Shaheed Syed Nazrul Islam Medical College Education Forum, Shaheed Syed Nazrul Islam Medical College, Kishoreganj., Kishoreganj (2026)

11/11/2020

One of the most common thyroid disorder.

Variety of presentation
Mainly : weight gain
Dry hair,dry skin
Cold intolerance
Constipation
Husky voice
Fatigue, somnolence
Menorrohagia
Vhule jawa sob kisu
R ekta common vallage na

ro onk kisui thakte pare.
Kokhno kokhno kono symptoms bade o test korle pawa jabe.
R hypothyroidism r c/f gula slowly develope kore.

Investigation : for confimation : serum TSH; FT4
supportive & treatment purpose : fasting lipid profile,SGPT;SGOT; ECG

management :

Primary hypothyroidism : (raised TSH more than 20u & FT4 very low)

Drug of choice : levothyroxine
dose 1.7mcg /per kg

ekhn apni jodi ekta pt r wt pailen 70kg sei hisebe apnar lagbe 120mcg

Ekhn ki apni 1st e eto dosage e diben kina??

Apni 1st 50mcg e suru korben. Then slowly baraben.apnar levothyroxine life long dite hobe tai apni kokhno full dose e start korben na.tahole kokhno kokhn transient thyrotoxicosis r feature develope korte pare.

Follow up:
apni 6 week pore serum TSH kore follow up aste bolben.
Tarpor TSH dekhe apni dose baraben.usually apnke dose barate hobe jehetu apni kokhno 1st e full dose osud diben na.
Eivabe apni 6 week por por f/u aste bolben upto serum TSH become normal.
Jokhn serum TSH normal e chole asbe tokhn apni 1yr por por serum TSH kore follow up aste bolben.

Counselling :
onk onk onk besi important.
Jehetu osud ta apnake whole life khaite hobe.
Apnke bole dite hobe jodi
Onk besi gorom lage
Palpitation lage
Insomnia hoi
Sweating hoi besi
Obbossoi jeno apnar kase ase.

Tahole apnke mone korte hobe over dose hoye gese.
R ekta jinis bole dite hobe je hypothyroid r c/f clinically resolve korte time lage. Bt biochemically apni hoito vlo improve dekhben.

Davidson e bola ase jodi young adult hoi apni full dose e 1st e start korte paren bt sir ra discourage kore. R old person hoile to kokhnoi na.

Subclinical hypothyroidism :

TSH besi not so high. Usually 5-20u r maje thkbe & FT4 kom thakbe ( normal range theke ektu kom)

Subclinical hypothyroidism r treatment kokhn korbo:
Jodi TSH level 10u r cheye besi hoi.
Jodi subfertility thake
Jodi kno Symptoms thake tahole amra low dose 25mcg diye treatment suru korbo.if need next f/u e dose barabo.
Jodi range normal hoye jai tahole amra withdraw o korte parbo.

Subclinical hypothyroidism r jonno amake Auto antibody ( Anti TPO dekhte hobe).
Jodi autoantibody positive hoi tahole eita autoimmune hypothyroid.
Today or tomorrow ultimately hypothyroidism develope korbe permanently.

Jodi autoantibody negetive hoi tahole other cause hote pare eita iodine deficiency or other drugs.
Ei sob khetre normal hoye jai.

case of endocrine disorder apni jodi sob feature o peye jan clinically tarpor o apni drug start korben na before biochemical report.

After all apni clinician apni always right.always treat the patient not the report ❤❤❤

Hypothyroidism with IHD & Pregnancy r ek din likhbo in shah Allah.

Keep praying to Allah
To protect us.

Dr. Al Mamun
SN02