Monday, September 24, 2007

Treatment of hypothyroidism

Treatment of hypothyroidism with thyroxine therapy is relatively straightforward. Most patients required maintenance doses of 100 to 150 ug daily. Alower initial dose is generally recommened usally 50 ug daily because patients with longstanding severe hypothyroidism can experience unpleasant symptoms such as palpitations if thyroxine is introduced too quickly, but occasionally an initial dose of 100ug may be used if the TSH level is very high and the patients is young and fit.

In the elderly and patients with cardiac disease, a lower starting dose of 25ug daily is more appropriate. Throids function tests should be performed six weeks after introducing thyroxine and after any dose adjustment but not within five weeks of the change, with tests result guiding gradual dose increases. In patients with cardiac disease, increased should be made gradully in increments of 25 ug.

The aim is to restore euthyroidism, but occasionally patients require TSH levels to be at the lower end of the normal range before they feel completely well. Once euthyroidism is achieved, thyroid function tests should be repeated yearly, unless a dose adjustment is made.


Common symptom of hypothyroidism

Common symptom of hypothyroidism included weight gain, fatique, cold intolerence, depression, constipation, dry skin, muscles and joint aches, menorrhagia and slowed mental processing. Physical signs may be few and may include cool and dry skin, bradycardia, hung up, reflexes, periorbital oedema, thinning of the outher third of the eyebrows, hoarse voice or goitre.

Hypothyroidism is suggested if several of these features occur in combination or with recent onset. Elderly patients may presents atypically, with congestive cardiac faolure or hypothermia. Some specialist groups advocate routine screening of thyroid fuction, particularly in older women, although currently there is insufficient evidence to support population based screening. However it is generally agreed that patients deemed to be at higher risk of developing hypothyroidism have throid fuction tests at regular intervals.

The cause of hypothyroidism include, Autoimmune thyroid disease which is the most common cause of primary hypothyroidism. Congential hypothyroidism for which new born TSH sceening is performed. Thyroid or head and neck surgery, Previous neck irradiation, Previous radioactive iodine treatment for thyrotoxicosis, Thyroiditis, Drug treatment such as amiodarone, lithium and interferon.

Patients with this conditions listed above and patients with other autoimmune disorders such as type 1 diabetes or a family history of autoimmune throid disease, should be screened regulars with thyroid function tests. The presence of hyperlipidaemia, hyponatraemia,hyperprolactinaemia or an elevated creatinine kinase level warrents screening with TSH measurement.

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