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Causes, signs and symptoms of hypothyroidism, how to treat?

Contents:

What is hypothyroidism?

Hypothyroidism is a process that occurs due to lack of thyroid hormones in the thyroid gland. The disease occurs in about one out of thousands of men and nineteen of thousands of women. Often there are cases when the disease is difficult to detect, and for a long period of time. The cause of diagnostic difficulties is the fact that the disease occurs and develops slowly, and it is characterized by the features according to which it is difficult to know exactly hypothyroidism. Usually the symptoms are mistaken for simple fatigue in women – for pregnancy or anything else.

Due to the emergence and spread of this disease the inhibition of the main metabolic processes in the body as thyroid hormones are responsible for energy metabolism.

Hypothyroidism:

  • Rarely becomes a separate disease associated with disorders of the thyroid gland only;
  • Not an independent disease and should not be the only diagnosis (except in rare cases);
  • Becomes a complication or natural consequence of any disease of the thyroid gland with the exception of hyperthyroidism;

  • It is based on functional disturbances in the form of an insufficient production of thyroid hormones (triiodothyronine, tetraiodothyronine (thyroxine), calcitonin), their dysfunction or premature inactivation in the tissues;

  • It is a violation of the General hormonal and metabolic processes in the body.

Each of these items requires a little explanation. Because the prevalence of this pathology is very wide, which causes high interest of the population towards the expansion of knowledge about her. Another name for extreme hypothyroidism – myxedema.

Hypothyroidism is rarely a separate disease or the only diagnosis

If you consider this statement from a pathogenetic point of view, it is 100% true. The only exceptions are those cases when to establish the primary cause of hypothyroidism is not possible, or normal amount of thyroid hormones clinical are registeredthe symptoms of hypothyroidism. Then this disease may be the only diagnosis, which sounds like "idiopathic hypothyroidism".

In all other cases, must necessarily be the primary disease which was the cause of the violation of the functional ability of the thyroid gland in relation to the synthesis of thyroid hormones. Long duration hypothyroidism will cause severe disorders in the body, which is displayed by the superimposition of other diseases in which it will become an unfavorable background for further progression.

Hypothyroidism functional thyroid disease with lesions of the whole organism

The basis of hypothyroidism are not organic changes in the tissues of the thyroid gland and their restructuring, and an impaired ability to synthesize the relevant hormones (thyroxine, triiodothyronine, calcitonin).

The effects that occur at the same time, lead to other functional and even of organic-anatomical disorder in almost all organs and tissues. Because thyroid hormones are involved in important biochemical reactions that regulate the metabolic processes of protein and mineral metabolism and synthesis of steroid and sex hormones, the growth and development of the musculoskeletal system, the functional capacity of the heart and brain. Hypothyroidism not only causes difficulty in the functioning of these bodies, but the violation of their anatomical structure.

Despite the fact that hypothyroidism is a functional disorder, manifested by thyroid dysfunction, its consequences and complications are organic in nature. The disease causes disruption of the normal structure of the target organs that are dependent on thyroid hormones. While the thyroid usually also changes its structure, but the changes are not caused by hypothyroidism, a disease that caused its appearance!

Hypothyroidism is a syndrome violations of the General hormonal background

The endocrine system of the human body operates on the closed circuit type. The loss of one of its parts will definitely slow down the performance of others. In respect of all hypothyroidism happens.

Because the hormones thyroxine, triiodothyronine and calcitonin interact with:

  • Hormones of the pituitary gland that regulates the thyroid gland – the lack of them stimulates the production of thyroid stimulating hormone which induces the proliferation of thyroid volume and diffuse, in the form of nodes or cancerous tumors;

  • Other tropic hormones of the hypothalamic-pituitary system – the decline of thyroid and increased activity of thyroid-stimulating hormone may increase the amount of prolactin. Such changes lead to permanent galactorrhea and breast changes, and additionally violate the synthesis of sex hormones by the ovaries;
  • Steroid hormones of gonadal and adrenal activity, their synthesis is greatly reduced, because thyroid hormones can't provide adequate activity of protein metabolism in the liver. As a result, the lack of building material for the steroids which in the most part it consists of protein, and a hormone of the testes, ovaries and adrenal glands;
  • The parathyroid glands – calcitonin deficiency causes a disturbance of calcium metabolism, which becomes the result of the leaching of calcium ions from bone tissue from excessive activity of the parathyroid hormone.

