1. Hypothyroidism Group A
UNIT 5: ENDOCRINE
Hypothyroidism
Group A

2. Hypothyroidism Background:
Primary hypothyroidism - Most common cause is HASIMOTO’S THYROIDITIS diagnosed in >80% of cases – is an autoimmune disease
Secondary hypothyroidism - <5% cases due to deficient pituitary production of TSH
Prevalence 3x higher in women compared to men
Annual incidence rate 1-2 per 1,000 women
Presentation of symptoms in elderly may be atypical or absent
Prevalence increases with age
Caucasians higher incidence than non-Caucasians

3. Risks: Risks highest in persons with: Type 1 diabetes mellitus
Family history of thyroid disease
History of head/neck cancers treated with radiation therapy
Previous radioactive iodine treatment
Previous thyroid surgery

4. Case:
Mr. T. presents to you concerned about her weight gain and fatigue. Both of these problems have been problems for years. Recently, a friend told her these problems may be because her thyroid is not working properly and she wants to have her thyroid checked.
What other signs and symptoms would you ask Ms. T. about?

5. What other signs and symptoms would you ask Ms. T. about
What other signs and symptoms would you ask Ms. T. about? Clinical Signs and Symptoms
Fatigue (reported by this patient)
Cold intolerance
Constipation
Impaired memory
Slowed mentation
Depression
Ataxia
Muscle weakness
Muscle cramps

6. Clinical Signs & Symptoms Continued
Menstrual disturbance
Hoarseness
Goiter
Periorbital edema
Weight gain (was reported by this patient)

7. Ask about family history:
Personal or family history of associated autoimmune disorders:
Pernicious anemia
Adrenal insufficiency
Diabetes mellitus Type 1
Ovarian failure
Celiac disease
Sjogren’s syndrome
Multiple sclerosis

8. Ask about previous thyroid injury or treatment
Thyroidectomy or other neck surgery
Radioactive iodine therapy
External radiation therapy

9. Ask about current medications
Drugs that impair thyroid function:
Lithium
Amiodarone
Aminoglutethmide
Interferon a
Thalidomide
Betaroxine
Stavudine

10. Ask about pituitary disorders
Pituitary tumor
Signs of sellar mass: headache, bi-temporal hemianopsia or diplopia
History of pituitary surgery or radiotherapy
History of head trauma

11. References:
Roberts, C. G., & Ladenson, P. W. (2004). Hypothyroidism. Lancet, 363,
Clinical practice guideline: Investigation and Management of Primary Thyroid Dysfunction. (2008). Retrieved February 1, 2009 from