Hypothyroidism

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Hypothyroidism Powered By Docstoc
					Vaishnavi Pulusani

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A postmenopausal woman of 48 years, presented to the Med OPD with an increase in weight, lethargy, and swelling around her eyes for the last 6 months. Her urine out put was normal. Examination revealed that she is obese (wt. 80kg) and her skin is dry and scaly. She had puffiness in her face. Systemic examination revealed no abnormality except that her pulse rate is 60beats/min, but regular and she has mild thyroid enlargement. On inquiry, she has intolerance to cold weather.

Patient's Values

Normal Values

Hb

9g %

Female 12-16g %

TLC and DLC Peripheral smear

In range Normocytic, normochromic 110 mg/dL 40 mg/dL
1mg/dL

P: 60%, L: 35%, E: 3-5%

Blood Sugar (random) Blood Urea
Serum Creatinine

60-90 mg/dL (fasting) 35-45 mg/dL
0.8-1.6 mg/dL

Patient’s Values
Fasting Serum Lipids 260 mg/dL

Normal Values
< 160 mg/dL

Fasting Serum Cholesterol
T3 (Triiodothyronine)

400 mg/dL
< 5 ng/dL

< 200 mg/dL
10-40 ng/dL

T4 (Thyroxine) TSH

< 1.6 µg/dL 46 µunits

5-12 µg/dL 0.4-5 µunits

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Weight gain Lethargy Dry and scaly skin Decrease in heat rate Mild thyroid enlargement Cold intolerance Puffiness of face Swelling around eyes

Possible Causes: 1) Iodine deficiency
2) 3) 4)
5)

Idiopathic nontoxic goiter

-Goiter

Chronic autoimmune thyroiditis Radiation induced Hashimoto’s thyroiditis
-Antithyroid autoantibodies

-Not due to iodine deficiency

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Early signs and symptoms:
◦ ◦ ◦ ◦ ◦ ◦ Fatigue, weakness Muscle cramps Constipation Thinning of hair Brittle nails Pallor Deepened, gruff voice Slow physical and mental activity Peripheral edema Dyspnea Unsteadiness and slightly slurred speech Cardiac enlargement

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Late signs and symptoms:
◦ ◦ ◦ ◦ ◦ ◦

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Thyroid gland examination: ◦ Gland is attached to the pretracheal fascia so it will move with deglutination ◦ Goiter: will feel soft on examination ◦ Enlargement due to autoimmune thyroiditis: will feel firm ◦ Presence of multinodular goiters: suspect malignancy

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Administration of thyroxine (T4): Levothyroxine ◦ Oral tablet uptake studies: In hypothyroidism, less than 10% of the administered dose is taken up by the gland Measurement of thyroid autoantibodies
Isotopic Imaging: to detect for tumors

 I131

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posted:9/26/2008
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