HYPOTHYROIDISM NAME : MAHFUZ ALAM GROUP : BA-410 TEACHER : DR. NATALIE LESOVAYA LECTURE PLAN DEFINITION ETIOLOGY CLASSIFICATION CLINICAL MANIFESTATION & COMPLICATION MANAGEMENT AND PREVENTION PATIENT MANAGEMENT DEFINITION HYPOTHYROIDISM : - It is a disease that occurs as a result of partial or complete loss of thyroid function. In hypothyroidism the thyroid gland is underactive, and can make too little thyroid hormone. The symptoms generally develop slowly and you may not realize you have a health problem for several years. ETIOLOGY Thyroiditis. An inflammation (swelling) of the thyroid gland which can lower the amount of hormones your thyroid produces. Autoimmune disease, Autoimmune thyroiditis (Hashimoto’s thyroiditis and atrophic thyroiditis). In some cases the immune system mistakes thyroid gland cells and their enzymes for invaders and can attack and damage them. Postpartum thyroiditis. This usually temporary condition occurs in 5% to 9% of women after childbirth. Iodine deficiency or too much iodine. Thyroid uses iodine to produce hormones. An iodine deficiency is a very common issue among several million people around the world. However taking in too much iodine can also cause or worsen hypothyroidism. Therefore, the most important is the iodine balance. ETIOLOGY Congenital hypothyroidism (hypothyroidism that a baby is born with) or a non-functioning thyroid gland. A few babies are born without a thyroid or with only a partly formed one, or all of their thyroid in the wrong place (ectopic thyroid). The condition, where the thyroid gland doesn’t work correctly from birth affects around 1 in 4,000 newborns. This may cause physical and mental issues in the future (if left untreated). Surgery that removes a part or all of the thyroid gland. In case thyroid nodules, thyroid cancer, or Graves’ disease, some people may need to have part or all of their thyroid removed. However, in case part of the gland is left, it may be able to produce adequate amounts of thyroid hormone. Radiation treatment. Some patients with nodular goiter, Graves’ disease, nodular goiter, or thyroid cancer are treated with radioactive iodine (I-131). Individuals with lymphoma, Hodgkin’s disease, or cancers of the neck or head are treated with radiation. All these treatments may cause a partial or total loss of thyroid function. Medicines. Drugs such as amiodarone, lithium, interferon alpha, and interleukin-2 may prevent the thyroid gland from being able to make hormones normally. ETIOLOGY Damage to the pituitary gland. When the pituitary, the “master gland,” which tells the thyroid how much hormone to make, is damaged (by a tumor, radiation, or surgery), it may no longer be able to offer the thyroid directions, and the thyroid may stop making enough hormone. Rare disorders that infiltrate the thyroid. In addition, in a few people, diseases such as for example amyloidosis, sarcoidosis or hemochromatosis can deposit abnormal substances in the thyroid and impair its ability to function CLASSIFICATION PRIMARY HYPOTHYROIDISM (Thyroid hormone insufficiency) :- SECONDARY HYPOTHYROIDISM (TSH Deficiency) TERTIARY HYPOTHYROIDISM (TRH Deficiency) Aplasia , Hypoplasia or Ectopia of thyroid gland, Endemic , Cretenism, Autoimmune Thyroiditis, Thyroidectomy, Mother’s use of drugs, Irradiation Isolated or Multiple Pitutary insufficiency. Isolated or multiple Hypothalamic insuffiency. PERIPHERAL HYPOTHYROIDISM(Defective TSH resistence (TSH or Adenylate cyclase receptor deficiency ) ; target organ) Genetically determined absence of response to thyroid hormones. OTHER UNUSUAL TYPES OF HYPOTHYROIDISM TUMOR- LIKE CARDIOVASCULAR EDEMATIC HEMATOLOGIC. MUSCULO-SKELETAL. RHEUMATOID. NEURO-PSYCHOTIC Features Of Clinical course of Hypothyroidism Isolated form Mild form Slowing of movements, pronunciation, thinking, puffiness of face , bradycardia is characteristic , Performance is not disturbed. Moderate form Manifestation of all characteristic symptoms Patient’s capacity is limited. Severe form Extreme manifestation of all the characteristic symptoms . “Myxedema” , Pale skin with a yellowish tinge. Patients are slowed down in movements , apathy , totally incapacitated. Risk of “Hypothyroid coma” CLINICAL MANIFESTATION & COMPLICATIONS FREQUENCY OF CLINICAL SYMPTOMS SIGNS FREQUENCY % WEAKNESS 90 - 70 DRY SKIN 90 - 70 SLEEPINESS 90 - 70 SLOW PRONUNCIATION 90 - 70 COLD INTOLORENCE 90 - 70 REDUCED SWEATING 90 - 70 TOUNGUE ENLARGEMENT 90 - 70 FACIAL PERIORBITAL EDEMA 90 - 70 HAIRLOSS 90 - 70 INCREASE AREA OF RELATIVE DULLNESS OF THE HEART 90 - 70 BRADYCARDIA 70 - 50 Complications Goiter. Heart problems. Mental health issues. In case of very severe hypothyroidism that hasn’t been diagnosed or treated, your risk of developing low serum sodium goes up. This could lead to seizures. Peripheral neuropathy. Infertility. Birth defects Myxedema. complications GOITER A term used to denote severe hypothyroidism. Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism. Myxedema refers to deposition of “mucopolysaccharides” in the dermis, which results in swelling of the affected area. When skin changes occur in hyperthyroidism, mostly Graves disease, it is called “pretibial myxedema.” Occurs in patients with long-standing, undiagnosed hypothyroidism Most often precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy. Patients presents with significant hypothermia and depressed mental status. It’s a medical emergency, continuous cardiac monitoring is required. Initial steps in therapy include airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures. DIAGNOSIS MANAGEMENT The Main Treatment Option is: Thyroid replacement medication. This standard treatment involves adding thyroid hormones back into your body with daily use of the oral synthetic thyroid hormone levothyroxine. It reverses the symptoms of hypothyroidism and restores adequate hormone levels. In addition, this treatment gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain. Treatment with levothyroxine will probably be lifelong, but because the dosage you need may change, your doctor is likely to check your TSH level every year