Hypothyroidism – Summary

by Michael Lazarus, MD

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    00:01 Let’s review the hypothyroid disorders that we have talked about.

    00:06 Primary hypothyroidism manifest with an elevated TSH and low T4 and T3.

    00:12 Key testing here would include thyroid peroxidase antibodies and if positive, the most likely cause Hashimoto’s thyroiditis.

    00:20 Remember the most common cause of hypothyroidism in the United States.

    00:25 Secondary or central hypothyroidism, you really manifest biochemically with a low TSH and a low T4 or T3.

    00:35 This is usually caused by a lack of TSH from the pituitary gland.

    00:39 You want to treat these patients to replace the thyroid hormone with levothyroxine but note that you cannot use the TSH changes to guide your therapy.

    00:49 Rather check serum T4 to gauge that you are treating them adequately with thyroid hormone.

    00:56 Subclinical hypothyroidism manifesting with high TSH but normal T4 and T3 usually here we repeat the TSH level in 2-3 months.

    01:07 The euthyroid sick syndrome or nonthyroidal Illness syndrome manifest with a low/normal TSH, a low/normal T4 and a low T3.

    01:17 The cause of this is reduced levels of thyroid hormone binding proteins and halted activity of deiodinases that one encounters in critically ill patients in the hospital, and no further assessment is necessary.

    About the Lecture

    The lecture Hypothyroidism – Summary by Michael Lazarus, MD is from the course Thyroid Disorders.

    Included Quiz Questions

    1. TSH normal | T4 low | T3 low: euthyroid sick syndrome
    2. TSH low | T4 high | T3 low | TPO Ab: Hashimoto thyroiditis
    3. TSH high | T4 low | T3 low: subclinical hypothyroidism
    4. TSH low | T4 low | T3 low: primary hypothyroidism
    5. TSH low | T4 normal | T3 normal: secondary hypothyroidism
    1. History and physical examination
    2. TSH testing
    3. Determining T3 level
    4. Determining T4 level
    5. Radioactive iodine uptake

    Author of lecture Hypothyroidism – Summary

     Michael Lazarus, MD

    Michael Lazarus, MD

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