HYPOTHYRODISM

Myxoedema
 Severe hypothyrodisn in which thre is accumulation of hydrophilic mucopolysaccharides in the ground substance of the dermis n other tissues, leading to thikening of the facial features n doughy indurtation of d skin.

CLASSIFICATION
 - Primary hypothyroidism- cause within d thyroid gland itself.
 - 2ndry hypothyroidism- due to failure of TSH

CAUSES-
 - Spontaneous atrophic hypothyrodism
 - iodine deficiency
 - thyroidectomy
 - hashimotor thyroditis
 - radiation

C/F
 - enlargement of the gland
 - wt gain, drcreased appetite, costipation, ascites.
 - angina, bradycardia, hypertension, cardiac failure, pleural effusiod
 - aches n pains, muscle stiffness. Carpel tunnel syndrome, psychosis.
 - myxoedema, dry flaky skin n hair , alopecia,
 - menorrhagia, infertility, galactorrhoea, impotence
 - macrocytosis, anaemia
 - tiredness, somnolence, cold intolerence, hoarseness of voice. Low pitched voice, slurred speech

INVESTIGATION
 - Serum T4 levels are low n TSH levels high
 - serum cholesterol n triglyceride level r raised.
 - LDH n CK levels r raised
 - serum sodium levels may b low
 - ECG Shows sinus bradycardia, low voltage ORS complex.
 - chest radiograph may show enlarged cardiac shadow.

TREATMENT
 - Hypothyroidism is treated wit thyroxine. Dose of 50 micro/ day for 3wk. Followed by 100 micro/ day for 3 wks followed by maintence dose 150 micro / day
 - in elderly pt n those wit ischaemic hrt disease, thyroxine is started at lower dose 25 micro/day.