Hypothyroidism

Question 1

What is a sign specific to hypothyroidism?

Answer 1

Hertoghe sign which is loss of the lateral eyebrow

Other signs include hoarse voice

Question 2

Most common cause of hypothyroidism in west?

Answer 2

Hashimoto’s, diffuse painless goitre associated with Anti-TPO & Anti-Tg and HLA-DR3.

Question 3

What is the most common cauase of hypothyroidism worldwide?

Answer 3

Iodine insufficiency

Question 4

What is the TFT for overt primary hyperthyroidism?

Answer 4

Overt primaryhypothyroidismis characterised byhighTSH levels and low T4 levels

Question 5

What is the TFT for subclinical hypothyoridism?

Answer 5

High TSH, normal T3 and T4

In order todiagnosesubclinical hypothyroidism, perform repeatTFTs3 months after the initial result

Question 6

What is the TFT for secondary hypothyoridism?

Answer 6

Inappropriately low/normal TSH and, low free T4

Question 7

What can interfere with levothyroxine?

Answer 7

Iron supplements canreducethe absorption oflevothyroxineand so they should be given2 hours apart

Question 8

Which infiltrative disorders can cause hypothyroidism?

Answer 8

Haemochromatosis
Sarcoidosis

Question 9

What are the neurological features of hypothyoridism?

Answer 9

Carpal tunnel syndrome
Slow reflexes
Peripheral neuropathy

Question 10

How is hypothyroidism managed during pregnancy?

Answer 10

Dose of levothyroxine is increased due to metabolic demand increase

Question 11

What is used to treat myxdema coma?

Answer 11

IV Liothyronine, active T3 , IV LevothyroxineAND iv corticosteroids

Question 12

Which drug can cause hypothyroidism?

Answer 12

Lithium

Question 13

What is sick euthyroid syndrome?

Answer 13

Presents during illness with pattern of everything to be low

Question 14

What is a side effect of levothyroxine?

Answer 14

Osteoporosis

Question 15

What is Hashimoto’s thyroiditis?

Answer 15

An autoimmune disorder of the thyroid gland

Question 16

What is typically associated with Hashimoto’s thyroiditis?

Answer 16

Hypothyroidism

Question 17

In what demographic is Hashimoto’s thyroiditis more common?

Answer 17

Women

Question 18

What are the features of hypothyroidism in Hashimoto’s thyroiditis?

Answer 18

Goitre: firm, non-tender; anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibodies

Question 19

What other autoimmune conditions are associated with Hashimoto’s thyroiditis?

Answer 19

*Coeliac disease
*Type 1 diabetes mellitus
*Vitiligo

Question 20

What type of lymphoma is Hashimoto’s thyroiditis associated with?

Answer 20

MALT lymphoma

Question 21

What is a rare cause of secondary hypothyroidism?

Answer 21

Pituitary failure

Question 22

List some conditions associated with secondary hypothyroidism.

Answer 22

*Down’s syndrome
*Turner’s syndrome
*Coeliac disease

Question 23

What are some side effects of thyroxine therapy?

Answer 23

*Hyperthyroidism
*Reduced bone mineral density
*Worsening of angina
*Atrial fibrillation

Question 24

What substances can reduce the absorption of levothyroxine?

Answer 24

*Iron
*Calcium carbonate

Question 25

What is the recommended initial starting dose of levothyroxine for elderly patients with cardiac disease?

Answer 25

25mcg od

Question 26

What is myxoedema coma?

Answer 26

A medical emergency associated with severe hypothyroidism

Question 27

What are the typical presentations of myxoedema coma?

Answer 27

*Confusion *Hypothermia

Question 28

What treatments are required for myxoedema coma?

Answer 28

*IV thyroid replacement *IV fluid *IV corticosteroids *Electrolyte imbalance correction *Sometimes rewarming

Question 29

Is thyroxine safe during pregnancy?

Answer 29

Yes

Question 30

What is the recommended increase in thyroxine dosage during pregnancy?

Answer 30

Up to 50% as early as 4-6 weeks of pregnancy

Question 31

What characterizes Riedel's thyroiditis?

Answer 31

Dense fibrous tissue replacing normal thyroid parenchyma

Question 32

What type of goitre is noted in Riedel's thyroiditis?

