Hypothyroidism is a silent thief stealing life. Symptoms, treatment of hypothyroidism

Hypothyroidism is a pathology (group of syndromes) that is caused by a severe lack or complete absence thyroid hormones. As a rule, it develops against the background of complete dysfunction of this endocrine organ. Important:According to medical statistics, hypothyroidism has become perhaps the most common pathology among all endocrine diseases. It affects most women over 65 years of age, as well as people living in great distance from the sea (i.e. in areas where the air is less iodized).

Classification

The thyroid gland is responsible for the production of T3 (triiodothyronine), T4 (thyroxine) and helps increase the pituitary hormone (TSH).
These biologically active compounds regulate all types of metabolism, control the activity of most organs and systems, are responsible for the growth and development of the body as a whole, strengthen and have an anti-stress effect. Please note:against the background of a lack of hormones of this group, women often experience menopause prematurely and menopausal disorders worsen. Hypothyroidism is usually divided into 3 groups:

Primary;
secondary;
central.

The primary form is caused by disruption of the activity of the endocrine gland itself and, as a consequence, a decrease in the secretion of its hormones. The secondary form is determined by malfunctions in the functioning of the pituitary gland or hypothalamus - these areas of the brain are responsible for regulating the production of TSH.
There is also hypothyroidism of central origin (tertiary). It is caused by toxic effects hormonal drugs, as well as a decrease in the number of cells producing thyroid hormonal compounds. In the latter case possible reason tumors may appear and viral infections. Per share central shape hypothyroidism accounts for up to 5% of clinical cases.

Causes of hypothyroidism

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As a rule, the cause of hypothyroidism is chronic thyroiditis of autoimmune origin - an inflammatory pathology during the synthesis of antibodies due to immune dysfunction. Other etiological factors include:

genetically determined defects in the formation of specific hormones;
underdevelopment (hypoplasia) of the gland from birth;
history of surgical interventions on the gland;
therapy performed toxic goiter through irradiation and radioactive isotopes iodine;
low dietary intake of iodine;
drug therapy with certain drugs;
organ tumors;
chronic infectious diseases of the endocrine gland (fungal, tuberculosis, etc.).

Secondary pathological process develops when:

elimination of the pituitary gland;
traumatic injury to the pituitary gland or hypothalamus;
inflammation of the endocrine organ;
necrosis of the thyroid gland;
gland tumors.

What changes are possible?

When the volume of incoming thyroid hormones drops for the worse, the overall metabolism changes and worsens functional activity cardiovascular system and gastrointestinal tract, changes in the psyche are recorded, libido decreases.

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The clinical picture of this pathology is growing very slowly, which is why patients come to a specialist when there are significant changes in the body. Typical symptoms of hypothyroidism are:

general lethargy and weakness;
feeling drowsy;
decreased ability to remember:
deterioration of attention;
decrease in cognitive abilities;
poor tolerance to temperature stimuli (cold and heat);
dry skin and dandruff;
alopecia (both men and women);
the appearance of edema (mainly of the face and limbs);
constipation;
increased body weight;
violation menstrual cycle in women;
decreased libido and erectile dysfunction for men:
reduction in heart rate;
sweating;
loss of appetite;
flatulence;
arrhythmia;
anemia.

Important:in the absence of adequate timely therapy (especially in elderly patients), a life-threatening condition may develop - hypothyroid coma. This condition is characterized by loss of consciousness and inhibition of basic body functions. Conditions that provoke coma can include hypothermia, acute diseases(including infectious origin), myocardial infarction, etc.

Diagnostics

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The diagnosis of hypothyroidism is made exclusively by an endocrinologist. The grounds for diagnosis are:

In case of primary hypothyroidism, if the cause of the disease lies in a malfunction of the thyroid gland, the analysis data for thyroid hormones will be as follows:

T3, T4 – reduced level (sometimes the level can be normal);
TSH – increased;
AT-TG, AT to TPO – normal.

With secondary hypothyroidism, if the cause of the disease lies in disorders of the brain, the following results are possible:

T3, T4, TSH – decreased;
AT-TG, AT to TPO – normal.

Important:Among the instrumental methods for examining the patient, ultrasound examination of the organ, as well as scintigraphy and biopsy of the thyroid gland are often indicated.

The basis modern therapy Hypothyroidism is a “replacement” form of treatment, during which the patient receives hormones that are not sufficiently produced by the own thyroid gland. Dosage medicines is selected by the attending endocrinologist taking into account the severity of the pathology, the patient’s age, as well as the presence (or absence) of certain other general somatic diseases. Modern drugs are well tolerated by most patients with hypothyroidism. Most medications need to be consumed only once a day. The majority of patients with hypothyroidism require lifelong maintenance treatment; To regularly monitor the level of TSH and thyroid hormones, patients need to undergo an annual medical examination (examination by an endocrinologist). One of the important etiological causes of hypothyroidism is insufficient iodine intake through the nutritional route (from food). In this case, patients are recommended to consume iodized salt (instead of regular table salt) and eat as much seafood as possible (of course, if they are not allergic to them).
Following the doctor’s recommendations and adequate use of appropriate medications allows you to completely get rid of the negative manifestations of the disease.