In any case, hypothyroidism may be an independent disease?

Those clinical variants of hypothyroidism, when the thyroid gland synthesizes sufficient amounts of hormones and their concentration in the blood is normal, referred to a paradoxical type of the disease. It's really incredible and seemingly impossible. After all, if the thyroid hormones are produced by normal, where they can take the symptoms of hypothyroidism? It turns out, it happens.

The main such mechanism is the anomalous structure of thyroid hormones or their rapid destruction in the blood. To run such pathological processes capable of different autoimmune state against the background of systemic diseases or after suffering a serious pathology (infections, trauma, necrosis, burns). Despite sufficient circulating plasma hormones, it is not able to implement before the end of its mission, as it is inactivated by its own immune cells. In the same way, clinical hypothyroidism occurs and the destruction of thyroxine receptors in its target organs.


The symptoms of hypothyroidism

The clinical picture of hypothyroidism can be represented by symptoms of the underlying disease of the thyroid gland, which was the cause of her dysfunction, and direct signs of hypothyroidism.

In short, the main symptoms of hypothyroidism is:

  • menstrual disruptions in women;
  • sudden weight gain, albeit slight. It's caused by the fallspeed metabolism, but appetite is reduced, does not allow a significant increase of body weight;

  • a feeling of nausea, bloating, constipation. Face and legs may swell;

  • the hair of the sick person become dry and brittle, begin to fall heavily;
  • the scalp may become yellowish;
  • it is a violation of the ear and the voice (this symptom is characteristic of acute forms, and occurs because of flow off of the tongue, larynx and middle ear);
  • fatigue, weakness; thinking and speech become slower; there is a feeling of chills that caused by a slow metabolism.

Details all of the symptoms discussed in the table:

Affected organ system in hypothyroidism

Symptoms

Skin and subcutaneous tissue
  • Pale skin in combination with a slight icteric tint;
  • Severe skin dryness combined with peeling;
  • Damage to the structure and growth of nails and hair;
  • Puffiness of face;
  • Dense swelling of the upper and lower extremities. After pressing on the swollen tissue not a trace remains;
  • The decrease in body temperature;

  • The increase in weight and obesity;

Musculo-skeletal system
  • Severe General weakness and impotence;
  • Reduced muscle tone and strength;

  • Muscle pain and cramping of individual muscle groups.

  • Density and disproportionate thickening of the muscles of the upper half of the body;
  • The inability to quickly relax the muscles after performing the stress;
  • Stiffness and slowness.

The heart and blood vessels

  • Bradycardia with a sharp decrease in heart rate;

  • Pain in the chest and behind the breastbone;
  • Irregular heart rhythm in arrhythmia;
  • The increase in heart size (cardiomegaly);
  • Voiceless heart tones auscultation;

  • The emergence of signspericarditis in effusion in the pericardial cavity;

  • The decrease in blood pressure.

Nervous system
  • Lethargy and apathy;
  • Numbness of limbs;
  • Decreased reflexes;
  • Depressing and hallucinatory syndromes;
  • Loss of memory and mental and intellectual abilities up to cretinism;
  • Decreased hearing and visual acuity.

Endocrine disorders

The defeat of the blood system
  • Lower hemoglobin and iron deficiency anemia;
  • Megaloblastic anemia;

  • Leukopenia (happens very rarely);

  • Immunosuppression;

Digestion and kidneys
  • Atonic constipation;

  • Gastritis, accompanied by constant pain in the epigastrium;

  • Nausea and vomiting;

  • Digestive disorders and the presence in the feces undigested food particles;
  • The decrease in the number of daily urine.

The main and the first symptoms of hypothyroidism include: skin lesions with severe dense swelling of the soft tissues, combined with General weakness, arterial hypotension, bradycardia, mental and sexual abuse!

Causes of hypothyroidism

Hypothyroidism as an endocrine disorder can arise due to direct damage of the thyroid gland and due to other pathologies associated with impaired function and structure of bodies governing its work.

The main causes of hypothyroidism and etiological classification is given inthe form of a table.