Answer 32

Hard, fixed, painless goitre

Question 33

Who is typically affected by Riedel's thyroiditis?

Answer 33

Middle-aged women

Question 34

What is Riedel's thyroiditis associated with?

Answer 34

Retroperitoneal fibrosis

Question 35

Thyroxine therapy should be started at a lower dose for which patients?

Answer 35

Elderly patients and those with ischaemic heart disease

Question 36

What is Hashimoto's thyroiditis?

Answer 36

An autoimmune disorder of the thyroid gland

Question 37

What is typically associated with Hashimoto's thyroiditis?

Answer 37

Hypothyroidism

Question 38

In what demographic is Hashimoto's thyroiditis more common?

Answer 38

Women

Question 39

What are the features of hypothyroidism in Hashimoto's thyroiditis?

Answer 39

Goitre: firm, non-tender; anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibodies

Question 40

What other autoimmune conditions are associated with Hashimoto's thyroiditis?

Answer 40

*Coeliac disease *Type 1 diabetes mellitus *Vitiligo

Question 41

What type of lymphoma is Hashimoto's thyroiditis associated with?

Answer 41

MALT lymphoma

Question 42

What is a rare cause of secondary hypothyroidism?

Answer 42

Pituitary failure

Question 43

List some conditions associated with secondary hypothyroidism.

Answer 43

*Down's syndrome *Turner's syndrome *Coeliac disease

Question 44

What are some side effects of thyroxine therapy?

Answer 44

*Hyperthyroidism *Reduced bone mineral density *Worsening of angina *Atrial fibrillation

Question 45

What substances can reduce the absorption of levothyroxine?

Answer 45

*Iron *Calcium carbonate

Question 46

What is the recommended initial starting dose of levothyroxine for elderly patients with cardiac disease?

Answer 46

25mcg od

Question 47

What is myxoedema coma?

Answer 47

A medical emergency associated with severe hypothyroidism

Question 48

What are the typical presentations of myxoedema coma?

Answer 48

*Confusion *Hypothermia

Question 49

What treatments are required for myxoedema coma?

Answer 49

*IV thyroid replacement *IV fluid *IV corticosteroids *Electrolyte imbalance correction *Sometimes rewarming

Question 50

Is thyroxine safe during pregnancy?

Answer 50

Yes

Question 51

What is the recommended increase in thyroxine dosage during pregnancy?

Answer 51

Up to 50% as early as 4-6 weeks of pregnancy

Question 52

What characterizes Riedel's thyroiditis?

Answer 52

Dense fibrous tissue replacing normal thyroid parenchyma

Question 53

What type of goitre is noted in Riedel's thyroiditis?

Answer 53

Hard, fixed, painless goitre

Question 54

Who is typically affected by Riedel's thyroiditis?

Answer 54

Middle-aged women

Question 55

What is Riedel's thyroiditis associated with?

Answer 55

Retroperitoneal fibrosis

Question 56

Thyroxine therapy should be started at a lower dose for which patients?

Answer 56

Elderly patients and those with ischaemic heart disease

Question 57

Why are corticosteroids given in myxcema coma?

Answer 57

If co-existing adrenal insufficiency, corticosteroids will orevent Addisonian crisis

Question 58

How does pregnancy affect levothyroxine managmeent?

Answer 58

Women with hypothyroidism may need to increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy

Question 59

What is the ideal thyorid hormone drug for hyperthyroidism in pregnancy?

Answer 59

Propylthiouracil replacing carbimazole however, propylthiouracil is associated with an increased risk of severe hepatic injury

Question 60

What is considered subclinical hypothyroidism?

Answer 60

TSH level of level is 5.5 - 10mU/L

Question 61

When to intervene for subclinical hypothyoridism?

Answer 61

offer SYMPTOMATIC patients < 65 years a 6-month trial of thyroxine if TSH remains at that level on 2 separate occasions 3 months apart and they have hypothyroidism symptoms

Question 62

What is Hashimoto’s associated with in thyroid disease?

Answer 62

Thyorid lymphoma

Question 63

How to amangement hypothyoridism in pregnancy?

Answer 63

increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy