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Hypothyroidism

Title

Ñ    Hypothyroidism

Definition

Ñ    Metabolic state caused by deficiency of thyroxine

Pathogenesis

Causes

Primary Hypothyroidism

Ñ    Congenital:

Thyroid agenesis, thyroid maldescent, dyshormonogenesis

Ñ    Traumatic:

Post-thyroidectomy hypothyroidism or following radioiodine therapy

Ñ    Inflammatory:

Hashimoto’s thyroiditis, lymphocytic thyroiditis, Riedl’s fibrosing thyroiditis

Ñ    Metabolic:

Iodine deficiency or excess

Ñ    Drugs:

Anti-thyroid drugs, lithium, amiodarone

Secondary Hypothyroidism

Ñ    Panhypopituitarism

Ñ    Isolated TSH deficiency:

Almost never occurs

Pathophysiology

Ñ    Decreased physiological effects of thyroxine

Clinical Features

History

E&M

Ñ    Tiredness

Ñ    Weight gain

Ñ    Cold intolerance

GIT

Ñ    Anorexia

Ñ    Constipation

RAG

Ñ    Menorrhagia or oligomenorrhoea

Ñ    Loss of libido

Ñ    Galactorrhoea

Examination

E&M

Ñ    Increased weight

Ñ    Goitre

IS

Ñ    Dry, coarse skin

Ñ    Peaches and cream complexion

Ñ    Dry, brittle hair

Ñ    Loss of eyebrows

Ñ    Puffiness below eyes

CVS

Ñ    Cold peripheries

Ñ    Hypertension

Ñ    Heart failure

Ñ    Pericardial effusion

RS

Ñ    Hoarse voice

HS

Ñ    Anaemia

CNS

Ñ    Poor memory

Ñ    Depression

Ñ    Psychosis:

Myxoedema madness

Ñ    Coma

Ñ    Deafness

Ñ    Ataxia

Ñ    Carpal tunnel syndrome

Ñ    Proximal myopathy

Ñ    Increased ankle jerk relaxation time

Investigations

Fluids

Blood

Biochemistry

Ñ    TSH levels:

Increased

Ñ    T₄ level:

Decreased

Immunology

Ñ    Thyroid peroxidase antibody:

Hashimoto’s thyroiditis

Ñ    Antithyroglobulin:

Hashimoto’s thyroiditis

Management

Support

E&M

Drugs

Ñ    Replacement with thyroxine

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