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Indications to test for hypothyroidism

Indications to test for hypothyroidism
Clinical symptoms and signs
  • Fatigue
  • Cold intolerance
  • Constipation
  • Impaired memory
  • Slowed mental processing
  • Depression
  • Nerve entrapment syndromes (eg, carpal tunnel syndrome)
  • Ataxia
  • Muscle weakness
  • Muscle cramps
  • Menstrual disturbance
  • Infertility
  • Bradycardia
  • Diastolic hypertension
  • Hoarseness
  • Goiter
  • Periorbital edema
  • Weight gain
  • Galactorrhea
Laboratory test abnormalities
  • Hypercholesterolemia
  • Hyponatremia
  • Hyperprolactinemia
  • Hyperhomocysteinemia
  • Anemia
  • Creatine phosphokinase elevation
Radiological abnormalities
  • Pericardial and pleural effusions
  • Pituitary gland enlargement
Risk factors for hypothyroidism
Autoimmune thyroiditis
  • Established serological or tissue diagnosis
  • Diffuse goiter
  • Previous Graves' disease, de Quervain thyroiditis, or painless (postpartum) thyroiditis
  • Family history of autoimmune thyroid disease
  • Down syndrome
  • Turner syndrome
  • Personal or family history of associated autoimmune disorders (eg, vitiligo, pernicious anaemia, adrenal insufficiency, diabetes mellitus type 1, ovarian failure, celiac disease, Sjögren syndrome)
  • Primary pulmonary hypertension
  • Multiple sclerosis

Previous thyroid injury

  • Thyroidectomy or other neck surgery
  • Radioactive iodine therapy
  • External radiotherapy
  • Exposure to polybrominated and polychlorinated biphenyls, and resorcinol

Postpartum status

Drugs impairing thyroid function
  • Lithium carbonate
  • Amiodarone
  • Aminoglutethimide
  • Interferon alfa
  • Thalidomide
  • Betaroxine
  • Stavudine

Hypothalamic disorders

  • Hypothalamic or suprasellar mass
  • History of hypothalamic radiotherapy or surgery
  • Disorders causing hypothalamic dysfunction (eg, sarcoidosis, hemochromatosis, Langerhans cell histiocytosis)

Pituitary disorders

  • Known pituitary tumour
  • Other elements of hypopituitarism
  • Manifestations of a sellar mass (eg, headache, bitemporal hemianopsia, or diplopia)
  • History of pituitary surgery of radiotherapy
  • History of head trauma
  • History of pituitary apoplexy, including Sheehan syndrome
  • History of other disorders causing hypopituitarism (eg, metastatic cancer and lymphocytic hypophysitis)
Reproduced with permission from: Roberts CG, Ladenson PW. Hypothyroidism. Lancet 2004; 363:793. Copyright © 2004 Elsevier.
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