maandag 6 februari 2012

Hypothyreoïdie, als de schildklier geen of te weinig hormoon maakt

Hypothyroidism is common, potentially serious, often clinically overlooked, readily diagnosed by laboratory testing, and eminently treatable. The condition is particularly prevalent in older women, in whom autoimmune thyroiditis is common. Other important causes include congenital thyroid disorders, previous thyroid surgery and irradiation, drugs such as lithium carbonate and amiodarone, and pituitary and hypothalamic disorders. Worldwide, dietary iodine deficiency remains an important cause.

Caroline G P Roberts, Paul W Ladenson

Hypothyroidism can present with nonspecific constitutional and neuropsychiatric complaints, or with hypercholesterolaemia, hyponatraemia, hyperprolactinaemia, or hyperhomocysteinaemia. Severe untreated hypothyroidism can lead to heart failure, psychosis, and coma. Although these manifestations are neither specific nor sensitive, the diagnosis is confirmed or excluded by measurements of serum thyrotropin and free thyroxine.

Caroline Roberts en Paul Ladenson behandelen in dit artikel allerlei aspecten van schildklieraandoeningen die hypothyreoïdie veroorzaken. Aan bod komen diagnose, behandeling, wisselwerking met medicijnen, te hoge of te lage dosis levothyroxine, TSH-waarde, enzovoorts.

In patients with primary hypothyroidism, serum thyrotropin concentration should be assessed, with the aim of restoring the thyrotropin value to the lower half of the normal range (about 1.0 mU/L).

Thyroxine replacement therapy is highly effective and safe, but suboptimal dosing is common in clinical practice. Patient noncompliance, drug interactions, and pregnancy can lead to inadequate treatment. Iatrogenic thyrotoxicosis can cause symptoms, and, even when mild, provoke atrial fibrillation and osteoporosis.

We summarise present understanding of the history, epidemiology, pathophysiology, and clinical diagnosis and management of hypothyroidism.

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