Hypothyroidism: Diagnosis And Treatment

Hypothyroidism: Diagnosis And Treatment

Etiopathology, clinical picture, and management of a case of secondary thyrotoxicosis. Write indication, contraindications and complications of methods applied for the treatment.

Answer. Secondary hyperthyroidism is the result of abnormal,excessive thyroid-stimulating hormone (TSH) release and stimulation of the thyroid resulting in excessive T4 release.

Etiopathology Of Secondary Thyrotoxicosis

• Autoimmune: Here the thyroid IgG antibodies stimulate thyroid to produce more hormone.
  This mechanism causes diffse enlargement of thyroid along with the hyperfunction.
  The antibodies which are directed specifially against TSH receptors are known as thyroid receptor antibodies.
  There is presence of circulating antibodies and lymphocytic infiltration of thyroid tissue.
• Genetics: Association of HLA B8 DR3 and DR4 indicates the genetic susceptibility to environmental factors such as viruses and bacteria which may produce antibodies which cross react with TSH receptors and causes thyrotoxicosis

“What Is Hypothyroidism Diagnosis”

Clinical Picture Of Secondary Thyrotoxicosis

• It occurs during 25 to 40 years of age.
• Swelling is present for the long time while symptoms remain for shorter duration.
• Skin over the swelling is not warm.
• Consistency of the swelling is fim to hard and surface is nodular.
• On auscultation bruit is commonly heard.
• Cardiovascular symptoms are predominant, i.e. Tachy-cardia—may be atrial fibrillation, presence of wide pulse pressure, extrasystole and/or heart failure.
• CNS and GIT manifestations are less predominant.
• Internodular tissues of gland are overactive.

Secondary Thyrotoxicosis Management

Secondary Thyrotoxicosis Antithyroid Drugs

Carbimazole and propylthiouracil should be given.
Treatment should be started 48 hours later and should be continued till radioiodine has had its effect till 6 weeks.
Carbimazole should be given in dose of 40 to 60 mg, treatment should be continued for 12 to 18 months.

“Understanding The Causes Of Hypothyroidism”

Indication

• In all patients preoperatively.
• In patients not willing for surgery
• In recurrence after surgery.

“The Role Of Blood Tests In Diagnosing Hypothyroidism”

Contraindication

• In cases with hypersensitivity
• Anemia or leukemia
• Kidney or liver disease.

Complications

• Agranulocytosis
• Arthralgia
• Skin rashes
• Fever.

Radioactive Iodine

I131 should be given 150 microcuries per gram orally.

Indication

• In patients over the age of 40 years.
• Toxicity recurring after previous subtotal thyroidectomy.
• In very nervous patients who have fear of surgery.
• In patients with severe thyrotoxic heart disease.

Contraindications

• In patients under 45 years of age because of high incidence of hypothyroidism.
• During pregnancy and lactation.

“Comprehensive Overview Of Hypothyroidism Symptoms”

Complication

• Hypothyroidism
• Worsening ophthalmopathy
• Risk for cancer and birth defects in long standing cases.

Subtotal thyroidectomy

• If cardiac symptoms are controlled well and risk of anesthesia is acceptable, subtotal thyroidectomy is done.
• Before surgery, it should be remembered that patient should be euthyroid. Antithyroid drugs should be stopped
  two weeks before surgery and is replaced by potassium iodate 170 mg daily orally.
• In the surgery, both lobes with isthmus are removed and a tissue equivalent to the pulp of figer is retained at lower pole of gland on both sides.

Indications

• In recurrent thyrotoxicosis after 12 to 18-month course of
  antithyroid drugs under the age of 40 years.
• In cases with sensitivity reactions to antithyroid compounds.
• In severe thyrotoxicosis not responding to medical treatment.
• In tracheal compression.

“Early Signs Of Hypothyroidism”

Contraindications

In patients showing evidence of marked exophthalmos.

Complications

• Hemorrhage
• Hematoma formation
• Edema of glotts
• Injury to recurrent laryngeal nerve
• Tetany.