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==[[Hypothyroidism classification|Classification]]==
==[[Hypothyroidism classification|Classification]]==
{| class="wikitable"
{| class="wikitable"
!
! rowspan="3" |
!Endagenous causes
! colspan="3" rowspan="2" |Origin of the defect
!Exagenous causes
! colspan="3" |Causes
!
|-
! rowspan="2" |Endagenous causes
! colspan="2" |Exagenous causes
|-
|-
!
!Thyroid
!
!Pituirtary
!Hypothalamus
!Surgery or radiation
!Surgery or radiation
!Other causes
!Other causes
|-
|-
|Primary hypothyroidism
|Primary hypothyroidism<ref name="pmid17512233">{{cite journal |vauthors=Harris KB, Pass KA |title=Increase in congenital hypothyroidism in New York State and in the United States |journal=Mol. Genet. Metab. |volume=91 |issue=3 |pages=268–77 |year=2007 |pmid=17512233 |doi=10.1016/j.ymgme.2007.03.012 |url=}}</ref>
|
|
|Thyroid gland
|
|
* Congenital hypothyroidism
* Congenital hypothyroidism
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|
|
* Thyroidectomy
* Thyroidectomy
* Radioiodine therapy of thyroid gland
* Radioiodine therapy
|
|
* Iodine deficeincy
* Iodine deficeincy
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** Thalidomide
** Thalidomide
|-
|-
|Transient hypothyroidism
|Transient hypothyroidism<ref name="pmid9294788">{{cite journal |vauthors=Canaris GJ, Steiner JF, Ridgway EC |title=Do traditional symptoms of hypothyroidism correlate with biochemical disease? |journal=J Gen Intern Med |volume=12 |issue=9 |pages=544–50 |year=1997 |pmid=9294788 |pmc=1497160 |doi= |url=}}</ref>
|
|
|Thyroid or pitui
|
|
* Subacute (de Quervain’s) thyroiditis
* Subacute (de Quervain’s) thyroiditis
Line 47: Line 56:
|
|
|-
|-
|Secondary hypothyroidism
|Secondary hypothyroidism<ref name="pmid8772595">{{cite journal |vauthors=Bates AS, Van't Hoff W, Jones PJ, Clayton RN |title=The effect of hypopituitarism on life expectancy |journal=J. Clin. Endocrinol. Metab. |volume=81 |issue=3 |pages=1169–72 |year=1996 |pmid=8772595 |doi=10.1210/jcem.81.3.8772595 |url=}}</ref><ref name="pmid1486881">{{cite journal |vauthors=Samuels MH, Ridgway EC |title=Central hypothyroidism |journal=Endocrinol. Metab. Clin. North Am. |volume=21 |issue=4 |pages=903–19 |year=1992 |pmid=1486881 |doi= |url=}}</ref><ref name="pmid18941435">{{cite journal |vauthors=Yamada M, Mori M |title=Mechanisms related to the pathophysiology and management of central hypothyroidism |journal=Nat Clin Pract Endocrinol Metab |volume=4 |issue=12 |pages=683–94 |year=2008 |pmid=18941435 |doi=10.1038/ncpendmet0995 |url=}}</ref>
|
|
|Pituitary gland
|
|
* Pituitary mass lesions, especially pituitary adenomas
* Pituitary mass lesions, especially pituitary adenomas
Line 60: Line 72:
|
|
* surgery of pituitary adenomas  
* surgery of pituitary adenomas  
* radiation therapy of pituitary adenomas or other mass lesions near pituitary gland
* radiation therapy
** pituitary adenomas
** other mass lesions near pituitary gland
|
|
* head trauma with injury of the stalk  
* head trauma with injury of the stalk  
|-
|-
|Tertiary hypothyroidism
|Tertiary hypothyroidism<ref name="pmid15144914">{{cite journal |vauthors=Benvenga S, Vigo T, Ruggeri RM, Lapa D, Almoto B, LoGiudice F, Longo M, Blandino A, Campennì A, Cannavò S, Trimarchi F |title=Severe head trauma in patients with unexplained central hypothyroidism |journal=Am. J. Med. |volume=116 |issue=11 |pages=767–71 |year=2004 |pmid=15144914 |doi=10.1016/j.amjmed.2003.12.038 |url=}}</ref>
|
|
|Hypothalamus gland
|
|
* hemochromatosis
* hemochromatosis
Line 89: Line 106:
== hei ==
== hei ==
* Primary hypothyroidism
* Primary hypothyroidism
** Congenital hypothyroidism <ref name="pmid17512233">{{cite journal |vauthors=Harris KB, Pass KA |title=Increase in congenital hypothyroidism in New York State and in the United States |journal=Mol. Genet. Metab. |volume=91 |issue=3 |pages=268–77 |year=2007 |pmid=17512233 |doi=10.1016/j.ymgme.2007.03.012 |url=}}</ref>
** Congenital hypothyroidism  
** Autoimmune (Hashimoto's) thyroiditis
** Autoimmune (Hashimoto's) thyroiditis
** Iodine deficeincy
** Iodine deficeincy
Line 103: Line 120:
** Thyroidectomy
** Thyroidectomy
** Radioiodine therapy
** Radioiodine therapy
* Transient hypothyroidism<ref name="pmid9294788">{{cite journal |vauthors=Canaris GJ, Steiner JF, Ridgway EC |title=Do traditional symptoms of hypothyroidism correlate with biochemical disease? |journal=J Gen Intern Med |volume=12 |issue=9 |pages=544–50 |year=1997 |pmid=9294788 |pmc=1497160 |doi= |url=}}</ref>
* Transient hypothyroidism
** Subacute (de Quervain’s) thyroiditis
** Subacute (de Quervain’s) thyroiditis
** Postpartum thyroiditis
** Postpartum thyroiditis