Possible consequences

Untreated hypothyroidism leads to rapid and steady deterioration general condition patient and appearance dangerous complications. In elderly and old age hypothyroid coma can cause fatal outcome. In children, this pathology leads to irreversible retardation of physical growth and mental development. One of possible consequences may become serious violation– cretinism. An endocrinologist talks about the symptoms, causes of development, methods of diagnosis and treatment of hypothyroidism in this video review:

Konev Alexander, therapist

Hypothyroidism, the treatment of which depends on the stage of its development, is a complex disease in which the function of the thyroid gland is reduced, which leads to insufficient production of many important hormones. Considering how important such elements play for human body, problems with the thyroid gland can cause serious problems with health.

Thyroid problems and hypothyroidism

If the thyroid gland produces insufficient quantity of one hormone or another, this can lead to the development of symptoms such as chronic fatigue and weakness, increased drowsiness, weight problems, slowed speech, thought processes and hypotension. In women, thyroid pathologies cause menstrual irregularities.

Hypothyroidism is a problem that can affect anyone, regardless of age. This pathology occurs in both children and adults. Elderly people often suffer from the disease. Hypothyroidism of the thyroid gland is very dangerous and requires timely treatment. In childhood similar pathology may cause cretinism. Moreover, hypothyroidism can lead to serious complications, which include coma, pathologies of the heart muscle and blood vessels, coronary disease, atherosclerosis and bradycardia.

In order to get rid of hypothyroidism, you need to see a doctor and undergo quality treatment. The most commonly used hormone therapy is thyroid hormones. However, there is also treatment without hormones, which will only be relevant for the initial stage of the disease.

Features of the disease

Hypothyroidism, the symptoms and treatment of which depend on the stage of development, is the most common form of diseases that are associated with the thyroid gland. This pathology develops due to a severe hormone deficiency that lasts for a long time. The peculiarity of this disease is that it does not manifest itself for a very long time. The course of the disease is so sluggish and the symptoms are mild that it is sometimes possible to determine hypothyroidism only on late stage its development. This is very dangerous and creates certain difficulties in treatment.

Increased fatigue

Often, patients who experience increased fatigue, drowsiness and other symptoms of hypothyroidism associate them with ordinary fatigue or depression. This is how a person can live long time until the manifestations of the disease become strong enough. This disease is diagnosed in 1% of men and 2% of women. In adulthood, 1 in 10 patients receive this diagnosis.

With a constant lack certain hormones Many negative changes occur in the patient’s body. Due to a lack of thyroid hormones, oxygen deficiency, energy production and its processing by the body decreases. Negative changes occur at the cellular level. All this is very dangerous, especially for the functioning of the heart and blood vessels.

Depending on the form of the disease, the symptoms are somewhat different. But still, the main signs, which are pronounced, occur in any case.

Classification of the disease

Hypothyroidism is divided into congenital and acquired. In the first case, the cause may be a genetic deviation, poor heredity and problems during pregnancy. As for the acquired type, there are a lot of reasons. Often, patients are diagnosed with a chronic type of hypothyroidism, which develops over several years when the thyroid gland is damaged. This type of disease is called autoimmune hypothyroidism. There is also an iatrogenic type of illness that occurs when treating the thyroid gland with radioactive iodine or when an organ is removed. It is the acquired form of the disease that is the most common. It is diagnosed in 99% of patients. Chronic and iatrogenic hypothyroidism are irreversible diseases. But a mild degree can be treated and corrected even without hormones.

Classification of acquired hypothyroidism

The classification of this disease includes hypothyroidism, which occurs against the background poor nutrition or lack useful substances in the body. Mild and moderate iodine deficiency often occurs in newborns and pregnant women. This type of disease is called transient hypothyroidism. To get rid of the problem, it is enough to eliminate the factor that causes iodine deficiency in the body. For this they use special diets, vitamin complexes and various physiotherapy procedures. Often this is quite enough to eliminate hypothyroidism in mild form.

Pregnant women should carefully monitor their diet. It is important that the expectant mother’s body has enough iodine and other useful elements. This is of great importance, since iodine deficiency during pregnancy can lead to underdevelopment of the central nervous system fetus This indicates that a child is awaiting mental retardation, including cretinism, underdevelopment skeletal muscles and some important organs. Thus, a lack of iodine alone can cause the baby to become disabled.

Doctors divide hypothyroidism into primary, secondary and tertiary. The first case is characterized by problems with the thyroid gland and high level. In a secondary disease, the pituitary gland is damaged, and in a tertiary disease, the function of the hypothalamus is disrupted.

