Hypothyroidism (QUICK HITS)

25 Apr


-TSH measurement is known to be the primary method of detecting thyroid disease

-After assessing TSH, Free T4 is the secondary test



-The Framingham study showed a rate of 4.4% of hypothyroidism in women over 60


Manifestations of Hypothyroidism

-Vary greatly from subclinical hypothyroidism to severe hypothyroidism

-Generally follow one of two changes

Slowing of metabolic processes:  

    • weight gain,
    • fatigue,
    • cold intolerance,
    • constipation,
    • bradycardia
    • irregular menses,
    • depression,
    • muscle weakness

Accumulation of glycosaminoglycans in tissues:  

    • Coarse hair and skin,
    • tongue enlargement,
    • hoarseness.

Myxedema (nonpitting edema) only occurs in severe hypothyroidism.

-Other important manifestations include anemia


Cardiovascular Effects

-Causes decreased cardiac contractility and decreased heart rate

-Patients often complain of dyspnea with exertion

Hypercholesterolemia secondary to decrease in cholesterol metabolism


Reproductive Effects

-Women may present with amenorrhea, hypermenorrhea, or normal cycles

-Both women and men with hypothyroidism have been shown to have decreased fertility

-Common complaints with men include decreased libido, erectile dysfunction, and delayed ejaculation. 


Metabolic Effects

-Decreased cholesterol metabolism and decreased drug clearance

Hyponatremia may occur secondary to an overall reduction in a person’s free water clearance. 


Myxedema Coma

-Severe hypothyroidism who are then exposed to new stresses including trauma, infection.

-Commonly present with hypothermic, hyponatremic, hypercapnic in a comatose patient. 



T4 Supplementation


Submitted by J. Grover.


Sources: Bensenor IM et al.  “Hypothyroidism in the Elderly:  Diagnosis and Management.  Clinical Interventions in Aging 2012:7 97-111. Tintinallis Emergency Medicine:  7th Edition. Uptodate:  Clinical Manifestations of Hypothyroidism.; picture

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