Thyroid - Hypothyroidism & Thyroiditis

Question 1

Who is hypothyroidism usually seen in?

Answer 1

Females aged > 65

Question 2

What effect does hypothyroidism have on appetite and weight?

Answer 2

Weight gain and decreased appetite

Question 3

What cardiac effects does hypothyroidism have?

Answer 3

Bradycardia, pitting oedema, heart failure

Question 4

Are patients with hypothyroidism intolerant of heat or cold?

Answer 4

Cold

Question 5

What effect does hypothyroidism have on the menstrual cycle?

Answer 5

Heavy periods

Question 6

What is the term given to a hypothyroid emergency?

Answer 6

Myxoedema coma

Question 7

Who does myxoedema most commonly affect?

Answer 7

Elderly women with unrecognised or untreated hypothyroidism

Question 8

What are some features that may be seen on an ECG of someone with myxoedema coma?

Answer 8

Bradycardia, varying degrees of heart block, T wave inversion, prolonged QT interval

Question 9

What type of respiratory failure is seen in patients with myxoedema coma?

Answer 9

Type 2

Question 10

How should patients with myxoedema coma be treated?

Answer 10

Thyroxine and hydrocortisone

Question 11

Worldwide, what is the most common cause of hypothyroidism?

Answer 11

Iodine deficiency

Question 12

Histologically, what is the thyroid gland infiltrated with in Hashimoto’s thyroiditis?

Answer 12

Lymphocytes and plasma cells

Question 13

Which autoantibodies are most commonly seen in Hashimoto’s thyroiditis?

Answer 13

Anti-TPO (95%) and anti-thyroglobulin (60%)

Question 14

Describe the goitre associated with Hashimoto’s thyroiditis?

Answer 14

Diffuse, firm, painless

Question 15

Patients with Hashimoto’s thyroiditis are at an increased risk of developing what malignancy in the affected gland?

Answer 15

B cell non-Hodgkin’s lymphoma

Question 16

What effect does Hashimoto’s thyroiditis have on the MCV?

Answer 16

Raised

Question 17

What is the treatment for hypothyroidism?

Answer 17

Oral thyroxine (levothyroxine)

Question 18

When should levothyroxine be taken?

Answer 18

Once daily before breakfast

Question 19

What dose of levothyroxine should young, healthy patients receive per day?

Answer 19

50-100 mcg

Question 20

Which individuals require a lower than usual dose of levothyroxine (25-50mcg)?

Answer 20

The elderly, and those with ischaemic heart disease

Question 21

Why is a lower dose of levothyroxine required in individuals who are elderly or who have ischaemic heart disease?

Answer 21

Levothyroxine may precipitate angina or an MI

Question 22

What happens to the dose requirement of levothyroxine in pregnancy?

Answer 22

Increases by 25-50%

Question 23

When treating hypothyroidism with levothyroxine, the TSH should always be kept above what value?

Answer 23

0.5mU/L

Question 24

What are some drugs which commonly interact with levothyrxine?

Answer 24

Calcium tablets, iron supplements and PPIs

Question 25

What are some clinical conditions which have associations with hypothyroidism?

Answer 25

Down's syndrome, Turner's syndrome, CF

Question 26

What is believed to be the cause of DeQuervain's thyroiditis?

Answer 26

Viral infection

Question 27

Who is DeQuervain's thyroiditis most commonly seen in?

Answer 27

Women aged 20-50

Question 28

How does DeQuervain's thyroiditis present?

Answer 28

Painful swelling of the thyroid, often associated with malaise and fever

Question 29

What may precede an episode of DeQuervain's thyroiditis?

Answer 29

URTI

Question 30

Does DeQuervain's thyroiditis typically cause hyper/hypo or euthyroid status?

Answer 30

Mildly hyperthyroid followed by hypothyroid

Question 31

What does a radioisotope scan of DeQuervain's thyroiditis show?

Answer 31

Low uptake throughout

Question 32

How is DeQuervain's thyroiditis treated?

Answer 32

Self-limiting, anti-inflammatory medications may help symptoms a little

Question 33

What is a type of thyroiditis which forms a diffuse inflammatory infiltrate throughout the thyroid gland and may extend beyond the capsule to adjacent structures and clinically mimic malignancy?

Answer 33

Reidel's thyroiditis

Question 34

What type of thyroiditis presents with a painless goitre, typically in children and young adults, usually beginning with hyperthyroidism, returning to a euthyroid state and then a phase of hypothyroidism?

Answer 34

Subacute lymphocytic thyroiditis

Question 35

In someone taking levothyroxine, a high TSH with a normal T4 suggests what?

Answer 35

Poor compliance with medication

Question 36

What is the most important blood test for assessing patients response to levothyroxine?

Answer 36

TSH

Question 37

What are some effects of untreated hypothyroidism in pregnancy on the offspring?

Answer 37

Reduced IQ and neurodevelopmental delay

Question 38

Describe the pattern of thyroid abnormalities typically seen with post-partum thyroiditis?

Answer 38

A period of hyperthyroidism followed by hypothyroidism

Question 39

How long after delivery does post-partum thyroiditis typically occur?

Answer 39

4 months

Question 40

After how long should treatment for post-partum thyroiditis be withdrawn, to assess the need for long-term therapy?

Answer 40

6-12 months

Question 41

90% of women with post-partum thyroiditis have which autoantibodies?

Answer 41

Anti-TPO

Question 42

How often should women who experienced post-partum thyroiditis be monitored and why?

Answer 42

Annually, as there is a risk of becoming permanently hypothyroid

Question 43

Women with what post-partum complication should always be screened for hypothyroidism?

Answer 43

Post-partum depression

Question 44

How is hypothyroidism picked up at birth?

Answer 44

Universal neonatal screening