Catad_tema Anesthesiology-reanimatology - articles

Catad_tema Diseases of the thyroid gland - articles

Life-threatening complications of hypothyroidism

E.A.Troshina, M.Yu.Yukina
Federal State Institution Endocrinological Research Center of Rosmedtekhnologii, Moscow

Hypothyroidism is a symptom complex of changes in various bodies and systems, due to a decrease in the level of thyroid hormones.

The quality of life of patients with hypothyroidism who constantly receive replacement therapy with levothyroxine differs slightly from that of patients without hypothyroidism. Hypothyroidism itself becomes a way of life for the patient, not a disease.

However, in the absence of timely adequate treatment of hypothyroidism, the risk of complications increases. Hypothyroid coma (HC) is a rare, life-threatening complication of hypothyroidism. First of all, it develops in elderly patients for a long time un- or poorly treated. Patients with GC die predominantly from respiratory and heart failure, in some cases from cardiac tamponade. Even with promptly initiated vigorous therapy, 40% of patients die.

Clinical symptoms of hypothyroidism develop in a patient with a gradual increase. Hypothyroidism is most common in patients undergoing surgery thyroid gland(primary postoperative hypothyroidism).

The doctor should suspect the presence of hypothyroidism syndrome in an elderly patient and determine the level of thyroid-stimulating hormone (TSH) in the blood serum if the patient had any history of thyroid disease or received medications that can provoke the development of hypothyroidism. In addition, the presence of constipation resistant to conventional treatment, cardiomyopathy, anemia of unknown origin, dementia, should be a reason to rule out hypothyroidism in an elderly patient.

Laboratory diagnostics

Laboratory parameters for the diagnosis of hypothyroidism are the determination of basal (not stimulated) TSH and free T 4 and T 3 values. normal basal TSH level rules out hypothyroidism. With elevated basal TSH, the diagnosis is confirmed by the detection of low concentrations of free T 4 and T 3 .

Mistakes in diagnosing hypothyroidism

The diagnosis of hypothyroidism is often untimely, since in its initial stage the detected symptoms are extremely non-specific. In addition, hypothyroidism syndrome can imitate various non-thyroid diseases, which is associated with multiple organ lesions found in conditions of thyroid hormone deficiency. Very often, manifestations of hypothyroidism in the elderly are considered by the doctor and patient as signs of normal aging. Indeed, symptoms such as dry skin, alopecia, loss of appetite, weakness, dementia, etc., are similar to the manifestations of the aging process. Typical symptoms of hypothyroidism are detected only in 25-50% of older people, while the rest have either extremely mild symptoms, or hypothyroidism is clinically manifested as some kind of monosymptom.

Clinical diagnostics

Clinical symptoms of hypothyroidism

General symptoms Fatigue, fatigue, weakness Weight gain, chilliness Cardiovascular symptoms Sinus bradycardia Heart failure cardiomegaly Pericarditis Arterial hypotension or paradoxical hypertension Respiratory system respiratory failure, hypercapnia Leather and its derivatives Dry skin, hair loss Thickening of nails Loss of the lateral parts of the eyebrows Skin coloration is pale with a yellowish tint Nervous system Apathy, drowsiness, disturbance concentration Memory impairment Depressive psychoses Stupor and coma Hyporeflexia

Musculoskeletal system muscle weakness Muscular atrophy Violation of skeletal formation in children Gastrointestinal tract Lack of appetite Constipation, megacolon, ileus Sex organs In women: cycle disorder like amenorrhea or menorrhagia Infertility In men: lack of libido, decreased potency, gynecomastia Metabolism Decreased basal metabolism Weight gain, obesity High cholesterol, hypoglycemia Fluid retention with volume expansion tongue, swelling of the face, especially the eyelids Laboratory data Hyponatremia Anemia Increasing creatine kinase levels Thyroid Goiter or its absence

hypothyroid coma

Resolving factors are severe comorbidities, surgery, trauma, sedatives and drugs, and hypothermia.

The basis of the pathogenesis of GC is alveolar hypoventilation followed by hypoxia of vital organs, resulting in a decrease in body temperature, bradycardia and hypoglycemia. With untimely assistance, a fatal outcome is possible. Mortality in HC ranges from 60 to 90%.

All symptoms of hypothyroidism increase in the patient. Drowsiness, disorientation, coma are expressed. Body temperature is reduced to 34-35 ° C, bradycardia occurs. The skin is cold, pasty.

The main symptom of GC is a decrease in body temperature. Coma is accompanied by progressive changes in the central nervous system, inhibition of all types of reflexes. Changes in the central nervous system lead to an increase in bradycardia, a decrease in blood pressure and hypoglycemia.

