Hypothyroidism: Symptoms and Treatment
Hypothyroidism is a condition that occurs against the background of a long and persistent lack of thyroid hormones produced by the thyroid gland. Hypothyroidism, the symptoms of which, to the extreme extent of their manifestation in adults, are noted in the form of myxedema with its characteristic swelling of tissues and organs, in children is manifested in the form of cretinism, the peculiarities of which are not only in reducing the functions of the thyroid gland, but also in delaying the mental and physical Development.
The thyroid gland is one of those organs in the endocrine system, in which a number of hormones are directly involved in various processes of the body. In particular, these hormones are triiodothyronine, thyroxine and thyrocalcitonin. Among the main functions performed by the thyroid gland, we can distinguish the following:
- regulation of metabolic processes in the body
- regulation of processes directly related to development and growth
- strengthening of heat exchange processes
- Enhance oxidation processes, as well as processes associated with the consumption of fats, proteins and carbohydrates by the body (this function plays an extremely important role in providing it with energy)
- isolation from the body of potassium and water
- activation of the functions of the adrenal glands, mammary glands and genital glands
- stimulation of the CNS.
Given the peculiarities of the location of the thyroid gland (and it is located on the neck, as it is known), it is often located in the very center of inflammatory processes, finding themselves in them as a «neighbor» of organs, by such processes being affected. In addition, the thyroid gland is also easily affected by environmental factors, it is subject to abundant blood supply, and also acts as the main site of biochemical scale processes.
If the normal functioning of the thyroid gland is disrupted, then there are corresponding disorders associated with the secretion of hormones in it. The diseases associated with this include nodal and diffuse goiter, thyroiditis, hyperthyroidism and, in fact, hypothyroidism of interest to us. Those basic syndromes that are relevant for diseases related to the thyroid gland become not only a reflection of the effect on the gland functions, but also a reflection of the effect on its growth.
It should be noted that urban residents are particularly prone to thyroid disorders. For example, only in Moscow, as part of the review of statistics in recent years, there has been a marked increase in the incidence of diseases associated with the functions of this body. This trend is explained by the fact that the ecological situation in the city is worsened, and proper measures concerning iodine prophylaxis are not made. Concerning the prevalence of hypothyroidism, according to the adult population of the capital, there are indices in the range of 0.5-1%, for newborns — 0.025%, for individuals whose age exceeds the 65-year mark — within 2-4%.
Retreating from the characteristics of the thyroid gland and the statistics of morbidity, we return to hypothyroidism, which, as we have already explained, arises against the background of insufficiency of providing the tissues and organs of the body with thyroid hormones, the production of which is reduced due to this disease. Hypothyroidism can be primary, which implies direct damage to the thyroid gland, as well as secondary, which in turn indicates the pathology of the hypothalamus and / or the pituitary gland. In addition, on the basis of previous varieties, tertiary hypothyroidism is also isolated — in this case, secondary hypothyroidism is considered as hypophysial hypothyroidism, and tertiary, respectively, as hypothalamic hypothyroidism. Secondary hypothyroidism, the symptoms and specificity of which is distinguished on a par with the tertiary, is due to a number of the following reasons:
- Pituitary necrosis, pituitary infarction;
- tumors that are relevant to the hypothalamic-pituitary system;
- Insufficiency of the Turkish saddle located in the body of the sphenoid bone
- inflammation of the brain of a particular etiology, etc.
Of the above options for the order of more than 99% of cases of incidence — this is the primary hypothyroidism, the symptoms of which we will consider below.At the heart of the mechanism of hypothyroidism is a decrease in the production of thyroid hormones by the thyroid gland, because of which inhibition is subject to metabolic processes. Among other things, this leads to the excretion of oxygen from the body, to a decrease in the level of activity of certain enzymes in combination with gas exchange, and also causes inhibition in the development of brain tissue with specific inhibition of nervous activity (which consists in the violation of behavioral reactions from the sick person, Which he inadequately reacts to certain situations, manifests itself in an overactive or, on the contrary, stalled). In particular, each of these pathologies in a pronounced way manifests itself in childhood.
