SPOTTERS MEDICINE
HYPOTHYROIDISM
🔹 Definition:
Hypothyroidism
is a clinical condition caused by deficiency of thyroid hormones (T3, T4),
resulting in slowing of metabolic processes throughout the body.
🔹 Types of Hypothyroidism:
1.
Primary Hypothyroidism – defect in the thyroid gland
o Most common type
o Causes: Hashimoto’s thyroiditis,
iodine deficiency, thyroidectomy, radioiodine therapy
2.
Secondary Hypothyroidism – due to pituitary failure (↓ TSH)
3.
Tertiary Hypothyroidism – due to hypothalamic dysfunction (↓ TRH)
🔹 Causes:
- Autoimmune – Hashimoto’s thyroiditis (most
common in developed countries)
- Iatrogenic – thyroid surgery, radioiodine
therapy
- Iodine deficiency – most common worldwide
- Drugs – amiodarone, lithium
- Congenital – agenesis, dyshormonogenesis
- Infiltrative diseases – sarcoidosis, hemochromatosis
🔹 Clinical Features:
- Fatigue, lethargy
- Weight gain despite poor appetite
- Cold intolerance
- Constipation
- Dry, coarse skin
- Hair thinning / hair loss
- Menstrual irregularities (e.g., menorrhagia)
- Depression, slow thinking
- Bradycardia, hoarseness of voice
- Periorbital puffiness, non-pitting edema (myxedema)
🔹 Signs in Children (Congenital
Hypothyroidism):
- Cretinism: delayed milestones, short
stature, mental retardation, macroglossia, umbilical hernia
🔹 Investigations:
- TSH (thyroid-stimulating
hormone): ↑ in
primary hypothyroidism
- Free T4: ↓
- Anti-TPO antibodies: positive in autoimmune
thyroiditis
- Lipid profile: hypercholesterolemia common
- CBC: may show anemia
🔹 Treatment:
- Levothyroxine (T4) – lifelong replacement therapy
- Starting dose: 1.6 mcg/kg/day
(adjusted based on TSH)
- Monitor TSH every 6–8 weeks
during adjustment
🔹 Complications:
- Myxedema coma (life-threatening emergency)
- Infertility
- Goiter
- Cardiovascular disease (due to dyslipidemia)
- Growth retardation in children
🔹 Prognosis:
- Excellent with lifelong hormone
replacement
- Regular monitoring is essential
- Poor compliance can lead to
complications
DR.C.GANESAN M.D.
PROFESSOR OF MEDICINE
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