Hypothyroidism

Question 1

Symptoms of hypothyroidism?

Answer 1

Cold intolerance
Bradycardia
Lethargy
Weight gain
Constipation
Menstrual disturbance (menorrhagia but all disturbances can occur)
Dry skin/cold hands

Question 2

TFT results in hypothyroidism?

Answer 2

Increased TSH

Reduced T3/T4

Question 3

Causes of hypothyroidism?

Answer 3

• Autoimmune Hashimoto’s thyroiditis (commonest in the west)
• Iodine deficiency (commonest worldwide)
• Iatrogenic (surgery, radioiodine, amiodarone)
• De Quervain’s thyroiditis (hyper then hypo)
• Congenital thyroid dysgenesis

Question 4

Timeline of De Quervain’s thyroiditis?

Answer 4

Hyperthyroidism then hypothyroidism (exhausts T3/4 stores)

- usually self-resolving but may need thyroxine replacement for a few weeks

Question 5

Management of hypothyroidism?

Answer 5

Levothyroxine 25-200mg/day

- monitor TFTs at 6 weeks and adjust dose accordingly (monitor @ 6 wks + titrate)