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Hypothyroidism Information

Hypothyroidism is the disease state caused by insufficient production of thyrohormone by the thyroid gland. There are several distinct causes for chronic hypothyroidism, the most common being Hashimoto's thyroiditis and hypothyroidism following radioiodine therapy for hyperthyroidism.

The severity of hypothyroidism varies widely. Patients are classified as "subclinical hypothyroid" if diagnostic findings show thyroid hormone abnormalities, but they do not exhibit any symptoms. Others have moderate symptoms that can be mistaken for other diseases and states. Advanced hypothyroidism may cause severe complications, the most serious one of which is myxedema.

Myxedema coma is a medical emergency. The major imbalances are hypoglycemia, hyponatremia, hypothermia and acute renal failure. The initial management includes warming the patient, monitoring the vitals. Parenteral steroids is the initial drug (injection hydrocortisone 100 mg - 200 mg) given. Levothyroxine 600 micrograms is given through nasogastric tube or parenteral route.

Clinically apparent hypothyroidism usually warrants treatment. In case the hypothyroidism is due to dietary minerals and iodine, supplementation with these may obviate the need for hormonal treatment, but only if iodine deficiency has been documented, which is very rare in the Western world. Whilst subclinical hypothyroidism is thought to have long-term consequences, such as atherosclerosis and coronary heart disease risks, there is no current consensus as to the benefits of treatment in this group.

Treatment is usually with levothyroxine (starting at 50 μg/day), a synthetic thyroxine analogue. There is no evidence suggesting that there is any need to substitute T3 as well.

Symptoms as well as TSH levels are used to monitor effect of substitution; a high TSH level suggests treatment is not yet adequate and that dose adjustments are necessary. A low ("suppressed") TSH may indicate the dose is too high. Some patients prefer a pig thyroid extract, natural desiccated thyroid hormones, which contains T3 as well as T4 and traces of T2, T1 and calcitonin.

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