Transcript Diagnosis: Hypothyroidism

Clinical Case # 9
By CHEN , I – CHUN (Afra)
Case study

C.D. a 33 year old from the Mt. Province came
in with a complaint of cold intolerance,
forgetfulness, puffiness & periorbital
swelling noted for several months, associated
with a bulging anterior neck mass. PE
showed a cardiac rate of 55 beats/min. She
has coarse and dry hair. Her skin is dry,
thick, and scaly. Her neck mass is about
10x15 cm and moves with deglutition.
Diagnosis: Hypothyroidism

Hypothyroidism is the most common pathologic
hormone deficiency. It is usually a primary process
resulting from failure of the gland to produce
adequate amounts of hormone. It may also be
caused by a lack of thyroid hormone secretion
secondary to the failure of adequate thyrotropin
secretion from the pituitary gland or thyrotropinreleasing hormone (TRH) from the hypothalamus
(secondary or tertiary hypothyroidism). Patients may
be largely asymptomatic or may rarely present with
coma and multisystem organ failure (myxedema
coma).
Clinical Feature
Somnolence, poor memory; sluggish
speech/movement
 Bradycardia
 Constipation
 Cold intolerance; ↓ sweating
 Cold dry skin; dry hair
 Myxedema
 Primary/secondary amenorrhea

Plan of management (× 2)
1.
Synthetic thyroid hormone (× 3)
2.
Natural thyroid hormone (× 2)
1. Synthetic thyroid hormone (×3)

Levothyroxine (Synthroid, Levoxyl,
 Levothroid, Unithroid)

Liothyronine (Cytomel, Triostat)

Liotrix
Levothyroxine

Description: In active form, influences growth and
maturation of tissues. Involved in normal growth,
metabolism, and development. Produces stable levels
of T3 and T4. Administered as a single dose in the
morning on an empty stomach. May be administered
PO/IV/IM. Has long half-life (7-10 d), and parenteral
dosing is rarely needed. Initial subtherapeutic doses
are recommended to avoid the stress of rapid
metabolic change in elderly patients and in those with
coronary artery disease or severe COPD.
Liothyronine

Description: Synthetic form of the natural thyroid
hormone T3 converted from T4. Used when a rapid
effect is desired perioperatively or for nuclear medicine
studies. Not intended as sole maintenance therapy.
Can be used in combination with levothyroxine in
small doses (5-15 mcg/d). Duration of activity is short
(half-life is 12-24 h) and allows for quick dosage
adjustments in event of overdosage. May be preferred
when GI absorption is impaired (95% absorbed
compared to 50-80% of T4) or if peripheral conversion
is impaired.Dosage recommendations are for shortterm use in special circumstances with the guidance of
an endocrinologist.
Levothyroxine & Liothyronine
Side effect:
 Weight loss
 Chest pain
 Rapid heartbeat
 Racing heart
 Shortness of breath
 headache
 vomiting
 excessive sweating
 fever
 hair loss
 tremors
Liotrix

Description: A mixture of levothyroixine and
liothyronine in a ratio of 4:1
2. Natural thyroid hormone (×2)
Thyroid

Fine powder from desiccated pig thyroid
 Preparation:
Armour of thyroid= 16-325 mg/tab
Thyroglobulin

Purified pig extrace
 Preparation:
Proloid= 32.5 and 65 mg/tab
Dose= 60-300 mg/day
Thank You!!