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Hypothyroidism

Definition Atrophic (Autoimmune) Hypothyroidism

Deficiency in Thyroid Activity Associated with Autoantibodies leading to Lymphoid Infiltration of Gland
↓ Thyroid Hormone Production Eventually lead to
Characteristics • Atrophy
↓ BMR (Basal Metabolic Rate) • Fibrosis
Fatigue Female ↑
Lethargy Incidence ↑ with Age
Women ↑
Hashimoto’s Thyroiditis
Pathophysiol ogy Autoimmune Thyroiditis
Normally, Thyroid release • Lymphocytic Infiltration of Gland
• T4 (100-125 nmol) • Circulating Antithyroid Antibodies
• T3 Lead to
Half-Life T4 – 7-10 days • Atrophic changes with Regeneration
T4 → T3 (5’-deiodination) • Goitre formation
Deficiency of Thyroid Hormone has wide range of systemic effe cts Common in
• Due to derangements of Metabolic Processes • Women
• Direct Effects by Myxedematous infiltration • Late Middle Age
Myxedematous changes in Heart
• ↓ Contractility Postpartum Thyroiditis
• Cardiac Enlargement A type of Autoimmune Thyroiditis occurring in Women after Childbirth
• Pericardial Effusion May Cause
• ↓ Pulse • Hyperthyroidism
• ↓ Cardiac Output • Hypothyroidism
GIT • Both (Sequentially)
• Achlorhydria (Absence of HCl secretion)
• ↓ Intestinal Transit with Gastric Stasis Dyshormonogenesis
GU Rare condition
• Delayed Puberty Due to Genetic Defects in Synthesis of Thyroid Hormones
• Anovulation Develop Hypothyroidism with a goitre
• Menstrual Irregularities
• Infertility Iodine Deficiency
↓ Thyroid Hormone Dietary Deficiency of Iodine
• ↑ Total Cholesterol Endemic Goitre
• ↑ LDL May be (depend on Severity)
• ↓ HDL (due to Metabolic clearance) • Euthyroid
(Hypothyroidism – result in ↑ Insulin Resistance) • Hypothyroid
Problem in
Etiology • Netherlands
Primary (1°) Secondary (2°) • Western Pacific
Autoimmune Hypothyroidism Hypopituitarism • South East Asia
Hashimoto’s Thyroiditis Tumours • Africa
Atrophic Thyroiditis Pituitary Surgery, Irradiation Overcome Deficiency
Postpartum Thyroiditis Isolated TSH Deficiency Iodine Salt
Iatrogenic Peripheral Resistance to Thyroid
Drugs Hormone
Congenital Hypothyroidism
(eg. Dyshormonogenesis)
Iodine Deficiency
Infiltrative Disorders
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Symptoms, Signs (Descending order of Frequency) Investigations

Symptoms Signs Serum TSH
Tiredness, Weakness Dry Coarse Skin ↑ TSH – Confirm 1° Hypothyroidism
Dry Skin Cool Peripheral Extremities Free T4
Feeling Cold Puff Face, Hands, Feet (Myxedema) ↓ Free T4 – Confirm Hypothyroid State
Hair Loss Diffuse Allopecia TPO Antibodies (Thyroid Peroxidase Antibodies)
Difficulty Concentrating Bradycardia Present in 90% patients of Hypothyroidism
Poor Memory Peripheral Edema Present in 80% patients of Grave’s Disease
Constipation Delayed Tendon Reflex Relaxation Anaemia (Menorrhagia)
Weight Gain, Poor Appetite Carpal Tunnel Syndrome ↑ Serum Aspartate Transferase Levels
Dyspnea Serous Cavity Effusions ↑ Serum CreaDnine Kinase Levels (Myopathy)
Hoarse Voice Hypercholesterolaemia, Hypertriglyceridaemia
Menorrhagia Hyponatraemia (↑ ADH, Impaired H2O clearance)
Paresthesia
Impaired Hearing

Hypothyroidism
Puff Eyes
Thickened, Pale Skin

Management
Replacement Therapy
Levothyroxine (Thyroxine, eg. T4) is given for life
Monitoring
Aim – Restore T4, TSH to well within Normal range
Assessment – Thyroid Function Tests

Complications
Myxoedema Coma
Rare
Fatal Complication of Long-Term Hypothyroidism
Patient is Comatose with
• Hypothermia
• Depression of Respiration
• Bradycardia
• Hypotension
Usually seen in Elderly patient during Cold weather

Physical Examination
Thyroid
Size
Consistency
Nodularity
Tenderness
Fixation
Lymphadenopathy
Supraclavicular
Cervical Regions of Neck