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gi, liver, kidney > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

Causes of hypothyrodisims

A

Iodine deficiency
Goitre
Hashimotos - aitoimmune thyroiditis
Iatrogenic - srugery/medications
Transient thryoiditis
Thyroid infiltrative disorders
Congential

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2
Q

Medications that cna cuase hypothryodisim

A

Amiodarone - acute
Carbimazole - overtreamtent for hyper
Lithium
Radioactive iodine

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3
Q

Symptoms of hypothyrodism

A

Tired
Weak
Cold
Constipation
Depression
Menstrual irregularities
Thyrpid pain

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4
Q

Signs of hypothryoidism

A

Hari loss
Dyr skin
Weight gain
Puffy eyes - oedema general aswell
Slow refleces
Bradycardia + diastolic HPTN
Pericardial effusion
HF
Hoarseness of voice - goitre
Paraesthesia - carpal tunnel syndrome or peripheral neuropahty

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5
Q

How does hypothryoidism cause HF

A

reduced level of thyroid hormone causes the decreased contractility + heart muscle cannot fully relax -> decreased CO-> diastolic dysfunction

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6
Q

What triggers the release of T3 and T4?

A

TSH

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7
Q

Where is TSH released from?

A

Anterior pituitary

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8
Q

Where is TRH released from?

A

Hypothalamus

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9
Q

Pathwya of thyroid hormones

A

TRH -> TSH -> T3 + T4

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10
Q

What thyroid hormone condition occurs in peripheral tissues?

A

T4 to more biologically active T3

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11
Q

Primary vs secondary hypothyroidims

A

Primary - thyroid gland unable to produce T3 and T4
Secondary/central hypothyroidism - insufficient thryoid stimulation due to pituitary or hypothalamic disorder

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12
Q

What are hormone levels ranges in subclincial hypothyroidism?

A

TSH levels increased
T3/T4 IN NORMAL range

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13
Q

Thyroid levels in overt hypothyroidism

A

TSH levels above normal reference range
Freee T4 below normal reference range

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14
Q

What are causes of transient thyroiditis?

A

Viral infection causing subacute (de Quervians) thyroiditis - painful swelling
Post partum - painless inflam autoimmune condition for up to a year

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15
Q

What gene is ass with hashimotos?

A

HLA DR5

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16
Q

THyroid infiltrative disorders

A

Amyloidosis
Sarcoidosis
TB
Malignant - lymphoma, thyroid, mets

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17
Q

What is congential hypothyrpoidism?

A

Absence or underdevleopment of thyroid fland
Ectopuc hypoplastic gland
Absence of enzymes required for hormone synthesis and iodide transfer

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18
Q

Causes of secondary hypothyroidism

A

Tumours = pituitary adenomas or gliomas
Surgery, radiotherapy, trauma
Pituitary infarction
Sheehand syndrome
INfiltrative disorders - + haemoachromatomas
Isolated TSH deficinecy or inactivity
Idiopathic
Drugs -

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19
Q

Drugs that cause secodnary hypothyroidism

A

cocaine, dopamine, glucocorticosteroids, metformin

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20
Q

Complications of hypothyroidims - groups

A

Cardiovascular
Reproductive
Neurological and cognitive

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21
Q

Cardiovascular complciations of hypothyroidism

A

Dyslipidemia
Metabolic syndrome - insulin resisitance
Coronary heart disease + stroke
Heart failure

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22
Q

Reproducitve/ pregnancy complciations of hypothyroidism

A

Increased risk of subfertility/infertility
IN pregnenayc:
INcreased risk of miscarriage, anaemia, pre eclampsia, placental abruption, pp haemorrhage, stillbirth
Adverse neonatal outcomes - prem, low birthweiht, resp distress, congenital abnormalities, hypothyrodism, impaired foetal neurocognitive development

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23
Q

Neurological and cognitive complciations of hypothyroidism

A

Decreased taste, vision, hearing
Impaired attention, concentration, memory, language, executive function, psychomotor speed

23
Q

Neurological and cognitive complciations of hypothyroidism

A

Decreased taste, vision, hearing
Impaired attention, concentration, memory, language, executive function, psychomotor speed

24
Q

Rare, life threatenting complciation of hypothyroidism?

A

Myxoedema coma

25
Q

Sings of myxodoema coma

A

Lethargy, bradycardia, hypothermia, seizures and.or coma

26
Q

What additional features can present with secondary hypothyroidism?

A

Caused by abnormal pituritary hormone production - skin depigmentation, atrophic breasts, galactorrhea, amenorrhea, erectile dysfunction, loss of body hair, cushings syndrome, acromegaly

27
Q

Hypothyroidism sus history

A

Typical symptoms of hypothyroisim
Current or recurrent pregnancy
Current or recent non thyroidal illness
Drug treatment
Risk facotrs

28
Q

Risk factors for hypothyroidism

A

FH of thyroid or autoimmune disease or hypothalamuc pituitary disease
Personal history autommune disorders
History of turners or DOwns syndromes
Prev radiotherapy to head or neck, radioiodine treatment, thryoid or neck surgery
History of iodine defucuency
Secondary causes:
Brain or metastatic cancer
Infiltrative disease
Head trauma
Surgery
Radiotheraoy
Disease affecting pituitary or hypothalamus

