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Thyroid Hormone Replacement Therapy for Primary and Secondary Hypothyroidism

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Hormone Replacement Therapy

Part of the book series: Contemporary Endocrinology ((COE,volume 13))

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Abstract

Primary hypothyroidism is defined as a deficiency of thyroid hormone owing to intrinsic failure of the thyroid gland. This leads to low levels of circulating thyroxine, insufficient levels of thyroid hormone in target tissues, and typical symptoms, signs, and laboratory abnormalities. When severe or long-standing, the clinical diagnosis is straightforward, confirmed by the finding of elevated serum levels of thyrotropin (TSH) and depressed serum concentrations of free thyroxine (fT4) or the free T4 estimate (free T4 index or FTI). Circulating serum triiodothyronine (T3) concentrations are generally low or low-normal. It is a relatively common disorder, affecting 1–3% of the population, with an annual incidence of approx 1–2 per 1000 in women and 1 per 10,000 in men (1). Autoimmune (Hashimoto’s) thyroiditis is the cause of spontaneous primary hypothyroidism in the vast majority of cases. Postablative hypothyroidism after therapy for hyperthyroidism or thyroid surgery is the second most common cause. Drugs may also precipitate primary hypothyroidism, especially in people with underlying autoimmune thyroid disease (i.e., positive antithyroid antibodies). Lithium and iodine-containing drugs such as the antiarrhythmic amiodarone frequently lead to hypothyroidism in such individuals. Rare congenital causes of primary hypothyroidism include thyroid agenesis or maldevelopment and a variety of hereditary intrathyroidal enzyme deficiencies or thyroglobulin biosynthetic abnormalities probably caused by specific genetic mutations.

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  1. David S. Cooper MD
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Editors and Affiliations

  1. Division of Endocrinology and Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    A. Wayne Meikle MD

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Cooper, D.S. (1999). Thyroid Hormone Replacement Therapy for Primary and Secondary Hypothyroidism. In: Meikle, A.W. (eds) Hormone Replacement Therapy. Contemporary Endocrinology, vol 13. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-700-0_6

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  • DOI: https://doi.org/10.1007/978-1-59259-700-0_6

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-092-2

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