Oligomenorrhea And Hypothyroidism Flashcards
Secondary amenorrhea?
No periods for three consecutive months
Oligomenorrhea?
Fewer than nine menses a year or intervals of more than 40 days between periods
Causes of oligomenorrhea and amenorrhea?
- Hypothalamus issues (excessive exercise, stress, infiltrative diseases)
- Diseases of the pituitary ( prolactinomas, adenomas)
- Empty sella syndrome and Sheehan syndrome
- Premature ovarian failure
- Diseases of the thyroid
- Adult onset Adrenal hyperplasia
Polycystic ovarian syndrome: history? Labs? Therapy?
Irregular menses since menarche, obesity, hirsutism
Elevated testosterone, elevated LH and FSH
Oral contraceptive agent
Hypothyroidism: history? Labs? Therapy?
Fatigue, cold intolerance
Elevated TSH
Thyroxine replacement
Hyperprolactinemia: history? Labs? therapy?
Headache, bitemporal hemianopsia, galactorrhea, hypothyroidism
Elevated prolactin level
Depends
Ovarian failure: history? Labs? Therapy?
Hot flashes, hypoestrogenism
Elevated FSH and LH
Replacement hormones
Sheehan syndrome: history? Labs? Therapy?
Postpartum hemorrhage, unable to breast-feed
Low pituitary hormones
Replacement of pituitary hormones
Most cases of hypothyroidism (95%) are caused by?
In the US, the most common cause of hypothyroidism is?
Worldwide, the most common cause of enlarged thyroid hypothyroidism is?
Primary thyroid gland failure
Hashimoto thyroiditis» Graves disease
Iodine deficiency
Myxedema?
Dull facies, swollen eyes, sparse hair, thickened tongue and doughy extremities (from the accumulation of hydrophilic polysaccharides)
Effect of hypothyroidism on the heart? Intestines? Reflexes?
Enlarged heart, intestinal obstruction, delayed relaxation phase of deep tendon reflexes
Way to estimate free T4?
One T4 and T3 uptake both are high patient is? When both are low patient is? If one is high and the other low?
T3 uptake (High T3 uptake means low T4 level)
Hyperthyroid, hypothyroid. Problem with binding proteins.
In mild cases when the TSH level is moderately elevated but the measured free T4 is within the normal range, how many of these patients progress to hypothyroidism within five years? These patients often have?
50%. Often have elevated total and LDL-cholesterol
Treatment of hypothyroidism? Half-life?
Once daily dose of synthetic levothyroxine. 6-7 days.
Dosing considerations with levothyroxine? (why?)
In older patients or those with cardiovascular disease, start a low-level dose (25 to 50) and increase once every 4 to 6 weeks
Rapid replacement can overwhelm the coronary or cardiac reserve
