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Hypothyroidism

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UG CLASS

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Hypothyroidism

  1. 1. Hypothyroidism
  2. 2. Terms  Adult hypothyroidism  Myxoedema  Cretinism
  3. 3. Cretinism  Fetal or infantile hypothyroidism  Endemic and sporadic  Sporadic –agenesis ,dyshormonogenesis  Hoarse cry , macroglossia , umbilical hernia  Immediate diagnosis and treatment
  4. 4. Adult type  • bradycardia  • cold extremities  • dry skin and hair  • periorbital puffiness  • hoarse voice  • bradykinesis, slow movements  • delayed relaxation phase of ankle jerks. The symptoms are:  • tiredness  • mental lethargy  • cold intolerance  • weight gain  • constipation  • menstrual disturbance  • carpal tunnel syndrome.
  5. 5. Myxoedema
  6. 6. Classification of hypothyroidism  Autoimmune thyroiditis (chronic lymphocytic thyroiditis 1) Non-goitrous: primary myxoedema 2) Goitrous: Hashimoto’s disease
  7. 7. Classification Iatrogenic  After thyroidectomy  After radioiodine therapy  Drug induced (antithyroid drugs,para- aminosalicylic acid and iodides in excess)
  8. 8. Classification  Dyshormonogenesis  Goitrogens  Secondary to pituitary or hypothalamic disease  Thyroid agenesis  Endemic cretinism- Often goitrous and due to iodine deficiency
  9. 9. Dyshormonogenesis  Deficient enzymes  Autosomal recessive  Young patients , thyromegaly , euthyroid state  Pendred syndrome – TPO deficiency goitre , sensorineural deafness , abnormal bony labyrinth
  10. 10. Investigations and management  TFT- low T3 , T4 and high TSH  High titres of TPO antibodies  Oral thyroxine (0.1 to 0.2 mg/day) or triiodothyronine (20mcg tds)  Myxoedema – bolus 500mg of T4 or 10 mcg of T3 oral or IV 4-6 hourly  Corticosteroids and broad spectrum antibiotics

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