The development of primary hypothyroidism occurs due to inflammation and hypoplasia of the thyroid gland. In addition, such a pathology can be a consequence genetic defect, which could lead to disruption of the production of thyroid hormones. But one of the most common reasons The development of this problem is an insufficient amount of iodine in the patient’s body. It is worth noting that the cause of hypothyroidism cannot always be determined immediately. In some cases, doctors remain unclear about the factor that caused such a disease in the patient.

The primary type of disease is much more common than others. Secondary and tertiary hypothyroidism occurs due to damage to the hypothalamus and pituitary gland. As a result, the brain's control over the thyroid gland is disrupted. Most often, this is observed due to a tumor, after surgery, trauma and radiation.

Hypothyroidism in older people

Among all endocrine diseases, hypothyroidism is the most common disease in older people. Problems that occur due to a persistent decrease in the amount of thyroid hormones occur in 15% of older people. At the same time, representatives of the stronger sex experience hypothyroidism much less frequently than women.

In 95% of cases, older people are diagnosed with primary hypothyroidism. This is especially true for those patients who have autoimmune diseases, have undergone surgery or complex treatment processes for the thyroid gland and the use of radioactive iodine. Autoimmune hypothyroidism is characteristic disease for those who had to undergo irradiation of the head and neck, as well as for patients with iodine or selenium deficiency.

Secondary and tertiary hypothyroidism in older people is not often diagnosed. However, a certain percentage of patients still encounter this problem.

Symptoms of the disease

A disease such as hypothyroidism is quite complex and dangerous. The thing is that it is very difficult to diagnose at an early stage of development. As a result, patients turn to professionals and receive proper treatment at a stage when the disease reaches a serious level of development and the prognosis is already disappointing.

The clinical manifestations of the disease directly depend on factors such as the degree of development of the disease, its form, the age of the patient, as well as the reasons why hypothyroidism began to manifest itself. The speed with which hormone deficiency increases is also taken into account.

In mild or moderate form, thyroid hypothyroidism may not manifest itself with any noticeable symptoms. However, even in this case, pathologies are possible internal organs. Each patient's symptoms are different, so it can be very difficult for a doctor to make a correct diagnosis.

Persistent type of hypothyroidism

With a persistent type of disease, everything is somewhat simpler, since in this case you can immediately notice the symptoms characteristic of this disease. First of all, it is worth highlighting swelling due to hypothyroidism, which is mainly concentrated in the facial area. Skin becomes yellowish, the patient is bothered by tingling, muscle pain and weakness of the upper limbs. Many patients with a significant decrease in the production of certain hormones due to iodine deficiency complain of dry skin, brittle nails and intense hair loss. People with persistent hypothyroidism have sparse and dull hair.

Not only physically, but also psychological state you can understand that a person has problems with the thyroid gland. Patients with persistent hypothyroidism are often in a state of apathy, they are inhibited and cannot overcome depression on their own. In the most severe phase of the disease, speech slows down. The person does not pronounce words normally. One gets the impression that he is drunk, although in fact the problem is a lack of hormones.

A common symptom of hypothyroidism is hearing problems. The patient's voice is hoarse and muffled. Due to severe hormonal imbalance, it is difficult for the patient to fight overweight. In addition, chilliness is noted against the background of hypothermia.

Nervous system in hypothyroidism

The nervous system suffers greatly with hypothyroidism. Because of this, memory decreases, attention and concentration differ from the norm, but most importantly, the patient loses interest in life. The patient does not want to learn anything new, constantly complains of fatigue, gets tired quickly, falls asleep during the day and cannot fall asleep at night.

When the first signs appear, both mental and physical, you must consult a doctor. Most often, specialists manage to normalize the patient’s condition. When using replacement therapy the symptoms of hypothyroidism disappear completely and the person can return to normal life. It is especially important to pay attention to signs of congenital hypothyroidism. In the absence proper treatment in children under 3 years of age the disease can cause severe harm body, and the consequences of hypothyroidism will become irreversible.

Lack of timely treatment of pathology can lead not only to central nervous system disorders, but also to diseases of the cardiovascular system, arterial hypertension, increased blood cholesterol, anemia and constant headaches.

Some patients also experience disturbances in the gastrointestinal tract. Abnormal hormonal levels lead to loss of appetite, constipation, nausea and hematomegaly.

Hypothyroidism in women

Representatives of the fair sex face the problem of hypothyroidism much more often than men. At the same time, women are characterized by certain symptoms that are associated with menstrual irregularities, uterine bleeding and pathologies of the mammary glands. Mastopathy often occurs against the background of hypothyroidism. Severe violation hormonal levels leads to infertility. Even if a woman can become pregnant, it is impossible to bear a child until the disease is cured. With hypothyroidism, both sexes experience a decrease in libido.

The symptoms of problems with the thyroid gland are extremely broad. This is a big problem, as it can be difficult for a specialist to make a correct diagnosis. It is easiest to identify the problem in young children. Initially, muscle hypotonia will be noticeable, bloated belly, enlargement of the fontanel and big tongue. If the baby does not receive proper treatment, he will stop eating normally, will suffer from constipation, his skin will become dry, and his muscles will become weak. At an older age, there will be noticeable deviations in mental and physical condition child. In addition, there is always a disproportionate growth of paired organs.

