This document discusses hypothyroidism, its symptoms, signs, and treatment. It notes that hypothyroidism can affect carbohydrate metabolism, cholesterol metabolism, growth, skeletal muscle, heart, CNS, calorigenic action, reproductive system, and hepatic conversion of carotene to vitamin A. Symptoms include cool and pale skin, decreased sweating, hair loss, fatigue, constipation, weight gain, joint pains, and decreased heart rate. Laboratory tests include TSH, total T4, total T3, and free T4 levels. Treatment involves thyroid hormone replacement via oral levothyroxine, with dosing based on age, health status, and pregnancy. Monitoring of TSH levels is needed every 4

1. Dr.venkat
DNB Family medicine

8.  Carbohydrate metabolism
 Cholesterol metabolism
 Growth
 Skeletal muscle
 Heart
 CNS
 Calorigenic action

9.  Reproductive system
 Hepatic conversion of carotene to vitamin A

11. SKIN
 Cool and pale
 Sweating is decreased
 Yellowish tinge
 Hyperpigmentation
 Coarse hair
 Hairloss
 Non pitting edema
 Cold intolerance

12.  Periorbital edema
 Graves opthalmopathy

13.  Normocytic anemia
 Microcytic anemia
 Macrocytic anemia

14.  Decreased heart rate
 Decreased cardiac output
 Pericardial effusion
 Diastolic hypertension
 Hypercholesterolemia
 hyperhomocystinemia

15.  Fatigue
 Shortness of breath on exertion
 Hypoventilation
 Sleep apnea
 Hoarseness of voice

16.  Constipation
 Ascites
 Weight gain
 Gastric atrophy
 Celiac disease is more common

17.  Oligorrhea
 Amenorrhea
 Menorrhagia
 Decreased fertility
 Early abortion

18.  Mental slowing
 Myxedema coma
 Mental retardation

19.  Joint pains
 Aches
 stiffness

20.  Hyponatremia
 Hyperlipidemia
 Increased homocystine

23.  TSH 0.4- 5.0 mU/L
 Total T4 4.6-11.2 mcg/dl
 Total T3 75-195 ng/dl
 Free T4 0.8-1.8 ng/dl
 Free T3 2.3-4.2 pg/ml

25.  INITIAL DOSE
 Young healthy-1.6mcg/Kg wt
 Elderly-50mcg
 H/O coronary artery disease-25mcg
 TIMING OF DOSE
 Half an hour before food
 SIDE EFFECTS-Rare
 Allergy to dye in the tablets

26.  MONITORING
 Every 6 weeks
 If TSH is not with in normal range increase
the dose by 12.5-25mcg
 If TSH normal ,monitor TSH once a year

27.  Thyroid replacement and monitor free T4
and not TSH levels.
 Look for other hormone deficiencies before
starting T4.

28.  Normal TSH values in pregnancy
 First trimester 0.1-2.5
 Second trimester 0.2-3.0
 Third trimester 0.3-3.0

29.  Preclampsia
 Placental abruption
 Gestational hypertension
 Preterm delivery
 Postpartum hemorrhage
 Low birth weight

30. Diagnosis is based on TSH and free T4 result
Moderate to severe 1.6mcg/kg wt
TSH <10 1 mcg/kg wt
Monitor TSH every 4 weeks

32.  TSH values between 2.5-4.5 during pregnancy
stop treatment
 Pre existing hypothyroidism-pre pregnant
dose to be continued