Hyper/hypothyroidism Flashcards
What is the commonest cause of hypo or hyperthyroidism
Autoimmne thyroid disease
What is meant by primary thyroidism
The problem is with the gland itself
What is meant by secondary thyroidism
The problem is with the hypothalamus or pituitary
What do we need to measure when measuring thyroid hormone
TSH
T4 and T3 (both free)
What would the thyroid hormones be like in hyperthyroidism
High level of T4 and T3 and low TSH
What would the thyroid hormones be like in hyperthyroidism
High TSH and low T3,T4
What is meant by primary subclinical hypothyroidism
on the way to developing primary hypothyroidism but have not quite got there yet but the pituitary is having to work harder to maintain normal levels
In what kind of hypothyroidism is TSH normal
Secondary
In what kind of hypothyroidism is fT4 normal
Subclinical hypothyroidism
What is the name given to the skin on the shins in Grave’s disease
Pretibial myxoedema
In what population is the incidence higher for hypothyroidism
Hispanics or African-American populations or in those with a high iodine intake
What are the 3 main categories for causes of primary hypothyroidism
Goitrous
Non-goitrous
Self-limiting
What are the 2 main goitrous causes of primary hypothyroidism
chronic thyoiditis or iodine deficiency
What is Hashimoto’s thyroiditis
The most common cause of hypothyroidism in Western world - autoimmune destruction of thyroid gland resulting in reduced thyroid hormone production
What is Hashimoto’s thyroiditis characterised by
Presence of thyroid peroxidase antibodies
T cell infiltrate and inflammation on microscopy
What are some signs and symptoms of hypothyroidism
Coarse, sparse hair Dull expresiionaless face puffiness around the eyes pale, cool skin doughy touch to skin vitiligo hypercarotenaemia cold intolerance constipation reduced heart rate cardiac dilatation pericardial effusion hyperlipidaemia decreased appetite weight gain ascites deep hoarse voice macroglossia obstructive sleep apnoea preipheral neuropathy muscle stiffness prolonged reactions depression, psychosis mental sluggishness Menorrhagia hyperprolactinaemia
What antibody is the most sensitive in Grave’s disease
anti-TPO antibody
What is the management for hypothyroidism in young
start thyroxine at 50-100ug daily
What is the management for hypothyroidism in older
thyroxine 25-50ug adjust every 4 weeks according to response
When should TSH be checked after treatment has commenced
2 months after any dose change then when stable, every 12-18 months
What should the dose of thyroxine be increased by in pregnancy
25ug
Who is typically affected by a myxoedema coma
Elderly women with long standing but frequently unrecognised or untreated hypothyroidism
How is a myxoedema coma treated
Intensive care passively rewarm cardiac monitoring for arrhythmias monitor BP,CVP, O2, urine output, BMs Fluids / electrolyte balance / fluid restriction
What are some signs and symptoms of hyperthyroidism
Palpatations/AF cardiac failure tremor sweating Anxiety nervousness irritability sleep disturbance loose bowel movements increased bowel movements lid retraction double vision brittle hair or thinning rapid fingernail growth menstrual changes muscle weakness weight loss decreased appetite intolerance to heat
