Hypothyroidism/hyperthyroidism Flashcards
Chronic thyroiditis (Hashimotos thyroiditis) Iodine deficiency -goitrous or non-goitrous?
Goitrous
primary hypothyroidism
Hashimotos thyroiditis histology?
Presence of thyroid peroxidase antibodies (in blood)
T-cell infiltrate and inflammation of microscopy
Atrophic thyroiditis?
Non-goitrous
Primary hypothyroidism
Skin condition associated with hypothyroidism?
Vitiligo
What is the skin and face like in hypothyroidism?
Coarse, sparse hair Dull expressionless face Periorbital puffiness Pale cool skin that feels doughy to touch Vitiligo may be present Hypercarotenaemia Fluid Retention: Pitting oedema
Cardiac signs of hypothyroidism?
Reduced heart rate
Cardiac dilatation
Pericardial effusion
Worsening of heart failure
Respiratory signs of hypothyroidism?
Deep hoarse voice
Macroglossia
Obstructive sleep apnoea
Tendon jerks in hypothyroidism?
Prolongation of tendon jerks
Neurology/CNS signs of hypothyroidism?
Carpal Tunnel Syndrome
(Cerebellar Ataxia, Encephalopathy)
Decreased Visual Acuity
Decreased intellectual and motor activities Depression, psychosis, neuro-psychiatruc Muscle stiffness, cramps Peripheral Neuropathy Prolongation of the tendon jerks
TRH effect on prolactin?
Hyperprolactinaemia - ↑ TRH causes ↑ prolactin secretion
Menorrhagia
Later oligo- or amenorrhoea
Thyroxine dose for younger patients?
Younger patients: start thyroxine at 50-100 μg daily
Thyroxine for older patients? (elderly)
In the elderly with a history of IHD: start thryroxine at 25-50 μg daily, adjusted every 4 weeks according to response
When should you check TSH after you have changed the dose?
Check TSH 2 months after any dose change
Once stabilised, TSH should be checked every 12-18 months
How do you monitor primary hypothyroidism treatment success?
Monitor using TSH levels
How do you monitor secondary hypothyroidism treatment success?
Monitor using T4 levels
Myxoedema coma findings?
ECG: bradycardia, low voltage complexes, varying degrees of heart block, T wave inversion, prolongation of the QT interval
Type 2 respiratory failure: hypoxia, hypercarbia, respiratory acidosis
Co-existing adrenal failure is present in 10% of patients
Hypothermia is usually present In myxedema crisis
Hypotension/shock
Standard hypothyroid signs
etc
Treatment for myxoedema coma?
Intensive care A, B, C
Passively rewarm: aim for a slow rise in body temperature
Cardiac monitoring for arrhythmias
Monitor blood pressure, CVP, oxygenation, urine output, blood glucose levels
Fluids/ fluid restrict/ electrolyte balance
Broad Spectrum Antibiotics
Thyroxine cautious (hydrocortisone
Amiodarone?
Amiodarone induced thyroid dysfunction!! Can cause hyper AND hypothyroidism
Amiodarone induced hypothyroidism and iodine uptake?
Common in areas with high iodine uptake
Goitre in Grave’s disease?
Smooth symmetrical goitre
