Endocrine System >
Hypothyroidism

“The clinical effect of lack of thyroid hormones”

Aetiology & Pathogenesis
  • Primary Autoimmune Hypothyroidism:
    • Primary Atrophic Hypothyroidism
      • No goitre
      • Diffuse lymphocytic infiltration of the thyroid, leading to atrophy
    • Hashimoto’s Thyroiditis
      • Goitre due to lymphocytic + plasma cell infiltration
      • May be hypothyroid or euthyroid
  • Other Primary Hypothyroidism:
    • Iodine Deficiency
    • Post-Thyroidectomy / Radioiodine treatment
    • Drug-induced i.e. Antithyroids, Amiodarone, Lithium, Iodine
    • Subacute Thyroiditis
      • Temporary hypothyroidism after hyperthyroid phase
  • Secondary Hypothydoisim:
    • Not enough TSH due to Hypopituitarism
    • Very rare
Clinical Presentation
  • Symptoms:
    • Tiredness, Sleepy, Lethargic
    • Low Mood
    • Cold Intolerance
    • Weight Gain
    • Constipation
    • Menorrhagia
    • Hoarse Voice
    • Decreased Memory/Cognition
    • Dementia
    • Myalgia
    • Cramps
  • Signs (BRADYCARDIC):
    • Bradycardia
    • Reflexes slow
    • Ataxia (cerebellar)
    • Dry thin hair/skin
    • Yawning/drowsy/coma
    • Cold hands
    • Ascites
    • Round puffy face/obese
    • Defeated demeanour
    • Immobile +/- ileus
    • CCF
Investigations
  • Bloods:
    • High TSH
    • Low T4
    • High Cholesterol + Triglycerides
    • Macrocytosis
  • Imaging: n/a
  • Special: n/a
Management
  • Levothyroxine
Complications
  • Myxoedema Coma
  • Pregnancy
    • Eclampsia
    • Anaemia
    • Prematurity
    • Low birth weight
    • Stillbirth

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