Infantile and Juvenile Hypothyroidism Hypothyroidism in newborn infants results in mental and physical impairment unless treatment is initiated within weeks after birth. Hypothyroidism in children is mainly characterized by retarded growth and impaired mental performances. Infantile hypothyroidism leads to sexual immaturity; juvenile hypothyroidism causes a delay in the onset of puberty followed by anovulatory cycles in girls. Rarely precocious puberty may occur.

Thyroid hormone is essential for normal growth and maturation of the skeleton. Deficient thyroid hormone production in utero and in the neonate retards growth and delays skeletal maturation. Deficiency in early life leads both to a delay in the development of and an abnormal stippled appearance of the epiphyseal centres of ossification (epiphyseal dysgenesis). Before puberty, thyroid hormones also play an important role in the maturation of bone. Impairment of linear growth leads to dwarfism in which the limbs are disproportionately short in relation to the trunk. Bone age is retarded in hypothyroid children.

Hypothyroidism in Adults

In adults, the clinical manifestations of hypothyroidism, though they may be profound, are reversible [68]. The development of spontaneous hypothyroidism is usually slow and many patients seek medical attention for variable and non- specific symptoms. In contrast, patients who develop hypothyroidism rapidly (when replacement therapy is discontinued in a patient with primary hypothyroidism, or after surgical removal of the gland) have more symptoms. In such patients, manifestations of overt hypothyroidism are present by 6 weeks. Older patients tend to have fewer symptoms and signs of hypothyroidism than do young adults.

In adults, common features of hypothyroidism include easy fatigability, tiredness, coldness, weight gain, constipation, menstrual irregularities, and muscle cramps. Drowsiness and slowing of intellectual and motor activity is often referred. Sensitivity to cold is suggested by the use of more blankets on the bed. Women frequently complain of hair loss, brittle nails, and dry skin. Periorbital puffiness may be present. Stiffness and aching of muscles may be attributed to rheumatism. Constipation may occur. Numbness and tingling of the extremities are frequent. Physical findings include a cool, dry skin, puffy face and hands, hoarse husky voice, and slow reflexes.

In a recent study [68] in overt autoimmune hypothyroidism, 94% of women and 91% of men reported at least one of the hypothyroidism- associated symptoms, with tiredness as the most common symptom followed by dry skin and shortness of breath. In contrast, women free of thyroid disease self- reported at least one hypothyroidism- associated symptom considerably more often than men.

Hypothyroidism in Older People

Hypothyroidism in older people is often atypical and elusive and lacks the classic clinical features present in younger patients. This is due to a combination of factors including the insidious onset, the ambiguity of several signs and symptoms (fatigue, weakness, cold intolerance, dry skin, hair loss, constipation, poor appetite, de pression and/ or mental deterioration, hearing loss, cardiomegaly, congestive heart failure) which may be attributed to normal ageing, and to the frequent coexistence of several age- associated diseases.

The most relevant clinical findings that lead one to suspect hypo thyroidism in older people are an unexplained increase in serum cholesterol, constipation, congestive heart failure (particularly when it presents as restrictive cardiomyopathy), and macrocytic anaemia (as a consequence of folate deficiency or coexistent autoimmune gastritis and pernicious anaemia). Other common clinical features encountered in elderly hypothyroid patients include neurological signs (syncope, seizures, impaired cerebellar function, carpal tunnel syndrome) and vague arthritic complaints. Due to the frequent involvement of the cardiovascular system, the presenting symptoms of hypothyroidism in elderly patients include dyspnoea in more than 50% and chest pain in up to one- quarter. A significant minority of elderly hypothyroid patients may paradoxically lose weight as a consequence of reduced appetite. Neuropsychiatric symptoms are often prominent and depression occurs in up to 60% of patients; psychoses are rare. Dementia may be found in elderly hypothyroid patients but it is rarely the direct consequence of thy roid failure, although a few patients show marked improvement of intellectual function after correction of hypothyroidism. In a recent population- based study of hypothyroidism, the power of symptom presence in predicting overt hypothyroidism in both young and older subjects was investigated. Hypothyroid symptom score is a good discriminating tool to identify hypothyroidism in young patients but fails to identify hypothyroidism in older people.

In a multicentre, double- blind, randomized, placebo- controlled, parallel- group trial involving old hypothyroid patients with persisting subclinical hypothyroidism, treatment with L- thyroxine had no consistent beneficial effect on thyroid related symptoms. Besides L- thyroxine treatment yielded no significant beneficial effects on a range of secondary outcome measures.

Elderly patients are more susceptible to myxoedema coma, a rare but serious complication of hypothyroidism. It generally occurs in the winter months, in hospitalized patients, and can be precipitated by intercurrent non- thyroidal illness, use of drugs, exposure to cold, and stress. Progressive deterioration of mental status to stupor and coma, localized neurological signs, marked hypothermia (which may not be present in patients with systemic infections), hyponatraemia, and hypoglycaemia are the hallmarks of myxoedema coma. The mortality of clearly hypothermic myxoedema coma is very high (over 80%), unless vigorous supportive therapy and thyroid hormone replacement are given immediately.

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Clinical Assessment and Systemic Manifestations of Hypothyroidism: Diagnostic Accuracy

Clinical Aspects of Hypothyroidism due to Different Aetiologies

Thalassemic Structural Variants

Chronic Care of the Adult Patient With Thalassemia : Novel Therapeutic Approaches

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Organ System Manifestations of Hypothyroidism: Haematological Changes

Organ System Manifestations of Hypothyroidism: Musculoskeletal Changes

Organ System Manifestations of Hypothyroidism: Cerebral and neurological Changes

Organ System Manifestations of Hypothyroidism: Respiratory Changes

Organ System Manifestations of Hypothyroidism: Cardiovascular Changes

Organ System Manifestations of Hypothyroidism : Cutaneous Manifestations and Changes in the Connective Tissues