Treatment of hypothyroidism

This disease is very complex and dangerous, so its treatment cannot be delayed. This is especially true for the congenital type, since in young children this disease can cause a lot of complications. Most of them are irreversible, so you need to start getting rid of the pathology at an early stage. If treatment for hypothyroidism in a newborn is not started immediately, this can cause the development of cretinism and serious damage to the central nervous system.

At the first suspicion of hypothyroidism, it is necessary to undergo diagnostics. This will allow you to start treatment on time and do it correctly. Most often, specialists prescribe hormonal therapy. However, if the patient consults a doctor when the illness is initial stage development, there is a chance to get rid of problems with the thyroid gland with non-hormonal treatment.

If you suspect autoimmune hypothyroidism, you should consult an endocrinologist.

The specialist must prescribe a series of tests that will determine the level of hormones in the blood, autoantibodies to the thyroid gland, the amount of cholesterol and various lipids. Important diagnostic method is an ultrasound of the thyroid gland.

If tests show that the patient has hypothyroidism, appropriate treatment will be prescribed. The most commonly used is hormonal therapy, that is, medications with artificial thyroid hormone. It's about about levothyroxine, which can fully replace the natural element. Positive results become noticeable already in the first week of using the medicines. But all the symptoms of hypothyroidism disappear after a month and a half. If the disease does not cause irreversible complications, the person will be able to return to normal life.

Conclusion

The sooner a patient sees a doctor, the higher his chances of quickly curing the disease. In mild cases, hypothyroidism is treated without hormones. It lies in the right diet. The diet should contain foods high in iodine, carrots and beets. An iodine solution helps well, which patients should take 3 times a day. An important component without hormone therapy is vitamin complex with high iodine content. Such drugs can also be taken to prevent hypothyroidism. This will allow you to avoid many problems with the thyroid gland, get rid of the need to use hormonal medications, which have a lot of side effects, including weight gain, decreased immunity, and the development of pathologies of the heart and stomach.

Hypothyroidism How cause depressed states

Fadeev V.V.

On the relevance of the problem of hypothyroidism in clinical practice There is no need to mention doctors of absolutely any specialization. Hypothyroidism is one of the most common diseases endocrine system. According to some epidemiological studies in certain population groups, the prevalence of subclinical hypothyroidism reaches 10 - 12%. With a deficiency of thyroid hormones, which are absolutely necessary for normal functioning almost every cell develops severe changes all organs and systems without exception, including the nervous system.

Definition and classification

Hypothyroidism - clinical syndrome, caused by persistent deficiency of thyroid hormones in the body. Like the failure of other pituitary-dependent endocrine glands, hypothyroidism is divided into primary, secondary and tertiary. Primary hypothyroidism, which develops as a result of destruction (removal) of the thyroid gland, is of greatest clinical importance. Among the causes of primary hypothyroidism highest value in clinical practice have chronic autoimmune thyroiditis (AIT), surgical interventions on the thyroid gland and therapy 131 I for various forms of goiter.

The overall prevalence of manifest hypothyroidism in the population is 0.2 - 2%, subclinical - approximately 7 - 10% among women and 2 - 3% among men. In the group of older women, the prevalence of all forms of hypothyroidism can reach 12% or more.

Primary hypothyroidism is classified according to severity into subclinical, manifest and complicated (Table 1). Thus, the severity of hypothyroidism can vary from the asymptomatic course of the disease, in which minimal hypothyroidism is detected only using modern laboratory methods, up to myxedematous coma.

Table 1. Classification of primary hypothyroidism by severity

The concept of subclinical hypothyroidism, which has finally emerged over the last decade, is based on the physiological relationship in the TSH-T4 system. Subclinical hypothyroidism refers to minimal thyroid dysfunction, in which an isolated increase in TSH levels is determined with a normal level of free T4 in the blood. Let us immediately emphasize that the fact of the presence or absence of any symptoms of hypothyroidism does not matter for the diagnosis of subclinical hypothyroidism. Manifest hypothyroidism is a deficiency of thyroid function in which an increased level of TSH is detected with a decrease in the level of free T4. In most cases, it is possible to identify symptoms of hypothyroidism of varying severity. However, even with obvious laboratory changes, they may not exist. Complicated hypothyroidism is spoken of in a situation where hypothyroidism has led to severe somatic or neurological disorders, such as cretinism, heart failure, polyserositis, myxedematous coma, etc. Note that this classification, which is currently given in most foreign manuals, is based primarily on data laboratory research, which is its significant advantage, since it is practically devoid of subjectivity.

