RxPG - Hyperthyroidism

CRETINISM: Congenital hypothyroidism, leading to retardation and deficient growth.

CLINICAL:
Baby born with puffy eyelids, narrow palpebral fissures (similar to Down's Syndrome), protruded tongue. Infants are apathetic and sluggish, poor growth and failure to thrive. Often see refractory anemia and dilated heart.

TREATMENT: Give supplemental T4. It is treatable if you catch it immediately and give thyroid hormone supplements.

SUBTYPES:
Sporadic Cretinism: Congenital malformation of thyroid. There is no goiter and the thyroid is small.
Endemic Cretinism: Thyroid due to maternal dietary deficiency of iodine. The thyroid is goiterous at birth.

MYXEDEMA: Adult hypothyroidism

SYMPTOMS:
Cold Intolerance. Patients always feel cold due to lack of thermogenesis.

SKIN:
Non-pitting edema of extremities (known as myxedema). It results from accumulation of proteoglycans.

Puffy eyelids, characteristic apathetic facies, enlarged tongue (due to proteoglycans).
Coarse, frowsy hair.
Pale, cool skin, and scaly dermatitis.

CV: Decreased cardiac output

Myxedema Heart: A dilated heart with pericardial effusion.

CNS: Lethargy, somnolence, memory loss, depression, cerebellar ataxia, dulled reflexes.
Deafness and/or night-blindness may be seen.

GI: Constipation, fecal impaction.

GOITEROUS HYPOTHYROIDISM:

-ENDEMIC GOITER: Iodine deficiency. Endemic to Great Lake region of USA (rare), central Africa, Himalayas.

-ENDEMIC CRETINISM:

-DRUG-INDUCED GOITER (ANTI-THYROID AGENTS): Lithium can induce goiterous hypothyroidism.

-IODIDE-INDUCED GOITER: Usually iatrogenic, as in the treatment of thyroiditis.

-HASHIMOTO'S THYROIDITIS