Endocrinology

  • Hypothyroidism

  • What is the commonest cause of hypothyroidism in the developed world?

  • Autoimmune – Hashimoto’s thyroiditis

  • What is the commonest cause of hypothyroidism in the developing world?

  • Iodine deficiency

  • Which site is the source of abnormality in primary hypothyroidism?

  • Thyroid gland

  • Which are the two possible sites of abnormality in central hypothyroidism?

  • 1) Pituitary – secondary

    2) Hypothalamic – tertiary

  • Approximately what percentage of hypothyroidism is accounted for by primary hypothyroidism?

  • More than 95%

  • Which 2 autoantibodies are found in autoimmune thyroiditis?

  • 1) Anti-thyroid peroxidase antibodies

    2) Anti-thyroglobulin antibodies

  • Which white blood cell infiltrates the thyroid gland in autoimmune thyroiditis?

  • Lymphocyte

  • How is the size of the thyroid gland typically affected in autoimmune thyroiditis?

  • Increased – goitre

  • What are the 2 main forms of autoimmune thyroiditis?

  • 1) Goitrous

    2) Atrophic

  • Which form of thyroid disorder may be associated with Down’s syndrome?

  • Autoimmune thyroiditis

  • Which form of thyroid disorder may be associated with Turner’s syndrome?

  • Autoimmune thyroiditis

  • Which hormone should initially be tested for in the investigation of hypothyroidism?

  • Thyroid-stimulating hormone (TSH)

  • Which form of hypothyroidism is more common – primary or central?

  • Primary hypothyroidism

  • List 3 iatrogenic causes of primary hypothyroidism

  • 1) Thyroidectomy

    2) Radioiodine therapy

    3) Previous external irradiation

  • What term is given to severe hypothyroidism associated with reduced mental status and hypothermia?

  • Myxoedema coma

  • List 4 possible triggers of myxoedema coma

  • 1) Trauma

    2) Infection

    3) Cold exposure

    4) Drugs affecting mental status such as opiates/hypnotics

  • In approximately what percentage of patients with hypothyroidism are serum anti-thyroid peroxidase antibody levels increased?

  • More than 90%

  • What is the approximate ratio of hypothyroidism in females compared to males?

  • 5-8 times more common in females

  • How is the level of serum thyroid-stimulating hormone (TSH) affected in primary hypothyroidism?

  • Increased

  • How is the level of serum thyroid-stimulating hormone (TSH) affected in secondary (central) hypothyroidism?

  • May be normal i.e., not appropriately elevated

  • How may puberty be affected by hypothyroidism?

  • Delayed puberty

  • How may serum sodium levels be affected in hypothyroidism?

  • Reduced – hyponatraemia

  • How may haemoglobin levels be affected in hypothyroidism?

  • Reduced – anaemia

  • How may serum creatine phosphokinase (CK) levels be affected in hypothyroidism?

  • Increased

  • How may serum prolactin levels be affected in hypothyroidism?

  • Elevated – hyperprolactinaemia

  • How may serum homocysteine levels be affected in hypothyroidism?

  • Elevated – hyperhomocysteinaemia

  • Which liver condition may be associated with hypothyroidism?

  • Non-alcoholic fatty liver disease

  • List 2 gastrointestinal autoimmune conditions which may be associated with primary hypothyroidism

  • 1) Pernicious anaemia

    2) Coeliac disease

  • How is weight typically affected in primary hypothyroidism?

  • Increased

  • How may skin be affected?

  • Dry, coarse, pale, cool skin

  • How may movement be affected?

  • Slowed

  • How may speech be affected?

  • Slowed

  • How may deep tendon reflexes be affected?

  • Delayed relaxation

  • How may heart rate be affected?

  • Bradycardia

  • What is the cause of yellow skin discolouration in primary hypothyroidism?

  • Elevated serum beta-carotene levels i.e., carotenaemia

  • How may voice be affected?

  • Hoarseness

  • How may the tongue be affected?

  • Enlarged – macroglossia

  • Where on the face is a typical site of oedema occur?

  • Peri-orbital region

  • How may eyebrows be affected?

  • Loss (typically outer third)

  • How may hearing be affected?

  • Reduced

  • How may blood pressure be affected?

  • Hypertension (diastolic)

  • What is an important pulmonary complication?

  • Pleural effusion

  • What abnormal clinical sign may be found on abdominal examination?

  • Ascites

  • What breast/nipple complication may occur?

  • Galactorrhoea

  • How may gait be affected?

  • Ataxia

  • Why may skin hyperpigmentation occur in primary hypothyroidism?

  • In cases of associated primary adrenal insufficiency

  • How may hair be affected?

  • Coarse

  • How may nails be affected?

  • Brittle

  • What is a common neurological complication?

  • Carpal tunnel syndrome

  • List 3 menses abnormalities which can occur in women with hypothyroidism

  • 1) Oligomenorrhoea

    2) Amenorrhoea

    3) Menorrhagia

  • How may the prevalence of gout be affected by hypothyroidism?

  • Increased prevalence in hypothyroid patients

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