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Transcript
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
binding.
C. Hypothyroidism
Definition:
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.
Etiology:
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
causes.
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
465