THYROID DISORDERS: HYPOTHYROIDISM
REFERENCES <ul><li>Practice Guidelines for Thyroid Disorders </li></ul><ul><li>The Malaysian Consensus 2000 </li></ul><ul>...
INTRODUCTION <ul><li>Hypometabolic state due to deficiency of thyroid hormones  </li></ul><ul><li>Accumulation of GAGs (mu...
ETIOLOGY <ul><li>PRIMARY : THYROID FAILURE  ( 95%) </li></ul><ul><li>SECONDARY : PITUITARY TSH DEFICIT </li></ul><ul><li>T...
<ul><li>Autoimmune hypothyroidism: </li></ul><ul><ul><li>Hashimoto’s thyroiditis </li></ul></ul><ul><ul><li>Atrophic thyro...
2°, 3° AND OTHER CAUSES <ul><li>Hypopituitarism (2°): </li></ul><ul><ul><li>Tumour </li></ul></ul><ul><ul><li>Surgery </li...
 
 
 
LABORATORY INVX <ul><li>Diagnosis : serum TSH </li></ul><ul><li>  : serum T 4     total or free? </li></ul><ul><li>  : th...
MANAGEMENT <ul><li>Aim: to make patient euthyroid, clinically & biochemically. </li></ul><ul><li>Treatment with L-thyroxin...
Continue.. <ul><li>OVERT  HYPOTHYROIDISM </li></ul><ul><ul><li>Starting dose : 50-100 ug/d ->-> 100-200ug/d within 2 weeks...
<ul><li>SUBCLINICAL  HYPOTHYROIDISM: </li></ul><ul><ul><li>L-thyroxine to ↓ risk of CAD </li></ul></ul><ul><ul><li>50-100 ...
<ul><li>EMERGENCY: </li></ul><ul><li>MYXEDEMA  COMA </li></ul>
<ul><li>Severe, uncompensated form of prolonged hypoTH </li></ul><ul><li>Precipitated by stress / infection / drug  </li><...
PLAN OF MANAGEMENT <ul><li>Treat precipitating cause </li></ul><ul><li>Gradual rewarming -> blanket </li></ul><ul><li>Accu...
<ul><li>CONGENITAL </li></ul><ul><li>HYPOTHYROIDISM </li></ul>
<ul><li>Incidence : 1 in 4000-5000 live births </li></ul><ul><li>Importance of TH hormones: </li></ul><ul><ul><ul><li>Norm...
Continue.. <ul><li>Signs (if left untreated, appear at 3-6 months): </li></ul><ul><ul><li>Coarse facies </li></ul></ul><ul...
MANAGEMENT <ul><li>Newborn screening </li></ul><ul><li>Diagnosis confirmed -> treat ASAP  </li></ul><ul><li>Dose: start at...
<ul><li>THANK </li></ul><ul><li>YOU </li></ul>
 
 
Upcoming SlideShare
Loading in...5
×

Hypothyroidism

2,961

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,961
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
153
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • screening: heel prick blood at 2-5/7 of life : cord blood is accepted now: if TSH increased, take venous blood and test for TSH and free T4 at day 7-10 of life.
  • Hypothyroidism