Violations by of cardio-vascular system, developing in a patient with GC, are often the cause of death. Peripheral hemodynamic parameters are among the first to respond to changes in the concentration of thyroid hormones. Hypothyroidism is accompanied by a decrease in heart rate (HR). The bradycardia that occurs with hypothyroidism is reversible when euthyroidism is achieved.

Another effect in hypothyroidism is a change in total peripheral vascular resistance (OPVR). Hypothyroidism causes an increase in peripheral vascular resistance, with which, to a certain extent, the development of diastolic arterial hypertension(AG). Diastolic hypertension in hypothyroidism is common. In patients with hypothyroidism and the presence of hypertension, the content of aldosterone and renin in the blood plasma is reduced, i.e. diastolic hypertension in hypothyroidism is hyporeninic in nature.

The alleged causes of impaired vasodilating function in hypothyroidism are: reduced generation of vasodilating substances and / or resistance to them of vascular smooth muscle cells; decrease in the concentration of atrial Na-uretic peptide.

The state of hypothyroidism is characterized by a decrease in the number of β-adrenergic receptors, which is associated with a lower likelihood of developing arrhythmias. However, it has been established that norepinephrine secretion and its content in blood plasma are increased in persons with hypothyroidism. Norepinephrine, being mainly an adrenergic stimulant, can contribute to spasm of the coronary arteries.

Hypothyroidism is characterized by a decrease in myocardial contractility, a decrease in ejection fraction, and the development of heart failure. The state of hypothyroidism is also accompanied by prolongation of diastole, an increase in the time of isovolumetric relaxation of the left ventricle.

Treatment of hypothyroidism

Since GC is the result of either the lack of treatment of hypothyroidism or inadequate therapy for this syndrome and is an extremely serious condition with high mortality, a doctor of any specialty should be aware of the algorithms for treating hypothyroidism and the drugs used for this.

It is very important to recognize hypothyroidism in time, which can be diagnosed by only one indicator of hormonal analysis - TSH, and prescribe replacement therapy with Euthyrox. Its difference from other thyroid hormone preparations is the ability to easily select the desired dosage - 25,50,75,100, 125 or 150 mcg, which greatly facilitates the replacement therapy of hypothyroidism.

Dosing regimen of the drug
EUTHIROX (levothyroxine sodium)
Set individually depending on the indications, the effect of treatment and laboratory data. The entire daily dose is taken 1 time / day in the morning, at least 30 minutes before breakfast and washed down with liquid.
With hypothyroidism at the beginning of treatment, a dose of 50 mcg / day is prescribed. The dose is increased by 25-50 mcg every 2-4 weeks until signs of a euthyroid state are achieved.
In patients with long-term hypothyroidism, myxedema, and especially in cases where there are diseases of the cardiovascular system, the initial dose of the drug should be no more than 25 mcg / day. In most patients, the effective dose does not exceed 200 mcg / day. The lack of an adequate effect when prescribing 300 mcg / day indicates malabsorption or that the patient does not take the prescribed dose of Euthyrox. Adequate therapy usually leads to normalization of the level of thyroid-stimulating hormone and thyroxine (T 4) in plasma after 2-3 weeks of treatment.

Presented short info manufacturer for dosing drugs in adults. Before prescribing the drug, carefully read the instructions.

Treatment of GC
The main task of the treatment of GC is the restoration of normal physiological functions all organs and systems disturbed due to hypothyroidism. The criterion for the adequacy of treatment is the disappearance of clinical and laboratory manifestations of hypothyroidism.

The severity and duration of hypothyroidism are the main criteria that determine the doctor's tactics at the time of initiation of treatment.

The more severe the hypothyroidism and the longer it has not been compensated, the higher will be the general susceptibility of the body to thyroid hormones, especially for cardiomyocytes.

The main therapeutic measures for GC:

1. Replacement therapy with thyroid hormone preparations (levothyroxine).
2. The use of glucocorticoids.
3. The fight against hypoventilation and hypercapnia, oxygen therapy.
4. Elimination of hypoglycemia.
5. Normalization of the activity of the cardiovascular system.
6. Elimination of severe anemia.
7. Elimination of hypothermia.
8. Treatment of concomitant infectious diseases inflammatory diseases and elimination of other causes that led to the development of coma.

GC treatment is carried out in a specialized intensive care unit and is aimed at increasing the level of thyroid hormones, combating hypothermia, and eliminating cardiovascular and neurovegetative disorders.

