Hypothyroidim

HYPOTHYROIDISM DIAGNOSIS AND MANAGEMENT

By: DR. MANSOOR ALI VIRK

CMC LARKANA

DIAGNOSIS OF HYPOTHYROIDISM

1. HISTORY

Headache Fatigue Lethargy Weakness Arthralgia Myalgia Weight gain Cold intolerance Sleep disturbance Absence of sweet Constipation Amenorrhea Menorrhagia

2. EXAMINATION

HANDS:- Peripheral cyanosis Swelling Dry cold skin Anemia ARMS:- Pulse carpel tunnel syndrome by tapping the flexor retinaculum medial to

the base of thenar eminent ) Bicep reflex Test for proximal myopathy FACE- Alopecia Dry thin hair Priorbital edema General swelling Loss of outer halves of eye brows Vitiligo Tongue swelling Check for the hoarseness of voice and slowness of speech

LEGS- Slow relaxation of ankle jerk Peripheral neuropathy and edema

CHEST:- Pleural or pericardial effusion Rough sand paper like appearance over

the chest

INVESTIGATIONS

SPECIFIC INVESTIGATION

TFT Thyroid function test Primary hypothyroidism Serum T4 Serum T3 not valuable Serum TSH 20 m/L Secondary hypothyroidism Serum T4 Serum TSH low or normal Note- Hashimotos thyroiditis increase

circulating level of anti thyroglobulin antibodies

NON-SPECIFIC INVESTIGATIONS

Serum LDH and cretinine kinase Serum cholesterol and triglycerides Serum sodium Anemia with normal or increase MCV

ECG- Prolonged hypothyroidism shows

sinus bradycardia with low voltage complex ST Segment and T WAVE abnormality.

DIFFERENTIAL DIAGNOSIS

Anemia Obstructive sleep apnea Dementia vitamin D deficiency Adrenal insufficiency Lyme disease

TREATMENT

Treatment with thyroxin replacement. Starts with low dose of 50 g/day for 3 weeks increasing

there after to 100 g/day for further 3 weeks. Finally shift maintenance dose 100-150 g/day.

Note:- thyroxin should be taken to avoid concomitant food and drugs that may interfere its absorption.

Note:- thyroxin half life is 7 days so it should always be taken as a single dose daily and at least 6 weeks pause to repeat the TFT.

Patient feel better within 2-3 weeks reduction in weight and peri-orbital puffiness occur quickly but restoration of skin texture take 3-6 months.

COMPLICATIONS

CAD and CF due to hyperlipidemia Increase chance for infection Mega colon Myxedema madness:- psychosis with

paranoid delusions Infertility(rare) Pregnancy in hypothyroidism often result

miscarriage Myxedema coma.

MYXEDEMA OF FACE

THANK

YOU