Hypothyroidism (hypothyroidism, thyroid insufficiency, myxedema) can develop at any age, but most often it occurs in 45 to 50 years. This disease is more affected by women – the ratio of men and women suffering from hypothyroidism 1: 4. The onset of its development often coincides with the climacteric period. Hypothyroidism can be primary and secondary.
Symptoms
The manifestations of hypothyroidism are diverse, but in a pronounced form it is characterized by clearly expressed complaints and objective indicators. Primary hypothyroidism is mainly found in women. If you characterize their state in one word, then this is “lethargy,” and if one phrase, “for some reason, nothing you want.” All the time, however they dress, they freeze, they feel cold, no matter how much they sleep, they get tired quickly anyway. Memory is out of hand, the language is a little stumbling.
With hypothyroidism, the face and limbs swell, but in a peculiar way – when pressing the finger in the front surface of the tibia, the fovea does not remain. Skin is dry, pale, with a yellowish tinge. Elbows and heels generally as emery. This change in the skin is associated with a decreased function of the sweat and sebaceous glands. Nails do not suit – they stick, bend, even tear crosswise. A voice hoarse always or wheezy at the slightest excitement, because the vocal cords swell. The hair on the head, on the lower third of the eyebrows and pubic, brittle, fragile, drop out in large quantities. Body temperature is lowered, as is blood pressure, although 10-20% have hypertension. There is a bradycardia (a decrease in the heart rate to less than 55 beats per minute), and when the condition is started, tachycardia occurs (heart rate increases to more than 90 beats per minute). The limbs are thickened. The fingers are thick and give the impression of being short. The body in patients with hypothyroidism usually does not sweat, but only hands can sweat. On the face and back often there are poorly treatable acne and acne vulgaris. There is also a violation of smell and taste. Due to swelling of the mucous membrane of the nasal cavity, nasal breathing is difficult, which contributes to the development of inflammatory processes in the upper respiratory tract. By the way, infectious diseases in people suffering from hypothyroidism often flow with a low temperature, which is associated with a slowed-down rate of metabolism.
If you do not adequately treat hypothyroidism, you may experience a puffiness of the face, slowness of speech (“hindering” the tongue that has become “occupy” most of the oral cavity), “bags” under the eyes, narrow eye gap, lack of expression (due to mixematous swelling, which do not lend themselves to treatment even with diuretics).
It should be remembered that at first the increased load on hormone production is compensated and does not cause a change in the thyroid gland and does not show any signs. But later, in order to accomplish the tasks of producing hormones in iron, its tissue is transformed, general and / or local increase in follicles develops, thereby forming a diffuse and / or nodal goiter.
Patients with these changes tend to have an euthyroid condition, i. E. normal amount of hormones. Reducing the level of thyroid hormones in combination with additional signs may indicate a transition to a state of subcompensation (ie, a greater deficit in the functionality of the gland). In this case, the increase in the amount of the hormone of the pituitary (thyroid-stimulating hormone – TSH) is natural, since it controls the activity of the thyroid gland. When the activity of the gland is restored, the level of TSH is normalized. This condition (the normal level of T4 (thyroid hormone) and high TSH) is called subclinical hypothyroidism, meaning that the body copes with the load and, as such, hypothyroidism, i.е. low levels of thyroid hormones, not yet. If the level of T4 is below the norm, and the TSH is higher, then the doctors talk about manifest (manifested) hypothyroidism. This is a true hypothyroidism, and it must be treated.
Description
Hypothyroidism is a condition characterized by a persistent decline in thyroid function associated with a low level of thyroid hormones and leading to metabolic and clinical abnormalities. The lack of thyroid hormones in the body causes a slowdown of all its functions. An exception is the thyrotropic function of the pituitary gland, which increases in compensation.
The majority of those suffering from hypothyroidism develop anemia (anemia). In some cases, it precedes the clinical manifestations of thyroid insufficiency. Anemia occurs as a result of decreased iron absorption in the intestine.
Violations in the activity of the nervous system in hypothyroidism are manifested by headaches, pains in the limbs. The pains in the loins proceed according to the type of radiculitis. In women, there are violations of sexual function and menstrual cycle, premature climax may occur, and in men the potency decreases drastically.
Insufficiency of thyroid hormones in the body also contributes to the deposition of cholesterol on the walls of blood vessels, primarily cardiac vessels, which leads not only to their tightening, but also narrowing the lumen. At the same time in the region of the heart there are contracting pains (by the type of angina pectoris), in the commonplace called the angina pectoris. True, despite serious changes in the heart (both in the vessels and in the muscles – the myocardium), complaints about pain in the heart are rare. And only with too pronounced changes, with a sharp narrowing of the lumen of the coronary (i.e., cardiac) vessels, patients note a pain syndrome of stenocardial nature.
In case of violations in the activity of the gastrointestinal tract, which is often observed with a decreased function of the thyroid gland, patients often complain of a decrease in appetite, flatulence, constipation. Change in the process of fat metabolism leads to a slow absorption of fat tissues and increased deposition of cholesterol plaques on the walls of blood vessels.