The treatment of GC is based on the principle of maximum administration of thyroid hormones, primarily levothyroxine, through a tube, either drip or intramuscular injections.

The goal of the treatment of hypothyroidism is stable normalization of the TSH level within the normal range (0.4-4.0 mcU/l). In adults, euthyroidism is usually achieved with levothyroxine at a dose of 1.6-1.8 µg/kg body weight per day. The initial dose of the drug and the time to reach the full replacement dose is determined individually, depending on age, body weight and the presence of concomitant heart disease. It is possible to gradually achieve a full replacement dose of levothyroxine - an increase of 25 mcg every 8-10 weeks. The need for levothyroxine decreases with age. Some older people may receive less than 1 mcg/kg of the drug per day.

The need for levothyroxine increases during pregnancy. Evaluation of thyroid function in pregnant women, which involves the study of the level of TSH and free T 4 , is appropriate in each trimester of pregnancy. The dose of the drug should ensure the maintenance of a low normal level TSH.

In postmenopausal women with hypothyroidism who are prescribed replacement therapy estrogens, an increase in the dose of levothyroxine may be necessary to maintain normal TSH levels.

The level of TSH, after changing the dose of levothyroxine, is examined no earlier than after 8-10 weeks. Patients receiving a titrated dose hormonal drug, it is recommended to examine the level of TSH annually. The TSH level is not affected by the time of blood sampling and the interval after taking levothyroxine. If, in addition to this, the determination of the level of free T 4 is used to assess the adequacy of therapy, the drug should not be taken in the morning before blood sampling, since for about 9 hours after taking levothyroxine, the level of free T 4 in the blood is increased by 15-20%. Ideally, the drug should be taken on an empty stomach at the same time of day and at least 4 hours apart before or after taking other drugs or vitamins. Taking drugs and compounds such as cholestyramine, ferrous sulfate, soy proteins, sucralfate and antacids containing aluminum hydroxide reduces the absorption of levothyroxine, which may require an increase in its dose. Increasing the dose of this medicinal product may be needed when taking rifampin and anticonvulsants that alter hormone metabolism.

Hypothyroidism is a condition caused by a deficiency of thyroid hormones. The disease is easy to control and treat at the initial stages, but has a lot of adverse, and sometimes irreversible, consequences in the case of a neglected condition. The onset of the problem often goes unnoticed, since the symptoms of hypothyroidism can "mask" as symptoms of other pathologies, and simply ignored.

Features and types of the disease

Why does hypothyroidism have such an extensive list of symptoms that do not differ in specificity? Symptoms of hypothyroidism indicate a disruption in the functioning of many organ systems, in particular: the cardiovascular, nervous, reproductive, endocrine systems, musculoskeletal system, metabolic processes are disturbed, etc.

This happens because the thyroid gland is an endocrine gland with a regulatory spectrum of action. Thyroid hormones do not have specific target cells or organs. They coordinate the functions and development of the whole organism, as they are directly involved in metabolism. Insufficient secretory activity of the thyroid gland leads to a decrease in the level of the hormones thyroxine and triiodothyronine. As a result, the activity of the most important cellular enzymes decreases. The patient's redox processes in the cells of the body are disturbed, the processes of synthesis and decomposition of complex compounds are slowed down.

The causes of hypothyroidism can be different. Depending on this, primary, secondary and tertiary hypothyroidism is distinguished.

• Primary hypothyroidism (thyroid), accounts for 95% of all clinical cases hypothyroidism. Occurs as a result of damage to the thyroid gland. Thyroid dysfunction can be caused by autoimmune diseases, thyroid surgery, radioactive iodine treatment of thyroid tumors, infectious diseases, thyroiditis. Problems associated with the synthesis of hormones also lead to the development of primary hypothyroidism. These include: a defect in the synthesis of thyroid hormones, acute deficiency or intoxication with iodine, treatment with hormonal preparations of the thyreostatics group.
• Secondary hypothyroidism (pituitary) develops with pathologies of the pituitary gland and a violation of the "pituitary - thyroid gland" system. The pituitary gland regulates the functioning of the thyroid gland through neurohumoral communication and the release of thyrotropin hormone.
• Tertiary hypothyroidism (hypothalamic) is a consequence of a disorder in the regulatory function of the hypothalamus. The hypothalamus-pituitary-thyroid system is disturbed.
• Tissue hypothyroidism (transport, peripheral) occurs as a result of a defect in the synthesis, transport or conversion of thyroid hormones, as well as with difficulty in the absorption of iodine in the intestine or by thyroid cells.

