Mar 04, 2018
Hypothyroidism occurs when the thyroid gland located on the neck and controlling body growth and metabolism, produces an insufficient amount of thyroid hormone, which leads to a slowdown in all metabolic processes in the body.
This condition, caused by a prolonged, persistent deficiency of thyroid hormones - occurs in 19 out of 1,000 women, and 1 in 1,000 men. This disease is associated with a decrease in thyroid function. As a result, inadequate amounts of hormones( thyroxine and triiodothyronine) enter the blood, many organs and tissues suffer.
Symptoms depend on the degree of thyroid hormone deficiency and can develop slowly over many years. When symptoms manifest themselves in full, this disease is called myxedema. Although hypothyroidism can occur at any age and in people of both sexes, it is most common in women aged 50 years. The disease can be completely controlled with proper treatment. In rare cases, severe hypothyroidism left untreated can lead to coma as a result of myxedema;this life-threatening condition can be accelerated by illness, sedatives, cold weather, surgery or trauma.
Hypothyroidism, which develops in early childhood and left untreated, leads to mental retardation and dwarfism( cretinism).
In 99% of cases, the cause of hypothyroidism is the destruction of the thyroid itself( primary hypothyroidism), in 1% - the pituitary or hypothalamus( secondary hypothyroidism).How to treat this ailment with folk remedies, look here.
Diseases of the thyroid gland against which hypothyroidism can be detected: endemic goiter, thyroiditis( inflammation of the thyroid gland), nodular goiter, multinodular goiter. Also, hypothyroidism can lead to: removal of the thyroid gland, irradiation of the thyroid gland, treatment with thyreostatics. In this case, the manifestations of the disease can not substantially differ.
This is one of the most common ailments associated with metabolism: according to statistics, every tenth woman over 65 years old has signs of an initial stage of this disease.
The disease can be caused by malformations of the thyroid gland, can develop due to insufficient intake of iodine in the body( see "Endemic goiter"), as well as as a result of hereditary disorders( the thyroid gland can not produce a normal amount of hormones or produces hormones whose structureis broken and which do not have the necessary effect on the body).Sometimes children with a congenital form of hypothyroidism are born from mothers with diffuse toxic goiter and who received iodine medications or other drugs that cause a decrease in thyroid function during pregnancy,
In children, hypothyroidism is more likely to be congenital, in adults, acquired. An important role for the child's organism is played by the way the mother's pregnancy took place: occupational hazards, women's diseases, infections, inadequate nutrition, air polluted by industrial enterprises - all this can affect the state of the thyroid gland of the baby.
In adults, hypothyroidism is more likely to occur due to a lack of iodine in the environment, after the inflammatory diseases of the thyroid gland, as well as after the operation for diffuse toxic goiter. Uncontrolled use of drugs aimed at reducing the function of the thyroid gland( which are used in diffuse toxic goiter), can also lead to a decrease in the function of the gland - hypothyroidism. Prolonged reception of radioactive iodine or uncontrolled intake of iodine preparations in a number of cases also lead to the disease. Hereditary predisposition and immunity disorders play a role: there are cases when the body of patients produces antibodies against the tissues of their own organism, in this case, against the tissues of the thyroid gland.
Less commonly, hypothyroidism is associated with impaired brain structures. In this case, it may occur after meningitis and meningoencephalitis( cerebral and brain inflammation), cerebral trauma, nasopharyngeal tumors, etc. The development of hypothyroidism is caused by disorders of the organs and tissues of the body, associated with a deficiency of thyroid hormones. Since its hormones affect all types of metabolism, bone growth, oxidative processes in the body, nutrition of the brain and nervous system cells, hearts, nutrition, growth and renewal of the skin, hair, teeth, it becomes clear that manifestations of the disease canbe very diverse. The process of growth and formation of bones is broken, oxidative processes in the whole body are reduced. Mechanisms of protein synthesis and decomposition are also violated. Glucose in the intestines is absorbed worse than in healthy people, which leads to further violations of carbohydrate metabolism. Fats do not split sufficiently. Reduces the evaporation of water through the skin, as well as its absorption from the tissues, there is swelling. Despite the fact that calcium and phosphorus ions are trapped in the bones, the bones grow irregularly, become unstable. Mental activity slows down, the heart muscle, which receives inadequate amounts of nutrients, becomes weaker.
Manifestations of the disease can be different depending on the severity of the disease. In adults, the disease usually proceeds slowly, so patients do not consult a doctor for a long time. With mild hypothyroidism, there is a slight inhibition, reduced mental and physical performance, slow reaction, fatigue, muscle weakness, swelling of the tissues. Patients, as a rule, add weight, become sluggish, slow, phlegmatic, as if "too calm."There may be dry skin, brittle hair and nails, dull hair color, lower hemoglobin blood. Patients do not tolerate heat and cold, often complain of chilliness. Often develops goiter. Complaints are more pronounced with a moderate form. There are changes in the coronary vessels, slowing of the pulse, when examined doctors can listen to heart murmurs. On the part of the osseous system, osteoporosis is revealed, fractures often occur, from the female cycle, hormonal background disorders. Men may have a violation of potency and a decrease in sexual desire. Impaired memory and mental activity, weakness and fatigue are more noticeable.
