Beruflich Dokumente
Kultur Dokumente
HYPOTHYROIDISM
DEFINITION
Increasing age
Female sex
Autoimmune disease eg. Coeliac, Addisons disease
Drugs eg. Lithium, amiodarone, carbimazole
Occurs more commonly in patients with Turners
syndrome & Trisomy 21
Genetic predisposition
Pregnancy or post partum
Cystic fibrosis
Thyroid surgery or radiation/ radio- iodine.
SYMPTOMS OF HYPOTHYROIDISM
Tiredness, lethargy, intolerance to cold.
Dry skin and hair loss
Slowing of intellectual activity, eg poor memory and
difficulty concentrating
Constipation
Decreased appetite with weight gain
Deep hoarse voice
Menorrhagia and later oligomenorrhoea or amenorrhoea.
Impaired hearing due to fluid in middle ear.
Reduced libido
Low mood
myalgia
CLINICAL FEATURES OF
HYPOTHYROIDISM
Tiredness Puffy Eyes
Department of Medicine,
INVESTIGATIONS
Diagnosis Hypothyroidism
TSH
FT4 and T3
Department of Medicine,
RCSI
SCREENING FOR COMPLICATIONS
Other causes
Post thyroidectomy or radioiodine
Drug induced eg. Carbimazole, lithium, amiodarone
Subacute thyroiditis
Iodine deficiency
Congential hypothyroidism
Post partum thyroiditis
Infiltrative causes eg. haemochromatosis
Secondary hypothyroidism
Due to TSH deficiency eg. Hypopituitarism ( rare)
Department of Medicine,
RCSI
HASHIMOTOS THYROIDITIS
Department of Medicine,
RCSI
TREATMENT OF HYPOTHYROIDISM
Caution:
Elderly or ischaemic heart disease: Start at 25micrograms daily
& adjust slowly in 4 weekly increments of 25 micrograms ( risk of
precipitating angina or myocardial infarction)
SIDE-EFFECTS
Myxoedema coma
Ischaemic heart disease
Weight gain/ obesity
Rare neurologic problems include reversible cerebellar
ataxia, dementia, psychosis, and myxedema coma.
Hashimoto's encephalopathy
SUBCLINICAL HYPOTHYROIDISM
Reasons to treat
1. Increase risk of future clinical hypothyroidism
2. Hyperlipidaemia and atherosclerosis
3. Pregnancy
4. Reduce quality of life if symptomatic
SUBCLINICAL HYPOTHYROIDISM
Management
Treat if TSH > 10mU/L
Treat if TSH between 4-10 mU/L
If symptomatic
If positive thyroid autoantibodies
Goitre
If pregnant or trying to conceive
If previous Graves disease or other autoimmune diseases, consider
treatment as more likely to progress to overt hypothyroidism
A 21 year old woman with a background history of type 1 diabetes presents with
cold intolerance, weight gain & lethargy. A diagnosis of hypothroidism is
considered.
Q1. List 5 signs on clinical examination that would support this diagnosis (5 marks)
Answer= see slide 6
Q2. What is the most common cause of hypothyroidism? ( 3 marks)
Hashimotos thyroiditis
Q3. What precaution would you take in starting thyroxine replacement if this
patient was 72 years old & had a history of ischaemic heart disease? Give details (
8 marks)
Answer= administer 25micrograms( 2 marks) of l-thyroxine ( 2 marks) as a
starting dose & titrate slowly ( 2 marks) e.g.. increase every 4 wks in 25 mcg
increments according to TFTs. ( 2 marks)
Q4. Describe the thyroid function tests results you would expect to find in this
patient `(4 marks)
Answer = T4 low, TSH raised
REFERENCES
Uptodate.com
Kumar & Clark- Clinical Medicine 2012
Harrisons clinical medicine 2012
Oxford handbook of clinical medicine 8th edition