Hypothyroidism

Medicine > Endocrine & metabolic

Background knowledge 🧠

Definition

Hypothyroidism is a condition characterised by insufficient thyroid hormone production.
Leads to a generalised slowing down of metabolic processes.

Epidemiology

Prevalence in the UK: around 2% of the adult population.
Common in older adults and women.
Increases with age.
More common in those with a family history of thyroid disease.

Aetiology

Autoimmune (Hashimoto’s thyroiditis).
Atrophic thyroiditis
Iodine deficiency.
Post-thyroidectomy or radioiodine therapy.
Medications (e.g., lithium, amiodarone).
Secondary hypothyroidism due to pituitary or hypothalamic disorders.

Types

Primary hypothyroidism: dysfunction at the thyroid gland level.
- Thyroid hormone deficiency.
Secondary hypothyroidism: pituitary gland dysfunction.
- TSH deficiency.
Tertiary hypothyroidism: hypothalamic dysfunction.
- TRH deficiency.

Clinical Features 🌡️

Symptoms

Fatigue.
Weight gain.
Cold intolerance.
Constipation.
Depression.
Menstrual irregularities.

Signs

Bradycardia.
Dry, coarse skin.
Hair loss.
Periorbital puffiness.
Delayed reflexes.
Goitre (in some cases).

Investigations 🧪

Tests

Serum TSH: elevated in primary hypothyroidism, low or normal in secondary.
Free T4: low.
Thyroid antibodies: anti-TPO and anti-thyroglobulin antibodies in autoimmune thyroiditis.
Full blood count and lipid profile.

Management 🥼

Management

Levothyroxine replacement therapy: dose adjusted based on TSH levels.
Regular monitoring of TSH and symptoms.
Patient education on adherence and symptoms of over- or under-treatment.
Follow-up in primary care.

Complications

Cardiovascular disease.
Myxoedema coma (severe hypothyroidism).
Hypercholesterolemia.
Depression.
Infertility.

Prognosis

Generally good with appropriate treatment.
Lifelong condition requiring regular follow-up.
Potential for normal life expectancy.
Need for dose adjustments over time.

Key Points

Common condition, especially in women and the elderly.
Symptoms can be non-specific and develop slowly.
Treatment is effective but requires lifelong adherence.
Regular monitoring is essential to ensure optimal management.

References

British Thyroid Foundation.
NICE Guidelines (https://www.nice.org.uk/guidance/ng145).

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