Hypothyroidism

Question 1

Pathomechanism of Hypothyroidism (Primary and Secondary Forms)

Answer 1

■ Primary hypoparathyroidism: Hashimoto, iatrogenic (thyroidectomy),
subacute thyroiditis, primary atrophic hypothyroidism (no goiter),
iodine deficiency, drug-induced (amiodarone, lithium)

■ Secondary: pituitary disease (TSH deficiency)

Question 2

Symptoms of Hypothyroidism

Answer 2

Fatigue, weakness, lethargy, (slight) weight gain, cold intolerance,
constipation, slow mental function, depression, dry skin, hoarse voice, nonpitting edema, slow deep tendon reflexes, menorrhagia, goiter.

Question 3

Complications of Hypothyroidism

Answer 3

Cardiovascular problems: Hypothyroidism can contribute to an increased risk of heart disease, including high blood pressure, elevated cholesterol levels, and an enlarged heart (cardiomyopathy). It can also lead to a slower heart rate (bradycardia) and impaired cardiac function.

Mental health issues: Untreated hypothyroidism can affect mental well-being and lead to symptoms such as depression, fatigue, cognitive impairment, and difficulty concentrating. It may also cause memory problems and a decreased ability to think clearly.

Myxedema: Severe and prolonged untreated hypothyroidism can lead to a condition called myxedema. Myxedema is characterized by intense cold intolerance, extreme fatigue, lethargy, swelling of the face and hands, thickened skin, and a life-threatening condition called myxedema coma.

Goiter: In some cases, the thyroid gland may enlarge and form a goiter due to the constant stimulation from the pituitary gland, which is trying to compensate for the low thyroid hormone levels. A goiter may cause visible swelling in the neck and may affect breathing and swallowing.

Infertility and menstrual problems: Hypothyroidism can disrupt the normal functioning of the reproductive system, leading to menstrual irregularities, heavy or prolonged periods (menorrhagia), and difficulties getting pregnant. It may also increase the risk of complications during pregnancy, such as preeclampsia and preterm birth.

Neurological complications: Prolonged and untreated hypothyroidism can affect the peripheral nerves and result in a condition called peripheral neuropathy. This can lead to symptoms like tingling, numbness, and muscle weakness in the extremities.

Impaired metabolism and weight gain: Hypothyroidism can slow down the body’s metabolism, leading to weight gain or difficulty losing weight, even with proper diet and exercise.

High cholesterol: Hypothyroidism can cause an increase in cholesterol levels, particularly LDL cholesterol (“bad” cholesterol), which contributes to an increased risk of atherosclerosis and heart disease.

Question 4

Diagnosis of Hypothyroidism

Answer 4

Low T4, Primary hypothyroidism has high TSH
■ Anemia, high cholesterol/triglycerides
■Hashimoto : Anti-TPO, anti- TG maybe anti-TSH- R

Question 5

Treatment of Hypothyroidism

Answer 5

Levothyroxine