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Hypothyroidism

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Synthroid one of most commonly prescribed drugs in Canada. Seven million ... Ectopic thyroid dysgenesis. Goitrogens. 8/29/09. MUN FP Academic Half Day. 9 ... – PowerPoint PPT presentation

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Title: Hypothyroidism


1
Hypothyroidism
  • Joy Ziradkar / Carl Robbins
  • Common disorder
  • Synthroid one of most commonly prescribed
    drugs in Canada
  • Seven million prescriptions last year
  • Rising at 12 per year (source CBC qq!!)

2
Thyroid
  • Historical Notes
  • Thyroid Thyreoeides Shield (Greek)
  • Goiter Known since 2700 BC
  • Thyroid gland Goiter relationship Hieronymus
    Fabricus 1619

3
Thyroid
  • Anatomy
  • Blood supply
  • Bilobed / Mass 15 20
  • Micro lobules / follicles
  • Cells - cuboidal epithelial (TSH) and
    parafollicular (calcitonin)

4
Thyroid
  • Physiology
  • Hormones
  • Calcitonin
  • Thyroxine
  • Iodination of tyrosine produces thyroxine (T4 /
    avg 125ug / day) and Tri-iodothyhtronin (T3)
  • T4 and T3 bound to globulin / Only small
    fractions not bound are biologically active
  • TSH - Glycoprotein released in response to
    hypothalamic TRH

5
Thyroid
  • Pathology
  • qualitative / quantitative alteration of function
  • hypothyroidism - hypo metabolism
  • hyperthyroidism - thyrotoxicosis
  • enlargement
  • generalized goiter
  • focal usually benign or malignant neoplasm
  • thyroxine deficiency

6
Thyroid Function
  • Radioimmunassay
  • T4, T3, TBG, TSH
  • T3 resin uptake using I131 most common
  • Isotope Imaging
  • Ultrasonography
  • Miscellaneous Tests
  • Thyroid antibodies
  • TSH receptor antibodies
  • Plasma thyroglobulin level

7
Hypothyroidism
  • Congenital
  • Congenital Non-Goitrous Hypothyroidism
  • Incidence 14000
  • Decreased T4 Elevated TSH
  • Newborn Screening critical
  • Manage by thyroid replacement
  • Congenital Goitrous Hypothyroidism
  • Unusual / rare (1 30,000)
  • Inborn error of metabolism

8
Hypothyroidism
  • Acquired
  • Hashimotos Thyroiditis
  • Autoimmune cause
  • lymphocytic thyroiditis
  • Radioactive iodide ablation
  • Surgical ablation
  • Idiopathic
  • Ectopic thyroid dysgenesis
  • Goitrogens

9
Diagnosis hypothyroidism
  • Do we really have to perform certain
    investigations before the management of
    hypothyroid?
  • Dry skin
  • Weight gain with decreased appetite / weakness
  • Reflexes depressed ( Colbourne
    modification!)
  • Hoarseness / hair loss / hypotension
  • Thick hair with loss of lateral eyebrow hair
  • Puffiness of face, proximal muscle weakness
  • Constipation
  • Intolerance to cold
  • Bradycardia
  • Tongue enlarged macroglossia
  • Menorrhagia or Amenorrhea
  • Obese
  • Hypercholesterolemia, Hyperprolactinemia

10
Diagnosis hypothyroidism
  • Laboratory / Imaging features
  • Decreased T4, T3 Raised TSH
  • Antimicrosomal antibodies, Antithyroglobulin
    antibodies present
  • Skeletal maturation delayed indicative of
    duration of hypothyroidism

11
Management hypothyroidism
  • Thyroid hormone replacement
  • Synthetic l-thyroxine
  • Start 1-2 ug/Kg /day single daily dose
  • Titrate treatment against serum T4 and TSH aim
    for normal range
  • Associated disorders that predispose to
    Hashimotos
  • Diabetes Mellitus
  • Adrenal Insufficiency
  • Trisomy 21
  • Turner Syndrome

12
Hypothyroidism
  • Comments / Questions

13
Case One F 8
  • Hx asthma required Rx
  • FH mom hypothyroid, g-mom hyper
  • Investigated because of FH
  • Absence significant symptoms except some fatigue
  • Symmetrically enlarged thyroid without nodules
  • What is your approach to this patient?

14
Case Two - F 15
  • Complaints of irregular periods and hirsuitism
  • Associated fatigue and cold intolerance
  • FH Hypothyroidism g-mom aunt
  • Bulky, firm ? Nodular thyroid
  • What is your approach to this patient?

15
Case Three F 46
  • Complaints tiredness several months with
    depression and mood swings. Describes herself as
    anxious and tends to get worked up
  • Irregular periods with menorrhagia for past six
    months
  • Normal PE (clinically euthyroid)
  • What is your approach to this patient?

16
Case Four M 39
  • Hospital admission Angina / IHD
  • Hx GERD and c/o fatigue
  • PE - nodule in inf pole lobe thyroid
  • What is your approach to this patient?

17
Case Five F 28
  • No symptoms Periodic Health Check
  • PE normal
  • clinically euthyroid
  • 3 cm nodule in (L) lobe of thyroid

18
Case Six F 56
  • Complaints of hoarseness, weakness
  • Five year previously presented with weight loss,
    heat intolerance, hyperactivity - Rx with
    radioactive iodine
  • What is your approach to this patient?
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