Diferencia entre revisiones de «Hypothyroidism»
Sin resumen de edición |
Sin resumen de edición |
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==Background== | ==Background== | ||
*3-10x more common in | *3-10x more common in females | ||
*Peak incidence age >60 | *Peak incidence age >60 | ||
===Types=== | |||
*Primary: failure of thyroid | |||
**elevated TSH, low FT4 | |||
*Secondary: failure of pituitary | |||
**low TSH, low FT4 | |||
*Tertiary: failure of hypothalamus | |||
===Etiology=== | ===Etiology=== | ||
| Línea 50: | Línea 57: | ||
==Diagnosis== | ==Diagnosis== | ||
===Work-up=== | |||
*TSH | *TSH | ||
*Total and Free T4 | *Total and Free T4 | ||
*T3 | *Total and Free T3 | ||
*Thyroid Binding Globulin (TBG) | *Thyroid Binding Globulin (TBG) | ||
*Auto-antibodies (anti-TPO, anti-microsomal, anti-Tg) | *Auto-antibodies (anti-TPO, anti-microsomal, anti-Tg) | ||
* | *Thyroid ultrasound | ||
== | ==Management== | ||
*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 | ||
| Línea 73: | Línea 74: | ||
==See Also== | ==See Also== | ||
*[[Myxedema | *[[Myxedema coma]] | ||
*[[Thyroid ( | *[[Thyroid (Main)]] | ||
==References== | ==References== | ||
<References/> | |||
[[Category:Endo]] | [[Category:Endo]] | ||
Revisión del 03:30 11 ago 2015
Background
- 3-10x more common in females
- Peak incidence age >60
Types
- Primary: failure of thyroid
- elevated TSH, low FT4
- Secondary: failure of pituitary
- low TSH, low FT4
- Tertiary: failure of hypothalamus
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
Work-up
- TSH
- Total and Free T4
- Total and Free T3
- Thyroid Binding Globulin (TBG)
- Auto-antibodies (anti-TPO, anti-microsomal, anti-Tg)
- Thyroid ultrasound
Management
- 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