Thyroid patholigies Flashcards
(33 cards)
Symptoms of hypothyroidisim
Cold intolerance
Weight gain
Constipation
Bradycardia
Lethargy
Muscle cramps
Slow movement
Slow thoughts
Depression
Thinned hair
Menstrual irregularities
Infertility
Complications of hypothyroidism
Dyslipidaemia
Coronary heart disease
Heart failure
Impaired fertility
Pregnancy complications
Impaired concentration
Myxoedema coma (rare but life-threatening medical emergency)
List the causes of primary hypothyroidism
Problem arises from thyroid gland itself e.g., drugs, surgery, trauma, iodine deficiency, autoimmune disease e.g., hashimotos thyroiditis
What labs are expected with overt hypothyroidism?
Low T3/4 and high TSH/THR
What labs are expected with subclinical hypothyroidism?
Normal T3/T4 and high TSH/THR
How often should TSH levels be checked once initated on levothyroxine?
Every 3 months until stable, then annually thereafter.
Which patient group is hypothyroisim most likely to affect?
Middle-aged females
When should T3/T4 levels be monitored if a patient is taking levothyroxine?
Only if patient is symptomatic- otherwise TSH levels only
Treatment recommendations for subclinical hypothyroidism in a patient with TSH levels >10mIU/L on 2 seperate occasions 3 months apart?
Levothyroxine should be considered and if sympotms persist, dose should be adjusted to optimal symptoms control without causing thyrotoxicosis/ TSH suppression
Treatment recommendations for subclinical hypothyroidism in a <65 years old patient with above reference range TSH levels <10mIU/L on 2 seperate occasions 3 months apart?
6-month trial of Levothyroxine should be considered.
TSH level should be checked and if still above reference range then adjust the dose.
If TSH within range, consider stopping levothyroxine even if symptoms still present
How is secondary hypothyroidism managed?
Urgent referral to endocrinologist
How should a pregnanct patient or a patient planning a pregnancy who have hypothyroidism be managed?
Referral to endocrinologist and if TSH levels are out a range advise to hold-off on conception.
How long a gap should be left between administration of ferrous sulphate and levothyroxine?
2 hours
How long a gap should be left between administration of calcium carbonate and levothyroxine?
4 hours
Which patient groups require a lower initiation dose of levothyroxine?
The elderly and those with cardiac disease
Dose administration label instructions for levothyroxine?
Should be taken 30-60 minutes before breakfast, other medications, and caffeine- containing drinks.
Symptoms of hyperthyroidism
Excitability
Heat intolerance
Anxiety
Tremor
Weight loss but increased appetite
Goitre
Tacycardia
Angina pain
Sweating
Arrythmias
Complications of hyperthyroidism
HF
AF
Graves’ orbitopathy
pregnancy complications
thyroidtoxcosis
Reduced bone mineral density
1st line treatment for graves disease
Radioiodine or antithyroid drugs (if thought to schieve remission)
2nd line treatment for graves disease
Carbimazole for 12-18 months
Rare but serious SE of carbimazole
agranuloycytosis/ neutropenia
MHRA warning for carbimazole
Risk of acute pancreatitis
If a sore throat/fever/malaise develops whilst on carbimazole, what action should be taken?
Stop carbimazole, seek urgent medical attention.
Carbimazole should not be re-started.
When should propylthiouracil be used in hyperthyroidism?
If carbimazole cannot be tolerated OR patient wishes to conceive in the next 6 months/ currently pregnant, OR if history of pancreatitis
