Thyroid Disorders

Question 1

What is hypothyroidism characterized by?

Answer 1

• Low production of thyroid hormone
• Often caused by Hashimoto thyroiditis
• More common in women, occurring 7 times more often than men
• Increased incidence in midlife

Symptoms include fatigue, lethargy, cold intolerance, weight gain, constipation, dry skin, and heavier, longer menstrual cycles.

Question 2

What are the symptoms of hyperthyroidism?

Answer 2

• Anxiety
• Palpitations
• Lighter and less frequent menses
• Heat intolerance

Prevalence is 0.5%, with the most common etiologies being Graves disease, toxic multinodular goiter, and solitary hyperfunctioning adenoma.

Question 3

What is the screening recommendation by the American Thyroid Association for thyroid disease?

Answer 3

Screening at age 35, then every 5 years after

This helps in early detection of thyroid disorders.

Question 4

What confirms overt hypothyroidism?

Answer 4

Elevated TSH and low Free T4

High TSH and High T4 may indicate rare TSH-producing pituitary adenoma or thyroid hormone influence prior to lab draw.

Question 5

What does a slightly elevated TSH with normal T4 indicate?

Answer 5

Subclinical hypothyroidism

Presence of antithyroperoxidase antibodies predicts progression to overt hypothyroidism.

Question 6

What is the standard treatment for hypothyroidism?

Answer 6

Levothyroxine

Dosage is 1.6 per kg of body weight per day, adjusted based on age and coronary heart disease status.

Question 7

When should TSH levels be monitored after a dose change of Levothyroxine?

Answer 7

4-6 weeks after any dose change

This ensures the patient reaches the optimal thyroid hormone level.

Question 8

What is the initial therapy for hyperthyroidism?

Answer 8

• Beta blockers for symptoms
• Methimazole for Graves and multinodular goiter

Referral to endocrinology is recommended for further management.

Question 9

What is the most definitive non-surgical treatment for Graves disease?

Answer 9

Radioactive iodine thyroid ablation

This treatment can result in permanent thyroid destruction and lifelong thyroid replacement may be required.

Question 10

What should be checked 6-8 weeks after starting oral estrogen therapy?

Answer 10

TSH levels

Levothyroxine may need to be increased due to oral estrogen increasing thyroid-binding globulin.

Question 11

True or false: Levothyroxine should be taken with food.

Answer 11

FALSE

It should be taken on an empty stomach, 60 minutes before breakfast or 3 hours after dinner.