Hypothyroidism (Myxedema) is a disease caused by the absence or severe insufficiency of thyroid function (Gall 1874, English physician). Hypothyroidism suffer at any age, but most often at the age of 35 : 50 years, women are more likely than male ranks. Children also suffer often CCA cially congenital hypothyroidism, which often is the cause of dwarfism, Chretien nism. Erased form of hypothyroidism is very often develop in women in the involutional term period and most of the remaining are unrecognized.
Etiology and pathogenesis.
Differences are the primary and secondary hyperthyroidism .
Primary hypothyroidism.
The causes of primary hypothyroidism is the set of Vienna:
- An overdose of thyreostatic drugs and radioactive iodine in the treatment of thyrotoxicosis.
- Chronic autoimmune thyroiditis .
- Genetically determined deficiency of thyroid enzymes involved in the synthesis of thyroid hormones.
- Congenital aplasia of the thyroid gland,
- athyreosis ,
- Faka syndrome (cretinism) ,
- The development of antibodies against its own thyroid gland, with no apparent pre preliminarily inflammatory processes thyroid owls.
Secondary hypothyroidism.
- Secondary G. ca shte due to lower total about induction of pituitary TSH (disease Skien , kraniofaringoma et al.).
Often hypothyroidism develops after 1-3 years after subtotal thyroidectomy , due to the development of autoimmune processes to its own tissue as a result of falling down in the blood tissue proteins of the thyroid gland. Postoperative late hypothyroidism is often the result of excessive trauma thyroid, hypothyroidism during surgery often Global Developing etsya on the basis of thyroid neoplasms, due to amyloidosis, chro -ethnic starvation, iodine Nedo sufficiency. There are also tissue hypothyroidism – inertness of tissues to thyroid hormones. This is evidenced by the cases of hypothyroidism, when repeatedly determining when SBY (protein-bound iodine) in the blood to give dissolved normal or even elevated indicators were.
The pathological picture is often due to the nature of the pathology. In congenital hypothyroidism marked hypo Plaza or the absence of the thyroid gland. In hypothyroidism, razvivshemsya due thyroiditis prevails proliferation Cpd tive tissue. In hypothyroidism, developed Xia due synthesizing enzyme deficiency of thyroid hormones occurs thyroid hyperplasia. When the secondary rated hypothyroidism atrophy and fat -hand gland degeneration.
Clinical symptoms.
Subjective and objective tive symptoms largely due depends on the severity of the disease.
When lung oligosimptomaticheskih forms are vague Ms loby weakness, lethargy, constipation, deterioration of memory and disability STI, chill, headache.
As you expressions cases, there otech skin Nost, mucous membranes, Uwe lichenie language formed myxedema swelling, which, when on davlivanii not form pits. Ha acteristic breakage and hair loss.
The skin is pale, cold, rough, prone to keratosis, palms xanthomatous , with calluses. The skin on to lenyah and elbows thickened with dingy shade – elbows symptom dirty “( Behr syndrome). Ksantomatoznaya yellowness obuslov sludge hyperlipemia and accumulation of carotene, which due to the lack Thyroid hormones are not transferred to vitamin A. The skin occurs hyperkeratosis and degenerative changes of epidermal cells with follicular plugging holes. Connector notkannaya basis skin edematous, collagen and elastic fibers are shifted mucinous substance is a viscous mucopolysaccharide , hyaluronic (mostly) and hondriotinsernuyu kis lots. Skin elasticity decreases Xia due to growth in it unite tion tissue.
Due to the swelling of the voice becomes hoarse losovyh Speech and thinking slowed lyayutsya. Deteriorating hearing because OTE ka auditory nerve. Patients often suffer from peripheral neuritis E, oligomenorrhea , oligoamenoreey , azoospermia, hypogonadism . Ha acteristic muscle cramps. The muscular system also prop Tyva mucopolysaccharides and times Viva myxedema muscle swelling. These patients have the form gipermu skulistyh . However, their muscle strength is much weaker than normal. Dwi limbs zheniya That something is called a state psevdogipermuskulyarnostyu .
The internal organs marked anatsidny gastritis, gallstone disease , functional Nye liver failure, constipation, colitis rarely – megacolon; lunge of the rectum is reflected zheniem myasthenia general and, in particular NOSTA, atony of smooth muscle. Notes arthropathy as proyav Lenie violation of fat and salt on the exchange.
Blood pressure is prone to hypertension, less often – in the initial stages, to hypotension; pulse in the range of 60-80 beats per minute.
As a rule, border serd tsa increased due to swelling of the myocardium, atony and dilatation of the Lost. In severe cases in the pericardial bag accumulates camping liquid. Slows down the speed of blood current and reduced weight compasses ruyuschey blood hence naru creases blood supply .. This reducible dit down metabolic protses owls, hypothermia. Therefore, the state of hypothyroidism liken hibernation – crazy ka inhibited, there is drowsy ness, indifference to the environment, reduced intelligence up to weakly Bowman’s, mental retardation.
Although hypothyroidism occurs considerable improved for cholest -width of the blood, its atherogenic dei Corollary small. This is due to the fact that with hypothyroidism, the level of beta-lipoproteins having an atherogenic property increases slightly. Vascular infiltration occurs predominantly neutral yarn set, rather than esters of fat as is the case with atherosclerosis.
There hypercalcemia , spo proper development arterioskle rose muscular and elastic vascular Nogo types. SBY level is in the lower their normal limits. There anemia, leukopenia small, yc root ESR of 50-60 mm per hour.
Diagnostics.
The diagnosis is not made difficult neny if hypothyroidism develops after subtotal thyroidectomy , leche Nia radioiodine or after receiving high doses of antithyroid drugs. In the spontaneous development should take into account vysheizlo conjugated symptoms, basal metabolic rate, SBY blood, the extent of absorption ra radio active iodine. We mention in primary hypothyroidism chaetsya significant reduction contains Zhaniya blood T 3) T 4 and increase TTG. In secondary hypothyroidism in series with decreased levels of T 3 and T 4 is reduced and TTG. In difficult cases the diagnosis can be established by a specific treatment: WWE deniem moderate doses of thyroid hormones for 10-20 days.
TREATMENT OF HYPOTHYROIDISIS (Myxedema) .
Treatment should be patogeneti cal.
- If the disease is not associated with adequate iodine, prescribers Mikroyod .
- In cases of chronic thyroiditis , steroid hormones .
- When oligosimptomaticheskih forms: a maritime climate, healing ‘exercises, restorative pre Paraty.
- It should be noted that often the cause of hypothyroidism is a functional suppression of the gland, which can be stimulated by TSH.
- When hypothyroidism develops as a result of atrophy of the thyroid gland, is assigned to sweep Tel’nykh terapiya- tireoidin of 0.1 – 0.15 g and triiodothyronine of 0.00002 grams per day. Dose thyroid drugs is determined individually and agrees with a pulse rate (not more than 100 ud.v min.), Basal metabolism and other symptoms.
- In hypothyroidism of pituitary origin initially appointed TTG, and then sweep -inflammatory therapy, as TTG & Input ditsya parenterally and as the peptide quickly causes the formation of anti- bodies – so it can not be take nen long.
- Addition of special agents applied leche symptomatic of anemia, heart failure STI et al. The most difficult to Xia treatment residual neuromuscular Dege nerativnye phenomena due PLO hoi restoring ability of the nervous system.