Hypothyroidism is a complex of various symptoms that occur with insufficient functioning of the thyroid gland due to insufficient production of hormones in it. The disease occurs mainly in women, but can be diagnosed in men and children.
Often this disease is very difficult to detect for a long time. This is due to the fact that the disease progresses slowly, and also certain signs are characteristic of it, which many perceive simply as severe overwork.
Disease classification
Depending on the etiology, pathogenesis and clinic of hyperthyroidism, the disease is divided into several different types. Depending on the severity, there are such forms of the disease as:
- latent or subclinical;
- compensated;
- manifest;
- decompensated;
- complicated.
The most dangerous form is considered to be a complicated form of the course of the disease, since during its course there are signs such as heart failure, pituitary adenoma, cretinism. Basically, it is detected if the disease has not been treated for a long time. Depending on the causes of the formation of such a pathology, congenital and acquired hypothyroidism are distinguished.
The congenital form is diagnosed in the absence or insufficient development of the thyroid gland. There are also genetic disorders of the enzymes involved in the production of thyroid hormones.
Acquired hypothyroidism often occurs after resection of the thyroid gland. The main reason may be:
- exposure to radiation;
- irradiation of the neck;
- the use of certain medications;
- the formation of tumors on the thyroid gland or inflammation of this organ.
In addition, hypothyroidism is divided into: primary, peripheral, secondary, tertiary. When making a diagnosis, you need to conduct a comprehensive examination that will help to prescribe treatment.
Pregnant Disease
It is very difficult for a woman who suffers from hypothyroidism to get pregnant. If complex treatment is performed, the reproductive system is fully restored. Pregnancy of a woman who suffers from a similar pathology should be pre-planned.
Fertilization should take place against the background of a normal indicator of thyroid hormones. When the pregnancy is confirmed, the dosage of the hormonal drug taken should be increased by at least a third. This ensures the normal course of pregnancy and the full development of the fetus.
The clinic of hypothyroidism in women during pregnancy is not quite pronounced, therefore, during the period of bearing a child, it is necessary to periodically undergo a comprehensive diagnosis to determine the amount of hormones. In some cases, with a severe course of the disease, goiter begins to grow in the woman and the fetus.
If the disease was detected during pregnancy, then hormone therapy is prescribed and hormone levels are monitored every 1-1.5 months. If necessary, the dosage of the drug is controlled.
Illness in the elderly
The cause of hypothyroidism in the elderly is autoimmune thyroiditis. The disease progresses slowly and manifests itself in the form of constipation, swelling of the legs and feet, severe snoring.
Patients often have anemia in their blood, high ESR, and high cholesterol. Basically, a person perceives such manifestations as natural signs of aging and rarely visits a doctor.
Feature of the disease in children
Hypothyroidism in children develops as a result of insufficient production of the thyroid gland. The disease can be congenital or acquired. In addition, the disease can occur against the background of insufficient sensitivity of tissues to thyroid hormones. This is the most difficult form of the pathology, since even substitution therapy in this case does not bring the desired result.
With a congenital type of thyroid hormone deficiency, a violation of the formation of nervous tissue in the early stages of the fetus is observed, which leads to the appearance of very serious malformations. After birth, the baby has a violation of the conduction of nerve fibers. In the cells of the nervous system, the ongoing metabolic processes are constantly inhibited, and the formation of the required biologically active substances is reduced.
The acquired form of the disease is much more difficult in young children. The clinic of hypothyroidism in children is characterized by the fact that the baby has serious deviations in physical and mental development. With a congenital form of the disease, ultrasound often reveals hypoplasia of the thyroid gland, and with the acquired variant, the iron is enlarged. According to severity, these types of hypothyroidism are distinguished:
- transient;
- subclinical;
- manifest.
Transient - the easiest form of the disease, which is characterized by a slight decrease in the number of thyroid hormones, which gradually recovers over time. Often, the pathology is almost asymptomatic and detected by accident.
In the subclinical form of the disease, the level of thyroid hormones, but thyroid-stimulating ones, is elevated. In this case, the clinic of hypothyroidism in children is absent and the ills of conducting a blood test to determine the presence of pathology is almost impossible. Children are prescribed a course of hormone therapy, after which no further special treatment is required.
The manifest type of the disease has a classic manifestation and is considered the most difficult variant of the pathology. Symptoms in this case are quite pronounced. If timely diagnosis and treatment are not carried out, then pathologically irreversible processes will begin to occur in the child's body, which will eventually lead to disability.
The first signs of hypothyroidism appear approximately 3-6 months after birth, when irreversible processes in the nervous system begin to develop. The clinic of hypothyroidism is characterized by the fact that in a newborn and a child up to a year, symptoms such as:
- a baby is born on time or is postponed;
- the fruit is very large;
- respiratory failure occurs;
- children are very weak;
- when feeding, the lips turn blue;
- excessive drowsiness.
