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USGAOKAR KAPIL K
CLINICAL CLERK
AMEC BCCM
DEFINITION
• Hypothyroidism is the most common disorder
arising from thyroid hormone deficiency.
Classification
• According to the time of onset it is divided in
congenital and acquired
• According to the level of endocrine
dysfunction in primary and secondary or
central
• According to the severity into severe/ overt/
clinical and mild or subclinical
hypothyroidism.
AUTOIMMUNE HYPOTHYROIDISM
• Associated with a goiter (Hashimoto’s, or goitrous
thyroiditis) or, at the later stages of the disease,
minimal residual thyroid tissue (atrophic thyroiditis)
• Incidence - 4 per 1000 women, 1 per 1000 men,
(21.94% of the population had autoimmune thyroiditis
(1)
• Mean age of diagnosis - 60 years
• Pathogenesis – lymphocytic infiltration, atrophy of
thyroid follicles with oxyphil metaplasia, absence of
colloid and mild to moderate fibrosis.
• Risk factors – genetic, environmental
• Markers – antibodies to TPO & Tg, antibodies against
TSH - R
ETIOLOGY
SIGNS & SYMPTOMS OF HYPOTHYROIDISM
(descending order of frequency )
Symptoms Signs
Tiredness, weakness Dry coarse skin, cool peripheral extremities
Dry skin Puffy face, hands, and feet (myxedema)
Feeling cold Diffuse alopecia
Hair loss Bradycardia
Difficulty concentrating and poor memory Peripheral edema
Constipation Delayed tendon reflex relaxation
Weight gain with poor appetite Carpal tunnel syndrome
Dyspnea Serous cavity effusions
Hoarse voice
Menorrhagia (later oligomenorrhea or
amenorrhea )
Parasthesia
Impaired hearing
MANAGEMENT
PRIMARY HYPOTHYROIDISM – Levothyroxine, monitor TSH levels
Manner of speech and tone of voice Hoarseness and husky voice could be
present in some thyroid mass or goiter
Mood
VITAL SIGNS
Data Significance
Respiratory rate Tachypnea- to assess for thyroid mass that may affect
manner of breathing
Data Significance
Inspect and palpate thyroid gland To note for the size, shape and
consistency of gland and nodules
Ask for pain and difficulty of swallowing
Assess for pericardial and pleural May be present in thyroid mass with
effusion hypothyroidism features
GASTRO INTESTINAL TRACT
Data Significance