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Year Two - Endocrine System > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

What is hypothyroidism?

A

It is is defined as a condition in which there is inadequate output of thyroid hormones by the thyroid gland

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2
Q

What are the two classifications of hypothyroidism?

A

Primary Hypothyroidism

Secondary Hypothyroidism

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3
Q

What is primary hypothyroidism?

A

It is defined as hypothyroidism resulting from a dysfunction within the thyroid gland

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4
Q

What are the six causes of primary hypothyroidism?

A

Hashimoto’s Thyroiditis

Riedel Thyroiditis

De Quervain’s Thyroiditis

Iodine Deficiency

Drug Administration

Thyroidectomy

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5
Q

What is the most common cause of primary hypothyroidism in the developed world?

A

Hashimoto’s thyroititis

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6
Q

What is Hashimoto’s thyroiditis?

A

It is defined as autoimmune inflammation of the thyroid gland due to the production of antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibodies against thyroid epithelial cells

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7
Q

What does Hashimoto’s thyroiditis cause acutely?

A

Transient hyperthyroidism

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8
Q

What are the three other autoimmune conditions Hashimoto’s thyroiditis is associated with?

A

Coeliac Disease

Type One Diabetes Mellitus

Vitiligo

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9
Q

What complication is associated with Hashimoto’s thyroiditis?

A

MALT lymphoma

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10
Q

What is Riedel thyroiditis?

A

It is a condition in which fibrous tissue replaces normal thyroid parenchyma

This results in the formation of painless goitre

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11
Q

What is another term for De Quervain’s thyroiditis?

A

Subacute thyroiditis

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12
Q

What is De Quervain’s thyroiditis?

A

It is a painful swelling of the thyroid gland thought to be triggered by a viral infection

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13
Q

How many phases of De Quervain’s thyroiditis are there?

A

Four

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14
Q

What is the first phase of De Quervain’s thyroiditis? How long does it last for?

A

It results in hyperthyroidism, painful goitre and raised ESR

3 - 6 weeks

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15
Q

What is the second phase of De Quervain’s thyroiditis? How long does it last for?

A

Euthyroid

1 -3 weeks

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16
Q

What is the third phase of De Quervain’s thyroiditis? How long does it last for?

A

Hypothyroidism

Weeks to months

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17
Q

What is the fourth phase of De Quervain’s thyroiditis?

A

It results in a normal thyroid structure and function

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18
Q

How do we manage hypothyroidism related to De Quervain’s thyroiditis?

A

It is a self-limiting condition, which can be managed with NSAIDs for symptomatic relief

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19
Q

How do we manage severe De Quervain’s thyroiditis?

A

Corticosteroids

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20
Q

What is the most common cause of primary hypothyroidism in the developing world?

A

Iodine deficiency

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21
Q

What are the two causes of iodine deficiency?

A

Decreased dietary consumption

Radioiodine treatment

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22
Q

What are the three drugs which are associated with hypothyroidism?

A

Anti-thyroid drugs

Lithium

Amiodarone

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23
Q

Name two anti-thyroid drugs

A

Carbimazole

Propylthiouracil

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24
Q

How does lithium cause hypothyroidism?

A

It inhibits the production of thyroid hormones in the thyroid gland

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25
Q

How does amiodarone cause hypothyroidism?

A

It is due to the high iodine content of amiodarone causing a Wolff-Chaikoff effect.

This an autoregulatory phenomenon where thyroxine formation is inhibited due to high levels of circulating iodide

26
Q

What is the management option of amiodarone induced hypothyroidism?

A

We administer levothyroxine and continue amiodarone

27
Q

What is secondary hypothyroidism?

A

It is defined as hypothyroidism resulting from a dysfunction within the pituitary gland – a gland which regulates the thyroid gland

Specifically, the pituitary gland is unable to produce enough TSH

28
Q

What are the six causes of secondary hypothyroidism?

A

Sheehan’s Syndrome

Pituitary Adenoma

Craniopharyngioma

Coeliac Disease

Down’s Syndrome

Turner’s Syndrome

29
Q

What is Sheehan’s syndrome?

A

It is a condition in which there is life-threatening blood loss during childbirth – resulting in ischaemic necrosis of the pituitary gland

30
Q

What is the most common cause of hypothyroidism in children?

A

Autoimmune Thyroiditis

31
Q

What are the eleven clinical features of hypothyroidism?

A

Weight Gain

Fatigue

Cold Intolerance

Anhidrosis, Yellow Skin

Non-Pitting Oedema

Dry Coarse Scalp Hair

Voice Hoarseness

Decreased Deep Tendon Reflexes

Carpal Tunnel Syndrome

Constipation

Menorrhagia

32
Q

What investigation is used to diagnose hypothyroidism?

A

Blood tests

33
Q

What three blood results indicate primary hypothyroidism?