Modern ideas about the clinical picture of hypothyroidism

The clinical picture of hypothyroidism varies significantly depending on the severity and duration of thyroid hormone deficiency, as well as on the patient’s age and the presence of concomitant diseases. The faster hypothyroidism develops (for example, after surgical removal of the thyroid gland), the more obvious clinical manifestations he is accompanied. On the other hand, even with the same severity and duration of hypothyroidism, the clinical picture will be very individual, that is, on the one hand, completely obvious hypothyroidism may not have any clinical manifestations and be detected by chance, on the other hand, some patients with subclinical hypothyroidism may present a lot of complaints characteristic of hypothyroidism.

But even these difficulties clinical diagnostics Hypothyroidism is not limited to. The fact is that most symptoms of hypothyroidism have very low diagnostic sensitivity and none of them are pathognomonic. Taking into account the foregoing, we can conclude that hypothyroidism is a rare disease in endocrinology, for the diagnosis of which, at present, clinical picture data are of secondary importance.

Nervous system in hypothyroidism

The most severe changes as a result of even minimal deficiency of thyroid hormones develop in the nervous system in perinatal period(Fig. 1, Table 2). With congenital hypothyroidism, in the absence of replacement therapy, severe developmental defects develop, which are combined with the term cretinism - extreme degree disorders of mental and physical development. Explicit morphological changes in the central nervous system can also be seen in the case of acquired hypothyroidism. Thus, in patients with long-term severe hypothyroidism, neuronal atrophy, gliosis, degeneration foci, as well as accumulation of mucinous material and round glycogen bodies (neuronal myxedematous bodies) were identified. In addition to obvious neurological changes, with hypothyroidism there is a disturbance in the metabolism and production of a number of mediators. Such a common symptom of both subclinical and manifest hypothyroidism as depression is associated with a decrease in the activity of 5-hydroxytryptamine in the central nervous system. Purpose large doses T3, in some cases, can reduce the severity of refractory depression or increase the effectiveness of antidepressants.

Table 2. Neurological manifestations of hypothyroidism in adults

Classic neurological manifestations obvious hypothyroidism are well known. Patients, as a rule, are depressed and almost always themselves find some good reason for this. A number of patients, describing their condition, say that it is as if “the power has been turned off” or “they want to lie down and not think about anything.” Severe hypothyroidism is characterized by memory impairment, slowed thinking processes and emotional poverty. As much as thyrotoxicosis is “rich” in emotions and experiences, hypothyroidism is “poor” in them. In the literature one can find many descriptions of severe mental changes and the so-called “myxedematous delirium”, as a result of which patients were mistakenly admitted to psychiatric clinics.

The brain is extremely sensitive to a deficiency of thyroid hormones in the body even with subclinical hypothyroidism, i.e., when hormonal study If only an increase in TSH level is detected, certain changes may develop. Most often suffers emotional sphere. This is manifested by depressed mood and depression (Table 3).

Table 3. Prevalence of depression (%) in subclinical hypothyroidism

Joffe R.T. and Levitt A.J. (1992) examined 139 patients with unipolar depression; 19 of them were diagnosed with subclinical hypothyroidism. The authors concluded that depression in subclinical hypothyroidism is characterized by the presence of feelings of panic and a “poorer” response to treatment with antidepressants. Study by Howland R.H. (1993) confirms the association between hypothyroidism and treatment-refractory depression. Among patients with depression refractory to treatment, 52% were diagnosed with subclinical hypothyroidism. With subclinical hypothyroidism, cognitive function decreases, memory and attention deteriorate, and intelligence is clearly or covertly decreased.

Diagnostics

Due to the fact that with hypothyroidism, as indicated, there are no pathognomonic symptoms and changes that occur exclusively with it, the latter very often “mask” another pathology. There are two main groups of diagnostic errors encountered in hypothyroidism. The first one is very characteristic group errors is due to the dominance of one symptom in hypothyroidism and the weak expression of others: for example, the patient has been diagnosed with depression, hypochromic anemia or chronic constipation for many years. The second option is exactly the opposite: the patient is given a lot of “diagnoses,” most of which are pathogenetically caused by hypothyroidism alone. Such diagnoses can take up half a page in extracts from medical records. At the same time, patients exhibit anemia, chronic constipation, diffuse alopecia, depression, polyserositis, dyslipidemia, obesity, gallstone and urolithiasis and even senile dementia or Alzheimer's disease. Both of these types of errors are natural and in the vast majority of cases do not fall under the category of medical negligence, since, in fact, the “mask” of hypothyroidism, according to modern ideas, can only be removed by a hormonal study.

Subclinical hypothyroidism – a syndrome caused by a persistent borderline decrease in the level of thyroid hormones in the body, in which a normal level of free T4 (thyroxine) is determined in combination with moderate increased level thyroid stimulating hormone (TSH).

Frequency of subclinical hypothyroidism in the population from 1.2% (in the group of people young) up to 21% (in elderly people).