Hypothyroidism may be accompanied by anemia. This gives the skin a pale and slightly yellowish hue. With hypothyroidism, the level of cholesterol in the blood rises, which can contribute to the development of atherosclerosis.
In severe form of the disease, deep lesions of organs and body systems develop. Deep mental deficiency( cretinism) may appear. In another way, the severe form of hypothyroidism is called "myxedema";as a rule, it occurs with congenital untreated hypotreosis in children: these children are lagging behind in growth and mental development;they have swollen, thick skin, dull, brittle hair and characteristic appearance: the tongue of such children often does not fit in the mouth, and the sharply lowered intellect can be judged by the expression on their face. Such children do not speak, they often do not go, they do not have the most usual motor skills at all. Such people usually consist of a disability in mental illness. But, fortunately, such severe forms of the disease are rare today. Most people have much lighter, and sometimes even erased, forms of the disease.
Hypothyroidism is especially dangerous for children: in childhood all the functions of the body are only being established, and if the thyroid hormones are not enough, then deep abnormalities in the body are possible, which then will be difficult to correct and restore. In most cases, children have congenital hypothyroidism. In this case, it is important to suspect the disease from birth, since its outcome depends on the age at which the treatment will begin. Treatment should begin in the first months of a child's life, as soon as possible. If it is started in the second year of life, then some of the functions( especially speech) may not recover and children will speak poorly, have difficulty learning, lagging behind in mental development.
Congenital hypothyroidism, as a rule, can be suspected already in the first 1-3 months after birth, but in any case - up to six months. More often it occurs in girls. Sick children in the period of newborns usually look healthy, but have an increased body weight, in comparison with usual children. The skin of these children is somewhat swollen. Many babies have "jaundice of newborns" for a long time. In addition, attract attention to a rough, low voice, noisy breathing, a tendency to constipation, a big belly, children are drowsy, sluggish. Often there are umbilical hernias. Despite the great weight at birth, many children have decreased appetite, insufficient weight gain. Most of these children often have ARI.If at this time the disease is not recognized, then by the half-year a more dramatic picture is revealed.
The skin of these children becomes dry, flaky, pale. A puffiness of the skin attracts attention. Edema is most often formed in the face, especially the forehead, eyelids, lips, cheeks. On the hands and feet due to the edema formed peculiar elevations in the form of pads. Facial facial expression is smoothed, it becomes less expressive, eyes narrower. Children tend to be overweight, but not because of the accumulation of excessive amounts of fat in the body, but because of the swelling of the tissues.
With hypothyroidism, characteristic changes can be seen from the side of the hair and nails. Nails are fragile, grow slowly, hair is dry, dull, brittle, often and often fall out.
Children are inactive, they have decreased muscle tone and muscle weakness. Children usually do not complain about changes in the heart, although they, as well as adults, have a slowing pulse, and electrocardiograms have been given a reduced voltage of the teeth. Vocal folds in patients tend to thicken, so a low voice appears characteristic of hypothyroidism. With untreated form of the disease, along with this, the tongue and lips usually thicken, which further changes the voice and appearance of the child. The breathing of such children is often noisy.
All patients have slowed mental reactions, delayed development of motor and mental skills, and in the absence of treatment, irreversible brain cell lesions, after which a full recovery of mental activity is impossible. In the severe form of the disease, one-year-old children practically do not differ in any way in their development from newborns. Afterwards, they begin to sit, crawl, walk later. These children have a bad memory, especially difficult to orient themselves in unfamiliar surroundings. The majority of patients are inactive, difficult to come into contact, are silent, withdrawn, do not show interest in adults and peers.
The growth of the bones of the skeleton is disturbed and slowed down. Children form short limbs, a relatively long body. The face of the patients becomes characteristic: a flat bridge of nose, a short nose, widely spaced narrow eyes. In terms of growth, such patients lag far behind their peers. There is a delay in the eruption of teeth - first dairy, and then permanent. The teeth usually appear in the wrong order, fragile, with incomplete enamel, they are strongly prone to tooth decay. Sexual development of children is delayed, as well as physical, and with the further absence of treatment, it is possible not only to disrupt ovarian function and disrupt the development of the cycle, but also to underdevelop the uterus and the sex glands. On the part of the blood, a decrease in hemoglobin is registered, an increase in the level of eosinophils, but there can be no pronounced changes on the part of the blood with hypothyroidism.
