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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

  1. Chronic lymphocytic autoimmune thyroiditis-( Hashimoto’s).
  2. Postpartum thyroiditis.
  3. Subacute(granulomatous thyroiditis)
  4. Drug induced type
  5. Iatrogenic hypothyroidism- anti-thyroid drugs such as carbimazole and propylthiouracil.

Causes of primary type

  • Post thyroidectomy
  • Iodine deficiency
  • Infiltrative disease like amyloidosis sarcoidosis
  • Agenesis
  • 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

Transient hypothyroidism

  • 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

  • Tiredness
  • Weight gain
  • Cold Intolerance
  • Goitre
  • Constipation
  • Bradycardia
  • Angina
  • Cardiac failure
  • Pericardial effusion
  • Body aches and pain
  • Carpal tunnel
  • Myxedema
  • Dry course skin
  • Deafness
  • Hoarseness of voice
  • Vitilago
  • Pyschosis
  • Depression
  • Hair loss
  • Iron deficiency anaemia
  • Pernicious anaemia
  • Infertility
  • Menorrhagia
  • Galactorrhoea

Signs of congenital type

  • P-pot belly
  • P-pallor
  • P-puffy face
  • P-protruding umbilicus
  • P-pocket out tongue

Myxedema Coma

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.
  • Cardiomegally
  • Hypothermia
  • Bradycardia
  • Pericardial effusion
  • Hyponatremia
  • Hypercarbia
  • Cardiogenic shock

Treatment

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

 

 

 

 

 

 

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