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HypothyroidismBy:
Farshid MokhberiMedical Student at:
Shahid Beheshti University of Medical Sciences and Health Services
Anatomy of Thyroid Gland
Histology
Transfering from cell to blood
Mechanism of action
Regulation of synthesis
FunctionsCarbohydrate metabolismCholesterol metabolismGrowthSkeletal muscleHeartCNSCalorigenic action
Hypothyroidism:
Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone.
Risk Factorswoman older than age 60Have an autoimmune diseaseHave a close relative autoimmune diseaseHave been treated with radioactive iodine or
anti-thyroid medicationsReceived radiation to your neck or upper chestHave had thyroid surgery (partial
thyroidectomy)Have been pregnant or delivered a baby within
the past six months
Clinical manifestations
SKINCool and paleSweating is decreasedYellowish tingeHyperpigmentationCoarse hairHairlossNon pitting edemaCold intoleranceDry skin
Eyes
Periorbital edema
Cardiovascular
Decreased heart rateDecreased cardiac outputPericardial effusionDiastolic hypertensionHypercholesterolemiahyperhomocystinemia
Respiratory
FatigueShortness of breath on exertionHypoventilationSleep apneaHoarseness of voice
Gastrointestinal
ConstipationAscitesWeight gainGastric atrophy
Reproductive
OligorrheaAmenorrheaMenorrhagiaDecreased fertilityEarly abortion
Neurologic
Mental slowing
Myxedema coma
Mental retardation
Myxedema comaThe condition occurs in patients with long-standing, untreated hypothyroidism.
mental status, including
lethargystupor delirium(acute confusional state)coma
Musculoskeletal
Joint pains
Aches
stiffness
Metabolic
Hyponatremia
Hyperlipidemia
Increased homocystine
Normal valuesTSH 0.4- 5.0 mU/L
Total T4 4.6-11.2 mcg/dl
Total T3 75-195 ng/dl
Free T4 0.8-1.8 ng/dl
Free T3 2.3-4.2 pg/ml
TreatmentINITIAL DOSEYoung healthy-1.6mcg/Kg wtElderly-50mcg
TIMING OF DOSEHalf an hour before food
SIDE EFFECTS-RareAllergy to dye in the tablets
MONITORINGEvery 6 weeksIf TSH is not with in normal range increase
the dose by 12.5-25mcgIf TSH normal ,monitor TSH once a year
Refrences