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It is the functional or structural de arrangement in
the synthesis of thyroid hormone
It can result from a lack of a thyroid gland or fromiodine-131 treatment, and can also be associated withincreased stress.
A 2011 study concluded that about 8% of womenover 50 and men over 65 in the UK suffer from anunder-active thyroid and that as many as 100,000 ofthese people could benefit from treatment they arecurrently not receiving.[1]
INTRODUCTION
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1.8% of total population.
Second only to DM as most common endocrine
disorder.
Incidence increases with age.
More common in females.
2-3% of older women.
Hypothyroidism
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PRIMARY HYPOTHYROIDISM Hoshimotos thyroiditis-most common
Idiopathic hypothyroidism-probably old Hoshimotos Irradiation of thyroid Surgical removal Late stage invasive fibrous thyroiditis Iodine deficiency
Drug therapy (Lithium, Interferon) Infiltrative Diseases:
Sarcoidosis, AmyloidosisScleroderma, Hemochromatosis
Etiology
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SECONDARY HYPOTHYROIDISM
5% of cases.
Pituitary or hypothalmic neoplasm.
Congenital hypopituitarism.
Pituitary necrosis (Sheehans syndrome)
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Occurs in hypothalamus
Results when the hypothalamus fails to produce
sufficient thyrotropin-releasing hormone (TRH).TRH prompts the pituitary gland to producethyroid-stimulating hormone (TSH). Hence may alsobe termed hypothalamic-pituitary-axis
hypothyroidism. It accounts for less than 5% ofhypothyroidism cases
Tertiary hypothyroidism
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Cretinism
Myxedema
Clinical Manifestations
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Hypothyroidism in infancy or early child hood.
Endemic iodine deficiency areas of the world i.e
himalya , waziristan & other hilly areas etc. it may be sporadic cretinism (hypothyroidism due
to inborn errors of metabolism)
Cretinism
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Impaired development of CNS & skeletalsystem.
Severe mental retardation(Related to time at whichthyroid deficiency occur in utero)
Maternal thyroid deficiency before the development of fetal thyroid
gland leads to severe mental retardation.
Short stature
Coarse facial features
Protruding tongue
Umbilical hernia.
Clinical features of
cretinism
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Hypothyroidism occuring in older children andadults is called myxedema.
CLINICAL FEATURES includeGeneralized apathy
Mental sluggishness in early stages may lead todepression
Individuals with myxedema are listless, cold intolerant , obese ,
have constipation & pericardial effusions.
Myxedema (Gull disease)
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Non-specific.
May be confused with other conditions especially in
postpartum depression and elderly.Maintain high index of suspicion.
In older patients, hypothyroidism may be confusedwith Alzheimers and depression.
Patient may end up getting treated for depression.
Signs and Symptoms
i d
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Common signs and symptoms
S/S % pts affected
Weakness 99
Skin changes 97
Slow speech 91
Eyelid edema 90
Cold sensation 89
Decreased sweating 89
Cold skin 83
Thick tongue 82
Facial edema 79
Coarse hair 76
Skin pallor 67
Forgetfulness 66
Constipation 61
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In Primary Hypothyroidism
Serum TSH is high.
Free thyroid hormone are depressed.
In Secondary Hypothyroidism
Both TSH and free thyroid hormones are low.
Diagnosis
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Generally
Once diagnosis of primary hypothyroidism is made,additional imaging or serologic testing is unnecessary
if gland is normal on exam.
In secondary hypothyroidism, further testing withpituitary provocative testing and imaging to rule outmicroadenoma. In general, evidence of decreased levelsof more than one pituitary hormone is indicative of apanhypopituitary problem.
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Lab Values
TSH level Free T4 level Free T3 level Likely Diagnosis
High
High (>10 U/mL
[{10mU/L]}
High (6-1uU/mL
{6-10mU/L])
High
High
Low
Low Low Primary Hypothyroidism
Normal Normal Subclinical hypothyroidism with
high risk for future development
of overt hypothyroidism
Normal Normal Subclinical hypothyroidism
with low risk for future development
of overt hypothyroidism
High Low Congenital absence of T4-T3
converting enzyme; amiodarone
Cordarone) effect on T4-T3
conversion
High High Peripheral thyroid hormone
resistance
Low Low Pituitary thyroid deficiency
or recent withdrawal of
thyroxine after excessive
replacement therapy