Hypothyroidism/Thyroiditis Flashcards

Question

how is hypothyroidism managed?

Answer 1

restore metabolic rate slowly to prevent arrhythmia younger = levothyroxine 50-100 micrograms daily elderly = 25-50 micrograms daily check TSH 2 months after dose change then every 12-18 months once stabilised

Answer 2

T4 taken before breakfast no benefit of combining with T3 may need to increase dose by 20-25% in pregnancy (due to increased TBG)

Answer 3

elderly women with long standing untreated hypothyroidism

Answer 4

bradycardia type 2 resp failure co-existing adrenal failure (in 10%) reduced consciousness

Answer 5

``` ICU slowly warm up patient monitor heart, urine, fluids, BP, BG and sats antibiotics thyroxine cautiously (hydrocortisone) ```

Answer 6

``` thyrotoxicosis = any state arising from tissues being exposed to excess thyroid hormone (can be from medication) hyperthyroidism = specific to overactivity of thyroid hormone leading to thyrotoxicosis ```

Answer 7

``` palpitations AF cardiac failure (rare) tremor sweating anxiety, nervous, irritable, sleep disturbance ```

Answer 8

``` loose bowels lid retraction double vision proptosis brittle, thin hair rapid fingernail growth light/less frequent periods muscle weakness weight loss despite increased appetite intolerance to heat ```

Answer 9

``` excessive thyroid stimulation - graves - thyrotropinoma - thyroid cancer - choriocarcinoma thyroid nodules with autonomous function - toxic solitary nodule - toxic multinodular goitre ```

Answer 10

``` thyroid inflammation - subacute (de quervains) thyroiditis - post partum thyroiditis - drug induced (amiodarone) exogenous thyroid hormones - over treatment with levothyroxine - thyrotoxicosis factitial ectopic thyroid tissue - metastatic thyroid carcinoma - struma ovarii ```

Answer 11

younger - 20-50 yrs sisters and children of women with graves disease smoking interacting susceptibility genes and environmental factors

Answer 12

``` reduced TSH and increased T3/4 hypercalcaemia raised alk phosphate leucopenia (low WCC) TSH receptor antibody (TRAb) - diagnostic if present so imaging not needed ```

Answer 13

pretibial myxoedema thyroid acropachy (clubbing with thyrotoxicosis) thyroid bruits (assoc with very large goitres) graves eye disease

Answer 14

TRAb driven pathology of the eye seen in graves - can affect one or both eyes also called thyroid eye disease (TED) and graves opthalmopathy (GO) can be sight threatening often causes protrusion of eyes

Answer 15

use clinical activity score (CAS, Mouritis) mild = topical lubricants severe = steroids, radiotherapy, surgery

Answer 16

asymmetrical goitre thyroid may feel nodular insidious onset usually older patients

Answer 17

increased T3/4 low TSH antibody negative (unless co-exsisting graves disease - would show TRAb) Scintigraphy shows high uptake

Answer 18

``` medical emergency severe hyperthyroidism hyperthermia resp and cardiac collapse exaggerated reflexes typically seen in hyperthyroid patients with an acute infection/illness or recent surgery ```

Answer 19

anti-thyroid drugs (ATDs) - carbimazole = first line - propylthiouracil = first line in 1st trimester of pregnancy as less potent

Answer 20

dose titration for 12-18 months then stop medication or block and replace for 6 months relapse is common

Answer 21

allergy liver disturbance agranulocytosis (rare, happens in first 6 weeks)

Answer 22

fever mouth ulcers oropharyngeal infection

Answer 23

``` Beta blockers (propanalol, or CCB if asthmatic) radioiodine (first line for relapsed graves, don't use in pregnancy) ```

Answer 24

hypothyroidism when used in graves

Answer 25

if radioiodine is contraindicated | risks = recurrent laryngeal nerve palsy, hypothyroidism

Answer 26

``` hashimotos post partum drug induced (amiodarone, lithium) radiation acute suppurative thyroiditis (bacterial) ```

Answer 27

``` 20-50 triggered by viral infection neck tenderness fever other viral symptoms self limiting over a few months ```

Answer 28

inhibits DIO1 - decreased T3 and T4, normal TSH causes abnormal TFTs in 50% of people causes hypothyroidism slightly more commonly than hyperthyroidism

Answer 29

abnormal TSH with normal thyroid hormone

Answer 30

if strongly TPO positive | treat if TSH >10 or pregnant

Answer 31

multinodular goitre osteoporosis AF treatment if TSH <0.1 or co-existing osteoporosis/AF

Answer 32

"sick euthyroid syndrome" | impact of incurrent illness on HPT axis causing suppression of TSH and then rise during recovery