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29: HYPOTHYROIDISM

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Hypothyreosis

  • Underactive thyroid

ICD-9-CM CODES

  • 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

ICD-10-CM CODES

  • E03.9 Hypothyroidism, unspecified

  • E89.0 Postprocedural hypothyroidism

PREFERRED PRACTICE PATTERNS1

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

PATIENT PRESENTATION

A 65-year-old female presents to the clinic feeling tired and fatigued all the time. She has also noticed an increasing problem of constipation despite adequate fiber intake. She is frequently cold when others are hot. Her skin has become dry, and she has noticed a swelling sensation in her neck area. On examination she is afebrile with a pulse of 60 beats per minute. She is in no acute distress and appears in good health. She has an enlarged, nontender thyroid noted on her neck. Her reflexes are diminished, and her skin is dry to the touch.2

KEY FEATURES

Description

  • 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 hormone3

FIGURE 29-1

Hypothyroidism: diagnostic approach. FT4, free thyroxine; TPOAb+, thyroid peroxidase antibodies positive; TPOAb–, thyroid peroxidase antibodies negative; TSH, thyroid-stimulating hormone. (From Nicoll D, Lu CM, Pignone M, Mcphee SJ. Pocket Guide to Diagnostic Tests. 6th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • Gradual onset

  • Palpation of thyroid/neck for enlargement of thyroid or any abnormalities

  • Thyroid function test

  • Three types of hypothyroidism

    • Primary: Thyroid gland dysfunction

    • Secondary: Pituitary gland dysfunction

    • Tertiary: Hypothalamus dysfunction

General Considerations

  • Can progress to myxedema if untreated

  • Thyroid needs iodine as a critical element3

  • May cause pathology in multiple organ systems

    • GI: Liver

    • Cardiovascular: Heart, peripheral circulation, blood pressure

    • Integumentary

  • May result in secondary problems indicating ...

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