Hypothyroidism patients often show signs of damage to many endocrine glands.
There is a decrease in the functional reserves of the hypothalamic-pituitary-adrenal system. Characterized by a decrease in the formation of cortisol and a decrease in its metabolism. The function of the sex glands in women is impaired: amenorrhea and infertility are observed. In primary hypothyroidism, there is often a combination of hyperprolactinemia, galactorrhea and amenorrhea. The lack of thyroid hormones leads to an increase in the secretion of thyroliberin, which increases the production of prolactin by the adenohypophysis, hyperprolactinemia blocks the action of gonadotropins at the ovarian level, which leads to amenorrhea.
In men, libido sexualis disappears, sexual weakness develops.
Hypothyroidism is often combined with insulin-dependent diabetes mellitus, with frequent hypoglycemia, since hypothyroidism disrupts the absorption of carbohydrates in the intestine. The combination of hypothyroidism with IDDM is due to the development of autoimmune mechanisms.
Patients usually develop hypochromic anemia (which is caused by a decrease in iron absorption in the small intestine and the absence of the stimulating effect of thyroid hormones on erythropoiesis), less often B12-deficient anemia (due to a violation of vitamin B12 absorption in the intestine).
In clinical practice, mild, moderate and severe forms of the disease are distinguished.
The mild form of hypothyroidism has an illymptomatic clinical picture:
- main complaints: daytime sleepiness, sluggishness in movements, swelling of the face, weight gain, loss of memory and active attention, a feeling of mild muscle weakness;
- changes in the cardiovascular system: bradycardia (pulse rate 60 per 1 min), blood pressure within the normal range, ECG without significant changes, a slightly pronounced extrasystole (up to 15 extrasystoles per hour) is possible, thickening of the chords of the mitral valve is detected on the echocardiogram;
- damage to the neuromuscular system is minimal, muscular strength is reduced slightly;
- pathology of the psychic sphere: neurosis-like symptoms, disorders of a neurasthenic and psychasthenic nature.
Hyperthyroidism of moderate severity is characterized by severe symptoms of the disease:
- the main complaints and data of objective research indicate a clearly defined clinical picture of the disease;
- changes in the cardiovascular system: bradycardia (pulse rate 50 per 1 minute or less), hypotension, ECG decrease in T wave amplitude, ST segment depression, moderately pronounced extrasystole (15-20 extrasystoles per hour), echocardiography reveals asymmetric septal hypertrophy myocardium, impaired systolic and diastolic cardiac function, reduced cardiac output;
- pathology of the neuromuscular system is expressed significantly: myopathies are observed, including the ocular form in the form of bilateral ptosis, a decrease in muscle strength, a slower reflex, and neuropathy;
- pathology of the mental sphere: progressive reduction of memory, intelligence, ignoring the symptoms of the disease.
Severe hypothyroidism is characterized by the following features:
- subjective and objective signs of the disease are pronounced, demonstrative;
- changes in the cardiovascular system: bradycardia (up to 40 heart contractions in 1 min), severe arterial hypotension, frequent sistrasystole (more than 30 per hour), cardiac arrhythmias, ECG – reduced voltage in all leads, reduced amplitude of the T wave and segment depression ST, on the echocardiogram – asymmetric septal myocardial hypertrophy, impaired systolic and diastolic cardiac function, volume indices of cardiac output decreased, peripheral resistance increased;
- the pathology of the neuromuscular system is maximally pronounced, the strength and muscle tone are sharply reduced;
- the pathology of the mental sphere is pronounced: memory and intellect are significantly reduced, apathy, hypochondria, melancholia prevail.
Hypothyroidism in newborns
Hypothyroidism of newborns may be associated with thyroid hypoplasia, a deficiency of enzymes involved in the biosynthesis of thyroid hormones, iodine deficiency during fetal development.
Hypothyroidism in newborns is manifested by the following clinical and laboratory signs:
- large body weight of the newborn;
- severe swelling of the face, hands, feet, tight skin;
- low body temperature;
- weak sucking reflex;
- intense weight gain;
- increase in the level of thyrotropin in the blood (determination of thyrotropin in the blood is a screening method for the diagnosis of hypothyroidism in newborns); thyreotropin is determined on the 4-5 day with the help of the test strip “neonatal”, on which a drop of blood taken from the heel is applied.
Hypothyroidism in children is manifested by the same clinical and laboratory signs as in adults, but in addition, a sharp lag in growth, sexual, physical and mental development. Characterized by a significant backlog of bone age from the passport.