Hypothyroidism/hyperthyroidism

Question 1

Chronic thyroiditis (Hashimotos thyroiditis)
Iodine deficiency
-goitrous or non-goitrous?

Answer 1

Goitrous

primary hypothyroidism

Question 2

Hashimotos thyroiditis histology?

Answer 2

Presence of thyroid peroxidase antibodies (in blood)

T-cell infiltrate and inflammation of microscopy

Question 3

Atrophic thyroiditis?

Answer 3

Non-goitrous

Primary hypothyroidism

Question 4

Skin condition associated with hypothyroidism?

Answer 4

Vitiligo

Question 5

What is the skin and face like in hypothyroidism?

Answer 5

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

Question 6

Cardiac signs of hypothyroidism?

Answer 6

Reduced heart rate
Cardiac dilatation
Pericardial effusion
Worsening of heart failure

Question 7

Respiratory signs of hypothyroidism?

Answer 7

Deep hoarse voice
Macroglossia
Obstructive sleep apnoea

Question 8

Tendon jerks in hypothyroidism?

Answer 8

Prolongation of tendon jerks

Question 9

Neurology/CNS signs of hypothyroidism?

Answer 9

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

Question 10

TRH effect on prolactin?

Answer 10

Hyperprolactinaemia - ↑ TRH causes ↑ prolactin secretion

Menorrhagia
Later oligo- or amenorrhoea

Question 11

Thyroxine dose for younger patients?

Answer 11

Younger patients: start thyroxine at 50-100 μg daily

Question 12

Thyroxine for older patients? (elderly)

Answer 12

In the elderly with a history of IHD: start thryroxine at 25-50 μg daily, adjusted every 4 weeks according to response

Question 13

When should you check TSH after you have changed the dose?

Answer 13

Check TSH 2 months after any dose change

Once stabilised, TSH should be checked every 12-18 months

Question 14

How do you monitor primary hypothyroidism treatment success?

Answer 14

Monitor using TSH levels

Question 15

How do you monitor secondary hypothyroidism treatment success?

Answer 15

Monitor using T4 levels

Question 16

Myxoedema coma findings?

Answer 16

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

Question 17

Treatment for myxoedema coma?

Answer 17

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

Question 18

Amiodarone?

Answer 18

Amiodarone induced thyroid dysfunction!! Can cause hyper AND hypothyroidism

Question 19

Amiodarone induced hypothyroidism and iodine uptake?

Answer 19

Common in areas with high iodine uptake

Question 20

Goitre in Grave’s disease?

Answer 20

Smooth symmetrical goitre