Physiology
Endocrine
Question 38 of 180
Which of the following clinical features is NOT typical of hypothyroidism:
Answer:
- Symptoms
- Weight gain
- Cold intolerance
- Fatigue
- Constipation
- Depression
- Muscle cramps
- Carpal tunnel syndrome
- Menstrual disturbance
- Reduced fertility
- Signs
- Alopecia
- Bradycardia
- Dry skin
- Brittle nails
- Periorbital myxoedema
- Goitre
- Pretibial myxoedema
Hypothyroidism
Physiology / Endocrine / Thyroid Function
Last Updated: 21st April 2019
Hypothyroidism is characterised by reduced circulating T3 and T4.
Causes
- Primary hypothyroidism
- Autoimmune (atrophic and Hashimoto's)
- Iatrogenic (thionamides, radioactive iodine, surgery, radiation)
- Hypothyroid phase of thyroiditis
- Drugs (lithium, amiodarone, interferon)
- Iodine deficiency
- Secondary hypothyroidism
- TSH deficiency secondary to hypothalamic-pituitary disease
Clinical Features
- Symptoms
- Weight gain
- Cold intolerance
- Fatigue
- Constipation
- Depression
- Muscle cramps
- Carpal tunnel syndrome
- Menstrual disturbance
- Reduced fertility
- Signs
- Alopecia
- Bradycardia
- Dry skin
- Brittle nails
- Peri-orbital myxoedema
- Goitre
- Pre-tibial myxoedema
![By Mikael Häggström.When using this image in external works, it may be cited as:Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain.orBy Mikael Häggström, used with permission. [CC0], from Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2018/08/Signs_and_symptoms_of_hypothyroidism.png)
Clinical Features of Hypothyroidism. (Image by Mikael Häggström, used with permission. [CC0], from Wikimedia Commons)
Investigations
- T3, T4 and TSH
- Low T4 with elevated TSH = Primary hypothyroidism
- Normal T4 with elevated TSH = Subclinical hypothyroidism
- Low T4 with non-elevated TSH = Secondary hypothyroidism (exclude pituitary disease)
- Thyroid antibodies (e.g. TPO antibodies)
Management
- Thyroxine replacement to normalise TFTs and resolve symptoms
Myxoedema Coma
Myxoedema coma is a rare medical emergency with a high mortality requiring treatment in a high dependency setting characterised by:
- Hypotension
- Pericardial effusion
- Bradycardia
- Reduced consciousness
- Hypoventilation
- Hyponatraemia
- Renal impairment
- Coagulopathy
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
