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甲状腺功能减退 Hypothyroidism

甲状腺功能减退 Hypothyroidism. 复旦大学医学院内分泌科 李 益 明. Hypothalamic-pituitary-thyroid axis. O verview. Clinical syndrome Slowing down of metabolism Slowing of growth and mental retardation in infants and children Generalized slowing down of organism Deposition of glycosaminoglycans in skin and muscle

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甲状腺功能减退 Hypothyroidism

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  1. 甲状腺功能减退Hypothyroidism 复旦大学医学院内分泌科 李 益 明

  2. Hypothalamic-pituitary-thyroid axis

  3. Overview • Clinical syndrome • Slowing down of metabolism • Slowing of growth and mental retardation in infants and children • Generalized slowing down of organism • Deposition of glycosaminoglycans in skin and muscle • Reversible with therapy

  4. Etiology and Classifcation • Primary(thyroid failure) • Hashimoto’s thyroiditis • Iodide deficiency or excessive • Radioactive iodine therapy for GD • Subtotal thyroidectomy • Subacute thyroiditis • Secondary: pituitary deficit • Tertiary: hypothalamic dysfunction • Peripheral resistance to thyroid hormone

  5. Pathogenesis • Affects each tissue • Accumulation of glycosaminoglycans (hyaluronic acid) • Not to excessive synthesis • But decreased destrution • Increased capillary permeability • Interstitial edema • Skin • Heart muscle • Striated muscle

  6. Clinical Features

  7. Adults • Symptoms • Easy fatigability • Coldness • Weight gain • Constipation • Menstrual irregularities • Signs • Cool, rough, dry skin • Puffy face and hands • Hoarse and husky voice • Slow reflexes • Yellowish color skin

  8. Clinical Features • Cardiovascular signs • Impaired myocardium contraction • Bradycardia • Diminished cardiac output • ECG: low voltage of QRS, P, T waves • Pericardial effusion • Coronary artery disease • Cardiac angina(Replacement therapy aggravate )

  9. Clinical Features • Pulmonary function • Shallow, slow respiration • Respiratory failure • Intestinal peristalsis • Markedly slowed • Constipation • Renal function • Decreased glomerular filtration

  10. Clinical Features • Anemia • Impaired hemoglobin synthesis • Menorrhagia and Absorption of iron • Folate deficiency • Pernicious anemia • Nuromuscular system • Muscle weakness • Slow reflexes • Central nervous system symptoms • Inability to concentrate • Anovulatory cycles and infertility • Depressed

  11. Symptoms of hypothyroidism Symptoms % of cases Weakness 99 Dry skin 97 Coarse skin 97 Lethargy 91 Slow speech 91 Edema of eyelids 90 Sensation of cold 89 Decreaseed sweeting 89 Cold skin 83 Thick tongue 82 Edema of face 79 Coarseness of hair 76 Pallor of skin 67 Memory impairment 66

  12. Symptomsof hypothyroidism Symptoms % of cases Constipation 61 Gain in weight 59 Loss of hair 57 Pallor of lips 57 Dyspnea 55 Peripheral edema 55 Hoarseness or aphonia 52 Anorexia 45 Nervousness 35 Menorrhagia 32 Palpitation 31 Deafness 30 Precordial pain 25

  13. Myxedema coma • Frequently in obese elderly woman • Yellowish skin • Large tongue • Thin hair • Bradycardia • Marked hypothermia • Lethargy progressing to stupor or coma • Hypoventilation • Hypotension • Shock

  14. Cretinism • Etiology • Low iodide intake and endemic goiter • Ectopic thyroid gland • TSH-R Ab[block] from mother • Inherited defects in thyroid hormone • Iodide,antithyroid drugs,radioactive iodine • Symptoms • Respiratory difficulty • Cyanosis • Jaundice • Poor feeding

  15. Hypothroidism in childen • Retarded growth • Mental retardation • Precocious puberty

  16. Face of hypothyroidism

  17. Face of hypothyroidism

  18. Laboratory Findings • FT4: • uTSH: • sensitive to detect 0.01u/mL • Most sensitive • Most convenient • Most specific • FT3: • Variable • May be within the normal range • TPOAb、TgAb： AITD (autoimmune thyroid disease) • TC

  19. Diagnosis Symptoms+Signs FT4 +TSH  or N FT4 +TSH  Secondary hypothyroidism Primary hypothyroidism If ? TRH test Excessive response Normal type response No response Pituitary lesion Primary hypothyroidism Hypothalamic lesion

  20. Treatment

  21. Drugs for hypothyroidism LT4 Desiccated thyroid Component T4 T4+T3 high ratio of T3 to T4 Dose 50g 40mg Intensity 50 g = 30mg Initial dosage 25~50 g 20mg Maintenaning dosage 50~150 g 40~120mg Half-life 7 days 1 days

  22. Institution of replacement therapy • Full adrenal support first if with concomitant adrenal insufficiency • Beginning with low dosage • Degress of hypothyroidism • Age • General health • Increase ½ tablet weekly • Needs 6 weeks before equilibration • Use powdered thyroid gland for myxedema coma • Monitoring FT4 and TSH • TSH will be suppressed in normal range in 3 mo

  23. Side effects • No allergy • Overdosage • Arrhythmia • Paroxyamal atrial tachycardia • fibrillation • Insomnia • Tremor • Restleness • Excessive warmth

  24. Thank you

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