Presentation is loading. Please wait.

Presentation is loading. Please wait.

Acquired Hypothyroidism Katrina L. Parker, MD. Acquired Hypothyroidism The thyroid gland makes too little or no thyroid hormone Occurs anytime during.

Similar presentations


Presentation on theme: "Acquired Hypothyroidism Katrina L. Parker, MD. Acquired Hypothyroidism The thyroid gland makes too little or no thyroid hormone Occurs anytime during."— Presentation transcript:

1 Acquired Hypothyroidism Katrina L. Parker, MD

2 Acquired Hypothyroidism The thyroid gland makes too little or no thyroid hormone Occurs anytime during childhood Usually affects infants starting at 6 months of age

3

4 Historical Review 1912 Dr. Hakaru Hashimoto described 4 patients with a chronic disorder of the thyroid He termed it struma lymphomatosa The thyroid glands had – Fibrosis – Diffuse lymphocytic infiltation – Parenchymal atrophy – Eosinophilic changes

5 Etiology Autoimmune disease Delayed onset congenital hypothyroidism Iodine deficiency Medications – Anti depressants – Lithium – Amiodarone % of patients Radiation therapy Radioactive iodine therapy Thyroid surgery

6 Causes of Acquired Hypothyroidism Thyroidectomy or radioiodine therapy – Thyroid cancer – Thyroxicosis – Lingual thyroid – Isolated midline thyroid TRH deficiency Pituitary disorder Chronic infections Idiopathic

7 Etiology Environmental factors – High iodine intake – Selenium deficiency – Pollutants – tobacco smoke – Infectious disease- chronic hepatits C

8 Incidence 0.3 to 1.5 cases per 1000 population per year times more frequent in women than men  in families with hypothyroidism or autoimmune disease Associated with other autoimmune diseases – Type 1 DM – Celiac disease – Type 2 and Type 3 polyglandular autoimmune disorders

9 Prevalence Annual incidence 4 per 100 women and 1 per 1000 men More common in certain populations sporadic inheritance, sometimes autosomal recessive post-partum thyroiditis affects 5% of women

10 Absorption of thyroid hormone Affected by – Iron supplements – Questran – Antacids containing Aluminum hydroxides – Calcium supplements – Soy products – Rifampin – Anti convulsants

11 Hypothyroidism Classification TYPEOriginDescription PrimaryThyroid glandThe most common form is Hashimoto thyroiditis SecondaryPituitary GlandOccurs if the pituitary does not create enough TSH TertiaryHypothalamusThe hypothalamus fails to produce sufficient TRH

12 Hypothyroidism and Concurrent Conditions Depression Euthyroid sick syndrome – Starvation – Critically ill – Corticosteroids and dopamine Infertility

13 Differential Diagnosis Primary versus hypothalamic failure Short stature – Coarse features R/O Down Syndrome Hurler & Hunter Syndrome Generalized gangliosidosis

14

15 Presentation of Hashimoto’s Thyroiditis Euthyroidism and goiter Subclinical hypothyroidism and goiter Primary thyroid failure Adolescent goiter Painless thyroiditis or silent thyroiditis Postpartum painless thyrotoxicosis Alternating hypo- and hyperthyroidism

16

17 Signs Depression Physical & mental sluggishness Dry skin Constipation Weight gain with poor appetite Dyspnea Poor muscle tone Menorrhagia Diminished sweating Hoarse voice or cry/large tongue

18 Signs Coarse, dry skin Cool peripheral extremities Puffy face, hands and feet (myxedema) Bradycardia Peripheral edema Delayed tendon reflex relaxation Carpal tunnel syndrome Mild unexplained weight gain NOT morbid obesity

19

20 Skin – dry, thick, scaly, coarse Hair- brittle, dry, coarse, excessive Lateral thinning of the eyebrows Prominent axillary & supraclavicular fat pads in infants Growth changes – short stature, infantile skeletal proportions with relatively short extremities Infantile naso-orbital configuration Delayed epiphyseal development

21

22

23 Delayed closure of fontanelles Delayed dental eruption Delayed epiphyseal development Menometrorrhagia or galactorrhea

24 Labs Decreased TT4 and FT4, elevated TSH Thyroid antibodies – Anti- Thyroglobulin and anti thyroid perioxidase (TPO) R/O TBG deficiency Normocytic anemia Elevated cholesterol and carotene in childhood but normal or low in infants Decreased GH levels

25 Imaging Skeletal maturation is delayed Ossification centers of the hip – Single stippled – Multiple small areas Anterior beaking of the vertebrae Coxa vara & coxa plana Thyroid scan or ultrasound

26 Treatment Levothyroxine – The drug of choice – Dosage infants mg/kg/day Long standing hypothyroidism start with a low dose of ug daily and gradually increase Monitor TSH and FreeT4

27 Treatment T4 only – Currently the standard treatment – Involves supplementation of levothyroxine alone T4 and T3 in combination – Involves administering both synthetic L-T4 and L- T3 simultaneously in combination Desiccated Thyroid Extract – animal based thyroid extract – contains natural forms of l-t4 and l-t3e

28 Glandular Concentrates Sold in health food stores Are not regulated by the FDA Potency is not guaranteed

29 QUESTIONS


Download ppt "Acquired Hypothyroidism Katrina L. Parker, MD. Acquired Hypothyroidism The thyroid gland makes too little or no thyroid hormone Occurs anytime during."

Similar presentations


Ads by Google