Hypothyroidism

Hypothyroidism is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Primary hypothyroidism (due to disease of the thyroid itself) accounts for >90% of cases.
  • Chronic lymphocytic thyroiditis (Hashimoto disease) is the most common cause in developed nations and may be associated with Addison disease and other endocrine deficits. Its prevalence is greater in women and increases with age.
  • Iatrogenic hypothyroidism due to thyroidectomy or radioactive iodine (RAI; iodine-131) therapy is also common.
  • Transient hypothyroidism occurs in postpartum (painless) thyroiditis and subacute thyroiditis, usually after a period of hyperthyroidism.
  • Drugs that may cause hypothyroidism include iodine-containing drugs, lithium, interferon (IFN)-α, IFN-β, interleukin-2, thalidomide, bexarotene, sunitinib, amiodarone, and checkpoint inhibitors.
  • Secondary hypothyroidism due to TSH deficiency is uncommon but may occur in any disorder of the pituitary or hypothalamus. However, it rarely occurs without other evidence of pituitary disease.

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General Principles

  • Primary hypothyroidism (due to disease of the thyroid itself) accounts for >90% of cases.
  • Chronic lymphocytic thyroiditis (Hashimoto disease) is the most common cause in developed nations and may be associated with Addison disease and other endocrine deficits. Its prevalence is greater in women and increases with age.
  • Iatrogenic hypothyroidism due to thyroidectomy or radioactive iodine (RAI; iodine-131) therapy is also common.
  • Transient hypothyroidism occurs in postpartum (painless) thyroiditis and subacute thyroiditis, usually after a period of hyperthyroidism.
  • Drugs that may cause hypothyroidism include iodine-containing drugs, lithium, interferon (IFN)-α, IFN-β, interleukin-2, thalidomide, bexarotene, sunitinib, amiodarone, and checkpoint inhibitors.
  • Secondary hypothyroidism due to TSH deficiency is uncommon but may occur in any disorder of the pituitary or hypothalamus. However, it rarely occurs without other evidence of pituitary disease.

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