Unfortunately, there are no clear pathogonic syndromes that allow high probability suspect hypothyroidism(even clinical). In practice, it may help that hypothyroidism affects all systems and organs, so its manifestations will most often be systemic in nature. Hypothyroidism, including subclinical one, will be characterized by the presence of damage to the cardiovascular system. At the same time, hypotension and bradycardia, classic for hypothyroidism, do not occur very often. On the contrary, patients often complain of interruptions in heart function, tachycardia, it is noted arterial hypertension(mainly diastolic). There is pastiness of the face, legs, periorbital, mainly morning edema, and a slight increase in body weight. Patients may note that they feel “more cold.” Anemia, tendency to constipation, brittle nails, hair loss, hyperprolactinemia and menstrual irregularities, hearing loss, frequent colds– all this can be a manifestation of hypothyroidism, including subclinical one.

Basic clinical feature neurological syndromes in primary hypothyroidism is their “mild” course, which most often does not lead to severe social maladaptation and disability of patients. But the neurological disorders present in patients worsened the quality of life, sometimes are the reason for visiting a doctor, and in some cases require neuroprotective and neurotrophic therapy in addition to hormone replacement therapy.

In subclinical hypothyroidism with a high frequency in the pathological process, to varying degrees, all parts of the nervous system are involved. Moreover, combined damage to the central and peripheral nervous systems is possible with the severity of clinical neurological disorders ranging from mild to moderate.

Damage to the central nervous system with mild deficiency of thyroid hormones, as a rule, leads to the formation of a syndrome complex (not reaching a pronounced degree), including:
frequent psycho-emotional disorders (asthenia and neurosis-like syndrome);
headaches;
cognitive impairment;
autonomic disorders;
focal neurological symptoms.

psycho-emotional disorders

Patients note that they began to “get more tired” (increased fatigue during usual household and professional activities), the appearance increased irritability, anxiety, drowsiness (it should be emphasized that insomnia is more common in patients with subclinical hypothyroidism than hypersomnia), a common complaint is general weakness and apathy. Moreover, both general weakness and apathy often occur at times (paroxysmal), persisting for several days, after which normal well-being returns, which may be due to the activation of metabolism under certain conditions and the disruption of relative hormonal compensation that exists in patients with subclinical hypothyroidism . These attacks of general weakness and apathy, as a rule, are provoked by physical, sometimes mental stress, or may be unrelated to anything.

headaches

Headaches with subclinical hypothyroidism occur in the vast majority of patients. Headache is based on venous, meningeal-hypertensive, vertebrogenic (and their combination) mechanisms of occurrence, which, in conditions of a lack of thyroid hormones, are based on myxedematous edema, most pronounced in connective tissue, failure of heart function with increased peripheral vascular resistance, decreased blood flow velocity. This can probably lead to mild swelling of the membranes of the brain, as well as disruption of venous and cerebrospinal fluid outflow. The consequence of these processes is the appearance of complaints in patients about a feeling of heaviness in the head, “pressure from within”, discomfort (the head is “stale”, “cast iron”), often combined with a feeling of pressure on the eyes and objectively detected periorbital edema. As a rule, these symptoms are expressed in the morning, after working in an inclined position. Some patients may develop night or morning headaches of a bursting nature, often with nausea, sometimes with vomiting.

cognitive impairment

Most often, patients with subclinical hypothyroidism complain of difficulties that arise when it is necessary to concentrate (“absent-mindedness”), to delve into what is being said or written, and a rapidly increasing decrease in attention. Some patients report forgetfulness, although memory loss is rarely the main complaint.

autonomic disorders

The most common symptoms of subclinical hypothyroidism are autonomic disorders. Often, with subclinical hypothyroidism, the development of a psychovegetative syndrome in the form of paroxysmal states similar to panic attacks. One of the manifestations of subclinical hypothyroidism is vegetative-vascular-trophic syndrome in the form of dry skin, acrohyperhidrosis, acrocyanosis, changes in dermographism, as well as progressive autonomic failure syndrome. With the latter syndrome, patients note periods of general weakness, periodic dizziness and darkening of the eyes during the transition to vertical position(insufficient autonomic support for the activity of the cardiovascular system, as a rule, is confirmed when conducting an orthoclinostatic test in this group of patients). An almost obligatory complaint is mild dizziness, which is mostly non-systemic in nature, short-lived and often has a positional dependence.

focal neurological symptoms

During examination, it is possible to identify malnutrition eyeballs, convergence paresis, staggering in the Romberg position, increased tendon and periosteal reflexes in combination with soft carpal analogues, less often - slight intention during the finger-nose and knee-heel test. In most patients, mild, predominantly sensitive polyneuropathy is detected, primarily affecting upper limbs, in combination with clinical signs tunnel syndromes. Most often, tunnel neuropathies are multiple in nature, involving mainly the nerves of the hands (syndromes of the carpal, cubital canals, Guyon's canal) with a predominance of sensory disorders in the clinical picture. In addition to objectively detectable neurological symptoms, when questioned, some patients complain of pain and a feeling of “crawling goosebumps”, a feeling of numbness (paresthesia) more pronounced in the hands (when analyzing the complaints, it turns out that numbness of the hands usually develops at night and morning time, as well as when performing monotonous work, for example, knitting).

