Hypothyroidism Amboss Style

Question 1

The most common cause of hypothyroidism in iodine-sufficient regions

Answer 1

Primary hypothyroidism Hashimoto thyroiditis

Question 2

Associated with HLA-DR3 and other autoimmune diseases (e.g., vitiligo, pernicious anemia, type 1 diabetes mellitus, and systemic lupus erythematosus)

Answer 2

Hashimoto thyroiditis

Question 3

A transient and self-resolving patchy inflammation of the thyroid gland that is associated with granuloma formation. Often occurs after a viral upper respiratory infection and is more common among women. The clinical course is typically triphasic, beginning with hyperthyroidism, followed by hypothyroidism, and finally a return to the euthyroid state. Classically presents with tender goiter, elevated ESR, and jaw pain.

Answer 3

De Quervain thyroiditis

Question 4

A lymphocytic thyroiditis that typically occurs 1-12 months after delivery and manifests with a period of transient thyrotoxicosis followed by hypothyroidism without thyroid enlargement or tenderness. Histologically characterized by lymphocytic infiltration and formation of germinal centers. Usually resolves spontaneously.

Answer 4

Postpartum thyroiditis

Question 5

occurs in IgG4-related systemic disease

Answer 5

Riedel thyroiditis

Question 6

Wolff-Chaikoff effect

Answer 6

A transient decrease in the production of thyroid hormones following the ingestion of a large amount of iodine.

Question 7

Secondary hypothyroidism

Answer 7

Secondary hypothyroidism: pituitary disorders (e.g., pituitary adenoma) → TSH deficiency

Question 8

Tertiary hypothyroidism

Answer 8

hypothalamic disorders → TRH deficiency

Question 9

Etiology Hashimoto thyroiditis

Answer 9

Autoimmune thyroiditis
Associated with HLA-DR3

Question 10

Anti-TPO and TgAb

Answer 10

Hashimoto thyroiditis

Question 11

Pathology findings Hashimoto thyroiditis

Answer 11

Lymphocytic infiltration with germinal centers and oncocytic-metaplastic cells (Hurthle cells)

Question 12

Multinucleated giant cells and granuloma formation

Answer 12

Pathology findings Subacute granulomatous thyroiditis (De Quervain)

Question 13

Dense and white fibrotic tissue
Inflammatory infiltrate

Answer 13

Riedel thyroiditis

Question 14

___________peripheral (thyroid) disorders → T3/T4 are not produced (↓ levels) → compensatory ↑ TSH

Answer 14

Primary hypothyroidism:

Question 15

_________pituitary disorders → ↓ TSH levels → ↓ T3/T4 levels

Answer 15

Secondary hypothyroidism:

Question 16

hypothalamic disorders → ↓ TRH levels → ↓ TSH levels → ↓ T3/T4 levels

Answer 16

Tertiary hypothyroidism:

Question 17

Effects of hypothyroidism Decreased sympathetic activity leads to:

Answer 17

Decreased sweating
Cold skin (due to decreased blood flow)
Constipation (due to decreased gastrointestinal motility)
Bradycardia

Question 18

Hyperprolactinemia

Answer 18

↑ prolactin production is stimulated by TRH → suppression of LH, FSH, GnRH, and testosterone and stimulation of breast tissue growth

Question 19

Myxedema: due to accumulation of ________________within the reticular layer of the dermis

Answer 19

glycosaminoglycans and hyaluronic acid

Question 20

Subclinical hypothyroidism levels

Answer 20

TSH Mildly ↑
FT4 Normal
FT3 Normal

Question 21

Euthyroid sick syndrome levels

Answer 21

TSH normal
FT4 dec free T3 and rT3 inc
FT3 dec

Question 22

Hypothyroidism is treated with lifelong hormone substitution____

Answer 22

Levothyroxine
Liothyronine

Question 23

First-line choice for the treatment of hypothyroidism

Answer 23

Levothyroxine: synthetic form of T4

Question 24

MOA Levothyroxine

Answer 24

Peripherally converted to T3 (biologically active metabolite) and rT3 (biologically inactive metabolite)

Question 25

T3 Part of the treatment for myxedema coma

Answer 25

Levothyroxine

Question 26

Long-term therapy considerations

Answer 26

Side effects: Overtreatment can lead to symptoms of thyrotoxicosis. Sweating, heat intolerance, tremors Tachycardia, palpitations, arrhythmias Weight loss, osteoporosis

Question 27

Exogenous thyrotoxicosis lev3el

Answer 27

Low/undetectable TSH High levels of T4 and/or T3

Question 28

Complications

Answer 28

Myxedema coma CVS risk inc Carpal tunnel Primary thyroid lymphoma

Question 29

Congenital hypothyroidism is called

Answer 29

Cretinism

Question 30

What are the 7 P's of congenital hypothyroidism

Answer 30

The 7 P's of congenital hypothyroidism are Pot-bellied, Pale, Puffy-faced, Protruding umbilicus, Protuberant tongue, Poor brain development, and Prolonged neonatal jaundice