Download - Hypothyroidim
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HYPOTHYROIDISM DIAGNOSIS AND MANAGEMENT
By: DR. MANSOOR ALI VIRK
CMC LARKANA
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DIAGNOSIS OF HYPOTHYROIDISM
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1. HISTORY
Headache Fatigue Lethargy Weakness Arthralgia Myalgia Weight gain Cold intolerance Sleep disturbance Absence of sweet Constipation Amenorrhea Menorrhagia
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2. EXAMINATION
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HANDS:- Peripheral cyanosis Swelling Dry cold skin Anemia ARMS:- Pulse carpel tunnel syndrome by tapping the flexor retinaculum medial to
the base of thenar eminent ) Bicep reflex Test for proximal myopathy FACE- Alopecia Dry thin hair Priorbital edema General swelling Loss of outer halves of eye brows Vitiligo Tongue swelling Check for the hoarseness of voice and slowness of speech
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LEGS- Slow relaxation of ankle jerk Peripheral neuropathy and edema
CHEST:- Pleural or pericardial effusion Rough sand paper like appearance over
the chest
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INVESTIGATIONS
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SPECIFIC INVESTIGATION
TFT Thyroid function test Primary hypothyroidism Serum T4 Serum T3 not valuable Serum TSH 20 m/L Secondary hypothyroidism Serum T4 Serum TSH low or normal Note- Hashimotos thyroiditis increase
circulating level of anti thyroglobulin antibodies
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NON-SPECIFIC INVESTIGATIONS
Serum LDH and cretinine kinase Serum cholesterol and triglycerides Serum sodium Anemia with normal or increase MCV
ECG- Prolonged hypothyroidism shows
sinus bradycardia with low voltage complex ST Segment and T WAVE abnormality.
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DIFFERENTIAL DIAGNOSIS
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Anemia Obstructive sleep apnea Dementia vitamin D deficiency Adrenal insufficiency Lyme disease
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TREATMENT
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Treatment with thyroxin replacement. Starts with low dose of 50 g/day for 3 weeks increasing
there after to 100 g/day for further 3 weeks. Finally shift maintenance dose 100-150 g/day.
Note:- thyroxin should be taken to avoid concomitant food and drugs that may interfere its absorption.
Note:- thyroxin half life is 7 days so it should always be taken as a single dose daily and at least 6 weeks pause to repeat the TFT.
Patient feel better within 2-3 weeks reduction in weight and peri-orbital puffiness occur quickly but restoration of skin texture take 3-6 months.
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COMPLICATIONS
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CAD and CF due to hyperlipidemia Increase chance for infection Mega colon Myxedema madness:- psychosis with
paranoid delusions Infertility(rare) Pregnancy in hypothyroidism often result
miscarriage Myxedema coma.
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MYXEDEMA OF FACE
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THANK
YOU