* Secondary hypothyroidism (due to decreased levels of TSH)<ref name="pmid8772595">{{cite journal |vauthors=Bates AS, Van't Hoff W, Jones PJ, Clayton RN |title=The effect of hypopituitarism on life expectancy |journal=J. Clin. Endocrinol. Metab. |volume=81 |issue=3 |pages=1169–72 |year=1996 |pmid=8772595 |doi=10.1210/jcem.81.3.8772595 |url=}}</ref> <ref name="pmid1486881">{{cite journal |vauthors=Samuels MH, Ridgway EC |title=Central hypothyroidism |journal=Endocrinol. Metab. Clin. North Am. |volume=21 |issue=4 |pages=903–19 |year=1992 |pmid=1486881 |doi= |url=}}</ref> <ref name="pmid18941435">{{cite journal |vauthors=Yamada M, Mori M |title=Mechanisms related to the pathophysiology and management of central hypothyroidism |journal=Nat Clin Pract Endocrinol Metab |volume=4 |issue=12 |pages=683–94 |year=2008 |pmid=18941435 |doi=10.1038/ncpendmet0995 |url=}}</ref>
* Secondary hypothyroidism (due to decreased levels of TSH)
** Pituitary mass lesions, especially pituitary adenomas
** Pituitary mass lesions, especially pituitary adenomas
** cysts and abscesses
** cysts and abscesses
Line 115: Line 132:
** craniopharyngiomas
** craniopharyngiomas
** surgery or radiation therapy for pituitary adenomas or other mass lesions near pituitary gland
** surgery or radiation therapy for pituitary adenomas or other mass lesions near pituitary gland
** head trauma with injury of the stalk <ref name="pmid15144914">{{cite journal |vauthors=Benvenga S, Vigo T, Ruggeri RM, Lapa D, Almoto B, LoGiudice F, Longo M, Blandino A, Campennì A, Cannavò S, Trimarchi F |title=Severe head trauma in patients with unexplained central hypothyroidism |journal=Am. J. Med. |volume=116 |issue=11 |pages=767–71 |year=2004 |pmid=15144914 |doi=10.1016/j.amjmed.2003.12.038 |url=}}</ref>
** head trauma with injury of the stalk  
** pituitary apoplexy
** pituitary apoplexy
** Sheehan syndrome (postpartum pituitary necrosis)
** Sheehan syndrome (postpartum pituitary necrosis)
Line 423: Line 440:


==Prevention==
==Prevention==
<references />

Revision as of 15:46, 10 July 2017


For patient information click here

Hypothyroidism Main page

Patient Information

Overview

Classification

Primary hypothyroidism
Hashimoto's thyroiditis
Secondary hypothyroidism
Tertiary hypothyroidism

