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Hypothyroidism

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Hypothyroidism

  1. 1. Hypothyroidism Definition Causes of hypothyroidism Clinical manifestations of hypothyroidism Laboratory evaluation Autoimmune hypothyroidism
  2. 2. Definition The thyroid gland produce 2 related hormones, thyroxine (T4) and triiodothyronine(T3) These hormones help to maintain thermogenic and metabolic homeostasis in the adult. Hypothyroidism results specially from glandular destruction and underproduction of thyroid hormones.
  3. 3. Causes of hypothyroidismPrimary hypothyroidism: Autoimmune hypothyroidism: hashimoto’s thyroiditis Iatrogenic: radioactive iodine trt, total thyroidectomy, external irradiation Drugs: amiodarone, lithium, antithyroid drugs Congenital hypothyroidism: absent thyroid gland, TSH Rc mutation Iodine deficiency Infiltrative disorders: amyloidosis, sarcoidosis, hemochromatosis…
  4. 4. Causes of hypothyroidismTransient hypothyroidism:Silent thyroiditis , including postpartum thyroidtisSubacute thyroiditisWithdrawal of thyroxine trt
  5. 5. Causes of hypothyroidismSecondary hypothyroidism:Hypopituitarism: tumors, pituitary surgery or irradiation, infiltrative disorders, Sheehan’s syndrome, traumaHypothalamic disease: tumors, trauma, infiltrative disorders , idiopathic
  6. 6. Clinical manifestationsSymptoms: Tiredness, weakness Dry skin Feeling cold Hair loss Difficulty concentrating and poor memory Constipation Weight gain Dyspnea Hoarse voice Dysmenorrhea Paresthesias
  7. 7. Signs: Dry skin and cool peripheral extremities Puffy face, hands and feet (myxedema) Diffuse alopecia Bradycardia Delayed tendon reflex relaxation Carpal tunnel syndrome
  8. 8. Laboratory evaluation Dyslipidemia with elevated cholesterol and triglycerides Anemia TSH ↑ and FT4 nle: subclinical hypothyroidism TSH ↑ and FT4↓:clinical hypothyroidism TSH nle or ↓ and FT4 ↓:secondary hypothyroidism
  9. 9. Autoimmune hypothyroidism Autoimmune hypothyroidism may be associated with a goiter (Hashimoto’s disease) or ,at the later stages of the disease, minimal residual thyroid tissue (atrophic thyroiditis) First preceded by subclinical hypothyroidism with normal thyroid hormones levels and elevated TSH Later ,FT4 levels fall and TSH levels rise further Female >male Anti TPO +++

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