Post infectious hypothyroidism
Short summary
35-year-old female felt unusual tiredness a few months after giving birth, she gained weight and felt pain all over her body, paresthesias in her hands, and loss of energy. Examination revealed diffusely enlarged thyroid gland, the patient was clinically hypothyroid, and levothyroxine was prescribed. In the expert's opinion, the high TSH and low levels of T3 and T4 suggests the patient most likely suffers from Hashimotos thyroiditis and replacement with thyroid hormone can be a solution for her condition.
Patient's questions
1. Diagnosis
2. Causes
3. Treatment / Solutions
Medical Background
Female, born in 1975
Diagnose: E03.3 Post infectious hypothyroidism
She felt unusual tiredness a few months after she gave birth to her third child on May 2008. She gained 5 kg of body weight. She felt pain all over her body and paresthesias in her hands. She is also describing also a loss of energy. Laboratory studies (October 2008) revealed S-TSH 182,16 mIU/L; S-T3 (free) 0,400 mIU/L; S-T4 (free) 0,688 mIU/L.
Physical examination revealed diffusely enlarged thyroid gland (to the grade II), patient was clinically hypothyroid.
US of thyroid gland revealed slightly diffusely enlarged thyroid gland, volume of the gland was 18,4 ml. Its structure was hypoechogenous. Doppler pattern PSV 15,7 cm/s.
Treatment: levothyroxine 50 mg daily for 10 days then 100 mg daily. Since November 2009 75 mg daily.
Current status: without any clinical problems.
Medical opinion
Female, D.O.B. 1975
The short description could be consistent with hypothyroidism. Normal laboratory values are not provided so I cannot categorically comment about the thyroid function tests. Assuming TSH is high, this would indicate primary hypothyroidism.
Hypothyroidism is the most common of thyroid disorders. It is most common in women and it can reach a frequency of 10% at a certain age. It happens when the thyroid gland becomes inactive and can no longer produce sufficient amounts of thyroid hormones which are responsible for controlling the body's metabolism.
The most common cause of non-functional thyroid gland is Hashimoto’s thyroiditis, which is caused by an autoimmune process. In this case, the patient’s own immune system attacks the gland, gradually destroying it.
Another cause of hypothyroidism mainly in underdeveloped countries is the chronic lack of iodine (necessary to produce the hormone) in the diet.
If there is no iodine in the diet, supplementing iodine into food could solve the problem. If Hashimoto’s thyroiditis is the cause then there is no cure but replacement with thyroid hormone is an excellent solution allowing for a normal quality of life with little to no co-morbidity. Some dietary supplements such as calcium should be avoided because they might interfere with absorption of the drug.
If the patient has had high TSH and low levels of T3 and T4 as suggested then she most likely suffers from Hashimotos thyroiditis. Actually replacement seems to work well in her case.
There are no natural remedies to treat this disease and thyroid hormone synthetic or extracted from animals appear to be equally effective. (I hope the dose mentioned in the consult is in micrograms not milligrams).
