Hypothyroidism - what is it? Symptoms, causes and treatment

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Hypothyroidism - a syndrome that develops at a low concentration of thyroid hormones, is one of the most common diseases of the endocrine system.

Especially dangerous is congenital hypothyroidism, and if in time, immediately after the birth of the child does not begin treatment, there can be an irreversible defeat of the intellect, the development of mental retardation.

This disease may not occur for a long time. This occurs as a result of a gradual, inconspicuous onset of the pathological process. In this case, in a mild to moderate hypothyroidism of the thyroid gland, the patients feel well, the symptoms are erased. The disease occurs in 1% of young people and in 10% of the elderly.

Reasons for

Why does hypothyroidism occur, and what is it? Considering hypothyroidism, the causes of which can be caused by a variety of factors, experts note that in the first place, they depend on the form in which the disease occurs. To date, there are two forms of the disease:

1. Congenital;
2. Purchased.

Acquired hypothyroidism

The most common form of the disease is acquired. The main reasons for its development are the following:

• chronic autoimmune thyroiditis - damage to the thyroid by its own immune system, which can lead to hypothyroidism in years and even decades after its appearance;
• iatrogenic hypothyroidism - develops after complete or partial removal of the thyroid gland or after therapy with reactive iodine;
• reception of thyreostatics in the treatment of diffuse toxic goiter;
• significant iodine deficiency in water and food.

Congenital hypothyroidism

Congenital hypothyroidism occurs as a result of:

• of congenital aplasia and hypoplasia( shrinking) of the thyroid gland;
• of congenital structural disorders of the hypothalamic-pituitary system;
• hereditary defects in the biosynthesis of thyroid hormones( T3 and T4);
• exogenous effects( the presence of maternal antibodies in autoimmune pathology, the use of medications) during the intrauterine period.

For example, by penetrating the placenta, the mother thyroid hormones compensate for the development of the fetus having a pathology of the thyroid gland, but after the birth of the child, when the level of the parent hormones in its blood drops sharply, their deficiency can cause an irreversible underdevelopment of the central nervous system of the child( cerebral cortexin particular).

The child manifests a violation of the development of the skeleton and other organs, and most importantly - mental retardation to varying degrees, not excluding complete cretinism.

Primary hypothyroidism

Primary hypothyroidism is associated with the pathology of the thyroid gland, leading to a decrease in the mass of the glandular tissue of the thyroid gland and inhibition of the synthesis of hormones of thyroxin and triiodothyronine. This may be a consequence of aplasia or agenesis of the thyroid gland, autoimmune processes, iodine deficiency, selenium deficiency.

Secondary hypothyroidism

Associated secondary hypothyroidism with loss of tropic pituitary function( decreased thyrotropin production).Inadequate intake of thyroid hormones in the body leads to a violation of protein, carbohydrate metabolism, flattening of the sugar curve after loading with glucose, to the violation of lipid, water-salt metabolism.

Degrees

The following forms of the disease are distinguished by the degree of manifestation:

• latent, or subclinical, form - there are no clinical manifestations, an increase in thyroid-stimulating hormone( thyroid hormone-increasing hormone) is detected at normal level of triiodothyronine and thyroxine( thyroid hormones);
• is an explicit form - the appearance of signs of hypothyroidism.

Symptoms of hypothyroidism

Severity of symptoms depends on the degree of thyroid dysfunction. Usually hypothyroidism develops gradually. Patients for a long time do not notice the symptoms of the disease and do not consult a doctor. They often complain of lethargy, reluctance to move, a sharp memory impairment, drowsiness, swelling, dry skin, constipation.

The manifestations of hypothyroidism of the miscellany, the individual symptoms are not specific:

• obesity, decrease in body temperature, chilliness - a constant sense of cold due to a slowing of metabolism, icterus of the skin, hypercholesterolemia, early atherosclerosis;
• myxedema edema: edema around the eyes, dentures in the tongue, difficulty in nasal breathing and hearing loss( swelling of the mucous membranes of the nose and auditory tube), hoarseness of voice;
• drowsiness, slowness of mental processes( thinking, speech, emotional reactions), memory loss, polyneuropathy;
• shortness of breath, especially when walking, sudden movements, pain in the heart and behind the breastbone, myxedema heart( reduction of heartbeats, increase in heart size), hypotension;
• susceptibility to constipation, nausea, flatulence, increased liver size, dyskinesia of the biliary tract, cholelithiasis;
  anemia;
• dryness, brittleness and hair loss, nails brittle with transverse and longitudinal grooves;
• menstrual irregularities in women.

With the course of the disease, the appearance of the patients varies, the movements become slow, the look is indifferent, the face is round, puffy, edematous, especially in the lower eyelids, the lips are cyanotic, on the pale face a slight blush also with a cyanotic shade. The patients are freezing in all kinds of weather.

Skin pale, sometimes with a yellowish tinge due to the increased amount of carotene in the blood, cold to the touch, dry, rough, thickened, scaly. Skin peeling is often most pronounced on the anterior surface of the shins. Characteristic is the excessive cornification and thickening of the superficial layers of the skin on the knees and elbows( Behr's symptom).

