Hypothyroidism

Hypothyroidism
  • Evaluation
    • General—state of decreased thyroid hormone with varied clinical manifestations
    • Clinical
      • Symptoms—tired, hypersomnia, dry skin, mild weight gain, constipation, cognitive slowing, and so on
      • Signs—bradycardia, slow speech, pallor, periorbital edema, delayed relaxation of reflexes, and so on
    • Etiology
      • Primary hypothyroidism (thyroid-stimulating hormone [TSH]) ↑, free T4 ↓)—disorder of the thyroid gland
        • Ninety-five percent of hypothyroidism in the United States is a result of primary thyroid failure, including the following:
          • Autoimmune thyroiditis (Hashimoto’s)
          • Ablation (surgical, radioiodine, radiation)
        • Other permanent causes
          • Congenital (1/3,500 live births in the United States)
          • Infiltrative disorders (e.g., hemochromatosis, amyloidosis, leukemia, etc.)
          • Iodine deficiency (not found in the United States, but found in third world regions)
        • Transient causes
          • Subacute thyroiditis (if viral—painful, if postpartum—painless)
          • Drug induced (amiodarone, lithium, interferon-α, etc.)
      • Secondary hypothyroidism (TSH ↓, free T4 ↓)—disorder of the hypothalamic-pituitary axis
        • Pituitary tumor
        • Sheehan’s syndrome
        • Cranial/pituitary radiation
        • Infiltrative disorders
      • Subclinical hypothyroidism (mild TSH ↑ [5-20 mIU/L], free T4 normal)
        • May progress to overt hypothyroidism.
    • Epidemology—8♀: 1♂; prevalence increases with age
    • Diagnostic algorithm
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Aug 28, 2016 | Posted by in PSYCHIATRY | Comments Off on Hypothyroidism

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