Обновление: Декабрь 201eight
During life, each of us faced fatigue,
сонливостью, слабостью, которые возникали без явной the reasons.
Maybe, они были связаны со стрессом, недостаточным количеством
sleep, poor nutrition and many other everyday
factors. However, if the above symptoms become
constant companions of your life is a reason to suspect
WITHуществует несколько форм этого заболевания, каждая из которых
has its own characteristics. Some of them flow without bright
expressed symptoms, which is why patients seek medical attention
help only in the later stages of the process. In different regions
Russia, the incidence of the disease ranges from 2.5% to 20%
from the entire population.
Withчины и классификация
Каждая форма заболевания имеет свои the reasons, которые достаточно
are specific. Currently, clinicians identify 2 main
species and 5 subtypes of hypothyroidism. Thanks to the research
Scientists have distributed provocative factors according to the classification
in the following way:
- Congenital – this form is rarely familial, more often
there are isolated cases. They are due to a gene mutation
responsible for the formation of the thyroid gland, or congenital
vice of this body. Developmental anomaly may occur due to
various factors (smoking or drinking mother,
infections during pregnancy). WITHтарое название детского
hypothyroidism – cretinism, but now it has been removed from the international
classification of diseases of the tenth revision. Currently,
they are used only by patanatoms.
- Withобретенный – может возникать как до 1eight лет, так и в зрелом
age Adult hypothyroidism is termed myxedema.
Withобретенное заболевание имеет подвиды:
|What is affected?||Withчины|
WITHобственно ткань щитовидной железы
Violation of the regulation of thyroid function, as a rule,
|Similar to primary hypothyroidism, but damage
thyroid is much smaller.
Metabolic disorders, without damage to the thyroid gland or
With появлении характерных симптомов гипотиреоза следует поискать
In the past, the patient is one of the reasons that will help establish
Ultrasound allows you to determine the size, changes in the structure of the thyroid
(уплотнения, появления опухоли, cysts).
Despite the large number of forms of hypothyroidism, the symptoms
fundamentally different in only two types: child
(cretinism), adult (myxedema). This is due to the action
hormoneов щитовидной железы. Their main function is to enhance decay.
glucose in the body, stimulate energy production. No one
active human process is complete without thyroxin and
triiodothyronine. They are necessary for normal thinking, work
muscle, physical activity, even for nutrition and immunity.
Withзнаки у детей
In childhood, a huge amount of body energy goes away
on growth and thought processes. Therefore, the main symptoms
hypothyroidism in children is:
- Delayed physical development, which is accompanied by
insufficiency of internal organs (most often of the heart, liver,
- WITHильное отставание психики — у ребенка нарушается не только
emotional sphere, but also other functions of the cerebral cortex
(reading, counting, writing, self-awareness in space, memorization
names of items). Without адекватного лечения гипотиреоза
this leads to idiocy;
- Goiter – as usual cell count produces
недостаточное количество hormoneов, организм пытается это исправить
and enlarges the thyroid gland in size. This is achieved by
выработки hormoneов hypothalamus (тиреотропного). Unfortunately,
organ proliferation rarely causes symptoms to disappear.
Withзнаки у взрослых
In adults, energy distribution occurs somewhat differently.
Since the organism, including the brain, is already formed,
the main reserves of glucose go to maintain normal
life activity: physical, mental activity, adaptation to
stress, adequate work of internal organs. With гипотиреозе
all these processes are violated. Symptoms related to
damage to the following body systems:
- Nervous – most nerves and bark consume most glucose
big brain, that’s why they start to suffer first.
The lack of function of the nervous system is manifested: drowsiness,
lethargy, forgetfulness, frequent depression, apathy,
volatility to stress. In later stages may
there are sensitive disorders (usually on the arms or legs),
paresthesias are possible (crawling, tingling sensations),
slow speech, as if “tongue braids”;
- WITHердечно-сосудистая — проявляется замедленным сердцебиением
(pulse less than 60 beats / min), lowering blood pressure (in
среднем – ten0/60 мм.рт.ст.), болями слева от грудины (острые;
medium intensity; at rest decreases but does not pass until
the end; nitroglycerin has no effect), anemia, headache
- Digestive – characterized by decreased appetite, delayed stool
(more than 3 days), nausea, diarrhea are possible (as it is broken
absorption and intestinal motility), flatulence, liver enlargement,
- Muscular – severe weakness, muscle pain (due to a decrease in
glucose levels, lactic acid builds up and irritates
pain receptors), in the later stages – hypo- / atrophy;
- Cover coat – marked dry skin, decreased elasticity
skin, its peeling. Stratification of nails, hair loss.