Differentiating different causes of hypothyroidism

Screening

Diagnosis

History and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Synonyms and keywords: Myxedema; myxoedema; thyroid activity decreased; hypothyroid

Overview

Classification

Origin of the defect Causes
Endagenous causes Exagenous causes
Thyroid Pituirtary Hypothalamus Surgery or radiation Other causes
Primary hypothyroidism[1] Thyroid gland
  • Congenital hypothyroidism
  • Autoimmune (Hashimoto's) thyroiditis
  • Thyroidectomy
  • Radioiodine therapy
  • Iodine deficeincy
  • Drug induced thyroiditis
    • Amiodarone
    • Lithium
    • Thionamide
    • Iodine
    • Iterferon
    • Sunitinib
    • Rifampicin
    • Thalidomide
Transient hypothyroidism[2] Thyroid or pitui
  • Subacute (de Quervain’s) thyroiditis
  • Postpartum thyroiditis
Secondary hypothyroidism[3][4][5] Pituitary gland
  • Pituitary mass lesions, especially pituitary adenomas
  • Brain cysts and abscesses
  • meningiomas
  • dysgerminomas
  • metastatic tumors
  • craniopharyngiomas
  • pituitary apoplexy
  • Sheehan syndrome (postpartum pituitary necrosis)
  • Idiopathic isolated TSH deficiency
  • surgery of pituitary adenomas
  • radiation therapy
    • pituitary adenomas
    • other mass lesions near pituitary gland
  • head trauma with injury of the stalk
Tertiary hypothyroidism[6] Hypothalamus gland
  • hemochromatosis
  • histiocytosis
  • autoimmune lymphocytic hypophysitis
  • Developmental abnormalities
  • internal carotid aneurysms
  • Other central nervous system (CNS) tumors
  • Idiopathic isolated TRH deficiency
  • Radiation in high doses to the
    • brain
    • infratemporal
    • nasopharyngeal
    • oropharyngeal
  • Infections
    • tuberculosis
    • syphilis
    • toxoplasmosis
  • sarcoidosis

hei

  • Primary hypothyroidism
    • Congenital hypothyroidism
    • Autoimmune (Hashimoto's) thyroiditis
    • Iodine deficeincy
    • Drug induced thyroiditis
      • Amiodarone
      • Lithium
      • Thionamide
      • Iodine
      • Iterferon
      • Sunitinib
      • Rifampicin
      • Thalidomide
    • Thyroidectomy
    • Radioiodine therapy
  • Transient hypothyroidism
    • Subacute (de Quervain’s) thyroiditis
    • Postpartum thyroiditis
  • Secondary hypothyroidism (due to decreased levels of TSH)
    • Pituitary mass lesions, especially pituitary adenomas
    • cysts and abscesses
    • meningiomas
    • dysgerminomas
    • metastatic tumors
    • craniopharyngiomas
    • surgery or radiation therapy for pituitary adenomas or other mass lesions near pituitary gland
    • head trauma with injury of the stalk
    • pituitary apoplexy
    • Sheehan syndrome (postpartum pituitary necrosis)
    • Idiopathic isolated TSH deficiency
  • Tertiary hypothyroidism
    • Infiltrative disorders affecting the pituitary or the hypothalamus include hemochromatosis, and histiocytosis
    • autoimmune lymphocytic hypophysitis
    • Developmental abnormalities
    • internal carotid aneurysms
    • Other central nervous system (CNS) tumors
    • Idiopathic isolated TRH deficiency

Differential diagnosis

Disease History and symptoms Laboratory findings Additional findings
Fever Goiter Serum glucose Urinary Glucose Urine PH Serum Sodium Urinary Glucose 24 hrs cortisol level C-peptide level Serum glucagon
Primary hypothyroidism + + + + - ↑ ↑ Normal Normal N/↑ Normal ↓ Normal Auto antibodies present

(Anti GAD-65 and anti insulin anti bodies)