Etiological type of hypothyroidism

The immediate cause of the disease

Primary (it is based on the defeat of the thyroid gland, which leads to its functional inferiority)

  1. Congenital factors:

    • The underdevelopment of the thyroid gland (Hypo - or aplasia);
    • Hereditary fermentopathy lesion of thyroid enzymes involved in the synthesis of thyroid hormones;

  2. Factors acquired origin:

    • Condition after removal of the thyroid gland (strumectomy);
    • Ionizing radiation in radiation therapy of neoplastic disease, or natural origin in the zones of technogenic catastrophes related to nuclear emissions;
    • Treatment with radioactive iodine;
    • Thyroiditis (inflammation of thyroid) microbial and autoimmune in origin;

    • Iodine deficiency and endemic goiter on the background;

    • Overdose of drugs that inhibit synthesis of thyroid hormones and amiodarone;
    • Tumor lesion of the thyroid gland.

Secondary (caused by decreased activity of the pituitary gland in relation to the ability of the synthesis of thyroid-stimulating hormone)

  • Ischemic lesions of the pituitary gland with atherosclerosis of cerebral vessels or severe acute anemia on the background of the bleeding;

  • Inflammation of the intracranial structures in the pituitary region of the brain;
  • Neoplastic transformation of cells adenogipofiza of the Department;
  • The defeat of the pituitary gland on the background of autoimmune diseases;
  • The toxic action of drugs on pituitary glandular cells (l-DOPA, parlodel).

Tertiary (represented by lesions of the hypothalamic nuclei)
  • Meningoencephalitis with involvement of hypothalamic areas;
  • Severe traumatic brain damage;
  • Intracerebral tumors;
  • Therapy drugs serotonin.

Peripheral (violation of validity of thyroid hormones)
  • Autoimmune processes, which produce antibodies to the thyroid hormones;
  • Congenital or inherited disorders of the structure of the receptors in the tissues through which thyroid hormones exert their effect;
  • Fermentopathy kidney and liver, leading to impaired conversion of thyroxine to triiodothyronine;
  • Defects in transport proteins that transporterowych hormones inside the cells of the organs.

This disease may very well be masked. The lack of thyroid hormones, especially in females, becomes the cause of depression, bad moods, feelings of sadness incomprehensible. A sick person may covertly or overtly decline the intellect, to become poor attention and memory, decrease cognitive function. A person becomes hard to sleep, starts insomnia, or, conversely, regularly sleepy.

The longer since the advent of the spread is not detected and treated, the disease, the greater the likelihood of intracranial hypertension. A person complains of regular pain in the head. The patient is able to live in peace, thinking that the reason the neck (or any other) low back pain. Suspicions also cause muscle pain in the hands, feeling of weakness in them, tingling and goose bumps. Take hypothyroidism and heart disease, as increased blood pressure and level of cholesterol in the blood of the patient.

In the case of female hypothyroidism may develop mastitis, a failure occurs in menstruation.

Another sign of this disease is the swelling of individual body parts. Often swollen eyelids, rest of the place – less, but the swelling is still the main indicators of the presence of hypothyroidism. Effect on the appearance of diseases may have re-reduced immunity in humans. And it can occur when the smallest disruption of the functioning of the thyroid gland. Another symptom is anemia, which occurs because the thyroid gland is responsible for hematopoiesis.

Hypothyroidism, more than 95% of cases are primary in nature and due to the thyroid. Therefore, the detection of clinical manifestations of hypothyroidism primarily examined this organ!


Primary hypothyroidism

Almost all cases of hypothyroidism involve direct violationthe structure and functioning of the authority, which is responsible for the synthesis of thyroid hormones. This organ is the thyroid gland. It is logical that the criteria of the degree of the pathological process in any organ are marked changes in its structure, and the ability to perform the function that it must perform. In relation to primary hypothyroidism causal relationship is constructed in such a way that the thyroid gland due to disruption of their structure is unable to synthesize the hormones T4 and T3. This causes the clinical symptoms of hypothyroidism, which are superimposed on the symptoms of the underlying disease.

