Hypothyroidism

Question 1

What is hypothyroidism?

Answer 1

Lack of thyroid hormones

Question 2

Which hormone is lacking?

Answer 2

T4 Thyroxine

Question 3

What is the main cause?

Answer 3

Primary Atropy: diffuse lymphocytic infiltration of the thyroid leading to atrophy

Question 4

What are the other causes? (6)

Answer 4

Hashimoto’s Thyroiditis (autoantibodies), Iodine Deficiency, Post-thyroidectomy, Radioactive treatment, Drugs (amiodarone, lithium), Secondary to low TSH

Question 5

Is it common?

Answer 5

Relatively, affects 4 in 1000 people per year

Question 6

Who does it affect?

Answer 6

More women (6:1), 50-60 years old

Question 7

Symptoms (10)

Answer 7

Fatigue, low mood, cold intolerance, weight gain, constipation, menorrhagia, hoarse voice, reduced memory, cramps, weakness

Question 8

Signs (9)

Answer 8

Bradycardia, hypotension, hyporeflexia, ataxia, coarse hair, dry skin, ascites, pre-tibial myxoedema, round face

Question 9

What blood tests would you do? (4)

Answer 9

TFTs, FBC, Cholesterol and Triglycerides

Question 10

Any investigations?

Answer 10

You could ultrasound the thyroid

Question 11

What treatment?

Answer 11

Thyroid Hormone Replacement using Thyroxine, blood tests needed 6 weekly to adjust

Question 12

Who needs dose reduction?

Answer 12

Elderly and people with heart disease

Question 13

Will the dose stay the same?

Answer 13

Not necessarily. If the atrophy is detected early, there may still be thyroid left that hasn’t atrophied yet

Question 14

What Complications are there? (4)

Answer 14

Causes risks in pregnancy such as Eclampsia, Anaemia, Prematurity, Low birthweight