Hypothyroidism

Question 1

What are the causes of hypothyroidism?

Answer 1

Hashimoto’s thyroiditis

• autoimmune condition causing inflammation and then atrophy of thyroid
• Anti-TPO antibodies

Medications
-amiodarone and lithium

Lack of dietary iodine

Hyperthyroid medication

Hypopituitarism

Thyroiditis

Question 2

What are the symptoms?

Answer 2

Weight gain
Fatigue
Menorrhagia
Cold intolerance
Constipation
Depression
Hair loss
Dry skin

Question 3

What are the signs?

Answer 3

Bradycardia
Dry skin
Hair loss 
Fluid retention
Ataxia
Hyporeflexia
Hoarse voice

Question 4

What investigations are needed?

Answer 4

Thyroid levels

• primary= high TSH and low T3/4
• secondary= low TSH and low T3/4

FBC- anaemia

Anti-TPO antibodies

Cholesterol raised
CK raised

Question 5

What is the management?

Answer 5

Oral levothyroxine
Titrate up till TSH levels in normal range
Monitor TSH levels monthly after starting treatment

Question 6

What is subclinical hypothyroidism?

Answer 6

High TSH levels but normal T3/4

Question 7

How is subclinical hypothyroidism managed?

Answer 7

TSH 4-10 and T4 normal

• symptomatic and <65 then trial of levo, stop if symptoms do not improve
• asymptomatic- observe and repeat in 6 months
• older patients, watch and wait

TSH>10 and T4 normal

• commence levo treatment even if asymptomatic and <70
• if older then watch and wait