Hypothyroidism is a clinical condition caused by low levels of circulating thyroid hormones. It can occur due to diseases of hypothalamus or can occur due to thyroid gland enlargement or thyroid destruction. Hypothyroidism is more common in females as compared to males and the incidence of this condition increase with age.
Symptoms of hypothyroidism depend on the age at which the condition manifests, duration of the disease and severity of the condition. Symptoms are quite variable and there can be mild to life threatening symptoms of the disease. In initial stages of the disease, the clinical features may be so mild that it remains undiagnosed.
Adult hypothyroidism is called as myxoedema. It is insidious in onset and the clinical picture of this condition is non-specific. The symptoms of the disease are due to slow metabolic rate. General features of adult hypothyroidism are tiredness, weight gain, lethargy, intolerance to cold, sluggishness and hoarseness of voice.
Hoarseness of voice can occur due to deposition of mucopolysaccharides in larynx. Deposition of these mucopolysaccharides can also occur in various other body tissues like ears, tongue and skin and cause deafness, slurred speech, puffiness of face, hands, feet and eyelids.
Women with low levels of circulating thyroid hormones will have irregularities of menstrual cycle. Infertility is also common in hypothyroidism. Skin of the patient will be dry and thick and brittle sparse hair will be present. Patient may also present with low levels of hemoglobin. Hypothyroidism can also affect the cardiovascular system. It decreases the overall function of heart and can slowdown the pulse rate and increase the arterial blood pressure. Angina and heart failure are uncommon symptoms of hypothyroidism.
Muscle stiffness and aches and pains also occur in hypothyroidism. This condition can also depress the nervous system and cause delayed relaxation of ankle jerks and fatigue. Depression, decreased muscle tone, deafness and psychosis are less common features of hypothyroidism. Constipation is a common symptom of this disease because of slow digestive tract activity.
It manifests at adolescence and is characterized by short stature, retarded growth and development. Delayed puberty and sexual maturation is also seen and the patient will show poor performance in studies. Coarse features like edematous face, thick lips and dry skin may also be there. Symptoms of adult hypothyroidism are also present to a variable degree.
In infants with age less than 1 year, the disease manifests with mental retardation, delayed growth and development, dry skin, protruding tongue, flat nose, edematous face, thick lips and sparse hair. This condition is called as cretinism. Infant will have short stature and mental retardation because brain and skeleton don’t develop properly.
Investigations of patient suffering from low levels of circulating thyroid hormones will reveal low serum level of T3 and T4 hormones and high level of serum cholesterol. Chest X-ray may appear normal or may show enlargement in size of heart and ECG will show slow heart rate. Delayed ankle jerk and macrocytic anemia may also be present in patients with hypothyroidism.
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