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[Up] [Hypothyroidism classification] [Risk factors] [Clinical features] [End organ impact] [Associated illnesses] [Diagnosis] [Treatment] [Dose titration] [Drug interactions] [Monitoring & follow up] [Myxedema coma]

 

 

 

 Clinical Criteria

  • History taking to evaluate patients at risk

  • Symptoms/signs of thyroid hormone deficiency

  • Evidence of disease/ previous treatment or exposure known to cause thyroid/pituitary/ hypothalamic failure

  • Conditions associated with increased risk of chronic autoimmune thyroiditis

 

 Laboratory Testing

 

 Specific tests

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Include measurement of TSH, T4 or FT4 (FreeT4),T3 or, FT3 (FreeT3)

 

 In primary hypothyroidism

  1. Decreased T3, T4 levels with elevated TSH or 

  2. Normal T3 lowT4 and high TSH / 

  3. LowT3 occurs in severe cases

 

 In sub clinical hypothyroidism

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Normal T 3, T4 levels with elevated TSH levels

 

 In central hypothyroidism

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Low T 3, and T 4 levels with normal or low TSH

 

 

Interpretation of  T 3, T 4, TSH levels

 

 

T3,T4 Normal

 

TSH Normal

 

 

 

T3, T4 Normal

 

TSH High

 

 

T3, T4 Low

TSH High or

T3, T4 Low

TSH Normal or

T3 Normal

T4 Low

TSH High

T3, T4 Low

TSH Low

 

    Normal

  Subclinical

  Hypothyroidism

  Primary

  Hypothyroidism

  Central

  Hypothyroidism

 

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In autoimmune thyroid disease causing hypo- thyroidism, antimicrosomal antibodies are present in 90% of patients.

 

 Neonatal screening for congenital hypothyroidism  

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It was introduced in 1974.. 

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This has improved the prognosis of patients with congenital hypothyroidism.

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Ideally, screening should be done with T 4 and TSH levels by 4th day of neonatal life and reconfirmed by with following values.

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FT4 < 6ug/dl and TSH > 20-40 uIU /L

 

 In case of central hypothyroidism

  1. MRI brain and pituitary

  2. Other hormonal evaluation

 

Typical reference ranges for Serum Thyroid Hormones and TSH

Reference ranges may vary according to laboratory

 

  Hormone

   Serum Levels

  TSH

  Free T4

  T4

  Free T3

  T3

   0.2-5.0 uIU/ml

   0.8-2.0 ng/dL

   4.5-12.5 ug/dL

   1.4-4.4 pg/ml

   86-186 ng/dL

 

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Early diagnosis can be a major step forward in the treatment of hypothyroidism.

 

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