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 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

The Nine Square

Game
To evaluate our Thyroid patient
As per the AACE and ITS Guidelines

HIGH
NORMAL
LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

8

HIGH
NORMAL

EUTHYROID

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

9

HIGH
NORMAL

PRIMARY
HYPOTHYROID

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

10

HIGH
NORMAL

PRIMARY
HYPERTHYROID

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

11

HIGH
NORMAL
LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

SECONDARY
HYPOTHYROID
LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

12

HIGH
NORMAL

SECONDARY
HYPERTHYROID

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

13

HIGH
NORMAL

SUB-CLINICAL
HYPERTHYROID

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

14

HIGH
NORMAL

SUB-CLINICAL
HYPOTHYROID

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

15

HIGH
NORMAL
LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

NON THYROID
ILLNESS or NTI
LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

16

HIGH
NORMAL

NTI or Pt.
on ELTROXIN

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

LOW

NORMAL

HIGH

THYROID STIMULATING HORMONE - TSH

17

HIGH

PRIMARY
NTI or Pt.
SECONDARY
HYPERTHYROID on ELTROXIN HYPERTHYROID

NORMAL

SUB-CLINICAL
HYPERTHYROID EUTHYROID

LOW

FREE THYROXINE or FT4

BASIC THYROID EVALUATION

SECONDARY NON THYROID

PRIMARY
HYPOTHYROID ILLNESS - NTI HYPOTHYROID
LOW

NORMAL

SUB-CLINICAL
HYPOTHYROID

HIGH

THYROID STIMULATING HORMONE - TSH

18

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

Signs and Symptoms :

Mental confusion, hypothermia, bradycardia, older age,
Na,

glucose, CO2,

WBC, Hct, CPK

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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