Hypothyroidism, causes signs $ symptoms.
Hypothyroidism is defined as deficiency in thyroid hormone production. It can be either primary or secondary.
It usually characterised by;
- Accumulation of polysaccharides and proteins in the skin.
- The body retains water giving it puffy like appearance-myxedema.
- Low metabolism and the person is lethargic, with bradycardia and cold intolerance.
- In young adults it causes abnormal brain synapses, with defective myelination
- It results to cretinism and mental retardation in children.
Types of primary hypothyroidism
- Chronic lymphocytic autoimmune thyroiditis-( Hashimoto’s).
- Postpartum thyroiditis.
- Subacute(granulomatous thyroiditis)
- Drug induced type
- Iatrogenic hypothyroidism- anti-thyroid drugs such as carbimazole and propylthiouracil.
Causes of primary type
- Post thyroidectomy
- Iodine deficiency
- Infiltrative disease like amyloidosis sarcoidosis
- Congenital hypothyroidism
Causes of secondary hypothyroidism
- Hypothalamic disease, tumor, trauma and infiltrative disorders.
- Pituitary disease such as hypopituitarism, sheehan syndrome.
- Bexarotene treatment
- Isolated TSH deficiency or inactivity
- silent thyroiditis including postpartum thyroiditis
- Subacute thyroiditis
- Withdrawal of supraphysiologic thyroxine treatment in individual with intact thyroid
- Treatment or subtotal thyroidectomy for Graves’ disease
Sign and Symptoms
- Weight gain
- Cold Intolerance
- Cardiac failure
- Pericardial effusion
- Body aches and pain
- Carpal tunnel
- Dry course skin
- Hoarseness of voice
- Hair loss
- Iron deficiency anaemia
- Pernicious anaemia
Signs of congenital type
- P-pot belly
- P-puffy face
- P-protruding umbilicus
- P-pocket out tongue
Its a severe form of hypothyroidism in a undiagnosed individuals or untreated and who are subjected to stress. They can be characterized by;
- Altered mental status.
- Pericardial effusion
- Cardiogenic shock
Daily replacement dose of levothyroxine(LT4) 100ug to 150ug. Full dose in young adults and in mild and modarates start with 50- 75ug daily.
Treatment of myxedema coma
- Intravenous LT4 at 4ug/kg(200-250ug) bolus
- After 24 hours 100ug of LT4 IV, then 50ug/day iv.
- For stress give a dose of glucocorticoids such as hydrocortisone, dexamethasone