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Causes of Hypothyroidism
Chronic lymphocytic thyroiditis (Hashimotos thyroiditis)
Atrophy of thyroid gland with aging
Therapy for hyperthyroidism
Radioactive iodine (131I)
Thyroidectomy
Medications
Lithium
Iodine compounds
Antithyroid medications
Radiation to head and neck for treatment of head and neck cancers, lymphoma
Inltrative diseases of the thyroid (amyloidosis, scleroderma)
Iodine deciency and iodine excess
Pathophysiology
More than 95% of patients with hypothyroidism have primary or thyroidal
hypothyroidism, which refers to dysfunction of the thyroid gland itself.
When thyroid dysfunction is caused by failure of the pituitary gland, the
hypothalamus, or both, it is known as central hypothyroidism.
It may be referred to as pituitary or secondary hypothyroidism if it is
caused entirely by a pituitary disorder, and hypothalamic or tertiary
hypothyroidism if it is attributable to a disorder of the hypothalamus
When thyroid deciency is present at birth, the condition is known as
cretinism.
myxedema in adults.
Although myxedema occurs in long-standing hypothyroidism, the term is
used appropriately only to describe the extreme symptoms of severe
hypothyroidism.
Clinical Manifestations
General
Lethargy, Somnalence
Weight gain, Goitre
Cold Intolerence
Cardiovascular
Bradycardia, Angina
CHF, Pericardial Effusion
HyperlipIdemia, Xanthelsma
Haematological
Iron def. Anaemia,
Normo cytic /chromic Anaemia
Reproductive system
Infertility, Menorrhagia
Impotence, Inc. Prolactin
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Neuromuscular
Aches and pains
Muscle stiffness
Carpel tunnel syndrome
Deafness, Hoarseness
Cerebellar ataxia
Delayed DTR, Myotonia
Depression, Psychosis
Gastro-intestinal
Constipation, Ileus, Ascites
Dermatological
Dry flaky skin and hair
Myxoedema, Malar flushes
Vitiligo, Carotenimia, Alopecia
HIGH
NORMAL
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
EUTHYROID
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
PRIMARY
HYPOTHYROID
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
PRIMARY
HYPERTHYROID
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
LOW
SECONDARY
HYPOTHYROID
LOW
NORMAL
HIGH
HIGH
NORMAL
SECONDARY
HYPERTHYROID
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
SUB-CLINICAL
HYPERTHYROID
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
SUB-CLINICAL
HYPOTHYROID
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
LOW
NON THYROID
ILLNESS or NTI
LOW
NORMAL
HIGH
HIGH
NORMAL
NTI or Pt.
on ELTROXIN
LOW
LOW
NORMAL
HIGH
HIGH
PRIMARY
NTI or Pt.
SECONDARY
HYPERTHYROID on ELTROXIN HYPERTHYROID
NORMAL
SUB-CLINICAL
HYPERTHYROID EUTHYROID
LOW
NORMAL
SUB-CLINICAL
HYPOTHYROID
HIGH
Treatment
Goal : Normalize TSH level regardless of cause of hypothyroidism
Treatment : Once daily dosing with Levothyroxine sodium (1.6g/kg/day) this
comes to 100 mcg per day
Monitor TSH levels at 6 to 8 weeks, after initiation of therapy or dosage
change
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Myxedema Coma
Precipitating factors :
Infection, trauma, stroke, cardiovascular, hemorrhage drug overdose, diuretics
glucose, CO2,
Treatment
ICU transfer, T3 100 g IV sixth hourly, 500 g of
T4 , antibiotics, ventilation,
hydrocortisone IV, passive warming, careful volume management
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