In addition, there are disorders of the stomach and intestines, a lag in physical development, problems with thermoregulation, and a slowdown in mental development. All these signs are characteristic of a severe course of the disease, which, without the required treatment, leads to disability.
Causes of occurrence
The clinic of primary hypothyroidism differs in adults and children, and can provoke a similar pathology:
- removal of the thyroid gland;
- autoimmune thyroiditis;
- congenital pathology of the thyroid gland;
- radioactive iodine treatment;
- violation of hormone production;
- exposure to toxic substances;
- iodine deficiency or an excess of iodine in the body.
Among the main causes of central hypothyroidism should be highlighted such as:
- brain tumors;
- surgery and radiation therapy in this area;
- circulatory disturbance;
- vascular aneurysm;
- congenital underdevelopment of the brain;
- some infectious diseases.
Transient hypothyroidism mainly occurs against the background of thyroiditis, which is asymptomatic. The subclinical form of the disease occurs with autoimmune thyroiditis, after resection of the thyroid gland, as a result of treatment with radioactive iodine.
Often, patients initially form the primary form of pathology that occurs as a result of thyroid surgery, the course of autoimmune thyroiditis. The pathogenetic basis of this disease is a violation of the energy processes occurring in the body, which occurs as a result of a lack of thyroid hormones. As a result of this, almost all organs and systems suffer. Pathology has a negative effect on:
- metabolism;
- nervous system;
- musculoskeletal system;
- respiratory system;
- heart and blood vessels;
- urinary system;
- digestive organs;
- reproductive system.
With the course of the pathology, the oxygen saturation of the tissues is significantly reduced, as a result of which the metabolism worsens. This leads to an increase in the weight of the patient. Severely prolonged and untreated hypothyroidism leads to partial or complete atrophy of nerve cells, as well as the appearance of areas of degeneration.
When the musculoskeletal system is damaged, formation processes slow down, and skeletal muscles atrophy. This is combined with muscle weakness and some slow motion.
Hypothyroidism is characterized by the fact that as a result of the course of the disease, the heart rate and cardiac output decrease. Organs and tissues located near the heart lack nutrients. There is a slight increase in pressure. With the course of the disease, heart failure is severely formed.
Main symptoms
The clinic of hypothyroidism is characterized by the fact that with a decrease in the production of thyroid hormones, the functioning of many organs and systems deteriorates. Symptoms of the disease develop very slowly and almost imperceptibly therefore, patients do not consult a doctor for a long time. With congenital hypothyroidism, the clinic manifests itself in the form of:
- drowsiness, lethargy;
- intolerance to heat and cold;
- decreased attention, memory and mental activity;
- swelling;
- hair loss, dry skin;
- constipation
- weight gain.
In women, a menstrual cycle may be observed, and in men, a decrease in potency. The clinic of hypothyroidism largely depends on the degree of the course of the disease, the reasons for its development, and the age of the patient. The main signs of the disease are mainly characterized by polysystemicity, however, many patients complain of the occurrence of disorders and problems in only one of the body systems, as a result, the diagnosis is somewhat difficult.
With moderate hypothyroidism, the clinic and symptoms for a long time are completely absent. With persistent and prolonged course of the disease, patients have swelling of the face and limbs, as well as slight yellowing of the skin. The causes of such manifestations are associated with fluid retention in the connective tissue.
Burning, tingling, weakness, muscle pain, and stiffness in the hands may also bother the patient. Among other signs, it is necessary to highlight dry skin, dullness and fragility of the hair, as well as their strong loss. Clinic of hypothyroidism in adults is often manifested in the form of lethargy and apathy. With a severe course of the disease, speech slowdown is possible. Due to swelling of the larynx and ear, a change in hearing and voice occurs.
Too pronounced lack of hormones can lead to infertility. When the first signs of the disease occur, a diagnosis is prescribed that will help determine the degree of the course of the disease, which guarantees a more successful treatment.
Diagnostics
When diagnosing hypothyroidism, the clinic and the features of the manifestation of the disease are taken into account in the first place. In addition, you need to pass tests. First of all, the doctor checks the level of thyroid and thyroid-stimulating hormones, which are reduced in the presence of the disease.
In addition, samples with radioactive iodine are required. If the level of its absorption by the thyroid gland increases, then this indicates the activation of hormone production. In addition, a decrease in their production may indicate the development of a tumor or thyroiditis. The presence of autoimmune processes may also be indicated by the presence of antibodies to thyroid antigens.
In the treatment of hypothyroidism, etiology, pathogenesis, clinical features and diagnosis is very important, which is why the examination must be carried out comprehensively, as this will allow you to choose the optimal treatment technique. For diagnosis, an ultrasound examination is used. It allows you to determine the size of the thyroid gland, the presence of seals, nodes and other neoplasms in it. Computer tomography will help to clarify the area of their formation.