Meanwhile, the violation of brain function is no less relevant for adults, against which they have a decline in intelligence and mental activity, the reactions arising in these or those situations are also weakened. Because of violations of the thyroid gland is not excluded, and the option of attaching disorders associated with the functions of other organs of the endocrine system.
If we consider in more detail what exactly happens with hypothyroidism, then the picture of the disease is as follows. First of all, against the background of deficiency of thyroid hormones, changes in the body begin to occur, and they concern absolutely all systems and organs in it. Given that the main function of these hormones is to support the basic metabolism, which consists in cellular respiration, their deficiency, in turn, leads to a decrease in the amount of oxygen consumed by the tissues and to a decrease in energy consumption in combination with the utilization of energy substrates. In addition, hypothyroidism, again, on the basis of this reason, leads to a decrease in the production of a number of cellular enzymes of a volatile type, which ensure their adequate functioning.
As a universal type of change, found during the development of severe hypothyroidism, a myxedema is observed, edema formed in its most pronounced form within the framework of connective tissue structures. The development of myxedema is explained by the excessive accumulation of hyaluronic acid and other type of glycosaminoglycans in interstitial tissues, because of which, because of their hydrophilicity, excess water retention occurs.
Causes of hypothyroidism
The greatest clinical significance is determined for hypothyroidism, which develops against the background of a chronic form of autoimmune thyroiditis. In addition to this form, iatrogenic hypothyroidism (or operational one, it develops as a result of exposure to a specific therapy using radioactive 131I). It should be noted that iatrogenic hypothyroidism is one-third of the total number of cases of hypothyroidism.
For the listed diseases hypothyroidism is mainly characterized by persistence and irreversibility of the nature of its own course. At the same time, many diseases of the thyroid gland or, otherwise, they can be determined, destructive thyroiditis, as well as the influence of a certain number of substances (thyreostatics, significant in amounts of iodine dosage, etc.) — all this can cause the development of a form of the disease as transient hypothyroidism , Which is self-limiting or in the course of the natural course of these diseases, or does so after the cessation of the effect of a particular factor, a disease in one form or another provoked (which concludes I’m canceling tireostatika).
Deficiency of iodine, as we have already identified, in its severe form can also cause the development of hypothyroidism. It should be noted that if it is a mild form of iodine deficiency, as well as a moderate form when considering the situation within the adult category, then under normal conditions it will not cause hypothyroidism.
If iodine deficiency in newborns is considered, then, with mild or moderate form in combination with an increased level of thyroid hormone metabolism, the possibility of developing a transient form of neonatal hyperthyrotropinemia is not ruled out. Iodine deficiency in pregnant women can cause a relative form of gestational hypothyroxinemia. Meanwhile, both considered variants of pathologies in full should not be identified with hypothyroidism.
In some cases, the origin of primary hypothyroidism can not be determined, which defines it as idiopathic hypothyroidism.
We highlight in a more graphic version of the reasons that provoke primary hypothyroidism. Given the fact that this hypothyroidism of the thyroid gland, its symptoms, respectively, provoke the factors directly affecting it, in particular here are:
- Complications against the background of medical manipulations, and this:
- surgical treatment of diseases of various specificities associated with the functions of the thyroid gland
- the effect of radiation therapy, topical in the treatment of malignant neoplastic lesions in the neck;
- therapy using radioactive iodine, focused on the elimination of toxic goiter;
- use of medications that include iodine
- use of sulfonamide drugs, estrogens, glucocorticoids, androgens
- surgery to remove the thyroid itself.
- Infections (acute or chronic), tuberculosis, tumors, sarcoidosis (a systemic disease accompanied by the formation of granulomas in tissues that have undergone an actual injury), an abscess
- Hypoplasia, characterized by underdevelopment of the thyroid gland on the background of defects that occurred within the period of intrauterine development. As a rule, this pathology is observed in children of newborns and in children under 2 years old, and often the pathologies associated with it are deafness and cretinism
As for the reasons provoking secondary hypothyroidism, it can be distinguished here that the disease develops against a background of lesions that directly affect the hypothalamus and / or pituitary gland. These lesions themselves can be traumatic or inflammatory, mainly manifested in the form of hemorrhage, tumor, destruction of the pituitary gland or its removal, necrosis. Such variants, in turn, lead to a disruption of their production of thyrotropin, which affects the processes of synthesis in the thyroid gland of hormones, and this, in turn, causes a decrease in the functional activity inherent in it. Much more often this form of the disease develops against the background of a general type of pituitary pathology, combined with an excessive amount of growth hormone, hypogonadism (in this case, a decrease in the sexual functions of the sex glands is implied).
