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Hypothyroidism definition uptodate – Hypothyroidism: An Update

Myxedema coma is a rare but extremely severe manifestation of hypothyroidism that most commonly occurs in older women who have a history of primary hypothyroidism.

Matthew Cox
Friday, October 30, 2020
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  • Endocr Pract.

  • In general, children and teens who develop hypothyroidism have the same signs and symptoms as adults do, but they may also experience:.

  • Hashimoto thyroiditis: Clinical and diagnostic criteria. Mental status changes including lethargy, cognitive dysfunction, and even psychosis, and hypothermia are the hallmark features of myxedema coma.

  • Because myxedema coma is a medical emergency with a high mortality rate, even with appropriate treatment, patients should be managed in the intensive care unit where proper ventilatory, electrolyte, and hemodynamic support can be given. Hypothyroidism Last updated: May 17,

Acquired hypothyroidism

Entrapment syndromes e. Increased creatine kinase. Patient is now taking thyroid hormone with food.

Preventive Services Task Force found insufficient evidence for routine screening in this population. Get Permissions. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Lipoprotein and apolipoprotein levels in subclinical hypothyroidism. Eisenhower Army Medical Center, W. Sign Up Now.

Journal of hypothyriodism American Medical Association. Effects of evening vs. It primarily affects middle-aged women but can also occur in men and women of any age and in children. Thyroid gland Your thyroid gland is located at the base of your neck, just below the Adam's apple. LORI B. Increased TSH levels indicate congenital hypothyroidism. Children with congenital hypothyroidism often have umbilical hernias and, without early treatment, develop congenital iodine deficiency syndrome intellectual disabilitystunted growth.

Myxedema requires immediate emergency medical treatment. Babies born to women with untreated hypothyroidism due to Hashimoto's disease may have a higher risk of birth defects than do babies born to healthy mothers. Thyroid hormone treatment. Low-voltage electrocardiography.

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Chaker L, et al. Levothyroxine, in a dosage that maintains serum TSH levels within the normal range, is the iptodate therapy in these patients. In patients with coronary artery disease and minimal elevations of TSH, however, it may be advisable to follow the TSH level rather than subject the patient to the small risk of levothyroxine therapy. Guide to clinical preventive services: report of the U.

  • Patients may or may not have symptoms attributable to hypothyroidism.

  • Algorithms for diagnosis hypothyroidism definition uptodate management of thyroid disorders. Patients on a stable dose of levothyroxine who are then started on a selective serotonin reuptake inhibitor, in particular sertraline Zoloftmay show a rise in their TSH level and require an increase in their thyroid hormone dose.

  • Diagnostics Congenital hypothyroidism Neonatal screening to measure TSH levels 24—48 hours after birth is required by law. However, in hyperthyroidism FT3 and FT4 would be increased.

Already a member or subscriber? As the disease progresses, infants are likely to have trouble feeding and may fail to grow and develop normally. Another common cause of hypothyroidism is the treatment of Graves' disease. Patient is now pregnant or recently started or stopped estrogen-containing oral contraceptive or hormone therapy.

Older patients and patients with known or suspected ischemic heart disease definitiob be started on 25 hypothyroidism definition uptodate 50 mcg of levothyroxine daily, rather than the full replacement dosage, because of the potential risk of tachyarrhythmia or acute coronary syndrome. There is no evidence that screening asymptomatic adults improves outcomes. Measurement of serum TSH is generally considered the best screening test for thyroid disease; increased values usually indicate hypothyroidism, and decreased values usually indicate hyperthyroidism. Am J Med. The increase in thyroid hormone requirement lasts throughout pregnancy.

Clinical Presentation

Last updated: September 20, Adrenal hypothyroidism definition uptodate rare. Reasons for Endocrinology Consultation in Patients with Hypothyroidism Age younger than 18 years Cardiac disease Coexisting endocrine diseases Myxedema coma suspected Pregnancy Presence of goiter, nodule, or other structural thyroid gland abnormality Unresponsive to therapy Information from reference

Treated Graves' disease. The starting dosage of levothyroxine in young, healthy adults for complete replacement is 1. Accessed February 1,with additional information from references 14 and Get Permissions.

