Hypothyroidism - secondary

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Primary and secondary hypothyroidism

Thyroid gland

Pituitary hypothyroidism

Early symptoms:

• Weakness
• Fatigue
• Cold intolerance
• Constipation
• Weight gain
• Depression
• Joint or muscle pain
• Brittle fingernails
• Coarseness, thinning of hair

• Slow speech
• Dry, flaky skin
• Thickening of the skin
• Puffy face, hands, and feet
• Decreased hearing
• Thinning of eyebrows
• Hoarseness
• Menstrual disorders

A physical exam usually reveals a small thyroid gland. Vital signs (temperature, pulse, rate of breathing, blood pressure) reveal a slow heart rate, low blood pressure, and low temperature.

A chest x-ray may reveal an enlarged heart.

Laboratory tests to determine thyroid function include:

• Free T4 test
• Total T3
• Serum TSH -- Results are generally low in secondary hypothyroidism because the pituitary is damaged. However, normal or even high values may be seen.

Additional laboratory abnormalities may include:

• Increased cholesterol levels
• Increased liver enzymes
• Increased serum prolactin
• Low serum sodium
• Low blood glucose
• A CBC that shows anemia
• Deficiency or excess of other pituitary hormones

Imaging will include an MRI of the pituitary to look for a tumor.

Review Date: 08/08/2006
Reviewed By: Robert Hurd, MD, Department of Biology, College of Arts and Sciences, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network