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Hypothyroidism in Adult
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Hypothyroidism in Adult

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Contributors: Christine Osborne MD, Benjamin L. Mazer MD, MBA, Marilyn Augustine MD
Other Resources UpToDate PubMed

Synopsis

Decreased thyroid hormone due to a defect anywhere in the hypothalamic-pituitary axis (HPA). Patients with primary hypothyroidism generally present with a generalized slowing of the metabolic processes with symptoms such as fatigue, slowed speech, cold intolerance, constipation, weight gain, bradycardia, and delayed relaxation of the deep tendon reflexes (Woltman's sign). Patients also present with cool or pale skin, coarse hair, alopecia, brittle nails, puffy facies, enlargement of the tongue, and hoarse voice.

Acute hypothyroidism may develop after thyroidectomy or withdrawal of thyroid hormone, and these symptoms are often less well tolerated than when hypothyroidism develops gradually. Hypothyroidism may be classified in the following ways:
  • Primary hypothyroidism – Disease of the thyroid gland that leads to decreased production of thyroxine and triiodothyronine with compensatory increase in serum thyroid-stimulating hormone (TSH) levels. Primary hypothyroidism has many causes including Hashimoto thyroiditis, thyroidectomy, radioiodine therapy to treat Graves disease, and medications such as lithium, amiodarone, interferon-alpha, interleukin-2, and oral tyrosine kinase inhibitors.
  • Secondary hypothyroidism – Caused by a TSH deficiency, often due to diseases of the pituitary such as pituitary tumor, postpartum pituitary necrosis, trauma, hypophysitis, infiltrating tumors, or nonpituitary tumors such as craniopharyngiomas. Patients will have inappropriately low or normal TSH values in the setting of suppressed thyroxine (T4) values.
  • Tertiary hypothyroidism – A deficiency of thyrotropin-releasing hormone (TRH) due to disorders affecting the hypothalamus or interfering with HPA portal.

Codes

ICD10CM:
E03.9 – Hypothyroidism, unspecified

SNOMEDCT:
40930008 – Hypothyroidism

Differential Diagnosis & Pitfalls

Fatigue:
  • Depression
  • Fibromyalgia
  • Sleep disturbances
  • Anemia
  • Autoimmune disease
  • Infection
  • Drug side effects (beta blockers, opiates, statins, antihistamines, anticholinergics, antidepressants)
Hypothermia:
  • Adrenal insufficiency (primary, secondary)
  • Drug side effects (antipsychotics, benzodiazepines, barbiturates, opiates)
  • Anorexia
  • Infection
Weight gain:
Menstrual cycle irregularities:
Constipation:

Best Tests

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 11/14/2018
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Hypothyroidism in Adult
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Hypothyroidism : Fatigue, Constipation, Dry skin, Hoarseness, Sinus bradycardia, Alopecia, Anorexia, Cold intolerance, Weight gain
Clinical image of Hypothyroidism
Goiter in hypothyroidism.
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