Medically Fit For Exams
Medically Fit For Exams



A condition in which the thyroid fails to produce enough thyroid hormone to maintain normal function, may be autoimmune in nature (Hashimoto’s thyroiditis)


Risk factors

  • Female
  • Middle age
  • Other autoimmune disorders (Hashimoto’s)


Differential diagnosis

  • Depression



  • Idiopathic is more common than Hashimoto’s
  • More commonly affects females
  • Most common onset = 55-65
  • More common than hyperthyroid



  • Hashimoto’s = autoimmune destruction of thyroid cells, antibodies specifically target thyroglobulin and thyroperoxidase, leads to inflammation and immune response
  • Idiopathic (more common)


Clinical features

  • Bradycardia
  • BP disturbance
  • Cold intolerance
  • Weight gain
  • Decreased appetite
  • Menorrhagia (oligomenorrhoea in later stages)
  • Tiredness/lethargy
  • Constipation
  • Dry hair/skin
  • Goitre
  • Deep/hoarse voice
  • Reduced libido



  • Hashimoto’s
    • Autoimmune destruction of thyroid cells/enzymes used for thyroid hormone production (thyroglobulin and peroxidase)
    • Th1 activation – are sensitised for thyroid antigens
    • Hypersensitivity type 4 – T cell response and activation of chronic inflammatory response – leads to goitre




  • Thyroid function tests
    • Decrease T4 and T3
    • Likely to have increased TSH (to attempt to compensate)
    • May have thyroid autoantibodies



  • Treatment with levothyroxine to replace thyroid hormone function
  • Treat other symptoms appropriately if do not resolve



  • Does not affect life expectancy
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