MA, 32 ani

lucreaza in IT
• Crestere in greutate 12 kg in 10 luni
• Astenie fizica importanta, tulburari de concentrare, lipsa randamentului la job
• 1 baietel de 2 ani; amenoree secundara de 3 luni
• Examen ginecologic
• Local - normal
• Ecografie: ovare de dimensiuni si aspect normal, uter cu aspect normal, endometru 2 mm
• FSH = 2UI/mL (2-12)
• LH = 3.1 UI/mL (1.2-12)
• Estradiol = 21 pg/mL (25-80)
• PRL 70 ng/dl (5-22)
Face din proprie initiativa RMN
Primary Hypothyroidism:
Primary Elevated
Hypothyroidism: Prolactin
Elevated Prolactin

Hypothyroid
Hypothyroid Euthyroid
Euthyroid
Clinic
• Voce usor voalata
• Edeme periorbitare
• Tegumente palide, uscate caderea parului
• Galactoree punctiforma
• Fc = 67/min
• TA = 110/80 mmHg

Analize?
• Uree, Creatinina
• TSH, fT4
• HLG, Fe seric
• colesterol
Echografie tiroidiana
• Hb = 10 g/dL, Ht = 31%, Fe seric = 40 mg/dL
• Uree = 36 mg/dL
• Creatinina = 0.6 mg/dL Diagnostic?
• TGP = 23 UI/L TIROIDITA AUTOIMUNA
• TGO = 34 UI/L HASHIMOTO
• Colesterol total = 318 mg/dL

• TSH = 68 uUI/mL (0.4-4)

Tratament?
• fT4 = 0.4ng/dL (0.89-1.76)
Euthyrox 100ug/zi
• AAT-TPO = 2569 UI/mL (< 34)
Control 8 saptamani
• TSH = 10 uUI/mL (0.4-4)
• fT4 = 1 ng/dL (0.89-1.76)
• PRL = 22 ng/dL (5-22)

Crestem doza sau ramane pe aceeasi doza?

• Ia tratamentul corect, in fiecare dimineata, cu minim

30 min. inainte de cafea sau orice alt medicament
• Euthyrox 125 ug/zi
12 saptamani de tratament cu Euthyrox
• TSH = 1 uUI/mL (0.4-4)
• fT4 = 1.4 ng/dL (0,89-1.76)
• PRL = 8 ng/dL
• Reaparitia menstrelor
• Hb = 12 g/dL Ht = 38%
• Colesterol = 145 mg/dL

Se intrerupe tt cu Euthyrox?
NUUUU
• se continua cu Euthyrox 125 ug/zi
cu evaluare la 6-12 luni
• evaluare inainte de a dori o noua
sarcina/sarcina neplanificata