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RB Y2 Endocrine - 2 Thyroid > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

prognosis

A

if treated - excellent

if not, disastrous - heart disease, dementia

one must be alert to subtle, specific symptoms

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2
Q

classification

A

primary - disease of gland itself

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3
Q

myoxedema

A

severe hypothyroidism - medical emergency

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4
Q

subclinical hypothyroidism

A

high levels of TSH, but normal levels of fT4

often a precursor to developing overt hypothyroidism

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5
Q

cretinism

A

hypothyroidism in babies - condition of dwarfism and limited mental functioning due to the deficiency of thyroid hormones present at birth

often owes to maternal hypothyroidism

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6
Q

hair and skin features

A

coarse, sparse hair

expressionless face

periorbital puffiness

pale, cool doughy skin

vitiligo may be present

hypercarotenaemia - yellow pigmentation of the skin

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7
Q

thermogenesis

A

cold intolerance

cold hands

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8
Q

fluid symptoms

A

pitting oedema - fluid retention

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9
Q

cardiac

A

reduced heart rate

cardiac dilatation

pericardial effusion

worsening of heart failure

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10
Q

metabolic

A

hyperlipidaemia - xanthelasma

decreased MR: decreased appetite and weight gain

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11
Q

xanthelasma

A

cholesterol deposits around the eyes

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12
Q

gi

A

constipation

rarely, megacolon and intestinal obstructionand ascites

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13
Q

respiratory

A

deep, hoarse voice

macroglossia

obstructive sleep apnoea

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14
Q

neurology

A

decreased intellectual and motor activities

lowered memory and cognition

depression, psychosis

peripheral neuropathy

carpal tunnel sydrome

decreased visual acuity

prolongation of tendon jerks eg reflexes relax slowly

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15
Q

muscles

A

muscle stiffness and cramps

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16
Q

gynae/reproductive

A

menorrhagia (abnormally heavy/prolonged bleeding)

later, oligomenorrhoea or amenorrhoea

hyperprolactinaemia

17
Q

prolactin

A

hormone that enables females to produce milk

inc TRH causes inc PRL secretion

18
Q

causes of self limiting primary hypothyroidism

A

withdrawal of anti thyroid drugs

subacute thyroiditis with transient hypothyroidism

post partum thyroiditis

19
Q

causes of non goitrous primary hypothyroidism

A

atrophic thyroiditis

post ablative surgery (radioiodine, surgery)

post radiotherapy to neck

congenital developmental defect

20
Q

causes of goitrous primary hypothyroidism

A

iodine deficiency

drug induced eg amiodarone, lithium

hasimotos thyroiditis

21
Q

iodine deficiency

A

dietary iodine deficiency still exists in some areas where goitre is common

patients may be euthyroid or hypothyroid depending on the severity

the mechanism is thought to be borderline hypothyroidism (lack iodine, cant synthesise MIT or DIT) leading to TSH stimulation and thyroid gland enlargment (even though it cant produce/secrete any hormone)

22
Q

Hashimoto’s Thyroiditis

A

autoimmune destruction of the thyroid gland and subsequent reduced thyroid hormone production

23
Q

what is the most common cause of hypothyroidism

A

Hashimoto’s Thyroiditis

24
Q

epidemiology of Hashimoto’s Thyroiditis

A

family history of auoimmune thyroiditis or other autoimmune disorders

more common in women

25
Q

pathophysiology of Hashimoto’s Thyroiditis

A
  • antibodies attack thyroid peroxidase, which is an enzyme used in the production of thyroid hormones (TPO antibodies are present in very high titres)
  • antibodies can also attack the thyroglobulin leading to destruction of the follicular cells of the thyroid - anti-Tg antibodies
  • T cell infiltration and inflammation produces a goitre
26
Q

what is the thyroid gland like in Hashimoto’s Thyroiditis

A

goitre

  • firm and rubbery
  • may range from soft to hard
27
Q

thyroid status in Hashimoto’s Thyroiditis

A

either

28
Q

causes of secondary hypothyroidism

A

rare

usually widespread deficiency or loss of function of either the hypothalamus or pituitary gland (not enough TSH produced)

causes include infiltration, infection and malignancy

29
Q

management of hypothyroidism

A

replacement therapy of thyroid hormones

normal MR should be restored gradually, so as not to precipitate cardiac arrhythmias

analogue of T4 - levothyroxine - is given for life

30
Q

what is the starting dose of levothyroxine

A

depends on the severity of the condition, less in the elderly

dose is gradually increased so as to avoid causing cardiac arrhythmias etc

TSH levels should be checked every 2 months after any dose change and once the dose is stabilised, every 12-18 weeks

31
Q

what is the dose of levothyroxine titrated to

A

fT4 level, as in secondary hypothyroidism TSH is not produced normally so is unreliable as a marker

32
Q

when should levothyroxine be taken

A

before bed

33
Q

dose requirements for levothyroxine in pregnancy

A

increase by 25-50% (usually 25mcg) as soon as pregnancy is suspected as thyroxine hormones are vital to the development of the baby

34
Q

myxoedema coma

A

the ultimate hypothyroid state before bed

mortality 60% despite early diagnosis and treatment

35
Q

who does myxoedema coma usually affect

A

elderly women with long standing but frequently unrecognised/untreated hypothyroidism

36
Q

ECG findings of myxoedema coma

A

bradycardia

low voltage complexes

varying degrees of heart block (heart failure)

T wave inversion

prolongation of QT interval

37
Q

other findings in myxoedema coma

A

goitre

type 2 respiratory failure: hypoxia, hypercapnia, respiratory acidosis, cyanosis

coma and seizures

adrenal failure

psychotic - myxoedema madness seen just before coma

38
Q

treatment of myxoedema coma

A

ABCDE

actively rewarm (blankets, fluids), aiming for a slow rise in body temperature

cardiac monitoring for arrhythmias

close montoring of urine output, central venous pressure, blood sugars, oxygenation

broad spectrum antibiotics

thyroxine cautiously, hydrocortisone for the first hour

39
Q

clinical features of Hashimoto’s thyroidits

A
  • Goitre: the gland is usually firm and rubbery but may range from soft to hard.
  • Patients may be hypothyroid or euthyroid.
  • Anti-thyroid peroxidase and also anti-Tg antibodies

RB Y2 Endocrine - 2 Thyroid (8 decks)

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