyroiditis?

Answer 12

Because this is the end stage of the autoimmune attack on the thyroid so the gland has been destroyed

Question 13

what is Turner’s syndrome?

Answer 13

female missing one sex chromosome (45X)

Question 14

which of these indicates thyroid failure and which indicates pituitary failure?

a) high TSH, low T3/4
b) low TSH, low T3/4

Answer 14

a) thyroid failure

b) pituitary failure

Question 15

give 2 facial symptoms of hypothyroidism

Answer 15

face swelling

hair loss outer 1/3 of eyebrow

Question 16

give 2 complications of hypothyroidism in pregnancy

Answer 16

pre-eclampsia
low birth weight
premature birth

Question 17

What are the causes of thyroid nodules? (4)

Answer 17

cyst
thyroiditis 
tumour 
overgrowth of normal tissue 
Iodine deficiency

Question 18

how many of the population have palpable goitres?

a) 1%
b) 9%
c) 30%
d) 70%

Answer 18

b) 9%

Question 19

how can smoking cause a goitre

Answer 19

thiocyanate in cigarettes interferes with body’s use of iodine

Question 20

how many goitres are thyroid cancer?

a) 1 in 10
b) 1 in 20
c) 1 in 100
d) 1 in 200

Answer 20

b) 1 in 20

Question 21

give 5 differential diagnoses for goitre

Answer 21

pharyngeal pouch
tumour 
cyst 
submandibular stones 
carotid aneurysm/tortuous (pulsatile)