If there is a disease, an ECG is also indicated, which will help determine the presence or absence of abnormalities in the functioning of the cardiovascular system. To clarify the diagnosis, if necessary, a biopsy of the thyroid gland nodes and its scintigraphy can also be prescribed. Analysis for congenital hypothyroidism is carried out in the maternity hospital, using a special filter paper for this.
Treatment features
Hypothyroidism is a very complex and dangerous endocrine disease, the treatment of which must be approached comprehensively. Depending on the clinic and the diagnosis of hypothyroidism, the treatment is selected individually and is aimed at normalizing the patient’s well-being and preventing the development of complications. To date, there are several methods of therapy that can be used individually or in combination. When carrying out the treatment,
- radioiodine therapy;
- drug treatment;
- surgery to remove part or all of the thyroid gland.
Based on the clinic and the diagnosis of hypothyroidism, the doctor selects the treatment purely individually, it all depends on the form and stage of the disease. The choice of treatment technique depends on factors such as:
- causes of the formation of pathology;
- the severity of the disease;
- patient age;
- allergy to medications.
The basis of drug treatment is the use of antithyroid drugs. However, they are required only if there is a slight increase in the affected organ. If there is a much larger increase in the thyroid gland, then drug therapy is used only as a preparatory measure before surgery.
Initially, high dosages of drugs are prescribed, at least 30-50 mg of the drug 2 times a day. Throughout the entire period of therapy, monitoring of hormone levels is required. The course of treatment lasts for 4-6 weeks. After the full normalization of all thyroid function, complex maintenance therapy is prescribed. To do this, prescribe a course of "Tiamzole" 10 mg of the drug 1 time per day. Such treatment should be carried out throughout the year.
Depending on the clinic and the diagnosis of hypothyroidism, treatment can be additionally carried out using non-drug therapeutic methods. Of particular importance is diet therapy and hydrotherapy. Patients are prescribed sanatorium treatment, in which special attention is paid to the prevention of the formation of diseases of the cardiovascular system. It is also important to follow a diet, namely, to consume food with a sufficient amount of vitamins and minerals. In addition, you need to limit the consumption of spices, coffee, chocolate, tea.
If acute symptoms and a hypothyroidism clinic occur, treatment is carried out with radioactive iodine. Such a technique is considered one of the most effective. This substance is very rapidly absorbed into the thyroid gland, causing a gradual decrease in the affected organ.
If conservative methods do not bring the desired result and the course and clinic of hypothyroidism are only exacerbated, treatment is carried out by surgical intervention. Indications for resection are:
- increase in goiter size;
- allergy to the medication used;
- relapse after conservative treatment.
In such cases, subtotal resection of the gland is indicated, in which at least 3 mm of tissue is left. Before surgery, a person must undergo preparatory therapy, which also needs to be passed after surgery to prevent relapse.
To eliminate the symptoms and clinic of hypothyroidism, treatment can be carried out using alternative methods, in particular, the use of beta-blockers that block the effect of thyroid hormones on the body. After a similar procedure, the patient feels better after a few hours.
Possible complications
Regardless of the etiology and clinic of hypothyroidism, various kinds of complications can occur, which are expressed in:
- decrease in metabolic processes in the body;
- chronic heart disease;
- decreased mental activity;
- an increase in the size of the gland and difficulty in swallowing and breathing.
One of the most dangerous complications is hypothyroid coma. This is a serious condition that occurs with a prolonged course of hypothyroidism. Among the provoking factors, it is necessary to highlight such as:
- hypothermia;
- acute respiratory infections;
- surgery and anesthesia;
- drug intoxication;
- food poisoning.
Coma develops very slowly. The patient noted an increase in weakness, drowsiness, indifference to what is happening around. In addition, a person becomes somewhat inhibited and his movements are slowed down. If at this stage there is no medical treatment, then the patient falls into a stupor, which then turns into a coma.
In addition, with the occurrence of hypothyroidism, pronounced dystrophic changes are observed in all organs and tissues. In a child, hypothyroidism can provoke a violation in the activity of the central nervous system. The extreme degree of this serious illness is cretinism.
Forecast
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Prevention
To normalize the patient's well-being, the clinic, treatment and prevention are of great importance in case of hypothyroidism. Excellent preventive measures that will avoid exacerbation are the prevention of diseases of the endocrine system, in particular the thyroid gland. For this, replacement therapy is carried out, which must be prescribed only by a doctor.
It is very important to review the usual diet, give up all bad habits, control your emotional background and lead an active lifestyle. In the presence of the slightest deviations with health, you must definitely consult a doctor.
Specific preventive measures are not provided, but it is imperative that immunity be strengthened.