With hypothyroidism, the function of the central and peripheral nervous systems is disrupted, which manifests itself in a change in neuropsychic functions, cranial innervation, and motor sphere. As a result, the person becomes sluggish, apathetic, with slow speech and mild expression, many reflexes are reduced.
Hypothyroidism is characterized by memory disorders and intellectual inferiority. These disorders, the depth of which depends on the length of the disease, determine the different degrees of dementia, which can vary in these cases from mild debility to idiocy. The latter is observed only if hypothyroid insufficiency was congenital or acquired from early childhood, was not timely diagnosed and not treated properly. But, fortunately, cretinism and idiocy of endocrine origin today, at least in our country, practically do not occur. Now, hypothyroidism is spreading, taking place in a mild form, when only mentality slows down from the psyche, memory loss, mental and, of course, physical fatigue, which is manifested in a somewhat debilous face, its puffiness and roundness, a slightly opened mouth.
At the expressed hypothyrosis (average severity of the disease) indifference, apathy, such people rarely laugh or cry. Sometimes there may be irritability, a grumbling-depressed mood and a depressed state. But if it is not actively treated at the same time, the disease passes into a more severe stage, which is characterized by emotional stupidity, indifference to the surrounding or even monotonous good nature. Those suffering from hypothyroidism can be evil, unfriendly enough that their uncontrolled fits of fear can frighten even close people who are aware of the disease. With electrocardiography (ECG), dystrophic changes in the cardiac muscle can be recorded. In more severe, neglected cases, heart failure develops. The liver can be enlarged.
With hypothyroidism, dystrophic lesions of the heart and vessels are possible, which is fraught with myocardial infarction, as well as with neuropsychic disorders. But the most formidable complication is the hypothyroid coma that develops in patients with thyroid insufficiency and is provoked by cooling, infection (influenza, pneumonia), surgery, taking sleeping pills, sedatives, and narcotic drugs. They can become triggers in the development of complications of hypothyroidism, because they have proven to reduce the activity of metabolic processes (including heat generation), which in patients without it are in a state of minimal activity.
When the precomatous condition comes, the symptoms of hypothyroidism are aggravated: breathing becomes rare, heart failure grows, hypoxia of the brain develops (anemia accompanied by oxygen starvation).
With the development of hypothyroid coma, the lowered body temperature is further reduced (below 35 ° C), in connection with which the hypothyroid is called hypothermic.
The hypothyroid coma has two phases: precoma and coma. In the first phase there is confusion, sometimes there are convulsions, stuporous state (numbness, immobility, suppression of mental activity, lack of verbal communication with others, reduction of all kinds of sensitivity). In the second phase, there is a deep loss of consciousness, or coma, which in most cases ends in a fatal outcome. This means that with the first symptoms of developing hypothyroid coma or even with the appearance of the first signs of a precomatous state, urgent hospitalization is needed. But it is much more reasonable not to wait for such a condition, but with a noticeable, and even worse, deteriorating condition, you need to go to the same, or, in extreme cases, the next day to see an endocrinologist for timely help. Then such a dangerous state can be avoided.
The cause of the development of primary hypothyroidism is direct damage to the thyroid gland due to congenital anomalies, inflammatory (for chronic infections) processes or autoimmune nature, damage to the thyroid after administration of radioactive iodine, surgery on the thyroid gland, due to a lack of iodine entering the body. The causes of secondary hypothyroidism are infectious, tumor or traumatic lesions of the hypothalamic-pituitary system. The functional form of primary hypothyroidism can result in an overdose of Mercazolil.
Peripheral hypothyroidism can be associated with impaired peripheral metabolism of thyroid hormones or with a decrease in the sensitivity of organs and tissues to thyroid hormones. Hypothyroidism can also occur due to congenital underdevelopment or the absence of the thyroid gland. This disease is also considered as a postoperative complication, since in operations on the thyroid gland, especially if they were carried out by unskilled surgeons, a few months after the removal of a certain part of the organ, a certain percentage of the patients undergo hypothyroidism, which becomes lifelong.
Often the development of hypothyroidism contributes to diseases of internal organs and living in a region with a predominantly cold climate. Since the main function of the thyroid gland is the regulation of energy metabolism in various cells and organs, also called caloric (this is the side of the metabolism that relates to the area of kilocalories received by the body from food and its own stores, and used by the cells of organs in the process of vital activity) with diseases of internal organs and conditions with energy deficiency, there is a growing need for thyroid hormones.
But endocrinologists, including great ones, admit that in many cases it is impossible to establish the cause of the development of hypothyroidism. Sometimes a decreased function of the thyroid gland is caused by a violation of the central nervous system, for example, encephalitis (inflammation of the brain). In rare cases, the hypofunction of this endocrine organ develops due to a decrease in the hormonal activity of the pituitary gland (which is possible in the postpartum period in women) due to inadequate production of thyroid-stimulating hormone (TSH). There are cases of the development of the disease in the period of menopause and after childbirth (in this case often there is a decrease in the functions of other endocrine glands, adrenal and sex).