There are also congenital and acquired forms of hypothyroidism. Let us consider in detail the main symptoms of primary hypothyroidism and explain the mechanism of their development.

Symptoms of Primary Hypothyroidism

Lack of thyroid hormones in the blood leads to disorders metabolic processes: protein, lipid, carbohydrate, electrolyte.

Violation of protein metabolism

Thyroid hormones are involved in the biochemical reactions of protein synthesis and breakdown. Proteins are not only the building material of our entire body, but also an integral element in the structure of enzymes and some hormones. With hypothyroidism, there is an accumulation of by-products of protein breakdown: complex organic acids. characteristic feature of these compounds is the ability to retain fluid, as a result - one of the symptoms of hypothyroidism - swelling of the face and extremities (myxedematous edema). There are swelling of the mucous membranes, which entail such manifestations as hearing loss and nasal congestion, hoarseness. Due to edema, such a life-threatening phenomenon as sleep apnea (breath holding) can occur.
Blood hemoglobin is also a protein compound. With hypothyroidism, the total amount of hemoglobin in the blood decreases, anemia develops, skin become pale, the tissues of the organs experience oxygen starvation.

Lipid metabolism disorder

Lipids (fats) are part of the cell walls, are a structural element of some (for example, sex) hormones, our energy reserve. With hypothyroidism lipid metabolism slows down and starts to accumulate. A person develops obesity. The disease is characterized by the fact that it is very difficult or even impossible to lose weight. All attempts to lose weight through diets lead to even more weight gain. The breakdown of fats is difficult, there is a lack of intracellular energy.

Fat accumulates in the vessels in the form of cholesterol plaques, atherosclerosis develops. Atherosclerotic formations in the vessels gradually lead to damage to the heart muscle. The myocardium experiences hypoxia, dystrophic processes begin in it, heart failure occurs - and this is a direct path to a heart attack.

Lipid metabolism disorders lead to problems such as reproductive dysfunction. Women are having trouble menstrual cycle, decreased libido, hormonal infertility. Men lose interest in the sexual sphere of life, while erectile function, as a rule, is not impaired.

Carbohydrate metabolism disorders

Hypothyroidism slows down the uptake of glucose by the tissues of the body. Glucose is a source of "fast" energy in our body, as well as the only source of nutrition for brain cells. That is why, in a person suffering from hypothyroidism, oppression occurs nervous system.

The patient experiences apathy, fatigue, muscle weakness, numbness of the limbs, drowsiness, indifference to what is happening, the reactions of such a person are slowed down, attacks of unreasonable fear periodically occur, accompanied by tachycardia. Cognitive processes are disturbed, namely: memory worsens, voluntary attention, speech slows down. In severe forms of hypothyroidism, depression develops, hallucinations are possible.

With hypothyroidism, the patient's body experiences an acute lack of energy, which leads to a slowdown in the dynamic processes in the body: the heart rate decreases - bradycardia develops, the activity of intestinal motility decreases, which leads to systematic constipation, nausea. In addition, the rhythm of contractions of the fallopian tubes is disturbed, which adversely affects the reproductive function in women. Figuratively speaking, a person with hypothyroidism falls into an "energy-saving" mode. His body temperature drops, hypothermia develops. Hypothermia is considered to be a state in which the body temperature constantly does not exceed 35.0 - 35.3 ° C.

Electrolyte disorders

Electrolyte imbalance leads to disruption of water metabolism and cell activity. Electrolytes are those compounds that dissociate into ions. Electrolytes include: salts of potassium, calcium, sodium, magnesium, chlorides, sulfates. The main symptoms of hypothyroidism associated with this type of disorder are: swelling of the face, limbs, mucous membranes and connective tissue, dryness and peeling of the skin, layering and brittleness of nails, hair loss, dryness, dullness and brittleness of hair.

With an imbalance of salts in the body, deviations from the cardiovascular system are observed, the patient has hypotension, in atypical cases - hypotension, bradycardia. Cardiac and vascular spasms, extrasystoles may appear. Kidney function is impaired, may develop kidney failure, pyelonephritis. From the side gastrointestinal tract there is a decrease in digestive function, appetite, biliary dyskinesia, nausea, and sometimes vomiting. A decrease in the absorption activity of the cells of the intestinal wall leads to the depletion of the reserves of nutrient organic and inorganic compounds in the body, hypovitaminosis and anemia develop. The disorder of water and electrolyte balance also contributes to the development of atherosclerosis.

Stages of development of primary hypothyroidism

The clinical picture depends on the severity of the patient's hypothyroidism. The symptoms listed above do not occur all at once. At the initial stages, damage to the body and its organ systems is moderate and fairly easy to treat. With advanced forms of hypothyroidism, irreversible and dangerous complications can occur. So, experts distinguish the following stages of progression of primary hypothyroidism.