28
Q

Risk factors for hypothyroidism

A

FH of thyroid or autoimmune disease or hypothalamuc pituitary disease
Personal history autommune disorders
History of turners or DOwns syndromes
Prev radiotherapy to head or neck, radioiodine treatment, thryoid or neck surgery
History of iodine defucuency
Brain or metastatic cancer
Infiltrative disease
Head trauma
Surgery
Radiotheraoy
Disease affecting pituitary or hypothalamus

29
Q

Examples of autoimmune diseases that increase risk of hypothyroidism

A

Addisons disease
Alopecia areata
Pernicious anaemia
Coeliac disease
T1DM
vitiligo
Rheumatoid arthritis

30
Q

INvestigations for hypothyroidsim

A

History and exam
Check TSH level with TFT blood test
free T4
FBC and serum B12 level
HbA1c
Coeliac serology
Serum lipids
Serum thyroid peroxidase antibodies - TPOAb if autoimmune cause sus
Ultrasound of neck

31
Q

What is a neck ultrasound looking for in hypothyroidism

A

= thyroid enlargement or focal nodularity

32
Q

When test for TPOAb

A

When autoimmune cause of hypothyroidism susepected

33
Q

What can alter thyroid hormone blood test reuslts - misleading

A

Treatment for hyperthryoidism
Diurnal variation - night shift workers, irregular sleeping patterns, vigorous exercise, mood disorders
Sick euthyroid syndrome
Adrenal insufficeinct
Obesuty - HPT acis affected, TSH raised
Age
Drugs

34
Q

TSH levels in adrenal insuffiiency and what fixes

A

Elevated TSH
Reverse with glucocorticoid replacement
Addisons disease

35
Q

Why is pernisicous anaemia linked to hypothyroidism?

A

It is also classified as an autoimmune disease - due to lack of internal factor in stomach

36
Q

Differnetial diagnosis hypothryoidism

A

Non thyroidal illness - sick euthyroid syndrome, range conditions, starveation and trauma can cause abnormal TFTs
Endocrine/autoimmune conditions
Haemotological conditions - anaemia, multipl myeloma
End organ damage
Metabolcia abdnormlaities eg hypercalcermia
Vitamin and miineral deficinciences
Stress, poor sleep, aclohol misuse, anxiety, depression
Dementia
Post virla and chronic fatigue sundromes
Polymyagua rheumatica, fibromyalgia
Obesity
Menopause
Carbon monoxide poisonning

37
Q

When screen for hypothyrodism?

A

Pregnant/planning pregnanyc with history, risk factors, T1DM or other autoimmune condition, prev problems eg miscarriage, morbidity

Goitre
Dyslipidemia
Sus dementia
Radioidine therapy
prev neck radiotherapy or surgery fo head and neck cancer
Other autoimmune diseases
Turners or Downs syndromes
Hisotry pregnancy problems
Drug treatment eg amiodarone or lithium
Postnatal depression

38
Q

When do you treat subclinical hypothyroidism?

A

TSH >10
FT4 within reference range

39
Q

Treatment for primary hypothyrodisimi

A

Levothyrozine (LT4)

40
Q

Treatment for primary hypothyrodisimi

A

Levothyrozine (LT4)

41
Q

When to repeat thryoid function tests after start T4

A

Few weeks

42
Q

TSH and free T4 in throtoxicosis/Graves disease?

A

TSH = low
Free T4 - High

43
Q

What conditions affect TSH but not T4?

A

Subclinical hypothyroidism
Poor compliance with thyroxine
Steroid therapy

44
Q

When are both TSH and T4 low?

A

Sick euthyroid syndrome
Secondary hypothyroidism

44
Q

When are both TSH and T4 low?

A

Sick euthyroid syndrome
Secondary hypothyroidism

45
Q

What are TSH and T4 levels in primary hypothyroidism?

A

High TSH
Low T4

46
Q

What is riedel thyrodiits

A

fibrous tissue replacing the normal thyroid parenchyma
causes a painless goitre

47
Q

What diseases is hashiotos thyroditis ass with

A

type 1 diabetes mellitus, Addison’s or pernicious anaemia

48
Q

Treatment levothyroxine when change

A

initial starting dose of levothyroxine should be lower in elderly patients and those with ischaemic heart disease. The BNF recommends that for patients with cardiac disease, severe hypothyroidism or patients over 50 years the initial starting dose should be 25mcg od with dose slowly titrated. Other patients should be started on a dose of 50-100mcg od
women with established hypothyroidism who become pregnant should have their dose increased ‘by at least 25-50 micrograms levothyroxine’* due to the increased demands of pregnancy. The TSH should be monitored carefully, aiming for a low-normal value

49
Q

When should TFTs be checked after changing levothyroxine dose

A

thyroid function tests should be checked after 8-12 weeks

50
Q

Therapeutic goal of levothyroxiine

A

the therapeutic goal is ‘normalisation’ of the thyroid stimulating hormone (TSH) level. As the majority of unaffected people have a TSH value 0.5-2.5 mU/l it is now thought preferable to aim for a TSH in this range

51
Q

What need to do when taking iron and levothyroxine

A

AT LEAST 2 hours apart - iron causes decreased absorption

52
Q

Side effects levothyroxine

A

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

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