Hypothyroidism: Symptoms, Diagnosis, Treatment, and Complications Explained

Hypothyroidism: Symptoms, Diagnosis, Treatment, and Complications Explained

Question. Write a short note on hypothyroidism.
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Write in brief on hypothyroidism. 
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Write signs and symptoms of hypothyroidism.
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Write all clinical features of hypothyroidism.
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Write clinical features, diagnosis, and management of hypothyroidism.
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Discuss clinical features, complications, investigations, and treatment of hypothyroidism.

Answer. Hypothyroidism is defined as a clinical condition caused by a low level of circulating thyroid hormones.

Types Of Hypothyroidism

• Primary: When the cause lies in the thyroid
• Secondary: When hypothyroidism occurs due to disease of the anterior pituitary.

Symptoms Of Hypothyroidism

• Feeling of tiredness
• Weight gain
• Cold intolerance
• Hoarseness of voice and lethargy
• Somnolence
• Goiter
• Hyperlipidemia.

Hypothyroidism Symptoms, Diagnosis, Treatment, and Complications

Signs Of Hypothyroidism

• Skin and subcutaneous tissues: Dry skin, puffiness of face with malar flush, baggy eyelids, alopecia, vitiligo
• Cardiovascular: Bradycardia, angina, heart failure
• Respiratory: Pericardial effusion, pleural effusion
• Psychiatric: Depression and psychosis
• Neuromuscular: Ache and pain, cerebellar ataxia, myalgia, delayed relaxation of reflexes, carpal tunnel syndrome
• Gastrointestinal: Constipation, ascites, ileus
• Hematological: Iron defiiency anemia, macrocytic anemia, pernicious anemia, normochromic normocytic anemia
• Reproductive: Infertility, impotence, menorrhagia
• Development: Growth retardation, mental retardation, and delayed puberty.

Investigations Of Hypothyroidism

• Serum T3 and T4 levels are low.
• Serum TSH level is high in primary hypothyroidism and low in secondary hypothyroidism.
• Serum cholesterol levels are high.
• ECG shows bradycardia, low amplitude of QRS, and ST­T changes.
• The blood picture shows macrocytic anemia.
• X­ray chest can be normal or show cardiomegaly

Treatment Of Hypothyroidism

• Treatment of hypothyroidism is lifelong.
• Thyroid hormones are replaced by L­thyroxine
• The initial starting dosage is 50–100 µg daily empty stomach a single dose in the morning for the first 3 to 4 weeks.
  Later dose is increased to 150 µg daily.
• Final dose adjustment is done by TSH levels. TSH levels are maintained in the normal range by increasing the dosage.
• The maximum dose of L-thyroxine is 300 µg.

Complications Of Hypothyroidism:

Symptoms of Hypothyroidism and Diagnosis

Untreated hypothyroidism can lead to a number of health problems:

• Goiter: Constant stimulation of the thyroid to release more hormones may cause the gland to become larger — a condition known as goiter.
• Hashimoto’s thyroiditis is one of the most common causes of goiter.
• Although generally not uncomfortable, a large goiter can affect appearance and may interfere with swallowing or breathing.
• Heart problems: Hypothyroidism may also be associated with an increased risk of heart disease, primarily because high levels of low­density lipoprotein (LDL) cholesterol the “bad” cholesterol — can occur in people with an underactive thyroid.
• Even subclinical hypothyroidism, a mild or early form of hypothyroidism in which symptoms have not yet developed, can cause an increase in total cholesterol levels and impair the pumping ability of the heart.
• Hypothyroidism can also lead to an enlarged heart and heart failure.
• Mental health issues: Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning.
• Peripheral neuropathy: Long­term uncontrolled hypothyroidism can cause damage to peripheral nerves the nerves that carry information from the brain and spinal cord to the rest of the body.
  Signs and symptoms of peripheral neuropathy may include pain, numbness and tingling in the area affcted by the nerve damage.
  It may also cause muscle weakness or loss of muscle control.
• Myxedema: This rare, life­threatening condition is the result of long­term, undiagnosed hypothyroidism.
• Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness.
• A myxedema coma may be triggered by sedatives, infection, or other stress on your body.
• If an individual shows signs or symptoms of myxedema, he/she needs immediate emergency medical treatment.
• Infertility: Low levels of thyroid hormone can interfere with ovulation, which impairs fertility.
• In addition, some of the causes of hypothyroidism — such as autoimmune disorders — can also impair fertility.
• Birth defects: Babies born to women with untreated thyroid disease may have a higher risk of birth defects than babies born to healthy mothers.
• These children are also more prone to severe intellectual and developmental problems.
• Infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development.
• But if this condition is diagnosed within the first few months of life, the chances of normal development are excellent.