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Endocrinology > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

What is another word for hypothyroidism?

A

myxoedema

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2
Q

What gender is it more common in?

A

females (5-10 times)

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3
Q

What are the causes of hypothyroidism?

A
  1. Iodine deficiency (chief worldwide cause)

2. Autoimmune - atrophic, Hashimoto’s thyroiditis

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4
Q

What is autoimmune HT associated w?

A

other autoimmune diseases e.g. DMT1, Addison’s, pernicious anaemia

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5
Q

What conditions is hypothyroidism associated w in general?

A

Turner’s
Downs
CF
PBC

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6
Q

Explain the pathophysiology behind primary atrophic HT

A

Anti-thyroid autoabs lead to lymphoid infiltration of the gland and eventual atrophy and fibrosis

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7
Q

How would u differentiate between primary atrophic HT and Hashimotos thyroiditis?

A

Atrophic - NO GOITRE

Hashimotos - GOITRE (lymphocytic + plasma cell infiltration)

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8
Q

Explain the pathophysiology behind hashimotos

A

thyroid peridoxase abs present in HIGH titres (enzyme needed for production + storage of thyroid hormone)

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9
Q

What age Is usually affected in hashimotos?

A

60-70

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10
Q

What is postpartum thyroiditis?what can it be mistaken as? what test would u do to differentiate?

A
  1. transient phenomenon after pregnancy
    can cause hyper or hypothyroidism (or both sequentially)
    Normally self-limiting, when abs are found - high chance of permanent
  2. Postpartum depression
  3. Do TFTs
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11
Q

What are iatrogenic causes of HT?

A

Thyroidectomy - rx of hyperthyroidism or goitre

Radioactive iodine rx or external neck irradiation for head + neck cancer

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12
Q

What drugs can cause HT?

A
  1. Carbimazole
  2. Lithium
  3. Amiodarone
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13
Q

What are the sx ?

A
  • Hoarse voice
  • Goitre
  • Constipation
  • Cold intolerant
  • Weight gain
  • Menorrhagia
  • Myalgia, weakness
  • Tired, low mood, dementia
  • Myxoedema
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14
Q

What is myxoedema?

A

deposition of mucopolysaccharides in the dermis resulting in swelling of the affected area

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15
Q

What are the signs?

A 
BRADYCARDIC:
Bradycardia
Reflexes relax slowly
Ataxia
Dry, thin hair/skin
Yawning/drowsy/coma
Cold hands +/- temp drop
Ascites 
Round puffy face 
Defeated demeanour 
Immobile +/- ileus
CCF
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16
Q

How may children present ?

A

slow growth
poor school performance
arrest in puberty

17
Q

How can young women present?

A 
may have oligomenorrhoea
amenorrhoea
menorrhagia
infertility 
hyperprolactinaemia
18
Q

How would u test? What is diagnostic of hypothyroid state

A
  1. TFTs - high TSH, serum free T4 low - DIAGNOSTIC
  2. Thyroid abs + organ specific abs e.g. TPO-Ab in Hashimotos
  3. FBC - normochromic
    normocytic
  4. Hypercholesterolaemia
19
Q

What is the treatment?

A

ORAL LEVOTHYROXINE (T4)

20
Q

How is treatment monitored?

A

titrate until TSH normalises

Check T4 levels 6-8 weeks after dose adjustment

21
Q

When should a lower dose of treatment be given?

A

in those w CAD - can exacerbate angina or MI

elderly

22
Q

What medication is known to cause hypothyroidism? what is the management?

A

amiodarone - iodine-rich, can inhibit T4 release

rx: stop amiodarone, glucocorticoids, thyroidectomy if drug can’t be discontinued

23
Q

What is the main hypothyroid emergency?

A

myxoedema coma

24
Q

what can precipitate myxoedema coma?

A

infection
MI
stroke
trauma

25
Q

What are the signs + sx of myxoedema coma?

A 
Looks hypothyroid 
Hypothermia
Hypoglycaemia 
Bradycardia
Coma  (psychosis may precede)
Seizures 
usually >65yrs
26
Q

What can u find on examination in myxoedema coma?

A

Goitre
Cyanosis
HF
Signs of precipitants

27
Q

What is Rx of myxoedema coma?

A

IV T3 (liothyronine) slowly 5-20mcg/12hrs
Correct hypoglycaemia
IV hydrocortisone if pituitary cause suspected
Active warming

28
Q

When would u suspect a thyroid cause of myxoedema coma?

A

goitre
previous radio iodine
prev thyroid surgery

29
Q

What is involved in further r xox myxoedema coma?

A

T3 until sustained improvement then levothyroxine

Hydrocortisone + IV fluids as needed

30
Q

T3 + T4 which is converted to which and which is the active form used by cells?

A

T4 -> T3, T4 is secreted in larger amounts than T3 but T3 is active form

Endocrinology (21 decks)

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