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Presented By:Dr. M. Ramzan Rajput

HYPOTHYROIDISM. Presented By:Dr. M. Ramzan Rajput. MBBS, FCPS (Med). DEFINITION. Decrease secretion or function of thyroid gland or thyroxin. CLASSIFICATION. PRIMARY HYPOTHYROIDISM : Due to diseases of thyroid gland.

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Presented By:Dr. M. Ramzan Rajput

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  1. HYPOTHYROIDISM Presented By:Dr. M. Ramzan Rajput MBBS, FCPS (Med)

  2. DEFINITION • Decrease secretion or function of thyroid gland or thyroxin . CLASSIFICATION • PRIMARY HYPOTHYROIDISM: Due to diseases of thyroid gland. • Without Goitre : eg; Idiopathic /Autoimmune Atrophic Hypothyroidism, Radioactive Iodine Therapy, Thyroidectomy, Congenital Agenesis, Transient(Infection, Post partum thyroiditis, Thyroid hormone withdrawal). • With Goitre : eg; Hashimoto’s Thyroiditis, Drug Induced(INF, ATD, Amioderone, Lithium), Endemic Iodine Deficiency, Dyshormonogenesis/Inborn Errors, Infiltrative disorders ( Amyloidosis, Sarcoiudosis, Riedel’s thyroiditis. • 2. SECONDARY HYPOTHYROIDISM: Due to pituitary lesions. • 3. TERTIARY HYPOTHYROIDISM: Due to hypothalamic lesions.

  3. CLINICAL FEATURES: • COMMON: Weight gain, Cold intolerance, Fatigue, Somnolence, Dry skin & hair, Menorrhagia. • LESS COMMON: Constipation, Hoarseness, Carpal tunnel syndrome, Alopecia, Aches & pains, Muscle stiffness, Deafness, Depression, Infertility, Malar flush, Periorbital edema/Myxedema, Loss of lateral eyebrows, Anemia, Carotenemia, Bradycardia, Hypertension, Delayed relaxation of tendon reflexes, Dermal myxedema. • RARE: Psychosis ( Myxedema madness ), Galactorrhea, Impotence, Ileus, Ascites, Pericardial & Pleural Effusion, Cerebellar Ataxia, Myotonia.

  4. INVESTIGATIONS: T4 : Decreased. TSH : Increased ( > 20 Mu/L ). Thyroid peroidase antibodies, Antibodies to Thyroglobulin& TSH receptors : Increased. Serum CK, AST, LDH : Increased. Cholesterol : Increased. Na : Decreased. Anemia : NCNC / Macrocytic. ECG : Sinus bradycardia, Low voltage complexes, ST-Segment & T wave changes.

  5. MANAGEMENT: Thyroxin replacement therapy: • 1st 03 weeks = 50 micro grams/day. • Next 03 weeks = 100 micro grams/day. • maintenance = 100- 250 micrograms/day IN ISCHEMIC HEART DISEASE & ELDERLY PATIENTS: • Initial = 25-50 micro grams/day along with beta blockers and vasodilators. In non-responders to beta blockers and vasodilators PTCA or CABG may be required. HYPOTHYROID AND PREGNENCY: • Pregnant women require 50 micro grams more thyroxin than non- pregnant due to increase serum TBG.

  6. MYXEDEMA COMA: Severe Hypothyroidism In Elderly Patients. • Hypothermia. • Hypoglycemia. • Hyponatremia. • Confusion or Coma • TREATMENT IN MYXEDEMA COMA: • Inj: T3 20 micro grams I/V x 8 h for 48-72 h or Levo Thyroxin Na (400 micro grams I/V stat than 100 micro grams/day) followed by oral thyroxin 50 micro grams/day or through N/G tube. • Oxygen inhalation. • Hydrocortisone (100 mg I/V stat followed by 25-50 mg I/V 8 h). • 5% D/W. • Broad spectrum antibiotics. • Gradual re-warming by blankets. ENDS

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