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Internal Medicine
Antithyriod treatment
Propylthiouracil: 250 mg PO QID (Or methimazole 20 to 40 mg PO or per NG Q6-8h).
Alternative is 0.5 g of sodium iodide in 1 L of NS over 12 hours.
Give steroids equivalent to about 300 mg of hydrocortisone per day (100 mg IV TID
Q8h). Dexamethasone has some theoretical advantage because it prevents conversion
of T4 to T3 peripherally.
Avoid aspirin because it may increase circulating active T3 and T4 by reducing protein
C. Hypothyroidism
Primary hypothyroidism: refers to a thyroid hormone deficiency as a result of thyroid gland
disease. Secondary hypothyroidism: results from TSH deficiency.
Tertiary hypothyroidism: results from thyrotropin-releasing hormone (TRH) deficiency.
Without thyroid enlargement
Hypothyroidism frequently develops following treatment of Graves’ disease with 131I
therapy or thyriodectomy.
Idiopathic hypothyroidism: is idiopathic atrophy of the thyroid gland. It is one of the
commonest causes of hypothyroidism.
Developmental defects and TSH or TRH deficiency are less common causes.
With thyroid enlargement
Chronic thyroiditis /Hashimoto’s thyroiditis is one of the most common causes of
spontaneous hypothyroidism.
Drugs, iodine deficiency, and inherited defects in thyroid hormone synthesis are rare
Signs and symptoms:
Fatigue, weakness, lethargy, slow movement, cold intolerance
Slight to moderate weight gain , but appetite tends to be diminished
Carpal tunnel syndrome, edema of the face and extremities,
Hearing loss, hoarseness of the voice
Dry skin , hair loss , sparse eyebrows with loss of the lateral half