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Hypothyroidism (Signs (Cold hands (may be with temp. drop), Ascites,…
Hypothyroidism
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Symptoms
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Tired, low mood, dementia
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Epidemiology
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The most common cause of primary hypothyroidism in areas with no iodine deficiency is autoimmune/atrophic hypothyroidism
In general hypothyroidism is associated with Turners', Downs', Cystic fibrosis, primary biliary cirrhosis and ovarian hyper-stimulation
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Aetiology
Post-partum thyroiditis
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May cause hyperthyroidism, hypothyroidism or the two sequentially
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Hashimoto's thyroiditis
Produces atrophic changes with regeneration that results in GOITRE due to lymphocytic and plasma cell infiltration
Drug induced
Examples include
- Carbimazole
- Lithium
- Amiodarone
- Interferon
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Diagnosis
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Blood tests
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Anaemia
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Or microcytic (in women, due to menorrhagia or undiagnosed coeliac disease)
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Thyroid Function Tests
Serum TSH high (confirm primary hypothyroidism) - increases in an attempt to make thyroid work again
In secondary hypothyroidism the TSH is inappropriately low for the low T4/T3 - since issue is in pituitary
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Pathophysiology
Underactivity is usually primary from disease of the thyroid but may be secondary due to hypothalamic-pituitary disease resulting in reduced TSH drive e.g. hypopituitarism
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Under-activity of the thyroid gland may be primary, from disease of the thyroid gland, or much less commonly, secondary to hypothalamic or pituitary disease (secondary hypothyroidism)