1. Latent or subclinical hypothyroidism. This form is characterized by a slight increase in the level of thyroid-stimulating hormone in the blood with a normal thyroxine level. The diagnosis - subclinical hypothyroidism - is made on the basis of data from a laboratory blood test. In this case, the patient does not yet have any anxiety symptoms and no treatment is required. Sometimes there are symptoms from the nervous system. First of all, brain cells respond to changes in the level of thyroxine. There are changes in the emotional sphere: the patient complains of depression, fatigue, drowsiness, etc.
2. Manifest hypothyroidism. The incidence of hypothyroidism is 3% among men, 10% among women. The incidence of hypothyroidism in postmenopausal women reaches 12%. Symptoms of hypothyroidism in women are more pronounced due to the physiological characteristics of the body, hormonal cycles. In the case of primary hypothyroidism, there is a low secretory activity of the thyroid gland with an increased concentration of thyrotropin. At this stage of the disease, symptoms of hypothyroidism appear. Serious damage to organ systems is not observed. Manifest hypothyroidism requires treatment with hormonal drugs, in particular synthetic L-thyroxine. In parallel, treatment is carried out aimed at eliminating the cause of the development of hypothyroidism. Medical treatment It is recommended to reinforce the correction of lifestyle and nutrition. Compliance always brings favorable results. On the initial stages Diet diseases are enough to stabilize the hormonal background and normalize the state of the thyroid gland and the body.
3. Severe hypothyroidism (complications). There are severe damage to organ systems. Often the consequences are not treatable. Kidney and heart failure, infertility, polycystic ovaries, myxedematous coma develop, and deaths are known.

Symptoms of central and tissue hypothyroidism

Pituitary and hypothalamic hypothyroidism are combined into a group of central hypothyroidism. The system of regulation of the thyroid gland is disturbed. Generally clinical picture This group of pathologies is similar to thyroid hypothyroidism. However, there are characteristic differences. So, with central hypothyroidism there is no obesity, the level of cholesterol in the blood is below normal. The man looks exhausted. Symptoms such as swelling, abnormalities in the cardiovascular system, anemia, biliary dyskinesia, are mild or absent. In tissue hypothyroidism, along with pronounced symptoms of hypothyroidism, a blood test reveals normal or even increased secretion of the thyroid gland.

Hypothyroidism during pregnancy requires special attention, as well as other thyroid diseases in women during this period.
Children's body, both during fetal development and after birth, is extremely sensitive to a lack of thyroid hormones. First of all, brain structures suffer. Lesions progress very quickly and in short time acquire intractable forms. The main symptoms of hypothyroidism in newborns:

• swelling, difficulty breathing, hoarseness of voice;
• hypothermia, bradycardia, anemia;
• inhibition of reactions and reflexes;
• lethargy, drowsiness, poor appetite, weak or absent sucking reflex.

In the further period of development, in the absence of treatment for hypothyroidism, symptoms such as:

• late teething, delay in general physical development;
• mental retardation, late mastery of speech, defects in pronunciation of sounds, deterioration of voluntary attention, memory;
• violation of the proportions of the body and face, dwarfism develops, the face is puffy, the eyes are wide-set.

During adolescence, children with hypothyroidism experience:

• low growth rates;
• delayed sexual development, underdevelopment of the genital organs, girls have interruptions in the menstrual cycle.

In the absence of proper treatment, hypothyroidism in childhood leads to the development of cretinism, oligophrenia, dwarfism, deaf-mutism.

Hypothyroidism - serious illness, which gradually takes away a person's vitality, destroys the body. The first signs of hypothyroidism should not be neglected, since at this stage treatment always gives favorable prognosis.

When the endocrine system begins to hurt, the first thing they remember is hypothyroidism, the consequences of which can be different. For each person, they manifest themselves in an individual form.

What characterizes hypothyroidism?

First of all, you need to understand well that this is not a separate disease that causes the thyroid gland.

This complication is mainly related to pathological changes thyroid gland. The exception is complications of hyperthyroidism.

The basis of the disease is functional disorders, in which the hormones necessary for the body are produced in very small quantities:

• triiodothyronine;
• tetraiodothyronine;
• calcitonin.

The disease appears in case of metabolic disorders and changes in the hormonal background of the whole organism.

Basically, hypothyroidism can be called a process in which there is a lack of hormones, so necessary for the thyroid gland. Basically, only women are affected by this disease. For men, this is very rare.

