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Thyroid Disorders
 
 

Hypothyroidism

 
 
 
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Overview

Hypothyroidism refers to underactivity of the thyroid, with reduced circulating thyroid hormones. This is usually accompanied by typical signs and symptoms of hypothyroidism.

Pathogenesis

  • Causes of Primary Hypothyroidism

  • Primary

  • Autoimmune thyroiditis - Hashimoto’s, atrophic
  • Hypothyroid phase of thyroiditis
  • Iatrogenic - radioiodine therapy, thyroidectomy, external irradiation of the neck
  • Drugs - amiodarone, lithium, interferons, interleukin-2, iodide
  • Iodine deficiency
  • Thyroid infiltration - amyloidosis, tumour
  • Congenital hypothyroidism
  • Secondary

  • Pituitary / hypothalamic pathology - trauma, tumour, surgery, radiation, infection, infarction, infiltration

Manifestations

  • Clinical Features

  • Symptoms

  • Weakness / lethargy / mental sluggishness
  • Weight gain
  • Cold intolerance
  • Dry, coarse skin
  • Constipation
  • Menorrhagia
  • Alopecia
  • Signs

  • Bradycardia
  • Psychomotor retardation
  • Impaired cognition
  • Cool, dry skin
  • Facial oedema
  • Loss of the outer â…“ of the eyebrow
  • Tongue enlargement
  • Alopecia
  • Hyporeflexia
  • Non-pitting oedema

Diagnosis

  • TFT Interpretation

  • Primary hypothyroidism - elevated TSH with reduced T4
  • Subclinical hypothyroidism - elevated TSH with normal T4
  • Central hypothyroidism - reduced TSH with reduced T4
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