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4 Cards in this Set

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Hypothyroidism: Clinical Presentation, Investigations, Hormone Abnormalities, Differential Diagnosis, Screening, When Treat, Effect in Pregnancy,
1. Clinical Presentation: fatigue, constipation, dry skin, family hx, no depression, sleeping well
2. Investigations: Start with sTSH, CBC, FSH, beta HCG, fasting blood glucose, creatinine, AST and if all normal do CXR, Abdo-Pelvic U/S
3. Hormone Abnormalities: sTSH high+ T3/T4 low (primary), sTSH low + T3/T4 low (secondary/tertiary)
4. Differential Diagnosis: primary (congenital, Hashimoto's thyroiditis, iatrogenic, subacute thyroiditis), secondary/tertiary (pituitary/hypothalamic disease), peripheral resistance (mutation in T3 receptor)
5. Screening: new born infants, pregnant women at increased risk, women over 60, presence of signs/symptoms, on drugs associated with hypothyroidism, have associated condition
6. When Treat: low T3/T4+high TSH + (symptoms/signs or TSH>10 or pregnant)
7. Effect in Pregnancy: in first trimester can affect neuropsychological development of fetus (decreases IQ)
Hashimoto's Thyroiditis: Clinical Presentation, Pathophysiology, Treatment
1. Clinical Presentation: hypothyroid symptoms or asymptomatic, small goitre (painless), positive anti-thyroid antibodies, other autoimmune disorder
2. Pathophysiology: cell and antibody mediated destruction of thyroid tissue that is not due to an infection, fibrosis and follicular cell hyperplasia
3. Treatment: levo-thyroxine indefinitely
Subacute Thyroiditis: Clinical Presentation, Pathophysiology, Disease Course, Treatment
1. Clinical Presentation: hypothyroid symptoms, decreased T3/T4+elevated TSH, painful (post-viral) or painless (post-partum) thyroid gland
2. Pathophysiology: infection or pregenancy causes inflammation of thyroid which damages follicles resulting in unregulated release of T3/T4 (thyrotoxicosis) followed by hypothyroidism as follicles recover
3. Disease Course: Hyperthyroidism (0-4mo)->euthyroid(4-6mo)->hypothyroid(>6mo), may or may not recover fully
4. Treatment: beta blockers for palpitations/nervousness/tremor and NSAIDs/glucocorticoids for pain during thyrotoxic phase, levo-thyroxine during hypothyroid phase
Treatment with thyroid replacement drugs: starting dose, how to take, pregnancy dose, time to reach steady state
1. Starting Dose: 0.0015mg/kg
2. How to Take: empty stomach with water, no food/drink for 30-60min, no vitamins or minerals for 3-4hr before or after
3. Pregnancy Dose: increase dose by 30-50% to keep TSH at 0.5-2.5, take two extra pills a week to accomplish this
4. Time to Reach Steady State: 6weeks