Sometimes the disease cannot be diagnosed, it cannot be detected for a very long time. The reason is the slow, very smooth development of the disease. Symptoms of the disease are often confused with overwork, considered pregnancy.

When complications of hypothyroidism are observed, the metabolic process becomes slower. Hormones that regulate energy metabolism do not work.

The most important cause of primary hypothyroidism are diseases that have a close interaction with the functions of the thyroid gland:

• hypoplasia;
• complications caused by taking medications that affect the synthesis of hormones;
• a small amount of iodine;
• inflammation.

In addition, this form of the disease is subject to a number of other reasons:

• pituitary defect;
• tumors and;
• concussions;
• various injuries;
• viral diseases of the nervous system.

Sometimes hypothyroidism appears due to radiation or complete resection of the thyroid gland. The diagnosis of congenital hypothyroidism is established after childbirth.

The cause of hypothyroidism is a malfunction of the thyroid gland, in which it cannot synthesize the hormones necessary for the body (for example, thyroxine).

The resulting consequences cause functional disorders of absolutely all organs of the human body.

Hormones secreted by the thyroid gland are present in the biochemical reactions necessary for a person that regulate metabolic processes. Without them, the following functions of the body are impossible:

• mineral metabolism;
• protein metabolism;
• synthesis of steroid hormones;
• synthesis of sex hormones;
• the work of the muscular system;
• vital activity of the bone apparatus;
• the work of the heart muscle;
• normal functioning of the brain.

Hypothyroidism as a signal of improper functioning of the hormonal background

The work of the endocrine system is very similar to the functioning of a closed electrical circuit. If at least one link drops out, the work of all the others is inhibited. With hypothyroidism, everything happens in a similar way.

The above hormones interact with different substances:

1. Pituitary hormones responsible for the normal functioning of the thyroid gland. If they are not enough, thyroid-stimulating hormone begins to be produced. This substance causes the thyroid gland to increase in size, which leads to the formation of various tumors, often the appearance of cancer.
2. Tropic hormones. When the number of thyroid hormones decreases and the increased activity of thyroid-stimulating hormone begins, the amount of prolactin begins to increase. As a result, there is a constant galactorrhea, there is a violation of the mammary glands, as a result, sex hormones have a disturbed synthesis. Gets off.
3. Teroid hormones responsible for the normal functioning of the sex glands, for the work of the adrenal glands. The synthesis of such hormones becomes minimal. This is due to the fact that thyroid hormones cease to create the necessary reaction of protein metabolism that occurs in the human liver. As a result, steroids do not receive a building material consisting of protein. A person develops diseases of the ovaries, testicles and adrenal glands. Basically lack of hormones.
4. Parathyroid glands. Due to the lack of calcitonin, calcium metabolism is disrupted. IN human body parahormone begins to actively act, which removes calcium ions from the bones.

The main symptoms characteristic of hypothyroidism

Symptoms of the disease can be:

• failures during menstruation;
• rapid weight gain, even if insignificant (this phenomenon is caused by a decrease in metabolic rate, while appetite begins to decrease, as a result, body weight does not increase);
• nausea;
• constipation;
• bloated belly;
• swelling of the face;
• limb swelling;
• hair loss;
• the skin on the head becomes yellowish;
• hearing is impaired;
• voice changes;
• there is rapid fatigue;
• general weakness;
• slow speech.

To accurately determine and confirm the diagnosis, the doctor prescribes certain tests:

• urine;
• blood;
• biochemistry;
• checking blood for the presence of hormones;
• immunology.

Depending on the severity, conditionally hypothyroidism can be divided into moderate and severe.

Thyroid hormones play a major role. They are supplied by the thyroid gland. If there is a complete absence of these hormones, the consequences can be dire. Hypothyroidism is expressed in a very severe form. This form of the disease is called. If the thyroid gland is able to at least partially produce hormones, the work of the body is also disrupted, but such consequences can be dealt with. Fatal outcome excluded.

If you do not carry out hormone replacement therapy, patients with hypothyroidism may experience negative consequences.

In sick children:

• mental development slows down;
• insufficient physical development;
• arises;
• secondary sexual symptoms do not appear for a long time;
• infantilism;
• heart disease;
• declining immune defense;
• constant cold;
• chronic diseases;
• weakness;
• inability to work physically.

In children with hypothyroidism, mental development slows down, immune defenses decrease, and heart disease occurs.