The main thyroid diseases that can cause primary hypothyroidism include congenital disease in the form of hypoplasia or complete absence of the organ, an inflammatory process (thyroiditis), cancerous tumors and banal endemic goiter insufficient intake of iodine. Full or partial removal of the thyroid is also called hypothyroidism of varying severity.

To make a differential diagnosis between all types of hypothyroidism and confirm that is the primary type will help:

  • Clinical data – the presence of signs of lesions of the thyroid gland (its enlargement, presence of nodes, difficulty swallowing and sore throat), along with symptoms of hypothyroidism;
  • The data of ultrasound investigation, MRI or radionuclide diagnostics that indicate the existence of structural adjustment of the thyroid gland and reducing its functional capacity;
  • Analysis of blood to determine plasma concentrations of thyroid hormones: T4, T3, TSH. In primary hypothyroidism the level of T3 and T4 is always reduced. Compensatory increases in TSH to enhance stimulation of the thyroid gland to the formation of hormones, or remains in the normal range.

Secondary hypothyroidism

Secondary hypothyroidism is a reduction in functional capacities of the thyroid gland that does not result from lesions of its tissues, and in connection with the dysregulation of the functional activity in relation to hormone production. The thyroid gland, like any organ of the endocrine system depends on the glands-regulators. These are the pituitary and hypothalamus. Speaking of the secondary hypothyroidism, mean a violation of the activity of the hypothalamic thyroid-stimulating hormone. He is either not produced by the pituitary gland, or gets abnormal structure. In any case this situation arises, in which anatomically healthy and unmodified thyroidgland is unable to synthesize thyroxine.

To cause damage to the glandular cells of the pituitary have different intracerebral pathological processes in traumatic injuries, tumors, circulatory disorders in cerebral arteries, autoimmune destruction. In relation to the clinical manifestations of secondary hypothyroidism differs from the primary fact that the typical clinical picture of join the symptoms of other endocrine glands: ovaries and adrenal glands. This causes coarser than in primary hypothyroidism, disorders of the muscular system and the heart, a severe impairment of intellectual abilities, disorders of sexual sphere in the form of persistent amenorrhea and infertility, atrophy of the genital organs and mammary glands, excessive body hair growth, sexual infantilism and electrolyte imbalance.

Confirm secondary hypothyroidism can help:

  • The absence of clinical and instrumental signs of thyroid lesions with obvious clinical symptoms of hypothyroidism;
  • Data x-ray studies of the skull in two projections with the study of the Sella, where the pituitary gland;
  • Computed tomography and MRI of the head, which will help to determine the presence or absence of objective reasons that cause secondary hypothyroidism;
  • Analysis of blood to determine plasma concentrations of specific hormones of the thyroid gland and pituitary gland. Diagnostic criteria for secondary hypothyroidism include decreased level of T3, T4 and TSH.

In some cases, we have to talk about tertiary hypothyroidism. It is also not associated with thyroid disease, and caused by disorders of regulation of its activity. In this case, the pathogenetic chain will be more difficult, since disrupted not one but two units of the regulatory processes. Marvel at the nucleus of the hypothalamic part of the brain that are responsible for the synthesis of hormones that regulate the activity of hormones by the pituitary gland. In the case of tertiary hypothyroidism, it looks like this: the hypothalamus does not produce tiroliberin – the pituitary gland does not produce TSH, the thyroid gland does not produce thyroid hormones.


The effects of hypothyroidism

Hypothyroidism can be divided into clinical forms of moderate and severe. All depends on the amount produced by the thyroid gland thyroid hormones. If they do not, the consequences will be catastrophic, and such hypothyroidismwill become extremely severe. This form of hypothyroidism is called myxedema. With partially retained ability of the thyroid to produce hormones the functioning of the body is violated, but such effects are quite reversible and compatible with everyday life.

Patients with hypothyroidism should know that without proper hormone replacement therapy may experience the following consequences.

Children:

  • The backlog of the child in mental and physical development up to cretinism;
  • Delayed appearance of secondary sexual characteristics, up to complete infantilism;

  • Heart problems;

  • A sharp decrease in the protective forces of the immune system that is manifested by frequent colds, severe exacerbations of chronic infections;
  • Severe weakness and the inability of a child to bear a physical load.

