Hypothyroid

Question 1

What are the causes of hypothyroidism?

Answer 1

iodine definciency
hashimoto's thyroiditis (autoimmune) 
atrophic thyroiditis (autoimmune) 
post thyroidectomy 
drug induced 
congenital
hypopituitarism

Question 2

What are the signs and symptoms of hypothyroidism?

Answer 2

• Fatigue/lethargy
• Weight gain
• Constipation
• Cold intolerance
• Abnormal menstrual cycles
• Myxoedema
• Delayed tendon reflex relaxation
• Hoarse voice
• Myalgia
• Muscle cramps/weakness
• Poor memory/concentration
• Dry thin skin/hair loss
• Low mood
• Bradycardia
• ± Goitre

Question 3

What investigations are needed for hypothyroidism?

Answer 3

Bloods - TFTs

Question 4

What would the blood results be in hypothyroidism?

Answer 4

increased TSH

decreased T4/3

Question 5

What investigations should be carried out for suspected autoimmune conditions?

Answer 5

thyroid autoantibodies
anti-thyroid peroxidase antibodies
TSH receptor antibodies

Question 6

What is the management for hypothyroidism?

Answer 6

Levothyroxine - LIFE LONGGG

Question 7

How is levothyroxine given?

Answer 7

• PO, initial dose of 50-100micrograms
• Taken first thing on empty stomach Repeat bloods in 6/52
• Dose adjusted in steps of 25-50micrograms according to clinical response & normalisation of TSH

Question 8

When should levothyroxine be used in caution?

Answer 8

in elderly patients or those with IHD as can precipitate angina or MI

Question 9

How are hypothyroid patents managed long term?

Answer 9

TSH checked annually
Entitled to free prescriptions
Lifestyle advice is still important - lose weight, smoking cessation