The clinic of hypothyroidism is directly related to the peculiarities of its etiology (conditions and causes, the disease provoked), with the speed with which the patient’s current deficiency of thyroid hormones develops, as well as with how old he is.
As the main problems arising in the diagnosis of the disease, the following are considered:
- the absence of specific symptoms (that is, symptoms that occur solely with the disease of interest);
- an increased prevalence of symptoms similar to manifestations of hypothyroidism, noted within the general population when they are associated with another kind of chronic illness (mental or somatic)
- The absence of a direct relationship between the actual degree of hormonal deficiency and the severity of the clinic (in some cases, symptoms with a clear diagnosis of hypothyroidism may not manifest, while subclinical hypothyroidism and symptoms manifested in it are characterized by their own severity).
The clinic for hypothyroidism is characterized in general by polysystemic nature, but in some cases, symptoms and complaints related to one of the systems predominate among patients, which is why in many cases the diagnosis of the disease is made in favor of «disease-masks». Let us pass directly to those manifestations that are noted in hypothyroidism.
A prolonged and pronounced course of hypothyroidism leads to the fact that patients acquire a rather characteristic appearance for this disease, which in particular lies in the myxedem with it. Accordingly, it determines pronounced puffiness, in which the face acquires a puffiness, and the skin has a pale yellowish tinge. The face resembles a mask due to the paucity of facial expressions, in the sight is marked estrangement.
In addition, the patients become dull and thinning hair, there is also an increased loss of hair. Also apathy, inhibition is peculiar. Speech becomes slow, in some cases (because of the characteristic stumbling language), it seems that a person clearly reproduces speech interferes with something in his mouth. Due to the fact that the mucous larynx also acquires puffiness, the timbre of the voice becomes hoarse and low enough. Pronunciation of certain words can lead to a person stammering on them; after that, after applying certain efforts to their reproduction, they will be able to reproduce them more intelligibly. As a classic constituent of hypothyroidism, there is a puffiness in the tongue, in which it is possible to notice prints of teeth on it.
On the background of swelling of the mucous membrane of the Eustachian tube, patients may experience a slight decrease in hearing. Also, often among patients’ complaints, dry skin is indicated.
As for the changes that occur with hypothyroidism with the nervous system, here, as you could determine from the descriptions already provided to the disease, there is a decrease in intelligence. In addition, memory decreases, depression and drowsiness occur. Children from 3 years old, like adults, change their nervous system changes in a different way compared to the congenital form of the disease in newborns. So, for these two age categories, the changes are not irreversible, moreover, there is the possibility of their complete elimination through the implementation of measures of adequate substitution therapy. Congenital hypothyroidism, the symptoms of which we consider below, are characterized, respectively, by physical and neuropsychic disturbances in an irreversible scale.
Because of the general lowering of the level inherent in the main metabolism, patients with hypothyroidism tend to gain weight, while actually hypothyroidism as a cause leading to a pronounced manifestation of obesity never appears. An extremely severe form of hypothyroidism can provoke hypothermia. Often, patients face a symptom such as chilliness, in other words, they are constantly cold, the reason is the centralization of blood circulation, characteristic of this disease.
As the most common variant of the manifestation of symptoms on the part of manifestations from the side of the cardiovascular system, there is a tendency to slightly increased pressure and to bradycardia, in addition, the pericardial cavity is characterized by the formation of effusion in it. Also, most patients experience the development of atherogenic dyslipidemia.
The digestive system is characterized by such symptoms as frequent constipation. In addition, often develops dyskinesia and hepatomegaly, somewhat reduced appetite. The pronounced form of hypothyroidism can be characterized by the development of hypochromic anemia.
