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UNIT 5: ENDOCRINE

UNIT 5: ENDOCRINE. Hypothyroidism Group A. Hypothyroidism. Background: Primary hypothyroidism - Most common cause is HASIMOTO’S THYROIDITIS diagnosed in >80% of cases – is an autoimmune disease Secondary hypothyroidism - <5% cases due to deficient pituitary production of TSH

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UNIT 5: ENDOCRINE

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  1. UNIT 5: ENDOCRINE Hypothyroidism Group A

  2. Hypothyroidism • Background: • Primary hypothyroidism - Most common cause is HASIMOTO’S THYROIDITIS diagnosed in >80% of cases – is an autoimmune disease • Secondary hypothyroidism - <5% cases due to deficient pituitary production of TSH • Prevalence 3x higher in women compared to men • Annual incidence rate 1-2 per 1,000 women • Presentation of symptoms in elderly may be atypical or absent • Prevalence increases with age • Caucasians higher incidence than non-Caucasians

  3. Risks: • Risks highest in persons with: • Type 1 diabetes mellitus • Family history of thyroid disease • History of head/neck cancers treated with radiation therapy • Previous radioactive iodine treatment • Previous thyroid surgery

  4. Case: Mr. T. presents to you concerned about her weight gain and fatigue. Both of these problems have been problems for years. Recently, a friend told her these problems may be because her thyroid is not working properly and she wants to have her thyroid checked. What other signs and symptoms would you ask Ms. T. about?

  5. What other signs and symptoms would you ask Ms. T. about? Clinical Signs and Symptoms • Fatigue (reported by this patient) • Cold intolerance • Constipation • Impaired memory • Slowed mentation • Depression • Ataxia • Muscle weakness • Muscle cramps

  6. Clinical Signs & Symptoms Continued • Menstrual disturbance • Hoarseness • Goiter • Periorbital edema • Weight gain (was reported by this patient)

  7. Ask about family history: • Personal or family history of associated autoimmune disorders: • Pernicious anemia • Adrenal insufficiency • Diabetes mellitus Type 1 • Ovarian failure • Celiac disease • Sjogren’s syndrome • Multiple sclerosis

  8. Ask about previous thyroid injury or treatment • Thyroidectomy or other neck surgery • Radioactive iodine therapy • External radiation therapy

  9. Ask about current medications • Drugs that impair thyroid function: • Lithium • Amiodarone • Aminoglutethmide • Interferon a • Thalidomide • Betaroxine • Stavudine

  10. Ask about pituitary disorders • Pituitary tumor • Signs of sellar mass: headache, bi-temporal hemianopsia or diplopia • History of pituitary surgery or radiotherapy • History of head trauma

  11. References: • Roberts, C. G., & Ladenson, P. W. (2004). Hypothyroidism. Lancet, 363, 793-803. • Clinical practice guideline: Investigation and Management of Primary Thyroid Dysfunction. (2008). Retrieved February 1, 2009 from http://topalbertadoctors.org

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