Hypothyroidism: Difference between revisions
Line 157: | Line 157: | ||
! align="center" style="background: #4479BA; color: #FFFFFF; " |TPOAb | ! align="center" style="background: #4479BA; color: #FFFFFF; " |TPOAb | ||
|- | |- | ||
| rowspan=" | | rowspan="3" style="background:#DCDCDC;" |Primary hypothyroidism | ||
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]] | | align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]] | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | + | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | + | ||
Line 165: | Line 165: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓''''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓''''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓''''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑''' | ||
Line 181: | Line 181: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* | *Infectious thyroiditis associated with neck pain | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" |Others | | align="center" style="background:#DCDCDC;" |Others | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
Line 196: | Line 195: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* History of hyperthyroiditis | |||
* Drug history | |||
|- | |- | ||
| colspan="2" style="background:#DCDCDC;" |Transient hypothyroidism | | colspan="2" style="background:#DCDCDC;" |Transient hypothyroidism | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/- | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/- | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | + | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/- | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | ||
Line 213: | Line 214: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* May present primarily with hyperthyroiditis | |||
|- | |- | ||
| colspan="2" style="background:#DCDCDC;" |Subclinical hypothyroidism | | colspan="2" style="background:#DCDCDC;" |Subclinical hypothyroidism | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
Line 224: | Line 226: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Asymptomatic | |||
|- | |- | ||
| rowspan="2" align="center" style="background:#DCDCDC;" |Central Hypothyroidism | | rowspan="2" align="center" style="background:#DCDCDC;" |Central Hypothyroidism | ||
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Pituitary | | align="center" style="padding: 5px 5px; background: #DCDCDC;" |Pituitary | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | + | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | + | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓''''' | ||
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓''''' | ||
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓''''' | |||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↓''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↓''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
Line 240: | Line 243: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Other pituitary hormone deficiencies signs | |||
|- | |- | ||
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Hypothalamus | | align="center" style="padding: 5px 5px; background: #DCDCDC;" |Hypothalamus | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | + | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | + | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | ||
Line 250: | Line 254: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Other pituitary hormone deficiency signs | |||
|- | |- | ||
| colspan="2" style="background:#DCDCDC;" |Resistance to TSH/TRH | | colspan="2" style="background:#DCDCDC;" |Resistance to TSH/TRH | ||
Line 256: | Line 261: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | - | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓''''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓''''' | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
Line 263: | Line 268: | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | | align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal | ||
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | | | align="center" style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Rare | |||
|} | |} | ||
Revision as of 20:43, 13 July 2017
For patient information click here
Hypothyroidism Main page |
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
Environmental iodine deficiency is the most common cause of hypothyroidism on a worldwide basis (16). In areas of iodine sufficiency, such as the United States, the most common cause of hypothyroidism is chronic autoimmune thyroiditis (Hashimoto’s thyroiditis).Autoimmune thyroid diseases (AITDs) have been estimated to be 5-10 times more common in women than in men.
Classification
The table below presents a classification of isolated thyroid disorders and its causes based on the classification:
Origin of the defect | Causes | ||||||
---|---|---|---|---|---|---|---|
Endagenous causes | Exagenous causes | ||||||
Thyroid | Pituirtary | Hypothalamus | Surgery or radiation | Other causes | |||
Primary hypothyroidism | + | - | - |
|
|
| |
Transient hypothyroidism | + | + | - |
|
|||
Central Hypothyroidism | Secondary
OR Pituitary originated |
- | + | - |
|
|
|
Tertiary
OR Hypothalamus originated |
- | - | + |
|
|
|
Classification of thyroiditis based on the duration algorythm
History, signs, and symptoms suggestive of hypothyroidism | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Measure FT4 and TSH | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Normal FT4, Elevated TSH>5.5 | Decresased level of FT4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subclinical hypothyroidism | Elevated TSH > 5.5 | Normal TSH level OR Decreased TSH level < 0.2 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Check anti-thyroid autoantibodies and TPOAb | Check TRH | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Increased | Normal | Normal or increased | Decreased | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
•Autoimmune thyroiditis • Resistance to TSH | •Iodine deficeincy •Thyroiditis | •Pituitary related hypothyroidism | •Hypothalamus related hypothyroidism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Differential diagnosis
Disease | History and symptoms | Laboratory findings | Additional findings | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Fever | Goiter | Pain | TSH | Free T4 | T3 | T3RU | Thyroglobin | TRH | TPOAb | |||
Primary hypothyroidism | Autoimmune | + | +/-
Diffuse |
- | ↑ | ↓ | N/↓ | Normal | N/↑ | Normal | ↑ |
|
Thyroiditis | + | +/- | + | ↑ | ↓ | Normal | Normal | N/↑ | Normal | Normal |
| |
Others | - | +/- | - | ↑ | ↓ | Normal | Normal | N/↑ | Normal | Normal |
| |
Transient hypothyroidism | +/- | - | +/- | ↑ | ↑ | Normal | Normal | ↑ | Normal | Normal |
| |
Subclinical hypothyroidism | - | - | - | ↑ | Normal | Normal | Normal | ↑ | Normal | N/↑ |
| |
Central Hypothyroidism | Pituitary | + | - | - | N/↓ | N/↓ | N/↓ | ↓ | Normal | Normal | Normal |
|
Hypothalamus | + | - | - | ↑ | Normal | ↓ | Normal |
| ||||
Resistance to TSH/TRH | - | - | - | ↑ | N/↓ | N/↓ | Normal | Normal | ↑/↓ | Normal |
|
General feature
Symptoms
Symptoms | Constituitional | HEENT | Neuromuscular | Others | Complications |
---|---|---|---|---|---|
More common |
|
|
|
|
|
Less common |
|
|
|
|
- Metabolic abnormalities associated with hypothyroidism include:
- anemia,
- dilutional hyponatremia,
- ,
- reversible increase in creatinine