HYPOTHYROIDISM

HYPOTHYROIDISM Hypothyroidism results from suboptimal levels of thyroid hormone. Thyroid deciency can affect all body functions and can range from mild, subclinical forms to myxedema, an advanced form. The most common cause of hypothyroidism in adults is autoimmune thyroiditis (Hashimotos disease), in which the immune system attacks the thyroid gland. Hypothyroidism also commonly occurs in patients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or who have had surgery.Causes of HypothyroidismChronic 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 excessPathophysiology 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 hypothalamusWhen 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 ManifestationsGeneralLethargy, SomnalenceWeight gain, GoitreCold IntolerenceCardiovascularBradycardia, AnginaCHF, Pericardial EffusionHyperlipIdemia, XanthelsmaHaematologicalIron def. Anaemia, Normo cytic /chromic AnaemiaReproductive systemInfertility, MenorrhagiaImpotence, Inc. Prolactin5NeuromuscularAches and painsMuscle stiffnessCarpel tunnel syndromeDeafness, HoarsenessCerebellar ataxiaDelayed DTR, MyotoniaDepression, PsychosisGastro-intestinalConstipation, Ileus, AscitesDermatologicalDry flaky skin and hairMyxoedema, Malar flushesVitiligo, Carotenimia, Alopecia

7The Nine Square Game To evaluate our Thyroid patientAs per the AACE and ITS Guidelines8 LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSH LOW NORMAL HIGHFREE THYROXINE or FT4BASIC THYROID EVALUATION9 LOW NORMAL HIGHFREE THYROXINE or FT4EUTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION10 LOW NORMAL HIGHFREE THYROXINE or FT4PRIMARYHYPOTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION11 LOW NORMAL HIGHFREE THYROXINE or FT4PRIMARYHYPERTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION12 LOW NORMAL HIGHFREE THYROXINE or FT4SECONDARYHYPOTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION13 LOW NORMAL HIGHFREE THYROXINE or FT4SECONDARYHYPERTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION14 LOW NORMAL HIGHFREE THYROXINE or FT4SUB-CLINICALHYPERTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION15 LOW NORMAL HIGHFREE THYROXINE or FT4SUB-CLINICALHYPOTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION16 LOW NORMAL HIGHFREE THYROXINE or FT4NON THYROIDILLNESS or NTI LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION17 LOW NORMAL HIGHFREE THYROXINE or FT4NTI or Pt.on ELTROXIN LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATION18 LOW NORMAL HIGHFREE THYROXINE or FT4EUTHYROIDSUB-CLINICALHYPERTHYROIDNON THYROIDILLNESS - NTINTI or Pt.on ELTROXINSUB-CLINICALHYPOTHYROIDSECONDARYHYPERTHYROIDSECONDARYHYPOTHYROIDPRIMARYHYPERTHYROIDPRIMARYHYPOTHYROID LOW NORMAL HIGHTHYROID STIMULATING HORMONE - TSHBASIC THYROID EVALUATIONTreatmentGoal : Normalize TSH level regardless of cause of hypothyroidismTreatment : Once daily dosing with Levothyroxine sodium (1.6g/kg/day) this comes to 100 mcg per dayMonitor TSH levels at 6 to 8 weeks, after initiation of therapy or dosage change19Myxedema ComaPrecipitating factors :Infection, trauma, stroke, cardiovascular, hemorrhage drug overdose, diureticsSigns and Symptoms :Mental confusion, hypothermia, bradycardia, older age, Na, glucose, CO2, WBC, Hct, CPKTreatmentICU transfer, T3 100 g IV sixth hourly, 500 g of T4 , antibiotics, ventilation, hydrocortisone IV, passive warming, careful volume management20