Transient hypothyroidism + + + + - ↑ ↑ Normal Normal ↑ Normal Normal ↑ Acanthosis nigricans
Subclinical hypothyroidism + + + - + ↑ ↑ Normal Normal ↑ Normal Normal N -
+ + - - - Normal Normal Normal ↓ Normal Normal Normal Normal -
+ + - - - Normal Normal Normal ↑ Normal Normal Normal Normal -
Transient hyperglycemia - - - - - ↑ ↑ Normal Normal ↑ Normal Normal N/↑ In hospitalized patients especially in ICU and CCU
Steroid therapy + - - - + ↑ ↑ Normal Normal ↑ ↑ N/↑ N/↑ Acanthosis nigricans,
RTA 1 - - - + - Normal Normal ↑ Normal ↑ Normal Normal Normal Hypokalemia, nephrolithiasis
Glucagonoma - - - - - ↑ Normal Normal Normal - Normal Normal ↑ Necrolytic migratory erythema
Cushing syndrome - - - - + ↑ - Normal ↓ N/↑ ↑ Normal Normal Moon face, obesity, buffalo hump, easy bruisibility

General feature

Symptoms

Constituitional Local Reproductive Neuropsysiological Others Physical exam
cold intolerance

puffiness

decreased sweating

coarse skin

hypothermia

Fever if accompanied by thyroiditis

weight gain

coarse, brittle, straw like hair with hair loss

obstructive sleep apnea (secondary to macroglossia) Females can present with galactorrhea and menstrual disturbances depression paresthesia and nerve entrapment syndromes decreased systolic blood pressure

increased diastolic blood pressure

bradycardia

pericardial effusion

abdominal distension

ascites (uncommon)

non-pitting edema (myxedema)

pitting edema of lower extremities

hyporeflexia with delayed relaxation

ataxia

fullness and pain in the throat and neck infertility emotional lability constipation
  • hoarseness
  • sore throat
 blurred vision macroglossia
goiter Attention deficit periorbital puffiness
slowed speech and movements
  • Metabolic abnormalities associated with hypothyroidism include:
    • anemia,
    • dilutional hyponatremia,
    • hyperlipidemia,
    • reversible increase in creatinine

Complications

Myxedema coma

Rare, severe form of hypothyroidism, a life-threatening condition

  • Altered mental status,
  • hypothermia,
  • bradycardia,
  • hypercarbia, and
  • hyponatremia.
  • Cardiomegaly,
  • pericardial effusion,
  • cardiogenic shock, and
  • ascites
  • commonly occurs in individuals with undiagnosed or untreated hypothyroidism who is subjected to an external stress, such as low temperature, infection, or medical intervention (e.g., surgery or hypnotic drugs)

Screening

Diagnosis

Treatment

Prevention

  1. ↑ Harris KB, Pass KA (2007). "Increase in congenital hypothyroidism in New York State and in the United States". Mol. Genet. Metab. 91 (3): 268–77. doi:10.1016/j.ymgme.2007.03.012. PMID 17512233.
  2. ↑ Canaris GJ, Steiner JF, Ridgway EC (1997). "Do traditional symptoms of hypothyroidism correlate with biochemical disease?". J Gen Intern Med. 12 (9): 544–50. PMC 1497160. PMID 9294788.
  3. ↑ Bates AS, Van't Hoff W, Jones PJ, Clayton RN (1996). "The effect of hypopituitarism on life expectancy". J. Clin. Endocrinol. Metab. 81 (3): 1169–72. doi:10.1210/jcem.81.3.8772595. PMID 8772595.
  4. ↑ Samuels MH, Ridgway EC (1992). "Central hypothyroidism". Endocrinol. Metab. Clin. North Am. 21 (4): 903–19. PMID 1486881.
  5. ↑ Yamada M, Mori M (2008). "Mechanisms related to the pathophysiology and management of central hypothyroidism". Nat Clin Pract Endocrinol Metab. 4 (12): 683–94. doi:10.1038/ncpendmet0995. PMID 18941435.
  6. ↑ Benvenga S, Vigo T, Ruggeri RM, Lapa D, Almoto B, LoGiudice F, Longo M, Blandino A, Campennì A, Cannavò S, Trimarchi F (2004). "Severe head trauma in patients with unexplained central hypothyroidism". Am. J. Med. 116 (11): 767–71. doi:10.1016/j.amjmed.2003.12.038. PMID 15144914.
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