Hypothyroid

Question 1

thyroid axis

Answer 1

hypo>TRH>pit>TSH>thyroid>T3+4>target

Question 2

where does T34 feedback to

Answer 2

hypo and pit (-ve)

Question 3

4 presentations of thyroid issues

Answer 3

1. hypo
2. hyper
3. mass effect
4. associated probs.

Question 4

see table of patterns

Answer 4

do it

Question 5

pattern of 1ry hypo

Answer 5

TSH up, T3-4 down

Question 6

what to measure for 1ry hypo

Answer 6

just TSH

Question 7

what to look for in fatigue to help show hypothyroid

Answer 7

FHx, common, not depressed, sleeping well, can have normal Phx

Question 8

labs for hypo

Answer 8

1. TSH, B-HCG
2. CBC, creatinine, AST - renal failure
3. fasting glucose - DM
4. FSH - menpause

Question 9

what to see on labs for hypothyroid

Answer 9

high TSH - can comfortably say

Question 10

3 tests not to order

Answer 10

1. T4
2. neck US
3. anti-thyroid ABs

Question 11

DDx for hypothyroid

Answer 11

1. congntial
2. hashimotos
3. iatrogenic - amiodarone, iodine, radiation, ectomy
4. subacute thyroiditis
5. hypothalamic disease (2ry)
6. peripheral resitance (3ry)

Question 12

2 most common casues

Answer 12

1. hashimotos

2. subacute thyroiditis

Question 13

hashimotos presentation

Answer 13

1. other autoimmune
2. small goitre
3. pos. anti-thyroid ABs

Question 14

presentation of subacute thyoiditis

Answer 14

1. inflammation of thyroid
2. throitoxicosis
3. may be painful or pain less

Question 15

treatment of subaucte thyroiditis

Answer 15

1. supportive during toxic phase (B-blocker, pain meds)

2. L-thyroxin during hypothyroid

Question 16

important things to look out for in thyroid drugs

Answer 16

1. common drug error
2. take on empty stomach with water
3. no food or drink for hour
4. no vits. for 3-4 hours

Question 17

2 times to involve endocrinologust in hypo

Answer 17

1. patient request

2. very young female

Question 18

3 groups that should be screened

Answer 18

1. infants
2. preggers
3. those at high risk (famhx, Sx, drugs that can cause)

Question 19

why is newborn screening done

Answer 19

prevent dev. delay

Question 20

3 times to treat subclincal hypo

Answer 20

1. patients with Sx
2. pregnant
3. TSH>10 - CV risk

Question 21

effects of preg. on normal thyoid

Answer 21

1. maternal thyroid incr. production
   - increase TBG binds thyroid
   - mother supplies thyroid for bb for T1

Question 22

how to adjust meds in preggers

Answer 22

T1 increase of 30-50%

Question 23

effect of low thryoid on BB

Answer 23

low IQ

Question 24

what to tell women that get pregs

Answer 24

take extra 2 pills/week when conceive and call you