The most rare in subclinical hypothyroidism are myopathic syndrome And myotonic phenomenon. Non-severe myopathy is manifested mainly by mild weakness in the proximal leg muscles and is verified by needle EMG data. It is possible to develop cramp-type cramps, more often in the muscles of the leg and foot, less often in the muscles of the hand.

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

The thyroid gland is often an arena of inflammation, as it is located on the neck, in close proximity to frequently infected organs, and is easily exposed to adverse effects. environmental factors, is very abundantly supplied with blood and practically serves as an arena for biochemical processes.

Violation normal condition thyroid gland leads to disruption of hormone secretion. The most common diseases are: hypothyroidism, hypoparathyroidism and hyperparathyroidism.

Thyroid diseases are the most common problem among city residents. In recent years, cases of thyroid dysfunction have increased significantly in Moscow. This is due to the deterioration environmental situation in the city and the lack of iodine prophylaxis measures.

The prevalence of this endocrinological disease (hypothyroidism) among the adult population of Moscow is 0.5-1%, among newborns - 0.025%, and among people over 65 years old - 2-4%.

General information

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

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

In adults with hypothyroidism, brain dysfunction develops, which is characterized by a decrease in mental activity and intelligence, a weakening of reactions to various situations, and other signs of hypothyroidism. When the functioning of the thyroid gland decreases, disorders of other endocrine organs can also be observed.

Who is more likely to suffer from hypothyroidism?

Hormones are microscopic particles that are formed through the close interaction and “fusion” of various chemical particles and elements. These particles very actively come into “contact” with the cells of all organs and contribute to their normal functioning.

To produce 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 (they are included in the diet for hypothyroidism). But, unfortunately, there are many countries, regions, cities and other settlements, significantly remote from the seas, where the need for iodine is not sufficiently met. In such regions, thyroid diseases are much more common. These territories are inhabited by up to 250 million people. Optimal iodine intake for normal operation thyroid gland about 150-300 micrograms (m/kg) per day. A daily iodine intake of less than 80 mcg is dangerous because it does not allow you to maintain normal working condition thyroid gland, which accordingly leads to the development of hypothyroidism, especially in children.

There are substances that prevent the movement of iodine to the site of hormone formation, which leads to dysfunction of the gland.

Products containing these substances are called “gumogenic” (i.e. they “work” against normal secretion thyroid hormones). These include: turnips, cauliflower and red cabbage, mustard, rutabaga, as well as milk from cows that are fed these products. A diet rich in these foods also contributes to the development of hypothyroidism. Hypothyroidism can be congenital, autoimmune, acquired as a result of various injuries and infectious diseases.

Thyroid diseases are the most common problem among residents of megacities such as Moscow. In recent years, cases of thyroid dysfunction have increased significantly in Moscow. This is due to the deterioration of the environmental situation in the city and the lack of iodine prevention measures.

What is the thyroid gland

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

regulation of metabolism;
increasing heat transfer;
strengthening oxidative processes and consumption of proteins, fats and carbohydrates, which is essential to provide the body with energy;
release of water and potassium from the body;
regulation of growth and development processes;
activation of the adrenal glands, reproductive and mammary glands;
have a stimulating effect on the activity of the central nervous system.

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

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

Symptoms of hypothyroidism

Thyroid hormones, as noted above, are involved in many body functions; therefore, when its performance decreases, disturbances in many organs are observed. The very first and characteristic symptom hypothyroidism is an increase in gland size.

Symptoms of hypothyroidism also lead to changes in the body during illness:
Cold, thick, swollen skin, jaundice is often noted, often on the palms in the form of spots, its age-related changes are accelerated. Decreased secretion of sebaceous and sweat glands. Brittle nails. Hair is dry, brittle, thick.

Pale, puffy, mask-like face (poor facial expressions). From the side of the eyes there is: ptosis (drooping upper eyelid) and swelling of the eyelids. Hair loss outer third of the eyebrows. Swelling of the vocal cords and tongue leads to slow, unclear speech, and the timbre of the voice decreases and becomes rougher. The tongue becomes enlarged and dents and teeth marks are visible on its lateral surfaces. .

Symptoms from the cardiovascular system manifest themselves in the form of a decrease in blood pressure (hypotension), a decrease in heart rate (bradycardia), shortness of breath, which increases even with slight physical exertion, discomfort and pain in the heart area and behind the sternum.

In the respiratory system, the following are observed: decreased ventilation of the lungs (hypoventilation), which causes a lack of oxygen and increased carbon dioxide. Patients are prone to bronchitis and pneumonia (pneumonia), which are characterized by a sluggish, protracted course, sometimes without temperature reactions.

