1
Q
symptoms of hypothyroidism
A
- Lethargy
- Cold intolerance
- ↓ appetite but ↑wt.
- Constipation
- Menorrhagia
- ↓ mood
2
Q
signs of hypothyroidism
A
- Cold hands
- Bradycardic
- Slow-relaxing reflexes
- Dry hair and skin
- Puffy face
- Goitre
- Myopathy, neuropathy
- Ascites
- Myxoedema
3
Q
what is myxoedema
A
- SC tissue swelling in severe hypothyroidism
- Typically around eyes and dorsum of hand
4
Q
primary causes of hypothyroidism
A
- Atrophic thyroiditis (commonest UK)
- Hashimoto’s thyroiditis
- Subacute thyroiditis (e.g. post-partum)
- Post De Quervain’s thyroiditis
- Iodine deficiency (commonest worldwide)
- Drugs: carbimazole, amiodarone, lithium
- Congenital: thyroid agenesis
5
Q
other causes of hypothyroidism
A
- thyroidectomy
- radio-iodine
- hypopituitarism (very rare cause)
6
Q
features of atrophic thyroiditis
A
- Thyroid antibodies +ve: anti-TPO, anti-TSH
- Lymphocytic infiltrate → atrophy (no goitre)
- Associations (Pernicious anaemia, Vitiligo, Endocrinopathies)
7
Q
features of Hashimoto’s thyroiditis
A
- TPO +ve
- Atrophy + regeneration → goitre
- May go through initial thyrotoxicosis phase
- May be euthyroid or hypothyoid
8
Q
investigations for hypothyroidism
A
- ↑TSH, ↓T3/T4
- ↑MCV ± normochromic anaemia
- ↑ triglyceride + ↑ cholesterol
- Hyponatraemia (SIADH)
- ↑ CK if assoc. myopathy
- Antibodies: TPO, TSH
9
Q
treatment for hypothyroidism
A
- Levothyroxine
- Titrate to normalise TSH
- Enzyme inducers ↑ thyroxine metabolism
- Clinical improvement takes ~2wks - Check for other AI disease: e.g. Addison’s, PA
10
Q
features of myxoedema coma
A
- Looks hypothyroid
- Hypothermia
- Hypoglycaemia
- Heart failure: bradycardia and ↓BP
- Coma and seizures
11
Q
precipitants to myxoedema coma
A
- Radioiodine
- Thyroidectomy
- Pituitary surgery
- Infection, trauma, MI, stroke
12
Q
management of myxoedema coma
A
- Bloods: TFTs, FBC, U+E, glucose, cortisol
- Correct any hypoglycaemia
- T3/T4 IV slowly (may ppt. myocardial ischaemia)
- Hydrocortisone 100mg IV
- Rx hypothermia and heart failure
