Causes Of Hypothyroidism: Diagnosis And Clinical Features

Causes Of Hypothyroidism: Diagnosis And Clinical Features . Disorders of thyroid glands are classified into 2 categories

Hyperthyroidism- due to excessive secretion.

Hypothyroidism- due to deficient secretion.

Hypothyroidism is due to suboptimal circulating levels of one or both T3 and T4.

Common causes of hypothyroidism are:

• Auto-immune thyroiditis.
• Hashimoto’s disease. In 1 and 2 there is progressive destruction of thyroid tissue. Circulating antibodies are present in high concentration.
• Other inflammatory diseases of the gland.
• Following treatment of hyperthyroidism.
• Post-thyroidectomy
• Post 131-iodine therapy
• Idiopathic hypothyroidism

Rare causes are exogenous goiter, drugs (including lithium) and dyshormonogenesis./> Main difference between primary and secondary forms of hypothyroidism is in levels of plasma TSH – high TSH level occurs in primary and low TSH occurs in secondary hypothyroidism.

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Clinical Features Of Hypothyroidism

General- tiredness, somnolence, weight gain, cold intolerance and goiter.

Skin and subcutaneous tissues- coarse dry skin, puffiness of face, baggy eyelids, minimal sweating, alopecia and vitiligo (white discoloration).

Myxedema- swollen edematous appearance of supra-clavicular regions, neck, back of hand and feet.

Cardiovascular and respiratory- bradycardia (slow heart rate- below 60 beats), angina, cardiac failure with pericardial effusion and pleural effusion.

Psychiatric features- depression and myxo-edema madness.

Neuro-muscular- aches and pains, carpel tunnel syndrome, slurred speech and ataxia with muscle cramps and stiffness. Hoarseness of voice.

Gastrointestinal- constipation and ascites.

Hematological- anemia (iron deficiency), vitamin B12 deficiency and pernicious anemia.

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Reproductive system- infertility, menorrhagia and impotence.

Development- growth retardation, mental retardation and delayed puberty.

Miscellaneous- impairment of smell, taste and hearing; hoarse husky voice, nails striated and tend to break and decreased tone of muscles.

Diagnosis Of Hypothyroidism

• Thyroid function test- reduction in free and total T4 and rise in serum TSH indicates primary hypothyroidism. Elevated serum TSH with normal serum T4 is termed ‘sub clinical’ hypothyroidism.
• Serum cholesterol- elevated in primary thyroid failure.
• Tendon reflex duration- tendon reflexes are prolonged.
• Thyroid antibodies- antibodies to thyroglobulin or thyroid peroxidase are typically strongly positive in Hashimoto’s thyroiditis.

Thyroxin (T4) replacement therapy is the treatment of choice. Duration of therapy is usually lifelong.