Hypothyroidism: symptoms, treatment, diagnosis,the reasons

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
hypothyroidism.

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

Primary

WITHобственно ткань щитовидной железы

  • autoimmune inflammation (when the body’s immunity destroys
    own cells) – Hashimoto, De Querven, Riedel thyroiditis;
  • bacterial, viral infections that have migrated to
    thyroid gland in the bloodstream (after sore throats, pneumonia,
    tonsillitis);
  • exposure (due to exposure to radioactive iodine);
  • taking certain medications (for example, Tiamazole);
  • surgery (removal of part of the gland – resection);
  • tumors (adenoma or cancer), metastases from other organs;
  • lack of iodine or violation of its absorption (often
    after removing a large portion of the small intestine).

 Secondary

Violation of the regulation of thyroid function, as a rule,
due to damage to the pituitary gland in which thyrotropic is produced
hormone

  • after traumatic brain injury;
  • for pituitary tumors;
  • hematomas of the brain;
  • after strokes in the basin of the middle cerebral artery.

 Peripheral

  • Происходит синтез «неполноценных» hormoneов щитовидной железы
    (triiodothyronine), which the body tissues do not recognize;
  • Повреждение рецепторов к тиреоидным hormoneам.
 Gene mutation

 Subclinical

Similar to primary hypothyroidism, but damage
thyroid is much smaller.

Transient

Metabolic disorders, without damage to the thyroid gland or
hypothalamus

  • Withем некоторых лекарственных препаратов (Карбамазепин,
    Амиодарон, WITHульфаниламидных антибактериальных веществ, Дифенина,
    oral contraceptives, Octreotide, Methadone);
  • Abundant application of iodine-containing antiseptics to the skin of a child
    (Povidone, iodine alcohol solution, Betadine);
  • Transient гипотиреоз щитовидной железы у женщин может
    appear during pregnancy;
  • Long-term use of products that reduce the level of thyroid
    hormoneов: лука, бобов, чеснока, маиса, просо, земляных орехов,
    sweet potato, yellow turnip.

With появлении характерных симптомов гипотиреоза следует поискать
In the past, the patient is one of the reasons that will help establish
diagnosis.

Ultrasound allows you to determine the size, changes in the structure of the thyroid
(уплотнения, появления опухоли, cysts).

WITHимптомы

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,
    kidney);
  • 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
    pain;
  • 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,
    biliary dyskinesia;
  • 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).

Complications

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,
    irregular
  • Body temperature decreases, shortness of breath appears
  • WITHердцебиение, пульс практически отсутствуют
  • There are swelling of the face, limbs, acute urinary retention,
    intestinal obstruction
  • 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
nervous system.

Pregnant women can give birth to a child with pathologies.
internal organs, heart defects, with functional
thyroid insufficiency.

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.

Diagnostics

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
should decline.
  • Norm у мужчин 4,6-ten,5 мкг% (59-135 нмоль/л);
  • in women, 5.5-11 μg% (71-142 nmol / l);
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 –
going down.
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
glands)
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.
carrying out:

  • 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,
    cysts).

The listed studies do not require special training.
the patient.

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
Adult women 1eight
Adult men 25

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

Primary

Moderately or strongly expressed

  • OAK – may increase ESR, leukocytes (more than 9 per
    ten9/л);
  • Blood biochemistry – increase C-reactive protein (more than 5.31
    ng / ml);
  • Hormones – a decrease in T-4 and T-3, an increase in TSH. Maybe,
    increase in AT to TG, AT to TPO.
  • Decreased glandular volume
  • Focal seal or the presence of nodules.

Secondary

Moderately or strongly expressed

Hormones – lower T-4, T-3, lower TSH. No changes

Peripheral

May be absent or moderately expressed. Without
treatments are progressing

  • Blood biochemistry — possibly an increase in C-reactive protein;
  • Hormones are the norm of T-3, T-4 and TSH. Increased AT to rTTG
No changes

Subclinical

Absent

Hormones – increase in TSH at the rate of T-3, T-4 May be absent, possibly reducing the volume of the gland.

Transient

In 40% moderately or strongly expressed. 60% – no symptoms

Symptoms of primary, secondary, or peripheral
hypothyroidism.
Most often, the changes are absent or mild

Treatment

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
    symptoms;
  • 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;
  • thyroxin;
  • triiodothyronine;
  • thyroidin.

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
no effect.

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,
Valocordin).

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
of death.

FAQ

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
positive effect.

Will I have a goiter?

Its formation is possible only in the primary form due to
elevated TSH levels. With своевременном лечении этого легко
to avoid.

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
months.

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.

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