Diferencia entre revisiones de «Hypothyroidism»

Revisión del 11:55 12 may 2015

Background

3-10x more common in F
Peak incidence age >60

Etiology

Primary (thyroid gland)
- Autoimmune (Hashimoto)
- Thyroiditis (subacute, silent, postpartum)
  - Often preceded by hyperthyroid phase
- Iodine deficiency
- After ablation (surgical, radioiodine)
- After external radiation
- Infiltrative disease (lymphoma, sarcoid, amyloid, TB)
- Congenital
- Meds
  - Amiodarone, Li, iodine, interferon, interleukin
- Idiopathic
Secondary (Hypothalamus-pituitary axis)
- Panhypopituitarism
- Pituitary adenoma
- Infiltrative causes (e.g., hemochromatosis, sarcoidosis)
- Tumors impinging on the hypothalamus
- History of brain irradiation
- Infection (e.g., tuberculosis)

Clinical Features

Constitutional
- Cold intolerance
- Wt gain
- Weakness
- Lethargy
- Hypothermia
- Hoarse voice
- Hair loss
- Constipation
- Dysfunctional uterine bleeding
Neuropsychiatric
- Delayed relaxation of DTRs
- Paresthesias
Cardiopulmonary
- Bradycardia
- Hypoventilation
- Pericardial/pleural effusions
Dermatologic
- Hair loss
- Non-pitting edema (periorbital, extremities)
- Facial swelling

Differential Diagnosis

Diagnosis

TSH
Total and Free T4
T3
Thyroid Binding Globulin (TBG)
Auto-antibodies (anti-TPO, anti-microsomal, anti-Tg)
UTZ to look for thyroid nodules

Types

Primary: failure of thyroid
- elevated TSH, low FT4
Secondary: failure of pituitary
- low TSH, low FT4
Tertiary: failure of hypothalamus

Treatment

Depends on etiology
- Consider starting levothyroxine daily but doses too high may lead to thyroid storm

Disposition

Most hypothyroidism is treated as an outpatient followed in ambulatory clinic
Admit and treat severe hypothyroidism or myxedema coma

References

Authors:

@@ Línea 1: / Línea 1: @@
 ==Background==
-#3-10x more common in F
+*3-10x more common in F
-#Peak incidence age >60
+*Peak incidence age >60
-==Types==
+===Etiology===
-#Primary: failure of thyroid
+*Primary (thyroid gland)
-##elevated TSH, low FT4
+**Autoimmune (Hashimoto)
-#Secondary: failure of pituitary
+**Thyroiditis (subacute, silent, postpartum)
-##low TSH, low FT4
+***Often preceded by hyperthyroid phase
-#Tertiary: failure of hypothalamus
+**Iodine deficiency
+**After ablation (surgical, radioiodine)
-==Etiology==
+**After external radiation
-#Primary (thyroid gland)
+**Infiltrative disease (lymphoma, sarcoid, amyloid, TB)
-##Autoimmune (Hashimoto)
+**Congenital
-##Thyroiditis (subacute, silent, postpartum)
+**Meds
-###Often preceded by hyperthyroid phase
+***Amiodarone, Li, iodine, interferon, interleukin
-##Iodine deficiency
+**Idiopathic
-##After ablation (surgical, radioiodine)
+*Secondary (Hypothalamus-pituitary axis)
-##After external radiation
+**Panhypopituitarism
-##Infiltrative disease (lymphoma, sarcoid, amyloid, TB)
+**Pituitary adenoma
-##Congenital
+**Infiltrative causes (e.g., hemochromatosis, sarcoidosis)
-##Meds
+**Tumors impinging on the hypothalamus
-###Amiodarone, Li, iodine, interferon, interleukin
+**History of brain irradiation
-##Idiopathic
+**Infection (e.g., tuberculosis)
-#Secondary (Hypothalamus-pituitary axis)
-##Panhypopituitarism
-##Pituitary adenoma
-##Infiltrative causes (e.g., hemochromatosis, sarcoidosis)
-##Tumors impinging on the hypothalamus
-##History of brain irradiation
-##Infection (e.g., tuberculosis)
 ==Clinical Features==
-#Constitutional
+*Constitutional
-##Cold intolerance
+**Cold intolerance
-##Wt gain
+**Wt gain
-##Weakness
+**Weakness
-##Lethargy
+**Lethargy
-##Hypothermia
+**Hypothermia
-##Hoarse voice
+**Hoarse voice
-##Hair loss
+**Hair loss
-##Constipation
+**Constipation
-##Dysfunctional uterine bleeding
+**Dysfunctional uterine bleeding
-#Neuropsychiatric
+*Neuropsychiatric
-##Delayed relaxation of DTRs
+**Delayed relaxation of DTRs
-##Paresthesias
+**Paresthesias
-#Cardiopulmonary
+*Cardiopulmonary
-##Bradycardia
+**Bradycardia
-##Hypoventilation
+**Hypoventilation
-##Pericardial/pleural effusions
+**Pericardial/pleural effusions
-#Dermatologic
+*Dermatologic
-##Hair loss
+**Hair loss
-##Non-pitting edema (periorbital, extremities)
+**Non-pitting edema (periorbital, extremities)
-##Facial swelling
+**Facial swelling
-==Work-Up==
+==Differential Diagnosis==
-#TSH
-#Total and Free T4
+==Diagnosis==
-#T3
+*TSH
-#Thyroid Binding Globulin (TBG)
+*Total and Free T4
-#Auto-antibodies (anti-TPO, anti-microsomal, anti-Tg)
+*T3
-#UTZ to look for thyroid nodules
+*Thyroid Binding Globulin (TBG)
+*Auto-antibodies (anti-TPO, anti-microsomal, anti-Tg)
+*UTZ to look for thyroid nodules
+===Types===
+*Primary: failure of thyroid
+**elevated TSH, low FT4
+*Secondary: failure of pituitary
+**low TSH, low FT4
+*Tertiary: failure of hypothalamus
 ==Treatment==
-#Depends on etiology
+*Depends on etiology
-##Consider starting levothyroxine daily but doses too high may lead to thyroid storm
+**Consider starting levothyroxine daily but doses too high may lead to thyroid storm
 ==Disposition==
-#Most hypothyroidism is treated as an outpatient followed in ambulatory clinic
+*Most hypothyroidism is treated as an outpatient followed in ambulatory clinic
-#Admit and treat severe hypothyroidism or myxedema coma
+*Admit and treat severe hypothyroidism or myxedema coma
 ==See Also==
@@ Línea 75: / Línea 76: @@
 *[[Thyroid (General)]]
-==Source==
+==References==
-Tintinalli's
 [[Category:Endo]]