There are a number gastrointestinal disorders: loss of appetite, nausea , flatulence(increased formation of gases in the intestines), decreased tone of the muscles of the intestines and bile ducts leads to stagnation of bile in the bladder and contributes to the formation of stones, sometimes to intestinal obstruction;

There is a decrease in fluid secretion by the kidneys. Decreased tone of the urinary tract favors the development of infection.

Patients are characterized by disorders of the nervous system in the form of: lethargy, decreased intelligence, drowsiness during the day and insomnia at night, slowed speech, depression, increased irritability and nervousness, memory deterioration. Sensitivity disturbances, mainly in the extremities, and neuralgia (inflammation of the nerve), accompanied by muscle pain, are also observed.

Bone lesions are not common in adults. In children, it can manifest itself in the form of delayed skeletal growth and shortening of the limbs. Patients of all ages experience muscle fatigue, sometimes joint pain.

60-70% of patients have blood disorders. There is a decrease in the absorption of iron and vitamin B12 gastrointestinal tract, which leads to the development of “thyriogenic anemia” (characteristic only with lesions of the thyroid gland), a slight decrease in blood sugar may be observed due to the slow absorption of glucose.

Decreased sexual desire (libido), possible development of infertility.
Despite the lack of appetite in patients, weight gain is often noted (but obesity uncharacteristic), the need for vitamins decreases. For most patients it is typical low temperature body (hypothermia)

Causes of primary hypothyroidism

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

Causes:

Complications therapeutic measures after:

surgical treatment various diseases thyroid gland;
treatment of toxic goiter with radioactive iodine;
radiation therapy for malignant diseases of organs located in the neck;
use of iodine-containing drugs;
taking glucocorticoids, estrogens, androgens, sulfonamide drugs;
removal of the thyroid gland.

Tumors, acute and chronic infections, thyroiditis (inflammation of the thyroid gland), abscess, tuberculosis, sarcoidosis ( systemic disease, characterized by the formation of granulomas in the affected tissues);

Hypoplasia is underdevelopment of the thyroid gland due to defects in intrauterine development, usually in newborns and children 1-2 years old, often combined with deafness and cretinism.

Causes of secondary hypothyroidism

Secondary hypothyroidism develops with inflammatory or traumatic lesions of the pituitary gland and/or hypothalamus (tumor, hemorrhage, necrosis, surgical removal or destruction of the pituitary gland), resulting in a disruption in the production of their thyrotropin, which affects the synthesis of thyroid hormones, resulting in a decrease in its functional activity. More often, secondary hypothyroidism occurs with general pituitary pathology and is combined with hypogonadism (decreased function of the gonads) and excess growth hormone.

Complications of hypothyroidism

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

Promote development this complication provoking factors, such as: cooling, especially combined with inactivity, deviations from the normal functioning of the cardiovascular system, myocardial infarction , acute infections, psycho-emotional and muscle overload, diseases or conditions that contribute to a decrease in body temperature.

Hypothyroid coma is characterized by the following symptoms:

dry, pale jaundiced, cold skin;
decreased heart rate (bradycardia);
decline blood pressure(hypotension);
rare breathing;
decreased urination.

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 thyroid deficiency is characterized by a decrease in iodine. In recent years, it has become possible to directly determine hormones in the blood: thyroid-stimulating (increased content), T 3, T4 (decreased content).

Also used for diagnosis ultrasound examination(ultrasound), determination of the time of tendon reflexes, electrocardiography (ECG). If necessary, the endocrinologist recommends a computed tomography of the thyroid gland, based on the results of which the specialist clarifies the diagnosis and develops an individual course of treatment. Sometimes a puncture is performed (sampling of organ material for diagnostic purposes) for 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, decreased heart rate (bradycardia), decreased blood pressure (hypotension), decreased and sometimes disappearance of tendon reflexes. In case of hypothyroid coma, the patient must be urgently hospitalized.

What is needed for consultation

The patient tells the doctor about his recent health.
Data Ultrasound of the thyroid gland, made shortly before the consultation and earlier in date.

Results of a blood test (general and glandular hormones).
Information about previous operations, if any discharge summary(a doctor’s report recorded in the medical history, which contains information about the patient’s condition, diagnosis and prognosis of his disease, treatment recommendations, etc.).

Treatment methods used or currently being used.

Information on examination of internal organs, if available

Treatment of hypothyroidism

The treatment method for all forms of hypothyroidism is based on the use of drugs that are synthetic analogues of thyroid hormones (thyroid drugs). The effect develops during the first month of treatment. When the dose is correctly selected, the drugs are absolutely harmless and do not cause side effects. drug addiction And hormonal changes. The dose is selected carefully and gradually, taking into account the age of the patient, the severity of hypothyroidism, the presence of concomitant diseases and the characteristics of the drug.

Forecast

Hypothyroidism is lifelong and in adult patients the prognosis is favorable if adequate treatment is selected. In children with congenital hypothyroidism Even with optimal treatment, it is practically impossible to restore brain function, which is why hypothyroidism may develop, and growth retardation is also observed.