Quite often (in particular, this is true for women), within the advanced symptoms of the disease, changes are made regarding the reproductive system. So, hypothyroidism can be characterized by a variety of disorders related to the menstrual cycle, from amenorrhea (absence of menstruation) and ending with dysfunctional uterine bleeding. There is also a decrease in libido, which is equally characteristic of the course of the disease in men, and its course in women. In a pronounced form of flow, hypothyroidism in almost all cases is combined with infertility, but with less obvious shortage of thyroid hormones in some women (about 2% of the total number of pregnant women) this cause does not become an obstacle to pregnancy. At the same time, such an opportunity is comparable with a significant risk of its possible interruption or with the birth of a baby with obvious disabilities in the development of the nervous system.
Congenital hypothyroidism: symptoms
Hypothyroidism is congenital is a chronic disease, the course of which is characterized by a violation of the thyroid gland in newborn babies with a simultaneous decrease in their blood levels of hormones produced by the thyroid gland. Hypothyroidism, the symptoms in newborns that can appear under the influence of a variety of causes, ranging from the effects of infections and ending with genetic mutations, etc., manifests itself primarily in the developmental gap, as regards the development of the physical and the development of the mental. In addition, the disease is also characterized by late closure in children fontanel, dry koi and late teething.
According to statistical data on congenital hypothyroidism, it is relevant in 1-2 cases of 5000 infants. In addition, it was found that congenital hypothyroidism is most often diagnosed in girls, and the data in this case indicate that in boys this disease is diagnosed twice less often.
The thyroid gland acts as a body that promotes the harmonious development and growth of children, and in particular its important effect is for the skeleton and nervous system. Congenital hypothyroidism is characterized by a decrease in the production of thyroid hormones by the thyroid gland, which, as we noted earlier, provokes serious inhibition in the child’s physical and mental development.
As the causes of hypothyroidism, the symptoms in children, which we consider below, are the following options:
- Heredity. In most cases, congenital hypothyroidism develops due to disruption of the formation of the thyroid organ even before the child was born, that is, during fetal development, to which certain genetically determined mutations are responsible.
- The pathology of the formation of hormones in the thyroid gland. This cause is caused, for example, that the thyroid cells lose sensitivity to iodine, by the fact that the process of transporting the substances required for the production of hormones, , That there are violations in the metabolic processes associated with iodine, etc.
- Actual hypothalamic damage. This pathology indicates secondary hypothyroidism, the hypothalamus acts as the center of the nervous system, through which the regulation of the thyroid gland functions as well as the other endocrine glands in the body is provided. Against the background of the defeat of the hypothalamus, severe forms of endocrine disorders also often develop.
- Reduced sensitivity (or resistance) to thyroid hormones. Mostly this option is relevant when used during pregnancy by a future mother of antitheroid medications, which is possible, for example, in goitre in a pregnant woman, etc.
So, let us now turn to the symptomatology that accompanies hypothyroidism in children. It is important to note here that the congenital form of this disease during the first weeks of the baby’s life does not manifest itself in any way, therefore the first symptoms of hypothyroidism in children in this case can be seen only a few weeks after their birth. Possible detection of this disease is due to the identification of signs indicating a child’s developmental lag. With regard to the possibility of identifying the disease within the first weeks of life in children, it is determined only for a small proportion of small patients with this diagnosis. Let us highlight the most typical and basic signs of congenital hypothyroidism in children in the first days of their life:
- the significant weight of the newborn (exceeding 3,500 g)
- half-open mouth
- puffiness of the face
- the presence of edema in the region of supraclavicular pits, reminiscent of «dense pads»
- prolonged jaundice
- cyanosis of the nasolabial triangle area
- The roughness of the voice, marked by crying.
As characteristic symptoms of the congenital form of hypothyroidism in children in the period of 3-4 months of their life, we can distinguish the following:
- chronic constipation;
- brittle hair
- Poor appetite
- reduced body temperature;
- skin peeling.
As for the later terms, they are characterized by the following symptoms with hypothyroidism:
- mental retardation
- delay in physical development
- delay in the timing of teething.