Diagnostics

An endocrinologist can presume the presence of hypothyroidism by characteristic manifestations:

• marked weakness, decreased efficiency;
• dry skin, hair loss, brittle nails.

To confirm the diagnosis, is assigned to certain diagnostic tests. :

1. Blood test for thyroid hormones: it measures the quantity of thyroxine and triiodothyronine in the blood. Normally their concentration is 2.6-5.7 mmol / L and 9.0-22.0 mmol / L, respectively. With hypothyroidism, these indicators will be significantly lower than usual. In addition, it is very important to examine the patient's blood for the thyroid-stimulating hormone( TTG) of the pituitary: with this manipulation determine what the nature of hypothyroidism is in a woman, that is, primary or secondary. Scintigraphy of the thyroid gland with radioactive iodine. In this study, there is an accumulation of radioactive iodine introduced into the body into the gland tissue. It is carried out to study the structure and function of the thyroid gland.
2. Computerized tomography of the brain with suspected pituitary tumor( brain area that regulates the functional activity of the thyroid gland).
3. ultrasound of the thyroid gland.

Differential diagnosis is performed with other endocrinopathies: growth retardation and nannism, encephalopathy, Down's disease, chondrodystrophy, rickets, Hirschsprung disease.

Treatment of hypothyroidism

Thanks to the achievements of the pharmaceutical industry, which allows artificially synthesizing thyroid hormone, modern endocrinology has an effective method of treating hypothyroidism in women. Therapy is performed by replacing the missing thyroid hormones in the body with their synthetic analog - levothyroxine( L-thyroxine).

If possible, it is necessary to eliminate the cause that caused the development of acquired hypothyroidism, for example:

• to abolish drugs that cause a decrease in thyroid hormone activity,
• to treat thyroiditis,
• to normalize the intake of iodine in food.

Manifest( clinical) hypothyroidism requires the appointment of substitution therapy, regardless of the patient's age and concomitant pathology. Individually appointed option to start treatment, the initial dose of the drug and the rate of its increase.

Forecast

With the daily administration of thyroid hormones, the prognosis is favorable: patients lead a normal lifestyle. In those cases when the treatment of hypothyroidism is absent, clinical manifestations can worsen until the onset of meksedematoznoy coma.

Diet

As mentioned above, hypothyroidism is characterized by a deficiency of thyroid hormones. If to explain in simple words, it means that in the human body all metabolic processes are slowed down. That is why the diet for hypothyroidism of the thyroid gland should be low-calorie.

Foodstuffs should be chosen with particular care, because their action should be aimed at restoring and stimulating all oxidative processes. The easiest way is to reduce the amount of carbohydrates and fats.

The list of non-recommended products includes:

• fat meats( pork, lamb) and poultry( goose, duck);
• liver( brains, liver, kidneys);
• jam, honey is limited;
• mustard, pepper, horseradish;
• strong tea or coffee, cocoa, coca-cola;
• bread made from the highest grade flour, all baked pastries, cakes, pastries, fried products( pies, pancakes, fritters);
• fish caviar;
• smoked and salted fish, canned fish;
• fatty sausages;
• margarine, lard, cooking oil;
• are all legumes;
• meat, poultry and fish;
• smoked meat, pickles;
• cruciferous( all kinds of cabbage, turnip, radish, radish, turnips);
• mushrooms in any form;
• rich broths from
• pasta and rice are limited.

The list of recommended products of includes:

• fish, predominantly marine( cod, mackerel, salmon), rich in phosphorus, polyunsaturated fatty acids and iodine;
• fruits are any, especially persimmon, feijoa, kiwi, which are rich in iodine, as well as cherries, grapes, bananas, avocados;
• vegetables except for the cruciferous family, fresh herbs;
• slightly brewed drinks( coffee and tea), tea with lemon or milk, freshly squeezed juices, decoctions of rose hips and bran;
• low-fat milk and lactic acid drinks, as well as cottage cheese and sour cream - in dishes;
• cheese of unsalted, low-fat and non-mild varieties;
• bread from 1 and 2 grade flour, yesterday or dried, dried biscuits;
• meat of low-fat varieties, "white" chicken meat, containing tyrosine;
• low-fat types of sausages;
• salads from fresh vegetables, seasoned with vegetable oil, salad, jellied;
• butter with caution, vegetable oils - in dishes and when cooking;
• protein omelets, soft-boiled eggs, yolk with caution;
• porridge( buckwheat, millet, barley), casseroles and dishes from them;
• seafood( mussels, scallops, oysters, sea kale, rolls and sushi from them).

The diet for hypothyroidism does not imply a sharp restriction of foods and the transition to special foods. The food system remains tasty and useful, with the application of certain specific rules. Adherence to therapeutic nutrition has a beneficial effect on metabolic processes, and, importantly, alleviates the symptoms of the disease in the patient. Proper nutrition saturates oxygen cells and reduces the risk of developing severe forms of the disease.