Thyroiditis, sporadic and endemic goiter

Question 1

Causes of

Question 2

Causes of secondary hypothyroidism

Answer 2

Are less than 5% of the cases of hypothyroidism.

• Pituitary adenoma
• Tumors of the hypothalamus
• Brain irradiation (hypothalamic damge to TRH/TSH cells)
• Dopamine, lithium.
• T4 hormone resistance - very rare.

Question 3

Etiology of hypothyroidism

Answer 3

Frequent, estimated 3-5% of population

6% of women and 3% of men over age 60

Question 4

Presentation of congenital hypothyroidism

Causes

Prolonged congenital hypothyroidism consequences

Answer 4

Is not rare, about 1.4000 births.

• Icterus neonatorum prolongatus
• Inactive succling, movements
• Constipation
• Umbilical hernia
• Excessive sleeping/lethargy
• Low body temperature

causes

• agenesis of the thyroid
• failure to descend
• TPO mutations
• Maternal antibodies inhibiting neonatal thyroid function
• Unknown causes.

Consequences

• Growth retardation,delayed puberty
• Bone age , teeth age are delayed.
• Cretinism,mental retardation
• Hardness of hearing, logopathy

Question 6

How is congenital hypothyroidism screened for?

Answer 6

5 days after delivery screened for TSH levels.

If they are high then this indicates that T3/T4 is low.

Question 7

Symptoms and physical signs of adult hypothyroidism

Answer 7

Symptoms:

• Weakness,
• lethargy,
• fatigue,
• memory impairment,
• cold intolerance,
• weight gain,
• constipation,
• loss of hair,
• hoarseness,
• deafness,
• dyspnea,
• myalgia,
• arthralgia,
• paresthesias,
• precordial pain,
• menstrual irregularity

Physical signs:

• Dry, coarse, cold skin
• Periorbital, peripheral edema
• Coarse thin hair, pallor, vitiligo
• Thick tongue
• Slow speech
• Decreased reflexes
• Hypertension, bradycardia
• Pleural- ,pericardial effusion, ascites

Question 8

Fatal consequence of adult hypothyroidism and causes

Answer 8

Myxedema coma, extremely rare, often fatal

caused by

• brought on by stress,
• infection,
• alcohol, drugs
• cold exposure

Leads to: hypothermia, respiratory failure, bradycardia, coma and death.

Question 9

hypothyroidism lab changes

Answer 9

hypercholesterinaemie

hyponateremia

anemia

bradycardia

mild elevated cardiac dreatine phosphokinase

Question 10

Treatment for hypothyroidism and for myxedema coma

Answer 10

Hypothyroidism treatment: Levothyroxine replacement, daily. (or iodine replacement)

Myxedema coma:

• large dose thyroxine IV, in a bolus, followed by a second dose hours later. Then 50 ug daily.
• Cortisol
• Glucose
• Electrolyte and fluid replacement
• Treatment of precipitating cause (infection)