Hypothyroidism

Question 1

What are the symptoms of hypothyroidism?

Answer 1

Lethargic, sleepy, low mood, weight gain, constipation, menorrhagia, intolerant to the cold, myalgia, weakness, muscle cramps, low cognition/memory, dementia, hoarse voice

Question 2

What are the signs of hypothyroidism? (BRADYCARDIC)

Answer 2

Bradycardia 
Reflexes relax slowly
Ataxia
Dry thin hair/skin
Yawning/drowsy/coma
Cold hands +/- decrease in general temperature 
Ascites +/- non-pitting oedema of the hands, feet, lids; pericardial and pleural effusions
Round puffy face/double chin/obese
Defeated demeanour
Immobile +/- ileus
CCF
Others: neuropathy, myopathy, goitre

Question 3

Describe the diagnosis of hypothyroidism

Answer 3

High TSH, low T4
Rare secondary (TSH normal/low, T4 low)
High cholesterol and triglycerides
Macrocytosis

Question 4

What are the causes of hypothyroidism?

Answer 4

Primary autoimmune
- Primary atrophic hypothyroidism (diffuse lymphocytic infiltration into the thyroid gland causing atrophy, hence no goitre)
- Hashimoto’s thyroiditis (goitre caused by lymphocytic and plasma cell infiltration, women 60-70, high Ab titres)
Other
- iodine deficiency (worldwide chief cause)
- post thyroidectomy/radio iodine treatment
- drug-induced (antithyroid, amiodarone, lithium, iodine)
- subacute thyroiditis
Secondary hypothyroidism e.g. hypopituitaism (rare)

Question 5

What is the treatment for hypothyroidism?

Answer 5

Levothyroxine