A

Decreased T3 Levels

Decreased T4 Levels

Increased TSH Levels

34
Q

Explain the blood test results of primary hypothyroidism

A

It is caused by thyroid gland dysfunction, therefore free T3 and T4 levels will be low

The TSH levels will be high due to the fact that there is no negative feedback inhibition on the pituitary to release these hormones

35
Q

What two additional blood results indicate primary hypothyroidism - related to Hashimoto’s disease?

A

Anti-TPO Positive

Anti-Tg Positive

36
Q

What three blood results indicate secondary hypothyroidism?

A

Decreased T3 Levels

Decreased T4 Levels

Decreased TSH Levels

37
Q

Explain the blood test results of secondary hypothyroidism

A

It is caused by pituitary gland dysfunction, therefore TSH levels will be low

The resulting effect is that free T3 and T4 levels will also be low

38
Q

How do we manage hypothyroidism?

A

Levothyroxine

39
Q

What is levothyroxine?

A

It is synthetic T4 hormone

40
Q

What dose of levothyroxine do we administer in adults < 50 years old?

A

It is initiated on a dose of 50 – 100mcg once daily, with this dose slowly titrated until TSH levels are normalised

41
Q

What dose of levothyroxine do we administer in adults > 50 years old OR cardiac disease OR severe hypothyroidism?

A

It is initiated on a dose of 25mcg once daily, with this dose slowly titrated until TSH levels are normalised

42
Q

What is the single most important blood test used to assess response to levothyroxine?

A

TSH Levels

43
Q

How often do we conduct TFT blood tests when individuals are administrated levothyroxine?

A

They are measured every three months until TSH levels are stable, with two similar measurements within the reference range three months apart

After this TSH levels can then be measured once a year

44
Q

How often do we conduct TFT blood tests when individuals are administrated levothyroxine - and a change in dose occurs?

A

They are conducted every 8 -12 weeks

45
Q

What are the four side effects of levothyroxine?

A

Hyperthyroidism

Osteoporosis

Angina

Atrial fibrillation

46
Q

What two drugs does levothyroxine interact with? What does this result in? How do we prevent this?

A

Iron

Calcium carbonate

Decreased absorption of levothyroxine

We administer these drugs four hour apart

47
Q

What two blood test results indicate poor compliance of levothyroxine? Explain

A

Increased TSH levels

Normal T4 Levels

The increased TSH levels implies that over recent days/weeks her body is thyroxine deficient

However, her free T4 is within normal range. This indicates that she started taking the thyroxine properly just before the blood test

This would correct the thyroxine level but the TSH takes longer to normalise

48
Q

How do we adjust the levothyroxine dose when hypothyroid individuals become pregnant? Why?

A

The dose should be increased by at least 25 – 50 mcg as early as 4 -6 weeks of pregnancy

This is due to the increased demands of pregnancy

49
Q

How often do we conduct blood tests in hypothyroid pregnant patients?

A

4 times weekly, until they are 20 weeks

50
Q

How do we adjust the levothyroxine dose once hypothyroid individuals have given birth?

A

We reduce their levothyroxine dosage to the pre-pregnancy dose two weeks following delivery

We then recheck that their levels are stable two to three months post pregnancy

51
Q

What is a complication of hypothyroidism?

A

Myxoedema Coma

52
Q

What is myxoedema coma?

A

It is defined as a is a rare life-threatening complication of hypothyroidism

53
Q

What are the eight clinical features of myxoedema comas?

A

Hypothermia

Bradycardia

Hyporeflexia

Seizures

Thin, Brittle Hair

Perioribtal Oedema

Confusion

Coma

54
Q

What are the four management options of myxoedema coma?

A

IV Thyroid Replacement

IV Fluids

IV Corticosteroids

Electrolyte Imbalance Correction

55
Q

What is subclinical hypothyroidism?

A

It is defined as a condition in which TSH levels are elevated, however the free serum thyroxine and triiodothyronine levels are normal

56
Q

What is the pathophysiological cause of subclinical hypothyroidism?

A

The thyroxine hormone levels are at the lower range of normal, resulting in an increased secretion of TSH to suppress this

57
Q

How do we manage subclinical hypothyroidism in individuals with a TSH > 10?

A

We consider administration of levothyroxine

58
Q

How do we manage subclinical hypothyroidism in symptomatic individuals with a TSH between 5.5 - 10?

A

We consider a trial of levothyroxine for a period of six months

59
Q

How do we manage subclinical hypothyroidism in asymptomatic individuals with a TSH between 5.5 - 10?

A

We observe and repeat thyroid function in six months

60
Q

What are the four clinical features of congenital hypothyroidism?

A

Hypotonia

Macroglossia

Puffy face

Neonatal jaundice

Year Two - Endocrine System (17 decks)

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