Adults:

  • The decline in mental abilities, memory and intellect;
  • Persistent problems of the heart;
  • A persistent decrease of blood pressure;
  • Prolonged course of chronic diseases and infectious processes;
  • Disorders of menstrual function;
  • Atrophy of ovaries, external genitalia and mammary glands;
  • Impotence, impotence and infertility;
  • Hypothyroid coma (critical decline in the level of hormones, leading to severe metabolic disturbances until the critical falling of indicators of cardiac activity and of the brain, accompanied by persistent loss of consciousness).

All the heavy consequences of hypothyroidism can be avoided by careful attention to the existing problem in the early stages of its development. The sooner you get a detailed diagnosis and started appropriate hormone replacement therapy, the fewer violations will occur in the body!


Treatment of hypothyroidism

The healing process in hypothyroidism involves the exposure of the main parts of this disease and includes the following methods:

Etiotropic therapy

Involves treatment of the underlying disease or condition that caused the hypothyroidism. Unfortunately, not always this kind of assistance is possible. Even when there is an opportunity to influence the true cause of the hypothyroidism, the effect occurs rarely.

The complex etiotropic therapyindications can be used:

  • Iodine (codomain, potassium iodide). Shown in endemic goitre caused by deficiency of iodine in food products and insufficient intake;
  • Adequate treatment of inflammatory and other diseases of the thyroid gland, which became the cause of hypothyroidism;
  • Radiotherapy or other treatments for diseases of the hypothalamic-pituitary system;

Pathogenetic and symptomatic therapy

Involves slowing the progression of pathological changes in organs and tissues that occur in the absence of thyroid hormones. This type of treatment can never be used as an independent, and always complements the basic treatment.

Patients with hypothyroidism is prescribed:

  • Cardioprotector (riboxinum, Trimetazidine, Preductal, Mildronate, ATP);
  • Cardiac glycosides (digoxin, strophanthin, korglikon) in the presence of signs of heart failure;
  • Vitamins (ascorbic acid, neurobeks, milhama, aevitum, tocopherol, vitamin complexes);
  • Drugs sex hormones in women to normalize menstrual function and ovulation;
  • Drugs to improve the metabolic processes in the brain (nootropics, neuroprotectant).

Topic: Diet for a week with hypothyroidism

Replacement therapy hormonal therapy

This type of treatment is the only right decision in hypothyroidism. Hormones should be a basic. All other arrangements are complementary. The principle hormone replacement therapy is simple: artificial introduction into the body of thyroid hormones.

Of drugs containing thyroid hormones, can be used thyroxine and triiodothyronine. If before the second drug is used much more often, modern endocrinologists came to the conclusion on inexpediency of its use. T3 has a negative effect on the myocardium, increasing heart disease on the background of hypothyroidism. The only situation where it may be more effective than thyroxine is hypothyroid coma, in which intravenous triiodothyronine has a rapid therapeutic effect.

As for hormone replacement therapy of T4, it involves the use of preparations containing levothyroxine (L-thyroxine). In pharmacies they can be purchased under suchnames:

  • Eutirox;
  • Biothrax;
  • L-thyroxine;

In prescribing of thyroxine, it is important to adhere to these principles:

  1. The expected life reception. With the exception of the cases, transient primary hypothyroidism, occurs against a background of thyroid pathology and in the early postoperative period after removal of part thereof;

  2. Gradual dose selection into account the severity of hormonal deficiency, patient's age, duration of illness. Traced such a pattern: the longer and more pronounced, untreated hypothyroidism, the higher the sensitivity of the organism to the action of hormonal preparations;

  3. Mandatory monitoring of the effectiveness of treatment for signs of clinical improvement and according to the hormonal spectrum of blood (increase in the concentration of T4, T3 and decrease TSH);

  4. The use of smaller dosages in patients with concomitant heart disease. The dose in these patients should be increased very slowly under ECG control;

  5. The feasibility of further increasing the doses are estimated after the maximum possible of efficiency of the previous (at least 4-6 weeks).

The most effective method of treatment of hypothyroidism is replacement therapy with L-thyroxin. The dose, frequency and regimen should be determined only by a consultant endocrinologist under the control of the hormonal spectrum of blood and clinical data!


obolenko, Valentina, endocrinologist