If Hashimoto is to a female, older adult,
cretin… cretinism is to a child.
This one we can walk through quickly.
Iodine lacking in a pregnant woman resulting
in decreased thyroid hormone nourishment to
the foetus; enzymatic deficiency in the foetal
thyroid gland resulting in lack of T3, T4.
Failure of the thyroid gland to properly descend
into the neck where it should belong or anti-thyroid
antibodies from the mother attacking the foetal
thyroid, therefore may result in cretin.
Can’t miss this child, unfortunately, a
new born, short stature; take a look at the
I want you to specifically look at the mouth,
see how large it is?
Because the tongue inside is macroglossic.
If you take a look at the stomach, it’s
If you were to take a look at the skin in
colour, you’d probably expect them to be
Not because of jaundice… do not confuse
this with kernicterus… this is accumulation
Short stature, coarse facial features, large
tongue, protuberant abdomen and umbilical
hernia and IQ in this child unfortunately
very, very low.
Let’s talk about myxoedema and hypothyroidism
and this would be for an adult.
Take a look at the face in this patient on
the left with hypothyroidism.
The patient was then treated with synthroid.
Upon administration, you’ll notice that
months afterwards, on your right, the same
patient, the puffiness on the face has now
The myxoedema subsides upon administration
of synthroid in a patient with hypothyroidism.
Would you expect such puffiness in a patient
with Graves’ disease?
Not at all, the myxoedema that you find in
Graves’ disease will be located most likely
Remember I showed you and have shown you pretibial
myxoedema along with dermopathy of Graves’?
This however is myxoedema in hypothyroidism.
Broadening, coarsening facial features, lower
pitched voice… what is myxoedema?
It’s the accumulation of Gags… glycosaminoglycans
and hyaluronic acid in the skin subcutaneous
to the fact that you even call this oedema
is a misnomer, right?
Because it is not fluid is the point.
It’s the fact that you are accumulating
other biochemical substances therefore giving
you the appearance of the puffiness.
Now, I will now mention our last topic in
myxoedema that’s upcoming and that would
be myxoedema coma which is the… that name
will be modified in due time, but please,
know it now.
There’s been worst case hypothyroidism where
your patient has not gone into a coma only
after hypothyroidism is completely and relentlessly
taken its course in your patient.
Myxoedema coma occurs in patients with long
standing, untreated, relentless, severe hypo…
hypothyroidism, not hyper.
Often precipitated by stress such as systemic
illness or surgery.
Presentation: hypothyroidism with mental status
changes to the point of absolute stupor, seizures
and coma and perhaps death.
Mortality… no joke, look at this 50 percent!
You want to do everything in your power to
prevent your patient with hypothyroidism ever
getting into such as state because you’ll
probably never get them back.
Topic now goes to subclinical hypothyroidism.
The last time we talked about this was subclinical…
well, the related topic earlier was subclinical
Subclinical hyperthyroidism is extremely common
in our society.
What subclinical means is the fact that the
patient is not exhibiting or expressing overt
symptoms of hypo or hyperthyroidism, thus
you call it subclinical.
On the wards and on your boards, do not get
subclinical confused with sub-acute; one has
nothing to do with the other.
Subclinical means that the patient appears
as though, on biochemical exam, that there
is decrease in T3, T4 with a slight elevation
of TSH, but the patient is not presenting
with severe hypothyroid symptoms… mild.
15 to 20 percent of individuals over the age
of 60 will be suffering from subclinical hypothyroidism,
but they don’t even know it.
Usually caused by a Hashimoto-type of event.