Hypothyroidism( Myxedema) - Causes, symptoms and treatment. MF.

Thyroid is one of the organs of the endocrine system that produces hormones: thyroxine, triiodothyronine, and thyrocalcitonin, which are involved in many of our body's processes.

The thyroid gland is often the arena of inflammation, as it is located on the neck, in immediate proximity to frequently infected organs, easily exposed to adverse environmental factors, is very abundant in blood supply and serves as an arena for biochemical processes.

Disruption of the normal state of the thyroid leads to a violation of hormone secretion. The most common diseases are: hypothyroidism, hyperthyroidism, thyroiditis, diffuse and nodular goiter of the thyroid gland. The main syndromes in diseases of the thyroid gland reflect a violation not only of its function, but also of growth.

Thyroid disease is the most common problem among the city's residents. In recent years, the incidence of thyroid dysfunction has increased significantly in Moscow. This is due to the deterioration of the ecological situation in the city and the absence of measures for iodine prophylaxis.

The prevalence of hypothyroidism among the adult population of Moscow is 0.5-1%, among newborns - 0.025%, and among individuals older than 65, 2-4%.

What is the thyroid gland?

The thyroid gland is one of the organs of the endocrine system that produces hormones: thyroxine, triiodothyronine, and thyrocalcitonin, which are involved in the following processes of our body:

• metabolism regulation;
• increase in heat transfer;
• intensification of oxidative processes and consumption of proteins, fats and carbohydrates, which is extremely necessary to provide the body with energy;
• release of water and potassium from the body;
• regulation of growth and development processes;
• activation of the adrenal, genital and mammary gland;
• have a stimulating effect on the central nervous system.

The thyroid gland is often the arena of inflammation, because it is located on the neck, in immediate proximity to frequently infected organs, easily exposed to adverse environmental factors, is very abundant in blood supply and serves as an arena for biochemical processes.

Disruption of the normal state of the thyroid leads to a violation of the secretion of hormones. The most common diseases are: hypothyroidism, hyperthyroidism, thyroiditis, nodular and diffuse goiter of the thyroid gland. The main syndromes in diseases of the thyroid gland reflect a violation not only of its function, but also of growth.

General information about hypothyroidism

Hypothyroidism is a disease that occurs as a result of inadequate supply of organs and tissues with thyroid hormones due to a decrease in the level of production of thyroid hormones. Distinguish primary( with lesion of the thyroid gland) and secondary( with damage to the pituitary and / or hypothalamus) hypothyroidism.

The mechanism of development of hypothyroidism is determined by the decrease in the level of thyroid hormones, which leads to inhibition of metabolic processes, excretion of oxygen by tissues( in excess amounts harms the body), a decrease in the activity of various enzymes and gas exchange, inhibition of brain tissue development and suppression of higher nervous activity( i.e.a violation of human behavior, which is expressed in an inadequate response to a different situation, or a hindered reaction, or an overactive reaction), which is especially noticeable in childhood.

But in adults, brain damage also develops, which is characterized by a decrease in mental activity and intelligence, a weakening of reactions to various situations. With a decrease in the thyroid gland activity, disorders from other endocrine organs can also be observed.

Symptoms of hypothyroidism

Hormones of the thyroid gland, as noted above, participate in the implementation of many functions of the body, therefore, with a decrease in its performance, violations of many organs are noted. The very first and characteristic symptom is an enlargement of the gland in size.

Changes in the body with hypothyroidism:

