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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
How does amiodarone cause hypothyroidism?
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
What is the management option of amiodarone induced hypothyroidism?
We administer levothyroxine and continue amiodarone
27
What is secondary hypothyroidism?
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
What are the six causes of secondary hypothyroidism?
Sheehan’s Syndrome Pituitary Adenoma Craniopharyngioma Coeliac Disease Down’s Syndrome Turner’s Syndrome
29
What is Sheehan's syndrome?
It is a condition in which there is life-threatening blood loss during childbirth – resulting in ischaemic necrosis of the pituitary gland
30
What is the most common cause of hypothyroidism in children?
Autoimmune Thyroiditis
31
What are the eleven clinical features of hypothyroidism?
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
What investigation is used to diagnose hypothyroidism?
Blood tests
33
What three blood results indicate primary hypothyroidism?
Decreased T3 Levels Decreased T4 Levels Increased TSH Levels
34
Explain the blood test results of primary hypothyroidism
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
What two additional blood results indicate primary hypothyroidism - related to Hashimoto's disease?
Anti-TPO Positive Anti-Tg Positive
36
What three blood results indicate secondary hypothyroidism?
Decreased T3 Levels Decreased T4 Levels Decreased TSH Levels
37
Explain the blood test results of secondary hypothyroidism
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
How do we manage hypothyroidism?
Levothyroxine
39
What is levothyroxine?
It is synthetic T4 hormone
40
What dose of levothyroxine do we administer in adults < 50 years old?
It is initiated on a dose of 50 – 100mcg once daily, with this dose slowly titrated until TSH levels are normalised
41
What dose of levothyroxine do we administer in adults > 50 years old OR cardiac disease OR severe hypothyroidism?
It is initiated on a dose of 25mcg once daily, with this dose slowly titrated until TSH levels are normalised
42
What is the single most important blood test used to assess response to levothyroxine?
TSH Levels
43
How often do we conduct TFT blood tests when individuals are administrated levothyroxine?
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
How often do we conduct TFT blood tests when individuals are administrated levothyroxine - and a change in dose occurs?
They are conducted every 8 -12 weeks
45
What are the four side effects of levothyroxine?
Hyperthyroidism Osteoporosis Angina Atrial fibrillation
46
What two drugs does levothyroxine interact with? What does this result in? How do we prevent this?
Iron Calcium carbonate Decreased absorption of levothyroxine We administer these drugs four hour apart
47
What two blood test results indicate poor compliance of levothyroxine? Explain
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
How do we adjust the levothyroxine dose when hypothyroid individuals become pregnant? Why?
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
How often do we conduct blood tests in hypothyroid pregnant patients?
4 times weekly, until they are 20 weeks
50
How do we adjust the levothyroxine dose once hypothyroid individuals have given birth?
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
What is a complication of hypothyroidism?
Myxoedema Coma
52
What is myxoedema coma?
It is defined as a is a rare life-threatening complication of hypothyroidism
53
What are the eight clinical features of myxoedema comas?
Hypothermia Bradycardia Hyporeflexia Seizures Thin, Brittle Hair Perioribtal Oedema Confusion Coma
54
What are the four management options of myxoedema coma?
IV Thyroid Replacement IV Fluids IV Corticosteroids Electrolyte Imbalance Correction
55
What is subclinical hypothyroidism?
It is defined as a condition in which TSH levels are elevated, however the free serum thyroxine and triiodothyronine levels are normal
56
What is the pathophysiological cause of subclinical hypothyroidism?
The thyroxine hormone levels are at the lower range of normal, resulting in an increased secretion of TSH to suppress this
57
How do we manage subclinical hypothyroidism in individuals with a TSH > 10?
We consider administration of levothyroxine
58
How do we manage subclinical hypothyroidism in symptomatic individuals with a TSH between 5.5 - 10?
We consider a trial of levothyroxine for a period of six months
59
How do we manage subclinical hypothyroidism in asymptomatic individuals with a TSH between 5.5 - 10?
We observe and repeat thyroid function in six months
60
What are the four clinical features of congenital hypothyroidism?
Hypotonia Macroglossia Puffy face Neonatal jaundice

Year Two - Endocrine System (17 decks)

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