396.2 📚 國考版醫垫國考 / PGY OSCE

396.2.0.1 📌 Cram Sheet

396.2.0.1.1 🔥 高 yield 15
  1. Hashimoto = 已開癌國家 #1; iodine def = 党球 #1
  2. TSH ↑ + FT4 ↓ = primary hypo; TSH 䜎 + FT4 ↓ = central
  3. Subclinical: TSH ↑ + FT4 normal
  4. Anti-TPO 95% sensitivity for Hashimoto
  5. LT4 1.6 ÎŒg/kg/d for full replacement
  6. 老人/cardiac 25 ÎŒg/d èµ·, slow titrate
  7. 空腹 30-60 min, avoid Ca/Fe/PPI 4 hr
  8. TSH q6-8 wk after dose change
  9. Pregnancy +30-50% LT4, trimester-specific TSH target
  10. Myxedema coma: HC + LT4 + passive warm + ICU
  11. Hung-up reflex = slow relaxation phase
  12. Macroglossia, periorbital myxedema, lateral eyebrow loss
  13. Drug-induced: lithium, amiodarone, ICI, TKI
  14. Postpartum thyroiditis 5-10%, biphasic
  15. Subclinical: treat if TSH > 10, TPO+, pregnancy, kids, symptomatic
396.2.0.1.2 🔢 必背
項目 æ•žå­—
LT4 full replacement 1.6 ÎŒg/kg/d
老人/cardiac 起始 25 ÎŒg/d
Subclinical 起始 25-50 ÎŒg/d
Pregnancy increase +30-50%
TSH target general 0.5-2.5
TSH target 1st trim < 2.5
TSH target 2-3rd trim < 3.0
Subclinical treat threshold TSH > 10
LT4 半衰期 7 days
Re-check after dose change 6-8 wk
Myxedema coma mortality 30-40%

396.2.0.2 ⭐ 高 yield

396.2.0.2.1 Symptoms by System
System Symptom
General 疲倊, 怕冷, 體重 ↑, 嗜睡
CV Bradycardia, diastolic HTN, pericardial effusion
GI 䟿秘
Skin Dry, coarse, myxedema, lateral eyebrow loss
Reproductive 月經倚, 䞍孕
MSK Carpal tunnel, ↑ CK, hung-up reflex
CNS Depression, slow thinking, dementia
Hematologic Anemia (norm/macrocytic)
396.2.0.2.2 Drug-induced 速蚘
  • Lithium: 50%+ chronic
  • Amiodarone: hypo or hyper (Type 1/2)
  • ICI: thyroiditis common (60%) hyper → hypo
  • TKI: 30% chronic use
  • IFN-α: hep C tx
  • Iodine excess: Wolff-Chaikoff persistent
396.2.0.2.3 Subclinical Hypothyroid 治療指匕
Indication Treat?
TSH > 10 Yes
TSH 4-10 + symptoms Yes
TSH 4-10 + Anti-TPO+ Yes
TSH 4-10 + pregnancy/planning Yes
TSH 4-10 + kids/teen Yes
TSH 4-7 + asymptomatic + TPO− Observe
老人 ≥ 80 + asymptomatic Observe
396.2.0.2.4 Myxedema Coma
  • Hypothermia + bradycardia + hyponatremia + 䜎意識 + 嚎重 illness/cold trigger
  • Treat:
    1. HC 100 mg IV q8h (cortisol first!)
    2. LT4 200-400 ÎŒg IV loading → 50-100 ÎŒg/d
    3. Passive rewarming
    4. Cautious fluids
    5. Treat trigger (antibiotic, etc)
  • Mortality 30-40%
396.2.0.2.5 Causes Quick
Type Cause
Hashimoto Autoimmune, anti-TPO+
Iodine def Endemic
Iatrogenic Post-thyroidectomy, post-RAI, neck RT
Drug Lithium, amiodarone, ICI, TKI, IFN-α, iodine excess
Subacute de Quervain (painful)
Silent / postpartum Painless
Congenital Dysgenesis, dyshormonogenesis
Central Hypopituitarism

396.2.0.3 🎯 自我檢枬

  1. Hashimoto Ab? → Anti-TPO 95%
  2. LT4 starting dose? → 1.6 ÎŒg/kg/d
  3. 老人/cardiac 起始? → 25 ÎŒg/d
  4. Pregnancy LT4 增 %? → 30-50%
  5. TSH target 1st trimester? → < 2.5
  6. LT4 半衰期? → 7 days
  7. Subclinical 治療 indication 5? → TSH > 10, TPO+, pregnancy, kids, symptoms
  8. Myxedema coma 氞遠先絊? → Hydrocortisone
  9. LT4 + Ca interval? → 4 hr
  10. Hung-up reflex? → Slow relaxation phase
  11. Subacute thyroiditis 特埵? → Painful + ESR ↑↑
  12. Postpartum thyroiditis %? → 5-10%
  13. Lithium hypothyroid %? → 50%+
  14. ICI thyroiditis biphasic? → Hyper → hypo
  15. 老人 acceptable TSH? → 范高 (up to 6)

⚠ AI 草皿。