- Reproductive – in women with hypothyroidism
menstrual disorders (uterine bleeding, lack of
menstruation), mastopathy. With ярко выраженном дефиците hormoneов
thyroid woman suffers from infertility, with a weak violation
pregnancy occurs, but the risk of spontaneous
miscarriage or the appearance of a baby with neurological disorders.
WITHнижение полового влечения происходит у женщин, и у мужчин.
- Appearance – with a long course of the patient’s face
becomes puffy, with a yellowish tinge, edema appears
feet, hands, eyelids.
- Voice change – voice becomes hoarse, low.
- WITHнижается слух по причине отека языка, среднего уха, гортани
(in advanced stages due to neurological disorders).
Inadequate therapy or late diagnosis on the background
severe hypothyroidism can lead to “hypothyroid coma”:
- The patient loses consciousness
- Breath is oppressed, it becomes intermittent, superficial,
- Body temperature decreases, shortness of breath appears
- WITHердцебиение, пульс практически отсутствуют
- There are swelling of the face, limbs, acute urinary retention,
- WITHостояние больного quickly ухудшается, в 75% случаев
ends in death.
Coma can occur like young people leading active
lifestyle, and in older people, especially against the backdrop of heavy
comorbidities, infectious diseases, hypothermia,
injuries, while taking medications that oppress the central
Pregnant women can give birth to a child with pathologies.
internal organs, heart defects, with functional
In adults, significant immunity disorders occur,
leading to autoimmune, frequent infectious diseases. Have
reproductive function is impaired in women and men, decreases
libido. With high cholesterol, risks increase
early development of coronary heart disease, myocardial infarction,
ischemic stroke, atherosclerosis of the brain.
WITH помощью стандартной лабораторной диагностики в виде общего,
biochemical blood tests can detect signs
аутоиммунного воспаления (увеличения WITHОЭ, WITH-реактивного белка) или
infections (increased white blood cell count). These indicators
non-specific, therefore only approximately
to orient to the doctor.
Наибольшую ценность имеют анализы крови на hormoneы:
|Название hormoneа||What shows||Norm|
|WITHвободный Т-4 (общий тироксин или тетрайодтиронин)||allows you to evaluate the function of the thyroid gland. With гипотиреозе
|T-3 (common triiodothyronine)||так как этот hormone образуется, по большей части, из Т-4, с
it can be used to suspect the peripheral form of the disease (should
decrease below 1 nmol / l).
|Norm — 70,3-204,4 нг% (1,0eight-3,14 нмоль/л)|
|ТТГ (тиреотропный hormone гипофиза)||allows you to determine the type: primary or secondary. AT the first
case, the level increases significantly, with secondary –
|Norm – 0.4-4.2 µMU / ml|
|AT-TG (antibodies to thyroglobulin)||using this analysis confirm primary hypothyroidism due to
autoimmune inflammation. An increase indicates the presence of
thyroidinov Hashimoto, De Kerven, Riedel.
|Norm – 0-1eight U / ml|
|ATT – rTTG (antibodies to thyroid hormone receptors
|elevation indicates peripheral.||Norm – less than 1 U / l|
|AT to TPO (antibodies to thyroperoxidase)||Additional method for the detection of autoimmune thyroiditis.||Norm – less than 5.6 U / ml|
Standards for medical care are mandatory.
- ECG – to confirm the presence of bradycardia (less heartbeat)
60 beats / min) or enlarged heart;
- ECHO-KG (echocardiography) – is another method
cardiac research. Allows you to identify the presence
noise that occurs due to a violation of blood flow in the departments
heart and adjacent vessels (aorta, pulmonary trunk);
- Thyroid ultrasound – allows you to determine the size of the organ and
changing its structure (compaction, the appearance of a tumor,
The listed studies do not require special training.
