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Hypothyroidism Disease
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Hypothyroidism Disease

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Questions and Answers

What is the primary significance of hypothyroidism?

  • The risk of death from the condition
  • The association with thyroid cancer
  • The many troublesome clinical manifestations that result from low thyroid hormone levels (correct)
  • The development of myxedema coma

    • What is the primary manifestation of fluid retention in hypothyroidism?

  • Dry skin and hair
  • Low hematocrit
  • Puffiness of the face and eyelids (correct)
  • High serum sodium concentration

    • Which of the following is a reversible cause of hypothyroidism?

  • Congenital iodide deficiency
  • Bacterial thyroiditis (correct)
  • Surgery-related loss of viable thyroid gland tissue
  • Hashimoto thyroiditis

    • Which of the following is a characteristic of the hair in patients with hypothyroidism?

    <p>Dry, coarse, and sparse</p> Signup and view all the answers

    What is the primary mechanism by which lithium impairs thyroid hormone synthesis?

    <p>Unknown mechanism</p> Signup and view all the answers

    What is the primary effect of thyroid hormones on the cardiovascular system?

    <p>Maintenance of cardiac contractility</p> Signup and view all the answers

    What is the expected result of serum TSH level in primary hypothyroidism?

    <p>High serum TSH level</p> Signup and view all the answers

    What is the expected result of serum sodium concentration in hypothyroidism?

    <p>Low serum sodium concentration</p> Signup and view all the answers

    Which of the following is a common symptom of hypothyroidism?

    <p>Constipation</p> Signup and view all the answers

    What is the primary cause of myxedema in hypothyroidism?

    <p>Accumulation of hydrophilic mucopolysaccharides between cells</p> Signup and view all the answers

    What is the expected result of serum prolactin concentration in primary hypothyroid disease?

    <p>High serum prolactin concentration</p> Signup and view all the answers

    What is the expected laboratory result in primary hypothalamic failure?

    <p>Decreased TRH, decreased TSH, decreased T3 and decreased T4</p> Signup and view all the answers

    Which of the following is a secondary cause of hypothyroidism?

    <p>Deficient pituitary thyroid-stimulating hormone (TSH) secretion</p> Signup and view all the answers

    What is the primary role of thyroid hormones in the central nervous system?

    <p>Development of the CNS</p> Signup and view all the answers

    What is the expected result of titers of antibodies against thyroid gland proteins in Hashimoto thyroiditis?

    <p>High titers of antibodies against thyroid gland proteins</p> Signup and view all the answers

    Who should be screened for thyroid disease according to the American College of Physicians?

    <p>All women older than 50 years</p> Signup and view all the answers

    What is the primary characteristic of hypothyroidism disease?

    <p>A deficiency of circulating triiodothyronine (T3) and thyroxine (T4)</p> Signup and view all the answers

    Which of the following is the most common cause of hypothyroidism?

    <p>Thyroid gland failure</p> Signup and view all the answers

    What is the trend in the prevalence of hypothyroidism with age?

    <p>It increases with age</p> Signup and view all the answers

    What is the approximate prevalence of hypothyroidism in babies born in the United States?

    <p>1 in 3,000-5,000</p> Signup and view all the answers

    Which of the following is a characteristic of hypothyroidism in terms of gender?

    <p>It is more common in females than in males</p> Signup and view all the answers

    What is the prevalence of hypothyroidism in women older than 60 years?

    <p>5.9%</p> Signup and view all the answers

    What is the primary effect of thyroid hormone deficiency on the body?

    <p>It affects virtually all bodily functions</p> Signup and view all the answers

    What is the relative frequency of primary hypothyroidism compared to secondary hypothyroidism?

    <p>Primary hypothyroidism is more common than secondary hypothyroidism</p> Signup and view all the answers

    What would laboratory studies likely show in a case of hypothyroidism?

    <p>Low T4, high TSH, and decreased T3 resin uptake</p> Signup and view all the answers

    What is the primary goal of therapy for hypothyroidism?

    <p>To return patients to a normal thyroid (euthyroid) state</p> Signup and view all the answers

    What is the treatment of choice for hypothyroid disease?

    <p>Levothyroxine</p> Signup and view all the answers

    What is the significance of the first 2 years of life in hypothyroid infants?

    <p>Most brain growth occurs during this period, leading to increased risk of mental retardation if left untreated</p> Signup and view all the answers

    What is the mortality rate for myxedema coma?

    <p>60%</p> Signup and view all the answers

    What is the effect of inadequate treatment of hypothyroidism?