In addition to severe manifestations of the disease, complications are also possible. A life threatening complication is the hypothyroid coma - it can develop in elderly patients who have not been treated. At a coma there is a loss of consciousness and oppression of work of all organs of an organism. Coma can be caused by cooling, trauma, acute infectious and other diseases. When there are signs of a hypothyroid coma, you should immediately call an ambulance and take the patient to the hospital!
The main component is the so-called "substitution therapy".It is carried out with thyroid medications, which replace the missing hormones in the body. Tireodine, thyrotome, thyreocomb, etc. are used. As a rule, treatment is carried out in two stages. At the first stage, the doctor eliminates the lack of thyroid hormones, and on the second - selects a maintenance dose of the drug, which will further allow the patient to feel good. In the vast majority of cases, the treatment of hypothyroidism is carried out all life, less often the symptoms of an illness disappear with time. Some authors recommend starting with small doses of the drug, gradually increasing them to a larger one;Others, on the contrary, prescribe large doses immediately( before the appearance of light signs of thyrotoxicosis, that is, the increased function of the thyroid gland), which are further reduced to the desired ones. In children not treated in a timely manner, the administration of drugs can cause aggression, capriciousness, pugnacity, increased motor activity. Therefore, it is recommended that such children begin treatment with slightly lower doses than the rest, and then increase the dose of hormones. In the forms of hypothyroidism associated with the violation of brain structures, it is sometimes not thyroid hormones but thyroid-stimulating hormone and thyrotropin-releasing hormone that are prescribed.
In case of prescribing excessive doses of drugs, palpitations, irritability, sweating, itching of the skin, diarrhea, vomiting, restlessness, sleep disturbances, that is, signs of thyrotoxicosis, are possible. In such cases, the dose of the drug is reduced. Criteria for a properly selected dose are no complaints, and in children there is also normal growth and development.
The medication is administered once a day - in the morning, the doctor selects a dose individually, depending on the depth of hypothyroidism, the age of the patient, the condition of the cardiovascular system, the presence or absence of another pathology. With a properly selected dose of the drug, the thyroid-stimulating hormone level is within the normal range. The level of TSH is monitored once every 6-12 months.
However, do not limit yourself to prescribing drugs alone and to consider that this is enough. Do not forget about a diet rich in vitamins and minerals, the right regime, with mandatory outdoor exercise and moderate exercise. Massage, physiotherapy exercises are also applied, with reduced hemoglobin of blood - iron preparations. Unfortunately, with late-started treatment in children, it is not always possible to achieve lasting improvement from the nervous system. Many children still lag behind in development. In this case, it is also necessary to train with teachers, psychologists, a complex of rehabilitation measures, drugs that improve metabolic processes in the brain and stimulate the development of brain activity.
Pathological significance for fetal development has both developed and subclinical variants of hypothyroidism in pregnant women.
Even with the normal laying of the thyroid gland in the fetus( secrete thyroid hormones the child begins with 15 weeks gestation) the effects of hypothyroxinemia in the first half of pregnancy are irreversible.
Medically compensated hypothyroidism is not a contraindication for pregnancy planning.
In connection with the fact that the need for thyroxine during pregnancy increases, it is necessary to increase the dose of thyroxin by 50 mcg immediately after pregnancy, and then calculate the dose, focusing on the low-normal level of thyroid-stimulating hormone and the high normal level of free T4.
When hypothyroidism is first detected in a woman during pregnancy, a full replacement dose of thyroxine( 2.3 μg / kg body weight) is immediately given without a gradual increase, as is customary outside pregnancy.
Congenital hypothyroidism may be due to aplasia or hypoplasia of the thyroid gland in newborns, a deficiency of enzymes involved in the biosynthesis of thyroid hormones, and a deficiency or excess of iodine during intrauterine development. The cause may be the effect of radionuclides of iodine, since from 10-12 weeks of intrauterine development the thyroid gland of the fetus begins to accumulate iodine. Clinical manifestations of congenital hypothyroidism include a large body weight of the newborn;puffiness of hands, feet, face, dense skin;hypothermia;weak sucking reflex;intensive weight gain.
When suspected of congenital hypothyroidism, TSH is determined on the 4th-5th day after birth. Increase in the level of TSH is considered an indication for treatment with thyroid hormones. Treatment begins no later than the 5th-17th day after birth. The adequacy of the dose is controlled by the concentration of cT4 and TSH.
If hypothyroidism is combined with chronic insufficiency of the adrenal cortex, correction of corticosteroids and careful selection of thyroid hormone doses are necessary to avoid an adrenal crisis.
There is no known way to prevent hypothyroidism, although scanning can detect it at an early stage and take appropriate measures to treat those who are at risk of congenital hypothyroidism.
It is important that there is a complete, rich in vitamins, minerals and iodine nutrition. In regions where there is a natural shortage of iodine, the use of iodized salt is recommended instead of the usual one. Restock the shortage of iodine in the environment can the products of the sea( shrimp, crab, mussels, shellfish, sea kale, etc.).It is recommended to eat seafood dishes several times a week.