Hypothyroidism - secondary

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Primary and secondary hypothyroidism

Thyroid gland

Pituitary hypothyroidism

The purpose of treatment is to replace the deficient thyroid hormone. Levothyroxine is the most commonly used medication. The lowest effective dose that leads to normal thyroid function is used. Life-long therapy may be necessary. Medication must be continued even when symptoms disappear.

After replacement therapy has begun, report any symptoms of increased thyroid activity (hyperthyroidism), such as restlessness, rapid weight loss, and sweating.

A high-fiber, low-calorie diet and moderate activity will help relieve constipation and promote weight loss, if weight was gained during the time when thyroid activity was low.

In individuals with accompanying hypoadrenalism (underactive adrenal gland), steroid replacement must be started before thyroid replacement is begun.

In patients who have hypothyroidism caused by a pituitary tumor, surgery may be required. However, surgery may not cure the hypothyroidism, and thyroid replacement will still be needed.

Myxedema coma is treated by intravenous (IV) thyroid replacement and steroid therapy. Supportive therapy of oxygen, assisted ventilation, fluid replacement, and intensive care nursing may be indicated.

With early treatment, return to the normal state is usual. However, relapses will occur if the medication is not continued. Myxedema coma can result in death.

Myxedema coma, the most severe form of hypothyroidism, is rare. It may be brought on by an infection, illness, exposure to cold, or certain medications.

Symptoms and signs of myxedema coma include:

• Unresponsiveness
• Decreased breathing
• Low blood pressure
• Low blood sugar
• Below-normal temperature

• Heart disease
• Infertility
• Miscarriage in pregnant women
• Adrenal crisis, if thyroid replacement is begun prior to steroid treatment in hypoadrenal patients

Call your health care provider if signs of hypothyroidism are present, or if chest pain or rapid heartbeat occur.

Call your provider if restlessness, rapid weight loss, sweating, or other symptoms occur after beginning treatment for this disorder.

Call your provider if headache, visual loss, or breast discharge occur.

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