    <p>Disease progression with gradual worsening of symptoms</p> Signup and view all the answers

    How long does it take to see significant increases in serum thyroxine levels after starting levothyroxine therapy?

    <p>2 weeks</p> Signup and view all the answers

    What is the best time to take levothyroxine?

    <p>In the morning with water</p> Signup and view all the answers

    What is a common consequence of rapid replacement therapy with levothyroxine?

    <p>Anxiety and insomnia</p> Signup and view all the answers

    What is the recommended frequency for increasing levothyroxine doses?

    <p>Every 1-3 weeks</p> Signup and view all the answers

    What is a potential consequence of chronic maintenance therapy with large doses of levothyroxine?

    <p>Bone demineralization</p> Signup and view all the answers

    What is the general outcome of patients who receive levothyroxine therapy?

    <p>Very satisfactory response to therapy</p> Signup and view all the answers

    What is a common effect of myxedema coma on patients?

    <p>High mortality rate</p> Signup and view all the answers

    What is the recommended daily dose of levothyroxine for most patients?

    <p>100-250 µg</p> Signup and view all the answers

    What can cause poor absorption of levothyroxine?

    <p>All of the above</p> Signup and view all the answers

    What can interfere with the absorption of levothyroxine?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Hypothyroidism

    • Hypothyroidism is a multi-symptom complex characterized by a deficiency of circulating triiodothyronine (T3) and thyroxine (T4)
    • Thyroid hormone deficiency affects virtually all bodily functions, with severity related to the degree of hormone deficiency

    Prevalence

    • Hypothyroidism is more common in females than in males, with a prevalence 2 to 8 times higher in females
    • Frequency of hypothyroidism increases with age, most prevalent in elderly populations
    • In adults older than 60 years, hypothyroidism was reported in 5.9% of women and 2.4% of men
    • Approximately 1 in 3,000-5,000 babies in the United States is born with hypothyroid disease

    Clinical Manifestations

    • Weakness, fatigue, intolerance to cold, constipation, weight gain, dry, flaky skin
    • Weakness, joint pain, muscle pain, muscle cramps, headaches, menstrual abnormalities, thin and brittle nails, thinning of hair and eyebrows, slow speech and thought, pallor, low body temperature, hoarseness, decreased sense of hearing, taste, and smell, difficulty breathing, increased weight, enlarged thyroid gland, slow heart rate, lactation not associated with pregnancy

    Causes and Risk Factors

    • Primary hypothyroidism: Hashimoto thyroiditis, loss of viable thyroid gland tissue, external beam radiation, 131I therapy, bacterial or viral thyroiditis, congenital or acquired iodide deficiency, genetic thyroid enzyme defects, medications that impair thyroid hormone synthesis, foods that interfere with thyroid hormone synthesis
    • Secondary hypothyroidism: deficient pituitary thyroid-stimulating hormone (TSH) secretion, deficient hypothalamic thyroid-releasing hormone (TRH) secretion, peripheral resistance to thyroid hormones

    Pathophysiology

    • Thyroid hormone affects many body tissues, regulating metabolic rate, body heat production, growth hormone secretion, skeletal growth, CNS development, β-adrenergic receptors, and Ca2-ATPase synthesis
    • Maintenance of normal respiratory rate, muscle tone, and vigor

    Diagnosis

    • Based on patient history, physical examination, and laboratory thyroid function test results
    • Laboratory tests may show: low or low-normal serum-free thyroxine concentration, low serum total thyroxine, high serum TSH level, low serum sodium concentration, high serum prolactin concentration, low hematocrit

    Serious Complications and Prognosis

    • Inadequate treatment leads to disease progression, worsening symptoms, and metabolic derangements
    • Progressive hypothyroid disease may result in life-threatening myxedema coma, characterized by marked hypothermia, hypoventilation, and hypotension
    • Mortality rate for myxedema coma is as high as 60%

    Treatment

    • Primary goal of therapy is to return patients to a normal thyroid (euthyroid) state
    • Levothyroxine is the treatment of choice for hypothyroid disease, partially converted in the body to T3
    • Doses can be increased by 25 µg every 1-3 weeks until the patient's thyroid status is normal
    • Striking transformations in the patient's appearance, exercise tolerance, and mental state often occur within several days after initiating therapy

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    Description

    Hypothyroidism is a disease characterized by a deficiency of circulating thyroid hormones, affecting bodily functions and causing various symptoms. The severity of manifestations depends on the degree of hormone deficiency.

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