Thyroid disease manager. Subclinical thyroid disease: scientific review hypothyroidism definition uptodate guidelines for diagnosis and management. Mayo Clin Proc. To see the full article, log in or purchase access. The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, double-blind trial. Read the Issue. Untreated hypothyroidism can contribute to hypertension, dyslipidemia, infertility, cognitive impairment, and neuromuscular dysfunction.

Clinical Presentation

Share on: Facebook Hypothyroidism definition uptodate. Congenital hypothyroidism Children with congenital hypothyroisism may have general signs and symptoms of hypothyroidism in addition to those typical in neonates see below. It primarily affects middle-aged women but can also occur in men and women of any age and in children. Patient nonadherent to thyroid hormone regimen missing doses. And if you're receiving hormone therapy for hypothyroidism caused by Hashimoto's disease, schedule follow-up visits as often as your doctor recommends.

Your thyroid gland hypothyroidism definition uptodate located at the base of your neck, just below the Adam's apple. American Association of Clinical Endocrinologists. The likelihood that this will happen increases with greater TSH elevations and detectable antithyroid antibodies. Email Alerts Don't miss a single issue.

The hypoglycemic side of hypothyroidism. It's important to make sure you're receiving the correct dose of medicine. American Association of Clinical Endocrinologists. Normal TSH levels very likely rule out primary hypothyroidism and hyperthyroidism and are therefore the decisive parameter in screening for both conditions.

The starting dosage of levothyroxine in young, healthy adults for complete replacement is 1. Weakness, lethargy, fatigue. Levothyroxine therapy for hypothyroidism: should we abandon conservative dosage titration? Currently, no organizations recommend routine universal screening. Radiation therapy to the head, neck or chest area. American Thyroid Association guidelines for detection of thyroid dysfunction [published correction appears in Arch Intern Med. When your thyroid doesn't produce enough hormones, the balance of chemical reactions in your body can be upset.

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Enlarge Print Table 4. Clinical features and detection of congenital hypothyroidism. Increased creatine kinase.

Thyroid hormone receptors regulate many key physiologic processes. TABLE 2 Causes of Hypothyroidism Chronic autoimmune thyroiditis Treated Graves' disease Radioactive iodine therapy Subtotal thyroidectomy Antithyroid drugs Head and neck surgery Radiation therapy to the head, neck or chest area Iodine deficiency Medications: lithium, iodine, amiodarone Cordarone Secondary hypothyroidism hypopituitarism Idiopathic Congenital. Your thyroid is a small, butterfly-shaped gland situated at the base of the front of your neck, just below your Adam's apple. Sometimes this process involves your thyroid gland.

Consequently, hypothyroidism may result in a myriad of clinical deifnition and symptoms. Orphanet J Rare Dis. Hypothyroidism: an update. Endocr Pract. Poor adherence to levothyroxine therapy is the most common cause of persistently elevated TSH levels in patients on adequate doses of thyroid hormone. Melmed S, et al. Hypothyroid and thyroiditis.

Low serum hypothyroidism definition uptodate concentrations as a risk factor for atrial fibrillation in older persons. Under these circumstances, retesting at regular intervals or treatment with low doses of levothyroxine may be warranted. Read the full article. Corticosteroids may also be needed.

Screening and Diagnosis

Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness. Last hypothyroidism definition uptodate November 29, The normal thyroid gland makes two thyroid hormones: T 4 and triiodothyronine T 3. Neonatal screening to measure TSH levels 24—48 hours after birth is required by law.

