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Flashcards in FN: Hypothyroidism Deck (15):
1

Epi

4/1000/yr
Sex: F>>M = 6:1
Age: >40yrs

2

Symptoms

Letheragy
Cold intolerance
reduced appetite and weight ain
constipation
Menorrhagia
reduced mood

3

Signs

Cold hands
Bradycardic
Slow-relaxing reflexes
Dry hair and skin
Puffy face
Goitre
Myo[athy, neruopathy
Ascites
Myxoedema
1. SC tissue swelling in severe hypothyroidism
2. Typically around eyes and dorsum of hand

4

Causes

Primary
Post surgical
Secondary

5

Primary causes

Atrophic thyroiditis (commonest UK)
Hasimoto's thyroiditis
Subacute thyroiditis (e.g. post-partum)
Post De Quervains thyroiditis
Iodine deficiency (commonest worldside)
Drugs: carbimazole, amiodarone, lithium
Congenital: thyroid agenesis

6

Post-surgical

thyroidectomy
Radioioding

7

Secondary

Hypopituitarism (v.rare cause)

8

Atrophic thyroiditis

1. Thyroid antibodies +ve: anti-TPO, anti-TSH
2. Lymphoctic infiltrate --> atrophy (no goitre)
3. Associations

9

Atrophic thyroiditis associatinos

Pernicious anaemia
Vitiligo
Endocrinopathies

10

Hasimotos thyroiditis

TOP +ve
Atrophy + regeneration --> goitre
May go through initial thyrotoxicosis phase
May be euthyroid or hypothyroid

11

Investigations

1. Raised TSH, reduced T3/T3
2. Raised MCV ± normochromic anaemia
3.raised triglyceride + raised cholesterol
4. Hyponatraemia (SIADH)
5. raised CK if assoc. myopathy
6. Abs: TPO, TSH

12

Treatment

Levothyroxine
1. titrate to normalise TSH
2. Enzyme inducers raised thyroxine metabolism
3. Clinical improvement takes - 2wks

Check for other AI disease e.g. addison's PA

13

Myxoedema Coma features

looks hypothyroid
Hypothermia
Hypoglycaemia
HEart failure: bradycardia and reduced BP
Coma and seizures

14

Myxoedema Coma precipitants

1. radioiodine
2. Thyroidectomy
3. Pituitary surgery
4. Infection, trauma, MI, stroke

15

Myxoedema Coma management

Bloods: TFTs, FBC, U+E, glucose, cortisol
Correct any hypoglycaemia
T3T4 IV slowly (may ppt. myocardial ischaemia)
Hydrocortisone 100mg IV
Treat hypothermia and heart failure

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