Hypothyroidism / Underactive thyroid gland presentation

All the information you need to know about Hypothyroidism - Introduction,
Etiology, clinical manifestations, complications, pathophysiology,
diagnosis, treatment, precautions.

1. HYPOTHYROIDISM
Presentation by –V. R. Riya Sri
Pharm D
GeethanjaliCollege of Pharmacy

2. INTRODUCTION
•Hypothyroidism refers to the common pathological
condition of thyroid hormone deficiency. If left untreated, it
can lead to severe adverse health effects and ultimately
death.
•Hypothyroidism is defined as when the concentration
thyroid-stimulating hormone (TSH) is above the reference
range and free thyroxineconcentrations below the
reference range.

3. •The thyroid gland is a small, butterfly-shaped
glandsituated at the front of the throat, below the larynx
(Adam's apple), and comprises two lobes that lie on either
side of the windpipe
•Thyroid gland secretes two hormones thyroxine(T4)
andtriiodothyronine(T3)

4. •It’s a part of yourendocrine system.
•Thyroxine(T4): This is the primary hormone thyroid
gland secretes and releases. Thyroid gland secretes most
of this hormone, although it doesn’t have much of an
effect on your metabolism. Once thyroid releases T4 into
your bloodstream, it can convert to T3 through a process
called deiodination.
•Triiodothyronine(T3): Thyroid gland produces lesser
amounts of T3 than T4, but it has a much greater effect on
our metabolism than T4.
•Reverse triiodothyronine(RT3): Thyroid makes very
small amounts of RT3, which reverses the effects of T3

5. TYPES OF HYPOTHYROIDISM
•Primary Hypothyroidism: The most common form,
where the thyroid gland itself is dysfunctional.
•Secondary Hypothyroidism: Due to inadequate
stimulation of the thyroid gland by the pituitary hormone
TSH, usually because of pituitary or hypothalamic
disease.
•Tertiary Hypothyroidism: Caused by insufficient
secretion of thyrotropin-releasing hormone (TRH) from the
hypothalamus.
•Congenital Hypothyroidism: Present at birth, often due
to developmental anomalies of the thyroid gland.
•Subclinical Hypothyroidism: Elevated TSH levels with
normal T4 levels and minimal or no symptoms.

6. ETIOLOGY
•Family history of thyroid
disease.
•Female gender, especially.
postmenopausal women.
•Older age.
•Presence of other
autoimmune diseases

7. CLINICAL MANIFESTATIONS

8. COMPLICATIONS
•Cardiovascular Issues: Hypothyroidism can contribute to
elevated levels of cholesterol and triglycerides, increasing
the risk of heart disease and possibly leading to heart
failure.
•Mental Health Challenges: Depression, cognitive
impairment, and memory problems can occur due to low
thyroid hormone levels affecting brain function.
•Reproductive Problems: Hypothyroidism can lower
libido and cause erectile dysfunction, affecting sexual
health and fertility.
•Muscle Weakness and Joint Pain: Individuals with
hypothyroidism may experience muscle weakness,
stiffness, and pain in the joints, which can impair mobility
and quality of life.

9. •Weight Gain: Slowed metabolism due to hypothyroidism can
lead to weight gain, even with reduced calorie intake
•Peripheral Neuropathy: Nerve damage causing tingling,
numbness, and pain in the hands and feet can occur in severe
cases.
•Impaired Immune Function: Hypothyroidism can weaken the
immune system, making individuals more susceptible to
infections.
•Delayed Growth in Children: If hypothyroidism develops in
childhood or adolescence, it can lead to delayed growth and
development.
•Goiter: In some cases, the thyroid gland may enlarge (goiter)
as it tries to compensate for the lack of hormone production.
In pregnancy -
•Maternal complicationsinclude gestational hypertension,
gestational diabetes, abrupt placenta and postpartum
hemorrhage.
•Foetal complicationsinclude abortions, premature birth,
stillbirths and low birth weight

10. PATHOPHYSIOLOGY
Genetic/Environmental Factors
↓
Thyroid Gland Dysfunction
↓
Reduced Thyroid Hormone Levels (T3, T4)
↓
Increased TSH Secretion (Pituitary Response)
↓
Compensatory Increase in Thyroid Hormone Production
↓
Near-Normal T3, T4 Levels with Elevated TSH
↓
Subclinical Hypothyroidism State
↓
Potential Progression to Overt Hypothyroidism

11. •Clinical Evaluation: Assessment of symptoms such as
fatigue, weight gain, hair loss, cold intolerance,
constipation, dry skin, and depression.

12. •Laboratory Tests:
➢Serum TSH: Elevated in primary hypothyroidism; low or normal in
secondary/tertiary hypothyroidism.
➢Free T4: Low in overt hypothyroidism; normal in subclinical
hypothyroidism.
➢Thyroid Antibodies: Presence of anti-thyroid peroxidase (TPO)
antibodies can indicate autoimmune thyroiditis.
➢Imaging: Thyroid ultrasound or radionuclide scanning if structural
abnormalities are suspected.
➢Other Tests: Lipid profile, complete
blood count (CBC), and other
relevant investigations to assess
the impact on other systems

13. TREATMENT
Levothyroxine (T4) Replacement Therapy: The standard
treatment for hypothyroidism. The dosage is individualized
based on the patient’s weight, age, severity of
hypothyroidism, and comorbid conditions.
▪Starting Dose: Typically 1.6 µg/kg body weight per day for healthy
adults.
▪Monitoring: Regular TSH and T4 levels to adjust the dose and
ensure therapeutic efficacy.

14. •Liothyronine(T3) Therapy: Occasionally used in
combination with levothyroxine or in specific cases where
T4 alone is insufficient.
•Management of Underlying Causes: Treating underlying
conditions such as iodine deficiency or adjusting
medications contributing to hypothyroidism.
•Lifestyle and Dietary Modifications: Ensuring adequate
iodine intake through diet or supplements, and
maintaining a healthy lifestyle to manage symptoms

15. PRECAUTIONS
•Encourage a balanced diet rich in fruits, vegetables, and
whole grains.
•Regular physical activity for weight management and
overall well-being.
•Excessive iodine intake can worsen thyroid function in
some cases.
•Take medications 30 to 60 minutes before the first meal
of the day. Take it at the same time every day to maintain
stable hormone levels.
•Avoid taking nicotine, caffeine, alcohol, carbonated drinks
and processed foods.
•Do not consume excessive diary products atleastfor 3-4
months until the disease is cured

16. •Consume more vitamin B12, vitamin C, and vitamin E in
diet as the have antioxidant properties that are beneficial
in deactivating the harmful effects of free radicals causing
hypothyroidism.
•Avoid Interactions: Certain foods, supplements (like
calcium and iron), and medications can interfere with
absorption. Maintain a gap of at least 4 hours
•Regular Check-Ups: Attend all scheduled appointments to
monitor the condition and adjust treatment as necessary.
•Hypothyroidism can affect bone density. Ensure adequate
calcium and vitamin D intake and engage in weight-
bearing exercises

17. REFERENCE
•www.niddk.nih.gov
•Cleveland clinic
•Mayo clinic
•Web MD