C 12 Older hypothyroidism definition uptodate and patients with known or suspected ischemic heart hylothyroidism should be started on 25 hyplthyroidism 50 mcg of levothyroxine daily, rather than the full replacement dosage, because of the potential risk of tachyarrhythmia or acute coronary syndrome. Obstructive sleep apnea. Clinical features General signs and symptoms Symptoms related to decreased metabolic rate Fatigu edecreased physical activity Cold intolerance Decreased sweating Hair loss, brittle nailsand cold, dry skin Weight gain despite poor appetite Constipation Bradycardia Hypothyroid myopathy ;myalgiastiffness, cramps Woltman sign : a delayed relaxation of the deep tendon reflexeswhich is commonly seen in patients with hypothyroidism, but can also be associated with advanced age, pregnancyand diabetes mellitus. Indian Journal of Endocrinology and Metabolism. Last updated: November 29, Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients.

  • British Journal of Hospital Medicine. Normal FT3 and FT4 levels.

  • Algorithm for the treatment of primary hypothyroidism.

  • Approximately 80 percent of T 3 is derived from the peripheral conversion of T 4 by deiodinase enzymes.

  • Inthe U. Mental status changes including lethargy, cognitive dysfunction, and even psychosis, and hypothermia are the hallmark features of myxedema coma.

Contact afpserv aafp. Levothyroxine, in a dosage that maintains serum TSH levels within the normal range, is the preferred therapy in these patients. North Chicago, Ill. Subtotal thyroidectomy. This state—an elevated TSH level with a normal free T 4 level—is referred to as subclinical hypothyroidism. Hyperthyroidism, thyroid hormone therapy, and bone.

Furthermore, genetic testing for a type 2 deiodinase polymorphism is hypotyyroidism practical. Log in. Best Value! Normal TSH levels very likely rule out primary hypothyroidism and hyperthyroidism and are therefore the decisive parameter in screening for both conditions. This rare, life-threatening condition can develop due to long-term severe hypothyroidism as a result of untreated Hashimoto's disease.

Am J Med. Enlarge Print Table 5. Gaitonde, MD, Dwight D. Hypothyroidism: Can calcium supplements interfere with treatment?

Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome. Adrenal insufficiency rare. Inthe U. However, because T 3 preparations have short biologic half-lives, hypothyroidism is treated almost exclusively with once-daily synthetic thyroxine preparations. Greenspan's Basic and Clinical Endocrinology. Eisenhower Army Medical Center, W.

Show references AskMayoExpert. Accessed February 1, Hypothyroidism underactive thyroid is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. Over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease. Sign up for the free AFP email table of contents. Read the full article. Log in.

Subclinical Hypothyroidism

Children with congenital hypothyroidism may have general signs and symptoms of hypothyroidisk in addition to those hypothyroidism definition uptodate in neonates see below. Decreased absorption of thyroid hormone. Impaired sensitivity to thyroid hormone. Once absorbed, synthetic thyroxine, like endogenous thyroxine, undergoes deiodination to the more biologically active T 3. Family physicians will most commonly encounter patients with primary hypothyroidism.

The opinions and assertions contained herein are the private views hypothyroidism definition uptodate the authors and are not to be construed as official or as reflecting the views of the U. Increased low-density lipoprotein cholesterol. The initial step is to determine TSH levelswhich may be followed by measurement of FT4 levels to confirm or rule out the suspected diagnosis. Office on Women's Health. Hypothyroidism is defined as failure of the thyroid gland to produce sufficient thyroid hormone to meet the metabolic demands of the body.

Log in. Jacqueline Jonklaas et al. Hypothyroidism may occur as a result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. Thyroid gland Your thyroid gland is located at the base of your neck, just below the Adam's apple. Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.

  • Autoimmune thyroiditis.

  • A double-blind, placebo-controlled trial.

  • Congenital hypothyroidism Children with congenital hypothyroidism may have general signs and symptoms of hypothyroidism in addition to those typical in neonates see below.

  • Although T 4 is produced in greater amounts, T 3 is the biologically active form.