It is important to note that due to early detection of congenital hypothyroidism with simultaneous early treatment, there are significant chances for the subsequent provision of normal development of the child. With a lack of hormones produced by the thyroid gland within the period of the first weeks after the birth of a baby, there is a risk of development of violations of an irreversible scale related to the nervous system. That is why the treatment of hypothyroidism in children is important to begin in time not later than the first month from the moment of birth. Cretinism, which develops when this necessity is ignored and implies a lag not only in the mental development that is habitual in understanding, but also in the development of the physical, manifests itself in the form of the following signs: the curvature of the limbs, the deformity of the face, low growth, susceptibility to the onset of chronic diseases, .
The Apgar scale allows to diagnose the congenital form of hypothyroidism in newborns, in particular, it is based on the following indicators (signs) for comparison:
- Facial puffiness — 2 points
- Constipation — 2 points
- umbilical hernia presence — 2 points
- pallor of the skin — 1 point
- jaundice duration exceeding 3 weeks — 1 point
- birth weight over 3,500 g — 1 point
- muscle weakness — 1 point
- The back fontanel is open — 1 point
- the language is increased — 1 point;
- the duration of pregnancy is more than 40 weeks. — 1 point.
The reason for the appearance of suspicions about the presence of hypothyroidism is the indicator of the sum of the above listed signs, exceeding 5 points.
The hypothyroid coma acts as the most severe and, at the same time, quite often fatal complication of the disease under consideration. It develops, as a rule, in a situation with unspecified hypothyroidism in the patient, as well as in the long absence of his treatment or in the treatment of insufficiently effective.
As a factor contributing to the development of this complication, hypothermia (especially in combination with inactivity), myocardial infarction, abnormalities in the functioning of the cardiovascular system, acute infections, conditions or diseases in which the body temperature decreases, muscle and psychoemotional Overload.
Symptoms of hypothyroid coma are as follows:
- coldness of the skin, its pallor, icteric, dryness
- rare breathing
- loss of urine
- low blood pressure;
- bradycardia (condition with concomitant decrease in heart rate)
The diagnosis of the disease we are considering is quite simple. It requires confirmation of the fact that thyroid gland functions are affected. This, accordingly, requires the determination of the level of thyroid-stimulating hormone (or TSH) in the blood, as well as T4. In an isolated increase in TSH, subclinical hypothyroidism is determined, while with a simultaneous decrease in T4 and TSH, a clear (acquired manifest) hypothyroidism is distinguished.
Given the fact that the disease has a significant number of nonspecific manifestations specific to it, difficulties appear only in determining against their background the appropriate indications for conducting an appropriate diagnosis for the level of thyroid hormones. Often subclinical hypothyroidism is diagnosed as part of a preventive medical examination.
Explicit hypothyroidism acts as an absolute indication for prescribing in the treatment of substitution therapy, in which levothyroxine (L-T4) is used, and it is prescribed regardless of any accompanying factors considered in other cases as an obstacle or a need for limitations Age, the presence of additional pathologies, etc.). Difference in treatment can consist only in that variant in which it is started (that characterizes the initial dose, and also the scheme of its increase). When planning pregnancy or pregnancy as a fact, substitution therapy is an absolute indication in the case of subclinical hypothyroidism.
Concerning the principles used in the treatment of secondary hypothyroidism, one can single out their similarity to the previous version, with minor adjustments. In the treatment of hypothyroid coma, intensive measures are applied, which is based on the appointment of medications of thyroid hormones, as well as glucocorticoids. In addition, the treatment includes correction of electrolyte and hemodynamic disorders.
With regard to the quality of life in patients with a diagnosis of compensated hypothyroidism, it can be said that it is usually not comparable with significant changes: there are no restrictions of any kind, the only requirement is the daily intake of L-T4.
The most favorable timing for the treatment of congenital hypothyroidism is within the first to second weeks of a child’s life, it is in this case that there is a probability of preventing violations related to mental (mental) and physical development.
In general, the effectiveness of treatment of hypothyroidism is characterized by fairly high rates. So, the regression of symptoms is observed after 1-2 weeks from the beginning of treatment. Severe treatment of the disease is carried over by the elderly. The duration of treatment for hypothyroidism, as a rule, is indicated for life.
For diagnosing hypothyroidism, when symptoms appear that can point to it, you need to contact the endocrinologist.