For adults, the consequences are:

• intelligence decreases;
• memory worsens;
• mental abilities are lowered;
• heart diseases;
• low pressure;
• chronic diseases having long-term treatment;
• infectious processes;
• violation of the menstrual process;
• ovaries atrophy;
• the work of the mammary glands is disrupted;
• the appearance of the external genitalia changes;
• impotence;
• infertility;
• sexual impotence.

Hypothyroidism is a disease that few people hear about. But international statistics are telling: 19 out of a thousand women and one in a thousand men have this thyroid dysfunction.

What is this disease?

The official history of the disease began in 1873, when it was first described.
In medical dictionaries, this term refers to a low level of thyroid hormone concentration over a long period of time.
Simplifying this definition, we can say that hypothyroidism is a dysfunction of the thyroid gland, in which an insufficient amount of hormones is produced or pathological disorders that affect the processes of hormonal metabolism.

Classification of hypothyroidism and the causes of the development of the disease

The disease is divided into five types.

primary type

It accounts for up to 95 percent of cases. The cause of the primary type of the disease is pathological lesions of the thyroid gland. The primary form is divided into congenital and acquired.

Congenital develops against the background of thyroid defects caused by hereditary defects in the production of thyroid hormones.
The acquired form is provoked by:

• operation of complete or partial removal of the thyroid gland;
• ionizing radiation of the thyroid gland;
• inflammatory processes in the thyroid gland;
• lack of iodine;
• reception medicines.

secondary type

It develops as a result of damage to the pituitary zone and a decrease in the level of thyrotropin hormone production.
Reasons for the development of a secondary type of disease:

• profuse traumatic or birth blood loss, resulting in ischemia of the adenohypophysis;
• tumor in the cells of the pituitary gland;
• inflammation in the pituitary gland;
• damage to the pituitary gland of an autoimmune nature.

Tertiary type

It is caused by pathological lesions of the hypothalamus and a decrease in the production of the hypothalamic hormone thyroliberin. Reasons for the development of the tertiary type of the disease:

• traumatic brain injury,
• inflammation in the hypothalamus,
• use of drugs based on serotonin,
• brain tumors.

Peripheral or tissue type

The reason for the development is a decrease in the activity of thyroid hormones, caused by a decrease in the level of sensitivity of tissues in peripheral areas to them.

Cellular hypothyroidism

A type of disease in which the patient's transport of the T4 hormone is disrupted. In hormonal analysis, the level of thyroid-stimulating hormone is normal and the diagnosis of the disease is difficult.

This fact makes TSH an unreliable indicator, although it is the key to diagnosing the disease.

Pathology is also classified according to the severity of the course. It looks like this:

Signs of hypothyroidism

On the early stages the disease is not manifested by almost any specific symptoms. Because of this, early diagnosis is difficult. This factor is the basis of the negative statistics of the disease. Diagnose it quite late.

Patients who develop this pathology often present a blurred set of symptoms to the therapist:

• chronic fatigue,
• emotional problems,
• overweight problems,
• hair loss and brittle nails,
• chair problems.

Such symptoms cannot tell the doctor anything specific. And so, ordeals begin in search of reasons, which often come down to recommendations to change the lifestyle and give the body a rest.

And only after a year or more, against the background of the same signs, others begin to appear that are specific to hypothyroidism:

• coarsening of the timbre of the voice,
• swelling of various parts of the body,
• puffiness of the face,
• yellowish skin tone
• lowering blood pressure.

This list allows us to assume the correct diagnosis and prescribe laboratory research thyroid hormone levels. Hormonal diagnosis is the main tool for determining the correct diagnosis.

Diagnosis of hypothyroidism

Diagnosis of the disease is not difficult. An analysis is prescribed for the level of three hormones:

• thyroxine,
• triiodothyronine,
• thyroid-stimulating hormone.

We give the norms of each of the hormones in the tables:

Signs of hypothyroidism are:

• decrease in thyroxin levels,
• decreased levels of triiodothyronine,
• increased levels of thyroid-stimulating hormone.

The severity of the disease is proportional to the level of decrease in the concentration of thyroxine and triiodothyronine. Thyroid-stimulating hormone always rises sharply, with the exception of the cellular form of pathology.

These characteristics are the classic clinical picture of the disease. But it doesn't always look like that. In medicine, the following nuances of diagnosing a disease are accepted:

• in the secondary type, thyroid-stimulating hormone may be normal (although an excess of TSH is the main symptom of the disease). But the biological activity of thyroid-stimulating hormone falls;
• in the primary type can be observed normal performance triiodothyronine. This happens due to increased secretion of the affected thyroid gland, which produces an excess of both thyroid-stimulating hormone and triiodothyronine;
• low thyroxine levels are not always a sign of hypothyroidism. This indicator, without analysis for triiodothyronine and thyroid-stimulating hormone, may be evidence of other problems.

