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Primary hypothyroidism

Last reviewed: 21 Sep 2025
Last updated: 25 Apr 2025

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • nonspecific symptoms
Detalhes completos

Outros fatores diagnósticos

  • lethargy
  • constipation
  • weight gain
  • depression
  • menstrual irregularity
  • dry or coarse skin
  • change in voice
  • bradycardia
  • hypertension
  • delayed relaxation of tendon reflexes
  • cold sensitivity
  • coarse hair
  • eyelid edema
  • goiter
Detalhes completos

Fatores de risco

  • iodine deficiency
  • female sex
  • middle age
  • family history of autoimmune thyroiditis
  • autoimmune disorders
  • treatment for thyroid disease
  • postpartum thyroiditis
  • Turner and Down syndromes
  • type 1 diabetes
  • radiation therapy to head and neck
  • infiltrative disease
  • iodine excess
  • exposure to pesticides
  • amiodarone use
  • lithium use
  • laryngectomy
  • treatment for multidrug-resistant tuberculosis (TB)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • serum thyroid-stimulating hormone (TSH)
Detalhes completos

Tests to avoid

  • thyroid ultrasound
Detalhes completos

Investigações a serem consideradas

  • free serum thyroxine (T4)
  • antithyroid peroxidase antibodies (anti-TPOAbs)
  • CBC
  • fasting blood glucose
  • serum cholesterol
Detalhes completos

Algoritmo de tratamento

CONTÍNUA

confirmed overt primary hypothyroidism

subclinical hypothyroidism

Colaboradores

Autores

Wail Malaty, MD

Adjunct Clinical Professor

Department of Family Medicine

University of North Carolina

Chapel Hill

NC

Declarações

WM declares that he has no competing interests.

Revisores

Sun Y. Lee, MD, MSc

Assistant Professor of Medicine

Boston University School of Medicine

Boston

MA

Declarações

SYL declares that she has no competing interests.

Salman Razvi, MD, FRCP

Consultant Endocrinologist

Queen Elizabeth Hospital

Gateshead

UK

Declarações

SR declares that he has no competing interests.

Lakdasa Premawardhana, MBBS, FRCP, FRCPE

Consultant Physician

Caerphilly Miners' Hospital

Caerphilly

UK

Declarações

LP declares that he has no competing interests.

Birte Nygaard, MD, PhD

Associated Professor

Consultant Endocrinologist

Herlev Hospital

University of Copenhagen

Denmark

Disclosures

BN declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Taylor PN, Medici MM, Hubalewska-Dydejczyk A, et al. Hypothyroidism. Lancet. 2024 Oct 5;404(10460):1347-64. Abstract

Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017 Mar;27(3):315-89.Full text  Abstract

American Association of Clinical Endocrinologists; American Thyroid Association. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028.Full text  Abstract

Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014 Dec;24(12):1670-751.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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