Please enable JavaScript.
Coggle requires JavaScript to display documents.
Hypothyroidism, Diagnostic Studies, Management of Myxedematous Coma,…
Hypothyroidism
Definition
The condition in which the thyroid gland produces less than the required amount of thyroid hormone which decreases the rate of metabolism.
Incidences
About 5% of USA citizens have Hypothyroidism
About 0.3% become severe Hypothyroidism
Women > Male
in neonates, Occur in about 1.5/1000 live birth
Types and Classification
1. Primary Hypothyroidism
When hypothyroidism is directly associated with Thyroid gland such as autoimmune destruction of thyroid gland.
2. Secondary Hypothyroidism
When the cause of Hypothyroidism is in Pituitary gland which decreases the Thyrotropin Releasing Hormone.
A. Congenital Hypothyroidism:
the etiology of hypothyroidism occurs before the baby is born. Ex.- Iodine Deficiency, genetics, Intake of goitrogenic substances during pregnancy (Cabbage, cauliflower, broccoli), ideopathic
B. Acquired Hypothyroidism:
the etiological factors begin after the birth: Iodide deficiency, medications (cough medication, anti-psychotics, beta-blockers, iodide, and cobalt), autoimmune destruction of the thyroid gland, thyroidectomy or RAI therapy
Etiology
Iodine Deficiency, Thyroidectomy, RAI therapy, medications, problems associated with pituitary gland, goitrogenic substances, genetics, ideopathic
Thyroid Hormone
Active form
: T3 (Tri-iodothyronine) and
Inactive form
: T4 (Thyroxine)
Thyroid hormone acts as negative feedback
Poor placental transport and fetal brain has the ability to convert T4 to T3 by 14 weeks
Signs and Symptoms
: Lethargy, frequent fatigue, drowsiness, poor growth and development, mental retardation, slowed speech and decreased initiative, somnolence, decreased cardiac contractility and cardiac output ( SOB, activity intolerance)
Associated Problems
CVS disorders (CMP and CHD)
Autoimmune disorders such as DM
Muscle dystrophy
Medical Management
Main goal
: to maintain Euthyroid state
Levothyroxine: the top choice
Tri-iodothyroxine
Complications
Myxedematous Coma
Mental confusion or delirium that progressively or suddenly leads to altered consciousness
Characteristics:
Hypethermia
Bradycardia
Hyperventilation
Hyponatremia
Precipitated By
1 Infections 2. CVS problems 3. Trauma 4. Exposure to cold 5. Drugs
Diagnostic Studies
Thyroid Function Tes
t: level of T3 and T4 as well as TSH are assessed
Chest X-ray: Cardiomegaly maybe detected
History collection
Physical Examination
Special Tests such as CT and MRI of the thyroid gland, USG, Thyroid Antibodies (it indicate autoimmune destruction of the thyroid gland), Thyroid radioisotope scan
Management of Myxedematous Coma
Stabilize the vitals
Normalize the thyroid hormone
Hyperventilation can lead to Heart Failure