Subclinical hypothyroidism and its features. The correct approach to treatment

  • Subclinical hypothyroidism and its features. The correct approach to treatment

    Hypothyroidism is a syndrome caused by an inadequate amount of certain thyroid hormones. This is one of the most frequent diseases of the thyroid, which is dangerous because its signs are similar to many somatic pathologies, and therefore possible long-term treatment for a completely different disease. There are three types of hypothyroidism:

    • manifest;
    • subclinical;
    • complicated.

    The greatest number of discussions in medicine is related to the second kind. Subclinical hypothyroidism is distinguished by the fact that its presence is indicated only by the signs revealed by laboratory testing of blood. With this syndrome, there is an increase in the level of the hormone TSH( thyroid-stimulating hormone) against the background of normal indices of free hormones.

    The main group at risk of the disease are elderly women. Sometimes subclinical hypothyroidism occurs in children, but it is, as a rule, temporary and is successfully eliminated by replenishing the level of hormones.

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    To the question of what?

    The following are the main causes of subclinical hypothyroidism:

    1. autoimmune thyroiditis( aka Hashimoto's disease, in which the body begins to destroy the thyroid cells);
    2. treatment with radioactive iodine preparations;
    3. resection of the thyroid( resection is an almost complete removal of the thyroid gland, performed in severe and neglected cases of thyrotoxicosis and oncology);
    4. treatment of diffuse toxic goiter, based on the use of thyreostatics;


    Symptoms of this disease are often absent, which complicates the process of its diagnosis. In a large number of cases, the diagnosis is made only after a hormonal blood test, which means, with a significant delay.

    If the symptoms are still present, that is, they have an external expression, then this:

    • memory and attention impairment;
    • mood disorders up to the development of depressive states;
    • disorders of menstrual function( irregular menstruation or none at all);
    • edematous syndrome: hearing loss, difficulty in nasal breathing, hoarseness of voice, presence of dentures in the tongue and other;
    • adverse changes in metabolism. It was found that subclinical hypothyroidism affects fat metabolism, which naturally leads to an increase in body weight, can cause atherosclerosis and development against it of coronary heart disease with angina attacks and the possibility of subsequent occurrence of myocardial infarction;
    • disruptions in the digestive system: constipation, cholelithiasis, biliary dyskinesia, hepatomegaly.

    There are some "buts":

    1. The set of symptoms in a particular person is purely individual, that is, there can be absolutely any combination. The picture of the signs should be evaluated as a whole.
    2. The most common symptoms, as the results of the studies show, are the first three of these symptoms.

    Symptoms, doubts - with guesses,

    should be examined Diagnosis of hypothyroidism consists of establishing the level of hormones TSH, T4( thyroxine), T3( triiodothyronine), and determining the exact causes of the disease. The content of the hormone T3 in the presence of the disease will be reduced or normal, and TSH - increased.

    Suspected subclinical hypothyroidism is performed by ultrasound. Depending on the results, ultrasound is prescribed either a scintigraphy of the thyroid gland, or the determination of antibodies, or a biopsy of thyroid nodules.

    Scintigraphy is a method of visualization, based on the introduction into the body of a radioactive isotope emitting radiation. Radiation is fixed, and thus the image of the thyroid gland is created: its anatomical structure is displayed, the presence or absence of additional lobes. Time of the research - 20 minutes. If you decide to perform a scintigraphy, do not worry, because the amount of isotopes introduced is such that the possibility of their toxic effect on the body is excluded.

    A biochemical blood test is also performed, as the cholesterol and other lipids in the blood are raised in this disease.

    How to treat and whether it is worth doing?

    Concerning the issue of the treatment of hypothyroidism, we should immediately point out the lack of a consensus among physicians. A number of authoritative scientists believe that subclinical hypothyroidism does not need treatment, since it is not a disease in general. But nevertheless, the need for treatment is due to the fact that the absolute majority of doctors and medical scientists confirm the potential danger of developing a number of complications in hypothyroidism.

    For this reason, the treatment of subclinical hypothyroidism is based on the correction of the level of TSH, and this is possible due to substitution therapy. The advantages of such therapy are:

    • preventing the progress of subclinical hypothyroidism to manifest;
    • reduced risk of death in cardiovascular diseases;
    • recurrent development of the symptoms of this disease.

    On the other hand, treatment involves lifelong administration of drugs, which entails certain difficulties. Therefore, the common practice is an individual approach to each patient, taking into account his age, the circumstances of the onset of the disease and some other factors. Exception is made only by pregnant women, who are prescribed therapy immediately. In all other cases, the decision to start treatment with L-thyroxine is taken only after evaluating the three components:

    1. what are the possible consequences in the absence of treatment;
    2. to what effect the use of the drug will result;
    3. what side effects will have L-thyroxine on the patient's body.
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