Thyroid Dysfunction

Question 1

What are the main causes of Hypothyroidism

Answer 1

1. Hashimoto’s
2. Iatrogenic
3. Carcinoma
4. Trauma/Surgery
5. Iodine deficiency
6. Autoimmune causes
7. Lithium/Amiodarone
8. Radiotherapy
9. Thyroiditis
10. Dishormonogenesis
11. Pregnancy
12. Congenital
13. Under treatment

Question 2

What are the signs of hypothyroidism?

Answer 2

1. Weight gain/fatigue/lethargy
2. Dec appetite/cold intolerance/dry skin
3. Hair loss/sleepiness/muscle pain/joint pain
4. Weakness in the extremities/depression
5. Mental impairment/inability to concentrate
6. Decrease perspiration/nerve issues
7. Blurred vision
8. Fullness in throat/hoarseness

Question 3

What are the physical signs of hypothyroidism?

Answer 3

1. Weight gain/slowed speech, movement
2. Dry skin/ jaundice/pallor/coarse hair
3. Los of hair/periorbital puffiness/macroglossia
4. Goitre
5. Hoarseness
6. Decreased sys and inc dias BP
7. Bradycardia
8. Pericardial effusion
9. Non pitting oedema
10. Hypoflexia

Question 4

What is a Myxedema Coma?

Answer 4

Myxedema coma is a severe form of hypothyroidism that mostly occurs in individuals with undiagnosed and untreated hypothyroidism who are subjected to external stress.

Question 5

What are the features of Myxedema Coma?

Answer 5

1. Altered mental state
2. Hypothermia
3. Bradycardia
4. Hypercarbia
5. Hypernatremia
6. Cardiomegaly/pericardial effusion/ascites
7. Cardiogenic shock

Question 6

What are the common symptoms of thyrotoxicosis/ hyperthyroidism?

Answer 6

1. Nervousness/anxiety
2. Increased perspiration
3. Heat intolerance
4. Hyperactivity/palpitations

Question 7

What are some common signs of thyrotoxicosis?

Answer 7

1. Tachycardia/atrial arrhythmia
2. Systolic hypertension with wide pulse pressure
3. Warm/moist/smooth skin/tremor
4. Lid lag
5. Stare
6. Tremor
7. Weight loss
8. Oligomenorrhea (reduction of menstrual flow)

Question 8

How is thyrotoxicosis presented in younger patients?

Answer 8

1. Sympathetic activation (anxiety, hyperactivity)

2. Also tremor

Question 9

His do older patients present with thyrotoxicosis?

Answer 9

1. Cardiovascular symptoms (anxiety, AF)

2. Unexplained weight loss

Question 10

What are the additional issues with graves disease?

Answer 10

1. More marked symptoms than patients with thyrotoxicosis from other causes
2. Opthalmopathy (periorbital oedema, diplopia, proptosis) suggests Grave’s disease

Question 11

How do you conduct a Goitre examination?

Answer 11

1. Inspect standing patient
2. Ask patient to swallow and watch
3. Then palpate from side/front ( not classically butterfly shaped)
4. Palpate swallowing
5. Can percuss a retrosternal goitre
6. Check for double vision
7. Examine for tremor
8. Lid lag test