History

A woman in her  20’s presents to OPD with irregular menstrual cycles, weight gain and excessive tiredness for past 6 months. She also has noticed swelling in the front of neck for the past 2 months.The patient reports that she is married for past 1 year and currently planning pregnancy.

Examination

All of the patient’s vital signs are within normal range, and the results of a physical examination are normal except for coarse dry skin and diffuse goitre and elevated Body mass index.

Hypothyroidism is a very common hormonal disorder wherein thyroid gland doesn’t produce adequate level of thyroid hormones. Symptoms develop gradually over time and include menstrual irregularities, weight gain , cold intolerance, excessive fatigue, coarse dry skin, constipation, etc.It might be the underlying factor causing  infertility. It commonly affects women in the reproductive age group. Prolonged untreated hypothyroidism may be dangerous producing severe myopathy, hypothermia and altered sensorium(coma) and needs intensive care.

Mild Hypothyroidism (also called subclinical hypothyroidism) if uncorrected during pregnancy can affect the brain development of the foetus,and can cause miscarriage , preterm labour and low birth weight. Hence it is necessary to screen all pregnant women for hypothyroidism and treat if necessary.

Causes of hypothyroidism in adults include autoimmune/Hashimoto’s thyroiditis, Iodine deficiency, surgical removal of thyroid gland and consumption of medications causing hypothyroidism. Hypothyroidism is diagnosed by laboratory tests for TSH and thyroid hormones(T3, T4).

Treatment of hypothyroidism is very simple and effective.Synthetic form of the Thyroid hormone is available as tablet to be taken everyday first thing in the morning.If this tablet is taken in the proper dosage daily, then thyroid hormones reach normal range within 8 weeks and symptoms resolve. With daily medication and regular follow up monitoring of thyroid function tests , hypothyroidism can be kept under check.

Outcome

In this case, routine blood check revealed a high TSH ad low thyroid hormones namely T3 and T4 thus confirming the diagnosis of Hypothyroidism. 

Clinical Pearl

When a woman in her reproductive age presents with irregular menstrual cycles with excess fatigue and weight gain, it is mandatory to screen for thyroid disorder, especially hypothyroidism as it is an easily treatable/correctable disorder.