Thyroid function Tests spirehealthcare甲状腺功能检查 spirehealthcare.pptVIP

Case 13 Female aged 34 years Secondary amenorrhoea Low TSH Low FT4 Hypopituitarism FSH/LH/Prolactin/cortisol MRI Pitutary; ?empty fossa ?large adenoma Start hydrocortisone first if needed, before thyroxine replacement Case 14 22 year old female Admitted with hyper emesis gravidarum Pulse 110 bpm FT4 29 TSH0.01 Management Usually HCG induced in which case it will resolve spontaneously by around 14 weeks If positive thyroid antibodies or history of grave’s disease then treat with PTU Case 14 A] Palpitations, 10 weeks post partum Ft4 32 TSH 0.2 B] Tired, 10 weeks post partum FT4 9 TSH 8 POSTPARTUM THYROIDITIS Incidence varies from 5-11% More common in women with a family history of hypothyroidism and positive TPO antibodies CLINICAL FEATURES Presentation is usually 3-4 months postpartum Can be hypothyroidism (40%), hyperthyroidism (40%) or biphasic(20%) Goiter is present in 50% of patients Pathogenesis Destructive autoimmune thyroiditis causing first release of thyroxine and then hypothyroidism as the thyroid reserve is depleted FNAC shows lymphocytic thyroiditis Diagnosis Advise routine TFT in females who have positive TPO antibodies and type 1 diabetes To distinguish from Graves disease use thyroid isotope scan and TSH receptor Ab Management Most patients recover spontaneously without requiring treatment If hyperthyroid use beta blockers rather than antithyroid drugs as the problem is increased release, not synthesis Hypothyroid phase is more likely to require treatment Only 3-4% remain permanently hypothyroid 10-25% will recur in future pregnancies Case 15 Female aged 30 years New Thyroid enlargement New Thyroid swelling FNAC if nodule size1 cm Repeat FNAC in 6 months Impossible to differentiate between benign and malignant follicular neoplasm using FNAC Case 16 Long standing goitre FT4 28 TSH 7 Measurable TSH with raised FT4 Heterophile antibodies TSH resistance syndromes TSH oma-very rare Thyroid hormone resistance Syndrome characterized by reduced responsiv