Hypothyroid

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Presentation :

• Symptoms:
  • weakness, lethargy, fatigue
  • depression, impaired concentration
  • myalgia
  • cold intolerance
  • constipation
  • weight gain
  • menstrual irregularity or menorrhagia
  • carpal tunnel syndrome
• Exam:
  • bradycardia
  • hypothermia
  • goiter
  • cool dry skin
  • delayed deep tendon reflex relaxation phase
  • myopathy

Pathophysiology :

• Etiologies:
  • Hashimoto Thyroiditis
  • Thyroidectomy
  • Radioactive iodine ablation
  • External beam radiation to the neck
  • Transient mild hypothyroidism typically occurs during the second phase of destructive thyroiditis
  • Medication-induced hypothyroidism (lithium, interferon alfa, interleukin-2, and amiodarone)
  • Central hypothyroidism: from pituitary disease, previous surgery/radiation to the sella
    • TSH and free T4 are suppressed

Diagnostic Testing:

• TSH and free T4
  • Measurement of T3 levels is generally not necessary

Treatment :

• Levothyroxine
  • Should be taken on an empty stomach 1h before consuming food
  • Calcium/iron supplements, and PPIs decrease absorpotion, must be taken at least 4 hours apart from levothyhroxine
  • 

Prognosis:

References: