HypothyroidismBy:

Farshid MokhberiMedical Student at:

Shahid Beheshti University of Medical Sciences and Health Services

Anatomy of Thyroid Gland

Histology

Transfering from cell to blood

Mechanism of action

Regulation of synthesis

FunctionsCarbohydrate metabolismCholesterol metabolismGrowthSkeletal muscleHeartCNSCalorigenic action

Hypothyroidism:

Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone.

Risk Factorswoman older than age 60Have an autoimmune diseaseHave a close relative autoimmune diseaseHave been treated with radioactive iodine or

anti-thyroid medicationsReceived radiation to your neck or upper chestHave had thyroid surgery (partial

thyroidectomy)Have been pregnant or delivered a baby within

the past six months

Clinical manifestations

SKINCool and paleSweating is decreasedYellowish tingeHyperpigmentationCoarse hairHairlossNon pitting edemaCold intoleranceDry skin

Eyes

Periorbital edema

Cardiovascular

Decreased heart rateDecreased cardiac outputPericardial effusionDiastolic hypertensionHypercholesterolemiahyperhomocystinemia

Respiratory

FatigueShortness of breath on exertionHypoventilationSleep apneaHoarseness of voice

Gastrointestinal

ConstipationAscitesWeight gainGastric atrophy

Reproductive

OligorrheaAmenorrheaMenorrhagiaDecreased fertilityEarly abortion

Neurologic

Mental slowing

Myxedema coma

Mental retardation

Myxedema comaThe condition occurs in patients with long-standing, untreated hypothyroidism.

mental status, including

lethargystupor delirium(acute confusional state)coma

Musculoskeletal

Joint pains

Aches

stiffness

Metabolic

Hyponatremia

Hyperlipidemia

Increased homocystine

Normal valuesTSH 0.4- 5.0 mU/L

Total T4 4.6-11.2 mcg/dl

Total T3 75-195 ng/dl

Free T4 0.8-1.8 ng/dl

Free T3 2.3-4.2 pg/ml

TreatmentINITIAL DOSEYoung healthy-1.6mcg/Kg wtElderly-50mcg

TIMING OF DOSEHalf an hour before food

SIDE EFFECTS-RareAllergy to dye in the tablets

MONITORINGEvery 6 weeksIf TSH is not with in normal range increase

the dose by 12.5-25mcgIf TSH normal ,monitor TSH once a year

Refrences