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Hypothyroidism (Examination (Completion (Cardiac exam: evidence of…
Hypothyroidism
Examination
General
- Large body habitus
- Depressed mentation
- Gruff voice
Skin
- Dry skin
- Other AI disease: vitiligo
Periphery
- Cool
- Bradycardia
- Proximal myopathy
- Slow-relaxing reflexes
Face
- Coarse, puffy looking features
- “Peaches-and-cream” complexion
- Loss of lateral eyebrows
- Xanthelasma
- Thin hair
Neck
- Goitre
- Thyroidectomy scar
-
Differential
No goitre
- Atrophic thyroiditis
- Radioactive iodine
- Drugs: e.g. amiodarone
-
Goitre = Hashimoto’s
Smooth Goitre
- Simple colloid goitre
- Hashimoto’s
- Graves’
Nodular Goitre
- Multinodular goitre
- Multiple adenomas
Solitary nodule
- Dominant nodule of a multinodular goitre
- Adenoma
- Malignancy
Viva
Hx
Symptoms
- Cold intolerance
- Appetite but ↑ wt.
- Constipation
- Menorrhagia
- Lethargy, tiredness
- Depression
Cause
- Neck pain
- Iatrogenic
- Drugs
- Radioiodine
- Surgery
-
Ix
Bloods
FBC: ↑MCV ± macrocytic anaemia
U+E: ↓Na
TFTs: ↑TSH, ↓fT4
Abs: TPO
Other: ↑ cholesterol, glucose (exclude DM)
CXR
Pericardial effusion
CCF
Causes of Hypothyroidism
Primary
- Autoimmune: Primary atrophic and Hashimoto’s thyroiditis
- Iatrogenic: rugs, surgery radioiodine
- Iodine deficiency: e.g. Derbyshire neck
- Genetic: thyroid agenesis
Secondary
- Hypopituitarism (v. rare)
-