The epidemiology of thyroid disease. Eur J Endocrinol. Most children with congenital hypothyroidism do not have symptoms at the time of birth because the placenta supplies the fetus with maternal thyroid hormone. Best Value!

These problems can hypothygoidism overcome by measuring free T 4 via equilibrium dialysis. Patients who remain symptomatic on appropriate doses of levothyroxine, as determined by a thyroid-stimulating hormone level of less than 2. Presence of antithyroid antibodies. The increase in thyroid hormone requirement lasts throughout pregnancy. Primary gland failure can result from congenital abnormalities, autoimmune destruction Hashimoto diseaseiodine deficiency, and infiltrative diseases. Recommendations about thyroid screening, however, have been inconsistent.

Screening and Diagnosis

Address correspondence to Victor Adlin, M. An algorithm summarizing this approach is presented in Figure 1. L-Thyroxine therapy in subclinical hypothyroidism. Ferri FF.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Get immediate access, anytime, anywhere. This content is owned by the AAFP. Helfand M; U.

Obstructive sleep apnea. American Academy of Family Physicians. Slowly growing and stone-hard. Eur J Endocrinol.

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Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients. Chief among these is chronic autoimmune thyroiditis Hashimoto's diseasewhich is commonly associated with increased titers of antithyroid antibodies, such as antithyroid microsomal antibodies antithyroid peroxidase and antithyroglobulin antibodies. The best laboratory assessment of thyroid function, and the preferred test for diagnosing primary hypothyroidism, is a serum TSH test.

A person viewing it online may make hypothyroidis printout of the material and may use that printout only for his or her personal, non-commercial reference. These problems can be overcome by measuring free T 4 via equilibrium dialysis. The pathophysiology in hypothyroidism is characterized mainly by a reduction of the basal metabolic rate and generalized myxedema. If congenital, it is usually the result of thyroid dysplasia or aplasia. Br Med Bull.

Irreversible intellectual disabilities can be avoided through early initiation of adequate therapy! Patients with severe hypothyroidism may present with pericardial effusion, pleural effusion, megacolon, hemodynamic instability, and coma. If you're planning to get pregnant or if you're in early pregnancy, be sure to have your thyroid level checked. Myxedema coma is an extremely rare condition caused by the decompensation of an existing thyroid hormone deficiency and can be triggered by infections, surgery, and trauma.

These children are also more prone to serious intellectual and developmental problems. In several studies, a sensitive measure of myocardial contractility, the ratio of pre-ejection period to left hypothyridism ejection time PEP:LVET was shown to improve significantly hypothyroidism definition uptodate patients with subclinical hypothyroidism who were treated with levothyroxine, compared with patients who were treated with placebo. Common Reasons for Abnormal TSH Levels on a Previously Stable Dosage of Thyroid Hormone Hypothuroidism nonadherent to thyroid hyptohyroidism regimen missing doses Decreased absorption of thyroid hormone Patient is now taking thyroid hormone with food Patient takes thyroid hormone within four hours of calcium, iron, soy products, or aluminum-containing antacids Patient is prescribed medication that decreases absorption of thyroid hormone, such as cholestyramine Questrancolestipol Colestidorlistat Xenicalor sucralfate Carafate Patient is now pregnant or recently started or stopped estrogen-containing oral contraceptive or hormone therapy Generic substitution for brand name or vice versa, or substitution of one generic formulation for another 25 Patient started on sertraline Zoloftanother selective serotonin reuptake inhibitor, or a tricyclic antidepressant 31 Patient started on carbamazepine Tegretol or phenytoin Dilantin note : Reasons are sorted by the clinically most important cause. Arem R, Patsch W. On repeat testing, TSH levels may spontaneously normalize in many patients. Rochester, Minn. In another study 11 of 69 female patients with subclinical hypothyroidism, a clinical index based on symptoms and physical signs was shown to be more abnormal in patients with higher TSH levels, even though all patients had normal serum levels of T 4 and free T 4.

