Hypothyroidism (Myxoedema) COPY Flashcards
What are symptoms of myxoedema?
Tiredness Sleepy Lethargic Low mood Cold intolerance Weight gain Constipation Mennhoragia Hoarse voice Reduced memory/cognition Demetnia Myalgia Cramps Weakness
What are signs of hypothyroidism?
BRADYCARDIC Reflexes relax slowly Ataxia (cerebellar) Dry thin hair/skin Yawning/drowsy/coma Cold hands Ascites± non-pitting oedema (lids, hands, feet) ± pericardial/pleural effusion Round puffy fact Defeated demeanour Immobile ± ileus CCF
Neuropathy, myopathy, goitre
How is myxoedema diagnosed?
TFT - raised TSH, low T4
In rare secondary hypothyroidism - low TSH, low T4 due to lack from pituitary
Macrocytosis
Raised liipids
What are causes of primary myxoedema?
Primary atrophic hypothyroidism - diffuse lymphocytic infiltration of the thyroid leading to atrophy
Hashimoto’s thyroiditis - goitre due to lymphocytes and plasma cell infiltration, autoimmune, may be hypothyroid or euthyroid, more common in women 60-70
Iodiine deficiency
Post-thyroidectomy or radioiodine treatment
Drug induced - amiodarone, lithium, iodine
Subacute thyroiditis - temporary hypothyroidism after hyperthyroid phase
Give causes of secondary hypothyroidism?
Not enough TSH due to hypopituitarism
What drugs cause hypothyroidism?
Anti-thyroid - carbimazole
Amiodarone
Lithium
Iodine
What is the treatment for hypothyroidism in the young and healthy?
LEvothyroxine (T4) Adjust 6 weekly by clinical state
Check TSH to ensure it is not suppressed
What is the treatment of hypothyroidism in the elderly or IHD?
Levothyroxine lower dose and increased according to TSH
Cautious as levothyroxine can precipitate angina/MI
How does amiodarone cause hypothyroidism?
Iodine rich drug like T4
Toxicity from iodine excess can cause hypothyroidism as T4 release is inhibited
Thyroidectomy may be needed if amiodarone cannot be discontinued
Check TFTs 6 monthly
What are facial features in myxoedema?
PAllor Coarse brittle hair Dull/blank expression Coarse features Puffy lids
