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Tatyana Beaubrun

February 4, 2017
Hypothyroidism
Dr. Mizuno

As a result of the lack of specificity of clinical symptoms seen in Hypothyroidism, the


diagnosis is made primarily on laboratory tests. Hypothyroidism is catergorized as either Primary or
Secondary. Primary Hypothyroidism is defined as high serum TSH and low serum free T4
concentration. However, subclincal hypothyroidism is characterized by low to normal serum free T4 in
the presence of high serum TSH. Nonetheless, Central or Secondary Hypothyroidism is characterized
as low concertrations of both serum TSH and free T4; not appropriately elevated. In terms of
epidemiology, the prevalence of hypothyroidism ranges from 0.1 2 percent, on the other hand,
sublinical hypothyroidism has a prevalence 4-10 perent of adults, with possibly a higher frequency in
older women. Hypothyroidism is 8-10 times more common in women than in men. According to
study done by the NHANES II, there are significant number of people in the United States have
laboratory results suggesting thyroid disease, portraying that routine laboratory screen could in fact be
useful.

The clinical features of Hypothyroidism vary greatly and depend upon both the severity
and the duration of the deficiency. However, common signs and symptoms of the diease include,
fatigue, cold intolerance, weight gain, constipation, dry skin, malagia, and menstrual irregularities.
Physical exam findings may include, goiter, bradycardia, hypertension, and delayed relaxation phase of
deep tendon reflexes. Also, a myriad of metabolic abnormalities may also be present, including,
hypercholesteremia, macrocytic anemia, elevated creatinine kinase, and hyponatremia.

Primary Hypothyroidism accounts for over 95% of Hypothyroid cases. In most cases, in
those with signs and symptoms of Hypothyroidism, a serum TSH should be measured. If low, a repeat
serum TSH should be done along a serum free T4. If TSH remains high, and free T4 is low, then a
diagnosis of primary hypothyroidism can be made, and therefore T4 should be replaced. If TSH
remains high, but free T4 is within normal range, this indicates a subclincal hypothyroidism and the
decsion about replacement therapy is made on a case by case basis, which depends partly on the degree
of elevation of TSH. If the TSH is normal, but the patient has convincing signs of hypothyroidsm, a
repeat TSH and free T4 is done to assess for Central Hypothyroidism.

Secondary, or even Tertiary (Central), Hypothyroidism is characaterized as insufficient


stimulation of the thyroid gland by TSH

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