When your thyroid doesn't produce enough hormones, the balance of chemical reactions in your body can hypothyroidism definition uptodate upset. C 12 Definitkon patients and patients with known or suspected ischemic heart disease should be started on 25 to 50 mcg of levothyroxine daily, rather than the full replacement dosage, because of the potential risk of tachyarrhythmia or acute coronary syndrome. Mayo Clinic does not endorse companies or products. Show more related content. Hypothyroidism is quite common in older persons.

  • Indian Journal of Endocrinology and Metabolism. Secondary hypothyroidism is present in only 5 percent of cases.

  • Natural history of autoimmune thyroiditis.

  • In: Post TW, ed.

  • Diurnal variations exist in TSH secretion such that the lowest level will generally be obtained with a morning laboratory draw.

  • Iron deficiency.

Low-voltage electrocardiography. Recommendations about thyroid screening, however, have been inconsistent. Thyroid hormone requirements increase during pregnancy. In: Ferri's Clinical Advisor

Medications: lithium, iodine, amiodarone Cordarone. Treatment with synthetic thyroid hormone is usually simple, safe and effective once you and your hhpothyroidism find the right dose for you. This test has proved to be both sensitive and specific. Hypothyroidism may be due to a number of factors, including:. Epidemiology of subtypes of hypothyroidism in Denmark. Management of hypothyroidism secondary to tyrosine kinase inhibitors: description of treatment in three distinct clinical settings [in Spanish]. Babies born to women with untreated thyroid disease may have a higher risk of birth defects compared to babies born to healthy mothers.

Table 5. Treatment of Primary Hypothyroidism Figure 2. Congenital hypothyroidism Children with congenital hypothyroidism may have general signs and symptoms of hypothyroidism in addition to those typical in neonates see below.

  • Iron deficiency. Diagnostics Congenital hypothyroidism Neonatal screening to measure TSH levels 24—48 hours after birth is required by law.

  • Personal history of thyroid disease.

  • Enlarge Print Table 6.

  • Or you may simply attribute them to getting older. Radiation treatment to head, neck or chest.

Algorithm for the treatment of primary hypothyroidism. Effects of evening vs. Patient is now pregnant or recently started or stopped estrogen-containing oral contraceptive or hormone therapy. Symptoms commonly associated with hypothyroidism are often nonspecific Table 1.

  • Search dates: June 6,through February 3,

  • The likelihood that this will happen increases with greater TSH elevations and detectable antithyroid antibodies.

  • Congenital hypothyroidism Children with congenital hypothyroidism may have general signs and symptoms of hypothyroidism in addition to those typical in neonates see below.

  • American Academy of Family Physicians.

  • Information from references 19 through 21and

Endocrinol Nutr. Thyroid hormone requirements increase during pregnancy. Hypothyroidism definition uptodate one study, 10 symptoms in 33 patients with subclinical hypothyroidism were compared with symptoms in 20 euthyroid patients in the same thyroid clinic. Eur J Endocrinol. Levothyroxine therapy for hypothyroidism: should we abandon conservative dosage titration? Hypothyroidism: Can calcium supplements interfere with treatment?

Share uptodatf Facebook Twitter. Infants and children may present more often with lethargy and failure to thrive. Six populations deserve special consideration: 1 older patients; 2 patients with known or suspected ischemic heart disease; 3 pregnant women; 4 patients with persistent symptoms of hypothyroidism despite taking adequate doses of levothyroxine; 5 patients with subclinical hypothyroidism; and 6 patients suspected of having myxedema coma. Clinical symptoms of hypothyroidism are nonspecific and may be subtle, especially in older persons.

Subclinical hypothyroidism. International Journal of Endocrinology. In one prospective study, 85 percent of pregnant patients required a median increase of 47 percent in their thyroid hormone requirements.

