hypothyroidism

Question 1

etiology

Answer 1

• autoimmune: hashimoto’s most common
• iatrogenic: medication, RAI, surgery, neck radiation
• central: CNS tumor, sheehan’s, infiltrative disease
• thyroiditis: think postpartum, subacute painless,
• medications: lithium amiodarone, immun modulators

Question 2

diagnosis

Answer 2

-made by TSH + fT4

Question 3

symptoms for hypothyroid

ROS: constitutional, HEENT, pulm, CV, GI, GU, renal, heme, MSK, and derm

Answer 3

-constitutional: weight gain, fatigue, cold intolerance
-HEENT: periorbital edema, voice change
-pulm: sleep apnea
-CV: diastolic HTN, bradycardia, dyslipidemia
-GI: constipation
GU: decreased libido, mesntrual irregularities
-renal: hyponatremia
-heme: anemia
-MSK: myalgias, carpal tunnel syndrome
-derm: brittle nails, brow loss, dry skin, hair loss

Question 4

treatment

Answer 4

Primary: levothyroxine

Subclinical hypothyroidism:
-TSH >10, treat and age >70

Question 5

monitoring/prescribing

Answer 5

• 1.6ug/kg/d
• if CAD, start at 25-50ug and slowly uptitrate

administer 60 min prior to food and always 3-4h apart from Ca or Fe

monitor:

• recheck TSH in 8 weeks
• once at goal q6-q12mo