Scientific editor: Volkov AA, endocrinologist, practical experience since 2015.
October, 2018.
Hypothyroidism - a clinical syndrome that develops due to long-term, persistent hormone deficiency thyroid gland in the body or in the development of resistance (stability) at the tissue to the hormone level.
There are primary, secondary and tertiary hypothyroidism.
Primary hypothyroidism develops in the thyroid lesion and is accompanied by increased levels of thyroid stimulating hormone - TTG.
Secondary hypothyroidism occurs when the defeat of a particular part of the brain - the hypothalamus-pituitary axis system - with insufficient thyroid-stimulating hormone release and subsequent reduction in thyroid function gland.
Tertiary hypothyroidism develops in the defeat of the hypothalamus. Often, secondary and tertiary hypothyroidism is combined in one form, called the secondary or central disease.
The predominant age of hypothyroidism - over 40 years. The prevailing gender - female.
Photo: the location of the thyroid gland
Causes
The causes of the disease depends on its shape.
Primary hypothyroidism:
- own immune system attack (autoimmune thyroiditis);
- treatment of diffuse toxic goiter;
- Iodine deficiency (in the region with its pronounced deficiency);
- congenital abnormalities (most often - hypoplasia of the breast).
Identifies a number of risk factors for the development of primary forms of the disease. Among them are older than 60, female gender, smoking, transferred tissue cancer of the head or neck. It increases the risk of disease pathology similar to someone from relatives.
Secondary and tertiary hypothyroidism can be caused by any of the states leading to insufficiency of the hypothalamus or pituitary function (trauma, tumor, radiation, surgery, etc.).
symptoms of hypothyroidism
The main symptoms are hypothyroidism:
- weakness
- drowsiness
- fatiguability
- speech and thinking slowdown
- constant feeling cold due to metabolic slowing
- puffiness of the face and limbs edema caused by accumulation of mucous substances in the tissues
- change of voice and hearing loss due to swelling of the larynx, tongue and middle ear in severe cases
- weight gain, which reflects a reduction in metabolic rate, however a significant gain does not occur, ie. k. Appetite decreased
- a tendency to reduce blood pressure
- nausea, flatulence, constipation
- hair loss, their dry and brittle, sometimes jaundice of the skin
- irregular menstrual cycle in women.
Symptoms of hypothyroidism have hidden many "masks."
Deficiency of thyroid hormones, predominantly in women, leading to depressed mood, inexplicable sadness, and even severe depression.
In hypothyroidism reduced cognitive function, worsening memory and attention, reduced intelligence (explicitly or implicitly).
May develop insomnia, fitful sleep, difficulty falling asleep and other sleep disorders, including hypersomnia.
With increasing limitations unrecognized and untreated hypothyroidism develops syndrome intracranial hypertension. There are frequent and then constant headaches.
Hidden Hypothyroidism often occurs under the guise of a cervical or thoracic osteochondrosis.
Symptoms of hypothyroidism such as follows:
concerned tingling, burning, "goose bumps"
muscle pain in the upper limbs,
weakness in the arms.
The most frequent cardiac "mask" Hypothyroidism: increased blood cholesterol, increased blood pressure.
In women, hidden hypothyroidism can occur menstrual dysfunction, breast.
Swelling can also be a "mask" hidden hypothyroidism. Swelling of the eyelids or general swelling of unknown origin are often the sole or leading feature of this disease.
A significant role in the development of hypothyroidism plays a secondary immunodeficiency, which can develop even with a slight decrease in thyroid function.
An indication may be latent hypothyroidism anemia as thyroid hormones stimulate hematopoiesis.
Separately isolated congenital hypothyroidism. Without medical correction it leads to severe cretinism in children, the development of secondary pituitary adenoma, serous effusion cavity severe cardiovascular pathologies, leading to death in the early age.
Diagnostics
Diagnosis of hypothyroidism even with bright clinical picture is not possible without additional laboratory and instrumental investigations.
Initially conducted hormonal study, which determined TSH levels. If the index is at or exceeds the normal level mark of 10 mIU / ml, a further study has shown hormone. If TTG component at a level of 4 to 10 mIU / ml, T4 conducted additional research.
For secondary diagnosis of hypothyroidism (central) is applied to the sample tireoliberinom.
Appoint more:
CBC (normo- or hypochromic anemia type available B12 deficiency anemia);
blood chemistry (increased levels of cholesterol, LDL, triglycerides, creatinine, sodium disadvantage gipoosmolyarnost, decreased glomerular filtration rate, excess enzymes);
assessment of the level of other hormones (prolactin increase, decrease testosterone in men and estradiol in women, the rate of LH and FSH).
Thyroid ultrasound will show a decrease in the volume of tissue (less common compensatory hypertrophy), hypoechogenicity.
Possible to perform an ECG to determine pathologies of the cardiovascular system, other organs ultrasound, radiography. If you suspect a central form of hypothyroidism is an MRI or CT scan. The result - a syndrome empty sella.
hypothyroidism treatment
The drug of choice in the treatment of hypothyroidism - levothyroxine sodium.
Treatment is carried out to normalize the level of thyroid stimulating hormone.
For adults, the average dose of levothyroxine sodium (L-thyroxine) - 1.6-1.8 mg / kg body weight per day. Different patients daily requirement ranges from 25 to 200 mg / day.
dose selection should be carried out gradually, starting with the lowest. The initial dose does not exceed 25-50 mg / day.
The increase is performed not earlier than 2 months, when the body adapts to the initial dose of drug. To assess the adequacy of replacement therapy is required periodic monitoring of TSH levels in the blood.
Body's need for thyroid hormones in the summer months is often reduced, which also must be considered.
Experience shows that men have an average need for L-thyroxine is slightly higher than in women. It is important to remember that children need for preparation is higher than in adults and elderly patients, in contrast, is much lower.
It is important to educate patients with hypothyroidism self-control: to monitor the well-being, pulse, blood pressure, body weight, portability thyroxine, keep a diary of observations. This will help avoid complications and side effects of hypothyroidism used hormones.
If early treatment prognosis.
sources:
- hypothyroidism. Guide for GPs. - Association of general practitioners (family doctors), the Russian Federation, 2015.