hypothyroidism group a unit 5: endocrine. hypothyroidism background: primary hypothyroidism - most...
TRANSCRIPT
HypothyroidismGroup A
UNIT 5: ENDOCRINE
Hypothyroidism Background: Primary hypothyroidism - Most common cause is HASIMOTO’S
THYROIDITIS diagnosed in >80% of cases – is an autoimmune disease
Secondary hypothyroidism - <5% cases due to deficient pituitary production of TSH
Prevalence 3x higher in women compared to men Annual incidence rate 1-2 per 1,000 women Presentation of symptoms in elderly may be atypical or absent Prevalence increases with age Caucasians higher incidence than non-Caucasians
Risks:
Risks highest in persons with: Type 1 diabetes mellitus Family history of thyroid disease History of head/neck cancers treated with radiation therapy Previous radioactive iodine treatment Previous thyroid surgery
Case:
Mr. T. presents to you concerned about her weight gain and fatigue. Both of these problems have been problems for years. Recently, a friend told her these problems may be because her thyroid is not working properly and she wants to have her thyroid checked.
What other signs and symptoms would you ask Ms. T. about?
What other signs and symptoms would you ask Ms. T. about? Clinical Signs and Symptoms
Fatigue (reported by this patient) Cold intolerance Constipation Impaired memory Slowed mentation Depression Ataxia Muscle weakness Muscle cramps
Clinical Signs & Symptoms Continued
Menstrual disturbance Hoarseness Goiter Periorbital edema Weight gain (was reported by this patient)
Ask about family history:
Personal or family history of associated autoimmune disorders:
Pernicious anemia Adrenal insufficiency Diabetes mellitus Type 1 Ovarian failure Celiac disease Sjogren’s syndrome Multiple sclerosis
Ask about previous thyroid injury or treatment
Thyroidectomy or other neck surgery Radioactive iodine therapy External radiation therapy
Ask about current medications
Drugs that impair thyroid function: Lithium Amiodarone Aminoglutethmide Interferon a Thalidomide Betaroxine Stavudine
Ask about pituitary disorders
Pituitary tumor Signs of sellar mass: headache, bi-temporal
hemianopsia or diplopia History of pituitary surgery or radiotherapy History of head trauma
References:
Roberts, C. G., & Ladenson, P. W. (2004). Hypothyroidism. Lancet, 363, 793-803.
Clinical practice guideline: Investigation and Management of Primary Thyroid Dysfunction. (2008). Retrieved February 1, 2009 from http://topalbertadoctors.org