A patient walked into your clinic today with the following complaints: Weight gain (15 pounds), however has a decreased appetite with extreme fatigue, cold intolerance, dry skin, hair loss, and falls asleep watching television. The patient also tearfulness with depression, and with an unknown cause and has noted she is more forgetful. She does have blurry vision.
PMH: Non-contributory.
Vitals: Temp 96.4˚F, pulse 58 and regular, BP 106/92, 12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.
Diagnosis: hypothyroidism.
Question: 5
What causes hypothyroidism?
Hypothyroidism is a condition characterized by an underactive thyroid gland, leading to decreased production and secretion of thyroid hormones. This essay aims to explore the various causes of hypothyroidism, shedding light on the underlying factors that contribute to this thyroid disorder.
The most common cause of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune disorder where the immune system mistakenly attacks the thyroid gland. This results in chronic inflammation, leading to thyroid gland damage and impaired hormone production.
Certain medical treatments and procedures can lead to hypothyroidism. Examples include:
Radioactive iodine therapy: Used to treat hyperthyroidism or thyroid cancer, this therapy can inadvertently lead to hypothyroidism if the administered dose is excessive.
Thyroid surgery: Partial or total removal of the thyroid gland can result in decreased hormone production, necessitating thyroid hormone replacement therapy.
Some individuals are born with an underactive thyroid gland, which may be due to genetic defects or an abnormal development of the thyroid gland during fetal development. Newborn screening programs help detect and manage congenital hypothyroidism promptly.
Certain medications can interfere with thyroid hormone production or utilization, leading to hypothyroidism. Examples include lithium (used to treat psychiatric conditions), amiodarone (a medication for heart rhythm disorders), and some anti-thyroid medications.
Exposure to radiation, particularly in the neck and head area, can damage the thyroid gland and disrupt hormone synthesis. This can occur as a result of radiation therapy for certain cancers, such as Hodgkin’s lymphoma, or as a side effect of radiation exposure from nuclear accidents.
Hypothyroidism can also result from dysfunction in the pituitary gland or hypothalamus, which play a crucial role in regulating thyroid hormone production. Insufficient secretion of thyroid-stimulating hormone (TSH) by the pituitary gland or impaired release of thyrotropin-releasing hormone (TRH) by the hypothalamus can lead to decreased stimulation of the thyroid gland.
Hypothyroidism is a complex condition with multiple underlying causes. Autoimmune thyroiditis, particularly Hashimoto’s thyroiditis, is the most common cause. However, iatrogenic factors, congenital abnormalities, medications, radiation therapy, and pituitary/hypothalamic dysfunction can also contribute to the development of hypothyroidism. Understanding the causes of hypothyroidism is crucial for accurate diagnosis, appropriate management, and effective treatment of this common endocrine disorder.
1. Chaker L, Bianco AC, Jonklaas J, et al. Hypothyroidism. Lancet. 2017;390(10101):1550-1562. doi:10.1016/S0140-6736(17)30703-1
2. Pearce EN. Diagnosis and management of thyrotoxicosis. BMJ. 2006;332(7554):1369-1373. doi:10.1136/bmj.332.7554.1369
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