Hypothyroidism

Question 1

Some abnormal labs with hypothyroidism

Answer 1

elevated lipids

increased CK (myopathy)

Hyponatremia

Question 2

Euthyroid sick syndrome

Answer 2

Features include low T3 and possible low or normal TSH. Normal T4. rT3 levels rise in acute illness due to impaired clearance.

So basically is you suspect thyroid illness and rT3 is high then its Euthyroid sick syndrome

but if low then maybe a central cause

Question 3

Treatment of myxedema coma

Answer 3

Levo (oral or IV) 500 mcg loading dose followed by 50-100 mcg IV daily

if sever can give T3

D5 if low glue

Can give hydrocortisone if hyponatremic 100 mg every 8 hours

Question 4

Hashimotos tx

Answer 4

Thyroid hormone replacement

Question 5

Hashimoto’s increased risk of

Answer 5

non-Hodgkin B cell lymphoma

Question 6

Subacute thyroiditis (deQuervains)

Answer 6

Post viral thyroid inflammation
young females

Hyperthyroid —euthyroid—hypothyroid

(no treatment or antiinflammatories, NSAIDs) Elevated ESR/CRP

Resolved in a few weeks

Question 7

Subacute Lymphocytic Thyroiditis

Answer 7

Variant of Hashimoto’s

Transient mild hyperthyroidism

Serum TSH stimulating ab not elevated

self resolves over weeks

Question 8

Fibrous Thyroiditis

Answer 8

Fibroblast activation and proliferation . Can often affect things beyond the thyroid.

IgG4 plasma cells

Tx: Thyroid hormone replacement
surgery is often required to relieve thoracic nerve compression.