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• Decrease secretion or function of thyroid gland or thyroxin . 1. PRIMARY HYPOTHYROIDISM: Due to diseases of thyroid gland. • Without Goitre : eg; Idiopathic /Autoimmune Atrophic Hypothyroidism, Radioactive Iodine Therapy, Thyroidectomy, Congenital Agenesis, Transient(Infection, Post partum thyroiditis, Thyroid hormone withdrawal). • With Goitre : eg; Hashimoto’s Thyroiditis, Drug Induced(INF, ATD, Amioderone, Lithium), Endemic Iodine Deficiency, Dyshormonogenesis/Inborn Errors, Infiltrative disorders ( Amyloidosis, Sarcoiudosis, Riedel’s thyroiditis. 2. SECONDARY HYPOTHYROIDISM: Due to pituitary lesions. 3. TERTIARY HYPOTHYROIDISM: Due to hypothalamic lesions. CLINICAL FEATURES: • COMMON: Weight gain, Cold intolerance, Fatigue, Somnolence, Dry skin & hair, Menorrhagia. • LESS COMMON: Constipation, Hoarseness, Carpal tunnel syndrome, Alopecia, Aches & pains, Muscle stiffness, Deafness, Depression, Infertility, Malar flush, Periorbital edema/Myxedema, Loss of lateral eyebrows, Anemia, Carotenemia, Bradycardia, Hypertension, Delayed relaxation of tendon reflexes, Dermal myxedema. • RARE: Psychosis ( Myxedema madness ), Galactorrhea, Impotence, Ileus, Ascites Pericardial & Pleural Effusion, Cerebellar Ataxia, Myotonia. INVESTIGATIONS: 1. T4 : Decreased. 2. TSH : Increased ( > 20 Mu/L ). 3. Thyroid peroidase antibodies, Antibodies to Thyroglobulin & TSH receptors : Increased. 4. Serum CK, AST, LDH : Increased. 5. Cholesterol : Increased. 6. Na : Decreased. 7. Anemia : NCNC / Macrocytic. 8. ECG : Sinus bradycardia, Low voltage complexes, STSegment & T wave changes. MANAGEMENT: Thyroxin replacement therapy: 1st 03 weeks = 50 micro grams/day. Next 03 weeks = 100 micro grams/day. maintenance = 100- 250 micrograms/day IN ISCHEMIC HEART DISEASE & ELDERLY PATIENTS: Initial = 25-50 micro grams/day along with beta blockers and vasodilators. In non-responders to beta blockers and vasodilators PTCA or CABG may be required. HYPOTHYROID AND PREGNENCY: Pregnant women require 50 micro grams more thyroxin than nonpregnant due to increase serum TBG. MYXEDEMA COMA: Severe Hypothyroidism In Elderly Patients. • Hypothermia. • Hypoglycemia. • Hyponatremia. • Confusion or Coma TREATMENT IN MYXEDEMA COMA: Inj: T3 20 micro grams I/V x 8 h for 48-72 h or Levo Thyroxin Na (400 micro grams I/V stat than 100 micro grams/day) followed by oral thyroxin 50 micro grams/day or through N/G tube. Oxygen inhalation. Hydrocortisone (100 mg I/V stat followed by 25-50 mg I/V 8 h). 5% D/W. Broad spectrum antibiotics. Gradual re-warming by blankets.