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