Thyroid Disease

Question 1

What are the clinical features of congenital hypothyroidism?

Answer 1

Congenital:
Often asymptomatic and found on screening. Relatively common 1 in 4000 most commonly caused by a failure of the thyroid to migrate into the correct position.

General:
Failure to thrive
Pale, cold, mottled, dry skin

Neck:
Goitre

Gastro:
Feeding problems
Prolonged jaundice
Constipation
Coarse faeces

Neuro:
Delayed development and learning difficulties

Question 2

What are the clinical features of acquired hypothyroidism?

Answer 2

General:
Malaise
Feeling cold
Learning difficulties if early on in life

Growth:
Short stature
Delayed puberty

Face:
Periorbital oedema

Heart:
Bradycardia

Gastro:
Constipation
Weight gain

Question 3

What are the clinical features of hyperthyroidism?

Answer 3

General:
Anxiety
Hot flushes
Tremor
Learning difficulties if early on in life

Face:
Exopthalamus

Neck:
May have goitre

Heart:
Palpitations

Gastro:
Diahorrea
Weight loss despite increased appetite

Limbs:
Proximal muscle weakness

Question 4

How should thyroid disease be investigated and managed?

Answer 4

Guthrie gets screening for hypothyroidism & TFT’s

Hypothyroidism:
Manage with levothyroxine

Hyperthyroidism:
Medical:
Carbimazole (risk of neutropenia and won’t help eye disease) + Beta blocker for symptoms initially

Surgical or Radio-iodine:
Levothyroxine will often have to be given for life following this as these treatments induce hypothyroidism