1. Cold, thick, edematous skin, jaundice is often noted, more often on the palms in the form of spots, its age changes are accelerated. Decreased secretion of sebaceous and sweat glands. Fragility of nails. Hair dry, brittle, thick.
2. Pale, puffy, masky face( impoverishment of facial expression).From the side of the eyes observed: ptosis( lower eyelid) and swelling of the eyelids. Hair loss of the outer third of the eyebrows. Swelling of the vocal cords and tongue leads to a slowed, fuzzy speech, the timbre of the voice decreases and coarsens. The tongue increases and dents and traces of teeth are visible on its lateral surfaces..
3. Symptoms from the cardiovascular system are manifested in the form of lowering blood pressure( hypotension), decreasing heart rate( bradycardia), dyspnea, worse even with a slight physical strain, discomfort and pain in the heart and behind the breastbone.
4. In the respiratory system, there are: decreased ventilation of the lungs( hypoventilation), which causes a lack of oxygen and an increase in carbon dioxide. Patients with hypothyroidism are prone to bronchitis, pneumonia( pneumonia), which are characterized by a sluggish, protracted course, sometimes without temperature reactions.
5. There are a number of gastrointestinal disorders: a decrease in appetite, nausea, flatulence( increase in the formation of gases in the intestine), a decrease in the tone of the musculature of the intestine and biliary tract leads to bile stasis in the bladder and promotes the formation of stones, sometimes to intestinal obstruction;
6. There is a decrease in the secretion of fluid by the kidneys. Reducing the tone of the urinary tract favors the development of infection.
7. Patients with hypothyroidism are characterized by disorders from the nervous system in the form of: inhibition, decreased intelligence, drowsiness during the day and insomnia at night, speech retardation, depression, increased irritability and nervousness, memory impairment. There is also a violation of sensitivity, mainly of the limbs, neuralgia( inflammation of the nerve), accompanied by muscle pain.
8. Bone lesions are not characteristic of adults. Children can manifest themselves as a lag in the growth of the skeleton and the shortening of the limbs. In patients of all ages, muscular fatigue is observed, sometimes pain in the joints.
9. 60-70% of patients have blood disorders. There is a decrease in absorption of iron and vitamin B12 in the gastrointestinal tract, which leads to the development of "tyriogenous anemia"( characteristic only for thyroid lesions), there may be a slight decrease in blood sugar in connection with the slow absorption of glucose.
10. Reducing sexual desire( libido), it is possible to develop infertility.
11. Despite the lack of appetite in patients, often there is an increase in weight( but obesity is uncharacteristic), the need for vitamins decreases. For most patients, a low body temperature( hypothermia) is characteristic.

Causes of primary hypothyroidism

Primary hypothyroidism is caused by damage directly to the thyroid gland, resulting in a decrease in the production of hormones.

Reasons:

1. Complications of treatment after:

• prompt treatment of various thyroid diseases;
• treatment of toxic goiter with radioactive iodine;
• radiotherapy for malignant diseases of organs located on the neck;
• use of iodine-containing drugs;
• administration of glucocorticoids, estrogens, androgens, sulfonamide preparations;
• removal of the thyroid.

1. Tumors, acute and chronic infections, thyroiditis( inflammation of the thyroid gland), abscess, tuberculosis, sarcoidosis( a systemic disease characterized by the formation of granulomas in the affected tissues);
2. Hypoplasia - hypoplasia of the thyroid gland due to intrauterine growth defects usually in newborns and children 1-2 years, often combined with deafness and cretinism.

Causes of secondary hypothyroidism

Secondary hypothyroidism develops with inflammatory or traumatic lesions of the pituitary and / or hypothalamus( tumor, hemorrhage, necrosis, surgical removal or destruction of the pituitary gland), resulting in a disruption of the production of thyroid stimulating thyroid hormone synthesis, as a result of which the functionalactivity. More often secondary hypothyroidism occurs in the general pituitary pathology and is combined with hypogonadism( decreased function of the sexual glands), an excess of somatotropic hormone.

Who more often suffers from hypothyroidism

Hormones are microscopic particles that are formed by close interaction and the "fusion" of various chemical species and elements. These particles very actively come into "contact" with the cells of all organs and promote their normal work. To form hormones, thyroid cells require constant absorption of iodine from the blood, the lack of which can also cause a decrease in the concentration of hormones. Iodine is mainly found in seafood. But, unfortunately, very many countries, regions, cities and other settlements significantly removed from the seas, where the need for iodine is not enough. In such regions, thyroid diseases are much more common. These territories inhabit up to 250 million people. The optimal intake of iodine for normal thyroid function is about 150-300 micrograms( m / kg.) Per day. Daily intake of iodine less than 80 mcg is dangerous, since it does not allow to maintain a normal working state of the thyroid gland, which leads to the development of hypothyroidism. There are substances that prevent the movement of iodine to the place of formation of hormones, which leads to a violation of the gland. Products containing these substances are called "strugogenic"( ie, "work" against the normal secretion of thyroid hormones).These include: turnip, colored and red cabbage, mustard, rutabaga, as well as milk of cows, which are fed with these products. Diet supersaturated with these products, also contributes to the development of hypothyroidism.