Diagnostics
Hypothyroidism is defined laboratory to reduce the hormone-educational function of the thyroid gland, or rather, to reduce all biochemical parameters: the level of protein-bound iodine (SBH), butanol extractable iodine (BAY), T4, T3. In this case, the thyrotropic function of the pituitary gland appears to be elevated, which is confirmed by laboratory tests when determining the thyroid-stimulating hormone (TSH) content in the blood. This is understandable, if we recall that the pituitary gland and the thyroid gland work on the principle of feedback: there are few hormones secreted by the endocrine gland – they are more stimulated by the reduced function of this or that organ of the pituitary gland. And vice versa. The same applies to the releasing factors of the hypothalamus (peptide hormones of the hypothalamus).
A radioisotope study determines the reduced endothelial cell engrafting capacity of the thyroid gland.
Usually, thyroid gland is not probed for hypothyroidism, but it can be enlarged, which is observed with sporadic or endemic goiter, and also (and in recent years it is very common) with autoimmune thyroiditis.
Hypothyroidism has a huge number of symptoms, this is used by lazy doctors who, with any complaint of the patient, even at the bleeding gums, even at the pain in the joints, refer him to the endocrinologist. But do not give in to panic. If you are in a rage for no apparent reason rush to the first one, or, on the contrary, your favorite comedy depresses you, and the won luxury tour to the Canary Islands is discouraging, this does not mean that you have hypothyroidism. This only indicates that you need to turn to a good doctor, take a blood test for hormones, not paying attention to its high cost (and it is often paid for, although it is included in the program of state guarantees of medical care), and then carefully follow the doctor’s recommendations, without fear of the word combination “hormonal therapy”. It really is only for the good. If the tests are normal, you just need to turn to a therapist or continue to spoil the lives of others with a bad temper. But a visit to an endocrinologist is mandatory, because not so terrible hypothyroidism as its complications.
Treatment
Forty years ago there were no effective drugs for the treatment of thyroid diseases, including hypothyroidism, and he therefore acquired a heavy, lifelong course. Such forms of hypothyroidism were called before myxedema. In neglected cases, especially when the disease began during the fetal development of the child or in the first months and years of his life, the myxedema turned into cretinism or even idiocy, which now, fortunately, is practically not found. Today, various kinds of thyroid disorders are diagnosed in a timely manner and corrected in a timely manner with the help of drug therapy.
The main thing in drug treatment is the appointment of substitution (hormonal) therapy. Each patient needs to choose the optimal dose of a thyroid drug (L-thyroxine, T-rheocomb, thyrotome or their analogues). Treatment begins with minimal doses to protect the heart). At the same time, the older the patient, the less medication starts from the treatment – with 1/6, 1/4 tablets. As the patient’s condition improves and the drug is well tolerated, the dose of the hormone is increased, adding to the previous one 1/4 tablet every 3-4 weeks. Usually the daily dose of a thyroid preparation is 1 to 1.5 tablets. The main principle of hormone treatment is the administration of maximum tolerated doses. Only this allows to achieve a compensated course of the disease, which after a few months allows many patients to feel almost healthy. Contrary to popular belief, recover from hormonal drugs used to treat hypothyroidism can not. These drugs improve the metabolism. On the contrary, some take them without testimony to NOT improve, and this, of course, is in vain, because it is possible in this way to disrupt the metabolism and this is very harmful to your body.
With timely begun, constantly conducted substitution therapy patients remain working capacity. Against the background of therapy with thyroid drugs, even the tendency to hypotension, as a rule, decreases or disappears altogether.
There is an operational (surgical) hypothyroidism, which leads to the removal of a critical part of the thyroid gland, which surgically provokes a load on the organ and the subsequent lack of hormones. In the case of operational hypothyroidism, a permanent (lifelong) intake of drugs containing hormones is necessary.
Iodine deficiency hypothyroidism occurs due to insufficient intake of iodine into the body, which prevents the normally functioning thyroid gland from producing the required amount of hormones, since iodine is part of the chemical formula for hormones (T3 and T4). The main direction in the treatment of iodine deficiency hypothyroidism is the introduction of the necessary iodine.
Lifestyle
It is necessary to adhere to the rational nutrition intended for patients with hypothyroidism. Food should be easily assimilated, enriched with vitamins of group B, A and especially C, as well as micro- and macro elements, which can improve the function of the thyroid gland (if, of course, it has reserves). In addition, such nutrition can restore disturbed metabolic processes. With obesity (in patients with hypothyroidism it happens often, because nutrients due to reduced metabolic processes are difficult to process to the end), the caloric content of the daily diet should be limited by animal fats and digestible carbohydrates, which are contained in sweet, flour products.
Symptoms
- amnesia (memory impairment)
- change of speech
- hair loss
- brittle hair
- difficulty in nasal breathing
- hoarseness
- loss (change) of the voice
- puffiness
- chilliness, cold sensation in the fingers
- general weakness, fatigue
- drowsiness
- low temperature
- puffiness overall
- pale skin
- yellow skin
- dry skin
- lowering of blood pressure
- acne
- irritability
- depression
- mental retardation
- lethargy
- goiter