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  • 244 Acquired hypothyroidism
  • 244.0 Postsurgical hypothyroidism
  • 244.1 Other postablative hypothyroidism
  • 244.2 Iodine hypothyroidism
  • 244.3 Other iatrogenic hypothyroidism
  • 244.8 Other specified acquired hypothyroidism
  • 244.9 Unspecified acquired hypothyroidism
  • Associated ICD-9-CM PT diagnoses/treatment diagnoses that may be directly related
    • 315.4 Developmental coordination disorder
    • 718.45 Contracture of joint, pelvic region and thigh
    • 719.70 Difficulty in walking involving joint site unspecified
    • 728.2 Muscular wasting and disuse atrophy not elsewhere classified
    • 728.89 Other disorders of muscle, ligament, and fascia
    • 729.9 Other and unspecified disorders of soft tissue
    • 780.7 Malaise and fatigue
    • 781.2 Abnormality of gait
    • 782.3 Edema
    • 786.0 Dyspnea and respiratory abnormalities
    • 786.05 Shortness of breath

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  • E03.9 Hypothyroidism, unspecified
  • E89.0 Post-procedural hypothyroidism

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Description

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  • A deficiency of thyroid gland activity
  • Characterized by decreased basal metabolic rate, fatigue and lethargy, sensitivity to cold, and menstrual disturbances
  • In infants, severe hypothyroidism leads to cretinism
  • Thyroid regulates metabolism and produces three types of thyroid hormone2

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Essentials of Diagnosis

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  • Gradual onset
  • Palpation of thyroid/neck for enlargement of thyroid or any abnormalities
  • Thyroid function test
  • 3 types of hypothyroidism
    • Primary: thyroid gland dysfunction
    • Secondary: pituitary gland dysfunction
    • Tertiary: hypthalamus dysfunction

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General Considerations

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  • Can progress to myxedema if untreated
  • Thyroid needs iodine as a critical element2
  • May cause pathology in multiple organ systems
    • GI: liver
    • Cardiovascular: heart, peripheral circulation, blood pressure
    • Integumentary
  • May result in secondary problems indicating the need for PT intervention depending on severity
    • Aerobic capacity and muscle endurance impairment
    • Sarcopenia
    • Weakness/impaired muscle performance
    • Musculoskeletal problems
    • Neuromuscular problems
    • Weight gain, indicating the need for PT intervention depending on severity
  • Hyperlipidemia

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Demographics

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  • Affects individuals through lifespan, starting at birth (1 in 4,000 infants)
  • Estimated 5 million in the U.S. and possibly double that are undiagnosed
  • Higher incidence in women
  • Higher incidence in those greater than age 60

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Signs and Symptoms

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  • Cold sensitivity
  • Fatigue
  • Weight gain
  • Slowed heart rate
  • Constipation
  • Joint pain
  • Muscle pain
  • Muscle cramps
  • Paleness
  • Dry skin
  • Hair thinning, including eyebrows
  • Brittleness of fingernails
  • Weakness
  • Unexplained weight gain with inability to lose it
  • Depression
  • Heavier menstrual periods
  • Decreased ability to smell
  • Decreased taste
  • Puffiness of hands, feet, and face
  • Peripheral neuropathy/numbness
  • Slowness of speech
  • Thickening of skin
  • Liver dysfunction
  • Heart disease
  • Worsening of angina if history of angina
  • Anemia
  • In severe cases

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Functional Implications

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  • Severe symptoms such as immediacy of need to urinate may be disabling, resulting in the inability to leave home
  • Fatigue
  • Infertility
  • Miscarriage
  • Heart disease
  • Decreased sex drive
  • Increasing weight with inability ...

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