    1. 1. THYROID DISORDERS: HYPOTHYROIDISM
    2. 2. REFERENCES <ul><li>Practice Guidelines for Thyroid Disorders </li></ul><ul><li>The Malaysian Consensus 2000 </li></ul><ul><li>Ministry of Health Malaysia </li></ul><ul><li>Oxford Handbook of Endocrinology & Diabetes </li></ul><ul><li>Helen E. Turner, and John A.H. Wass </li></ul><ul><li>1 st edition, 2003 </li></ul><ul><li>Update on the management of hyperthyroidism and hypothyroidism, Kenneth A. Woeber,, Arch Fam Med (2000) 9; 743-747 </li></ul>
    3. 3. INTRODUCTION <ul><li>Hypometabolic state due to deficiency of thyroid hormones </li></ul><ul><li>Accumulation of GAGs (mucopolysaccharides) in the SC tissue </li></ul><ul><li>Incidence : mid-50s </li></ul><ul><li> : male:female ratio -> 1:10 </li></ul>
    4. 4. ETIOLOGY <ul><li>PRIMARY : THYROID FAILURE ( 95%) </li></ul><ul><li>SECONDARY : PITUITARY TSH DEFICIT </li></ul><ul><li>TERTIARY : HYPOTHALAMIC DEFICIENCY OF TSH </li></ul><ul><li>PERIPHERAL RESISTANCE TO THE ACTIONS OF THYROID HORMONES </li></ul>
    5. 5. <ul><li>Autoimmune hypothyroidism: </li></ul><ul><ul><li>Hashimoto’s thyroiditis </li></ul></ul><ul><ul><li>Atrophic thyroiditis </li></ul></ul><ul><li>Iatrogenic: </li></ul><ul><ul><li>Radio-iodine therapy </li></ul></ul><ul><ul><li>Thyroidectomy </li></ul></ul><ul><ul><li>External radiation to the neck (lymphoma/CA) </li></ul></ul><ul><li>Drugs : </li></ul><ul><ul><li>Antithyroid drugs , amiodarone, lithium, interferon </li></ul></ul><ul><li>Congenital hypothyroidism: </li></ul><ul><ul><li>Thyroid agenesis </li></ul></ul><ul><ul><li>Dyshormogenesis </li></ul></ul><ul><ul><li>TSH-R mutation </li></ul></ul>PRIMARY CAUSES <ul><li>Iodine deficiency </li></ul><ul><li>Infiltrative disorder </li></ul>
    6. 6. 2°, 3° AND OTHER CAUSES <ul><li>Hypopituitarism (2°): </li></ul><ul><ul><li>Tumour </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Radiation </li></ul></ul><ul><ul><li>Postpartum: Sheehan’s syndrome </li></ul></ul><ul><li>Hypothalamic causes (3°): </li></ul><ul><ul><li>Tumour </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><li>Peripheral resistance (rare) </li></ul>
    7. 10. LABORATORY INVX <ul><li>Diagnosis : serum TSH </li></ul><ul><li> : serum T 4  total or free? </li></ul><ul><li> : thyroid autoantibodies </li></ul><ul><li>In outpatient setting -> serum TSH !!! </li></ul><ul><li>SUBCLINICAL HYPOTHYROIDISM: </li></ul><ul><li>patient is not overtly hyperthyroid </li></ul><ul><li>serum free T4 is normal, but TSH is ↑ </li></ul>
    8. 11. MANAGEMENT <ul><li>Aim: to make patient euthyroid, clinically & biochemically. </li></ul><ul><li>Treatment with L-thyroxine is life-long -> ensure compliance!! </li></ul><ul><li>Monitoring: </li></ul><ul><ul><li>Clinically & biochemically </li></ul></ul><ul><ul><li>Measure TSH and free T4 2-3 month after initiation of therapy -> determine maintenance dose </li></ul></ul>
    9. 12. Continue.. <ul><li>OVERT HYPOTHYROIDISM </li></ul><ul><ul><li>Starting dose : 50-100 ug/d ->-> 100-200ug/d within 2 weeks </li></ul></ul><ul><ul><li>IHD / grossly hypothyroid / elderly: </li></ul></ul><ul><ul><ul><li>Start at 25 ug/d </li></ul></ul></ul><ul><ul><ul><li>↑ slowly within 2-4/52 according to pt response </li></ul></ul></ul><ul><ul><ul><li>Angina: withhold / ↓ dose. Proper mx of IHD </li></ul></ul></ul><ul><ul><li>Hypopituitarism: </li></ul></ul><ul><ul><ul><li>Cortisol: to avoid adrenal crisis </li></ul></ul></ul>
    10. 13. <ul><li>SUBCLINICAL HYPOTHYROIDISM: </li></ul><ul><ul><li>L-thyroxine to ↓ risk of CAD </li></ul></ul><ul><ul><li>50-100 ug/d ->-> adjust to maintain TSH at normal level </li></ul></ul><ul><li>PREGNANCY: </li></ul><ul><ul><li>↑ dose, especially in 2 nd / 3 rd trimester </li></ul></ul>
    11. 14. <ul><li>EMERGENCY: </li></ul><ul><li>MYXEDEMA COMA </li></ul>
    12. 15. <ul><li>Severe, uncompensated form of prolonged hypoTH </li></ul><ul><li>Precipitated by stress / infection / drug </li></ul><ul><li>Complication: </li></ul><ul><ul><li>Hypoventilation </li></ul></ul><ul><ul><li>Cardiac failure </li></ul></ul><ul><ul><li>Fluid & electrolyte imbalance </li></ul></ul><ul><ul><li>coma </li></ul></ul>
    13. 16. PLAN OF MANAGEMENT <ul><li>Treat precipitating cause </li></ul><ul><li>Gradual rewarming -> blanket </li></ul><ul><li>Accurate core T° -> rectal thermometer </li></ul><ul><ul><li>Aim for slow ↑ in core T° : 0.5 °C/hr </li></ul></ul><ul><li>Cardiac monitoring </li></ul><ul><li>Correction of electrolyte abnormalities </li></ul><ul><li>Adequate hydration & nutrition (dextrose) </li></ul><ul><li>L-thyroxine (300-400 ug oral/iv) & </li></ul><ul><li>tri-iodothyronine 10 ug 8 hrly </li></ul><ul><li>8. Hydrocortisone : blood cortisol </li></ul>
    14. 17. <ul><li>CONGENITAL </li></ul><ul><li>HYPOTHYROIDISM </li></ul>
    15. 18. <ul><li>Incidence : 1 in 4000-5000 live births </li></ul><ul><li>Importance of TH hormones: </li></ul><ul><ul><ul><li>Normal development of nervous system !! </li></ul></ul></ul><ul><li>Features: </li></ul><ul><ul><li>Prolonged jaundice </li></ul></ul><ul><ul><li>Poor feeding </li></ul></ul><ul><ul><li>Constipation </li></ul></ul><ul><ul><li>Unusually quite baby </li></ul></ul>
    16. 19. Continue.. <ul><li>Signs (if left untreated, appear at 3-6 months): </li></ul><ul><ul><li>Coarse facies </li></ul></ul><ul><ul><li>Dry skin </li></ul></ul><ul><ul><li>Hoarse cry </li></ul></ul><ul><ul><li>Umbilical hernia </li></ul></ul><ul><ul><li>macroglossia </li></ul></ul><ul><ul><li>Delayed developmental milestones </li></ul></ul>
    17. 20. MANAGEMENT <ul><li>Newborn screening </li></ul><ul><li>Diagnosis confirmed -> treat ASAP </li></ul><ul><li>Dose: start at 10-12 ug/kg/day </li></ul><ul><li>Aim : maintain TSH at normal level </li></ul><ul><li> : maintain free T4 at upper limit of normal range </li></ul><ul><li>Life-long treatment: if transient hypoTH is suspected, re-evaluate at 2 years old. </li></ul><ul><li>Monitoring: antropometry/milestones/bone age progression </li></ul>
    18. 21. <ul><li>THANK </li></ul><ul><li>YOU </li></ul>
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×