Diseases of the thyroid gland - this is the most common among the inhabitants of megacities, such as Moscow, the problem. In recent years, the incidence of thyroid dysfunction has increased significantly in Moscow. This is due to the deterioration of the ecological situation in the city and the absence of measures for iodine prophylaxis.

The prevalence of hypothyroidism among the adult population of Moscow is 0.5-1%, among newborns - 0.025%, and among individuals older than 65, 2-4%.

Complications of hypothyroidism

The most severe, often fatal complication is the hypothyroid coma. It usually occurs with undiagnosed, long-term untreated or poorly treated hypothyroidism. The most typical for older women.

Stimulating factors contribute to the development of this complication, such as: cooling, especially when combined with lack of mobility, deviations from the normal functioning of the cardiovascular system, myocardial infarction, acute infections, psychoemotional and muscle overload, diseases or conditions that contribute to lowering body temperature.

Hypothyroid coma is characterized by the following symptoms:

• dry, pale yellow, cold skin;
• reduction in heart rate( bradycardia);
• lowering of blood pressure( hypotension);
• rare breathing;
• decrease in urinary output.

Diagnosis of hypothyroidism

The diagnosis of hypothyroidism is primarily established on the basis of characteristic clinical manifestations, namely, the appearance of patients and diagnostic laboratory tests. Functional deficiency of the thyroid gland is characterized by a decrease in iodine. In recent years, it has become possible to determine directly in the blood hormones: thyroid-stimulating( elevated content), T3 , T4( reduced content).

For diagnosis, ultrasound( ultrasound), timing of tendon reflexes, electrocardiography( ECG) are also used. If necessary, an endocrinologist recommends carrying out a computer tomography of the thyroid gland, according to which the expert specifies the diagnosis and develops an individual course of treatment. Sometimes a puncturematerial of the organ for diagnostic purposes) for the determination of malignant formations in the gland.

The diagnosis of hypothyroid coma in the absence of a diagnosis of "hypothyroidism" in the medical history can be difficult. The most important clinical manifestations of this condition are dry, pale, cold skin, a decrease in the heart rate( bradycardia), a decrease in blood pressure( hypotension), a decrease, and sometimes the disappearance of tendon reflexes. With hypothyroid coma, the patient must be urgently hospitalized.

What is necessary for consultation with hypothyroidism

1. Tell the patient about his state of health recently.
2. Thyroid ultrasound data taken shortly before the consultation and earlier by date.
3. Results of a blood test( total and on the hormones of the gland).
4. Information about the transferred operations, if there was a discharge epicrisis( recorded in the medical history of the doctor's report, which contains information about the patient's condition, diagnosis and prognosis of his illness, treatment recommendations, etc.).
5. Applied or applied treatment methods.
6. Information on the examination of internal organs, if any.

Treatment of hypothyroidism

The method of treatment of all forms of hypothyroidism is based on the use of drugs that are synthetic analogues of thyroid hormones( thyroid preparations).The effect develops during the first month of treatment. With a properly selected dose, the drugs are absolutely harmless, do not cause side effects, drug dependence and hormonal adjustment. The dose is chosen cautiously and gradually, taking into account the age of patients, the severity of hypothyroidism, the presence of concomitant diseases and the characteristics of the drug.

Prognosis of hypothyroidism

Hypothyroidism is life-long and in adults, the prognosis is favorable if adequate treatment is selected. In children with congenital hypothyroidism, even with optimal treatment, it is almost impossible to restore the functions of the brain, because of which the development of the disease is possible, and growth retardation is also observed.