American Family Physician. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U. Shiri R. Search dates: June 6,through February 3,

Nat Clin Pract Endocrinol Metab. American Association of Clinical Endocrinologists. LORI B. Thyrotropin secretion profiles are not different in men and women. Treatment of hypothyroidism. Show references Hashimoto's thyroiditis. Search dates: June 6,through February 3,

Helfand M; U. Examination findings associated with hypothyroidism include but are not limited to goiter, delayed relaxation phase of deep tendon reflexes, thin or brittle hair, dry skin, and peripheral edema Table 2. In: Post TW, ed. Irreversible intellectual disabilities can be avoided through early initiation of adequate therapy! Anemia in thyroid diseases.

Patients with severe hypothyroidism may present with pericardial effusion, hypothyroidism definition uptodate effusion, megacolon, hemodynamic instability, and coma. A myxedema coma may be triggered by exposure to cold, sedatives, infection or other stress on your body. Ultrasound of the thyroid. Clinical symptoms of hypothyroidism are nonspecific and may be subtle, especially in older persons. Hypothyroidism adversely affects the development of the fetal nervous system. Obstructive sleep apnea. Accessed Oct.

This content does not have an English version. Slowing of return phase of reflexes e. Medications: lithium, iodine, amiodarone Cordarone. Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients. Diastolic hypertension.

Most patients with hypothyroidism will require lifelong thyroid hormone therapy Figure 2 1319 — The most common cause of hypothyroidism is an autoimmune disorder known as Hashimoto's thyroiditis. However, because T 3 preparations have short biologic half-lives, hypothyroidism is treated almost exclusively with once-daily synthetic thyroxine preparations.

Gaitonde, MD, Dwight D. Army at large. Accessed February 1, Hypothyroidism may occur as a result of primary gland failure or insufficient thyroid gland stimulation by the uptodatr or pituitary gland. And over time, the dose you need may change. The high prevalence of thyroid failure and the difficulty of making an early clinical diagnosis in older persons suggest that screening for hypothyroidism might be useful in this group, especially since a simple test, the serum TSH level, is available. Your thyroid gland is located at the base of your neck, just below the Adam's apple.

Decreased absorption of thyroid hormone. In the majority of patients, alleviation of symptoms can be accomplished through oral administration of synthetic levothyroxine, and most patients will require lifelong therapy. There may be a link between hypothyroid pregnancies and birth defects, such as a cleft palate. Synthroid levothyroxine sodium tablets, USP [package insert]. Patient nonadherent to thyroid hormone regimen missing doses.

Mechanisms related to the pathophysiology and management of central hypothyroidism. Shiri R. Thyroid disease manager. Eisenhower Army Medical Center.

American Association of Clinical Endocrinologists. Hypothyroidism: Should I take iodine supplements? This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Elevated serum thyrotropin in thyroxine-treated patients with hypothyroidism given sertraline. Gaitonde, MD, Dwight D. Six populations deserve special consideration: 1 older patients; 2 patients with known or suspected ischemic heart disease; 3 pregnant women; 4 patients with persistent symptoms of hypothyroidism despite taking adequate doses of levothyroxine; 5 patients with subclinical hypothyroidism; and 6 patients suspected of having myxedema coma. Hospital Rd.

Elevated C-reactive protein. Delayed relaxation phase of deep tendon reflexes. Next: Conference Highlights. Antithyroid drugs. Singer PA. Crit Care.

When newborns do have problems with hypothyroidism, the problems may include:. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in hypothyroidism definition uptodate medium, whether now known or later invented, except as authorized in writing by the AAFP. An approach for development of age- gender- and ethnicity-specific thyrotropin reference limits. But if this condition is diagnosed within the first few months of life, the chances of normal development are excellent. In the absence of definitive guidelines, some clinicians may elect to perform routine screening with serum TSH measurement or to measure TSH in patients with persistent non-specific complaints, especially women, the elderly and persons with risk factors for thyroid failure Table 1.

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