thyroid - underactive

Question 1

bloods hypothyroid

Answer 1

raised TSH but ok T3/4

Question 2

mx subclinical hypothyroid if TSH >10 + free T4 normal

Answer 2

levothyroxine // if bloods >10 on 2 separate bloods, 3 months apart

Question 3

mx subclinical hypothyroid if TSH 5.5-10

Answer 3

<65 + symptoms on 2 bloods 3 months apart = levothyroxine // asymptomatic recheck 6months

Question 4

most common cause primary hypothyroid

Answer 4

autoimmune hashimotos

Question 5

other causes primary hypothyroid

Answer 5

subacute, riedels, thyroidectomy, iodine deficiency, lithuim or amiodarone

Question 6

secondary causes hypothyroid

Answer 6

downs, turners, coeliac

Question 7

bloods primary hypothyroid

Answer 7

TSH = high // free T4 = low

Question 8

bloods secondary hypothyroid

Answer 8

TSH = low // T4 = low

Question 9

features hypothyroid

Answer 9

weight gain // always cold // dry skin + hair // non-pitting oedema // constipation // heavy periods

Question 10

neuro symptoms hypothyroid

Answer 10

hyporeflexua // carpal tunnel

Question 11

features hashimotos

Answer 11

hypothyroid + goitre

Question 12

antibodies hashimotos

Answer 12

anti TPO + anti-Tg

Question 13

conditions assoc with hashimotos

Answer 13

coalic, T1DM, vitligo

Question 14

what cancer is hashimotos assoc with

Answer 14

MALT lymphoma

Question 15

features congenital hypothyroid

Answer 15

prolonged jaundice // delayed milestones // short // puffy face, big tongue // hypotonia

Question 16

how is congenital hypothyroid diagnosed

Answer 16

screened at day 5-7 with heelprick test

Question 17

pathology Riedel’s thyroiditis

Answer 17

fibrous tissue replaces thyroid parenchyma –> fixed, painless goitre

Question 18

TFT’s sick euthyroid syndrome

Answer 18

TSH, T4, T3 all low // (TSH can be normal)

Question 19

causes sick euthyroid syndrome

Answer 19

systemic illness, normally in elderly

Question 20

mx sick euthyroid syndrome

Answer 20

none

Question 21

presentation myxoedema coma

Answer 21

hypothyroid –> confusion + hypothermia

Question 22

mx myoexedema coma

Answer 22

IV levothyroxine + IV fluid + IV steroids // fix U+Es

Question 23

starting dose hypothyroid

Answer 23

50-100mcg OD

Question 24

what people should be started on a lower dose of levothyroxine (25mcg)

Answer 24

cardiac disease, severe hypo, 50+

Question 25

what needs to be checked after changing levothyroxine dose

Answer 25

TFTs 8-12 weeks later

Question 26

what should happen to levothyoxine in pregnancy

Answer 26

increase by at least 25-50 // double

Question 27

SE thyroxine

Answer 27

hyperthyroid // reduced bone mineral density // worsening of angina // AF