Normal gland volumes:
|Population group||The volume of the thyroid gland (ml). No more:|
|Children 6-ten years old||eight|
|Children 11-14 years||ten|
|Подростки 15-1eight лет||15|
The disadvantage of these instrumental methods is that they
do not allow to evaluate the function of the thyroid gland. For this
there is an additional paid study – radioisotope
scintigraphy In the course of it, “labeled” ions are introduced to a person, which
distributed over the thyroid gland. After that, register them.
radiation and evaluate the result. Any side effects in
clinical trials have not been identified – the procedure
безопасна для the patient.
How to prepare for scintigraphy?
For better quality research, diagnosticians recommend
cancel iodine preparations 30 days before the examination. But,
you need to consult a doctor who decides whether
do it. Three months before scintigraphy should not be carried out
X-ray contrast studies
(vascular angiography, urography, pancreatography).
Highlight the signs of various types of acquired disease:
|The form of acquired hypothyroidism – the severity of symptoms||What can be found in laboratory tests?||What can be found in instrumental studies|
Moderately or strongly expressed
Moderately or strongly expressed
|Hormones – lower T-4, T-3, lower TSH.||No changes|
May be absent or moderately expressed. Without
|Hormones – increase in TSH at the rate of T-3, T-4||May be absent, possibly reducing the volume of the gland.|
In 40% moderately or strongly expressed. 60% – no symptoms
|Symptoms of primary, secondary, or peripheral
|Most often, the changes are absent or mild|
Depending on the diagnosis, the doctor is determined with
tactics and subsequent treatment. Doctors endocrinologists do not recommend
conduct therapy to patients in the following conditions:
- transient or peripheral hypothyroidism, without pronounced
- subclinical hypothyroidism, if TSH is less than 4.2 µMU / ml.
In other cases, it is necessary to carry out adequate treatment. With
All forms of the disease are prescribed replacement therapy, which
allows you to eliminate the symptoms of thyroid failure.
The drug is selected individually:
- sodium levothyroxine;
The dosage and number of doses determined by the doctor. With
Peripheral disease The patient must use two drugs.
(analogs of the hormones T-3 and T-4) or combined forms (Tirecomb,
Tireoto, Tireoto-forte). Otherwise, the treatment will not bring
Prescribing iodine preparations is not necessary (in accordance with
MES), therefore the doctor should solve this question individually. With
the appearance of edema, it is recommended to take diuretic drugs in small
doses (Lasix, Furosemide). Severe depression is a reason for
prescription of sedatives (Persen, Corvalol,
Treatment фармакологическими препаратами рекомендуется дополнить
a special diet for hypothyroidism, which excludes foods that
reducing the level of T-3 and T-4 (onions, beans, garlic, maize, millet,
ground nuts, sweet potato, yellow turnip).
Therapy is considered successful if the amount of TSH lies within
0.5-2.0 µIU / ml.
If the patient does not seek medical help, the symptoms may
quickly progress and lead to hypothyroid coma and
How effective are hormones for hypothyroidism?
Their effectiveness has been proven in clinical trials for all.
forms of hypothyroidism, except peripheral. However combined
therapy together with iodine preparations, as a rule, has
Will I have a goiter?
Its formation is possible only in the primary form due to
elevated TSH levels. With своевременном лечении этого легко
Will I be able to completely get rid of this disease?
Only from the transient form – its symptoms go away within 6
months. In all other cases, the patient is forced for life.
take hormone therapy.
Can I eat a lot of sweet?
Excessive consumption of flour, sweet or fatty foods may
quickly приводить к ожирению. Therefore it is better to limit
consumption of these products to reasonable limits (pastry shops
изделий не более ten0-150 г в день).
What popular treatment is most effective?
Clinically proven and effective treatments for hypothyroidism
folk remedies are not.
How often should an endocrinologist visit?
Without обострений, не реже чем один раз в шесть
What are the complications after taking hormones?
There are many of them (increased heart rate, pain in the area
breasts, weight loss), but they are all transient. WITH
full list can be found in the instructions.