Summing up the features of diagnosing hypothyroidism, we can conclude that this process is simple and clear with the necessary set of tests.
Visual signs of the disease, especially in the early stages, are not always informative and do not allow a clear diagnosis of the pathology.

Hypothyroidism: symptoms in women

Hypothyroidism has no gender specific symptoms. The manifestations of the disease in men and women are similar.
In advanced form in women, the disease can manifest itself:

• forms of puffiness, in which pressure does not leave persistent depressions;
• hoarseness of voice during emotional stress;
• thickening of the limbs and fingers;
• acne that does not respond to symptomatic treatment;
• impaired taste and smell.

These signs are non-specific for women. But they are more typical for them.
Hypothyroidism according to statistics - more women's problem and all its symptoms can be attributed to the female.

Problems associated with hypothyroidism

Concluding the conversation about the definition of hypothyroidism, you need to highlight the health problems that it provokes. Often they are manifested by concomitant symptoms, which makes it difficult to determine the disease.

To systematize the impact of the disease on the functioning of body systems, we present them in the table:

Life System	Disorders in the work of hypothyroidism
Cardiovascular	Hypothyroidism in the work of the cardiovascular system can be manifested by bradycardia, increased diastolic blood pressure, tachycardia, fluid in the pericardium.
hematopoietic	chronic nature.
Respiratory	Sleep apnea, presence of fluid in the pleural cavities, hoarse voice, shortness of breath.
nervous	General weakness, delayed mental activity, slowing down a number of basic reflexes, hearing problems.
digestive	chronic, poor appetite.
Urogenital	Various problems with menstrual function, erection problems, swelling of the genitals, problems with urination.

If these problems are considered as manifestations of hypothyroidism, then we will see that the doctor gets a blurry picture of the symptoms, in which making the correct diagnosis is a difficult task that requires a lot of experience.

Therefore, there is an opinion that the level of thyroid-stimulating hormone should be analyzed once every two years in the prophylactic mode, so as not to miss the development of pathology.

Treatment of hypothyroidism

Therapy of the disease is based on three areas:

• restoration of normal hormone levels,
• symptomatic treatment,
• elimination of the causes of the development of the disease.

Synthetic hormone replacement therapy is used to normalize hormone levels. The main drugs in this group:

A drug	Price	Description
Thyroidin	from 83 rub.	Preparation from the thyroid glands of animals. Slows down the thyrotropic activity of the pituitary gland and inhibits the activity of the thyroid gland.
Triiodothyronine	from 539 rubles	Synthetic thyroid hormone. It is used to replenish thyroid hormones, in particular, with hypothyroidism.
Thyreotom	from 268 rubles	Thyroid hormone replacement drug. Contains L-isomers of the hormones T3 and T4. At dosages that are used in the treatment of hypothyroidism, it inhibits the production of thyroid-stimulating hormone by the pituitary gland.
L-thyroxine	from 87 rub.	When using the drug in the treatment of hypothyroidism, L-thyroxine inhibits the synthesis of thyroid-stimulating hormone and thyrotropin-releasing hormone of the hypothalamus.

Hormone therapy is a complex process. There can be no talk of any universal dosages of drugs.
The doctor who builds the tactics of treatment begins hormone therapy with minimum doses, which are calculated taking into account:

• disease stage,
• comorbidities,
• the physical condition of the patient,
• body mass index.

The drugs of this group are prescribed in increments, depending on the result of the previous dosage. It is important to monitor the state of the cardiovascular system using an ECG.

With this selection, for several months, the dosage is selected that keeps the level of thyroid hormones normal. Replacement therapy is used throughout life.

Examinations for the level of hormones and monitoring of the state of the cardiovascular system become regular for the patient.
The other two areas of treatment are individual.

It has already been mentioned above that the manifestations of this disease are in a wide range. Depending on how the problem has made itself felt, symptomatic therapy is prescribed.

The same applies to treatment to eliminate the causes of the development of the disease. Most often it provokes iodine deficiency. They fight it with iodine preparations: food additives, vitamin complexes, medicines. We will talk more about them in the section on the prevention of hypothyroidism.

Complications of hypothyroidism

Left untreated, hypothyroidism can lead to serious complications. All that will be discussed below are rare situations that occur when total absence treatment and related factors. But you should not forget about them.

Particularly dangerous in terms of complications: a congenital form of the disease and hypothyroidism in a woman during pregnancy. In these cases, there is a high risk of developing complications of the disease in a child:

• mental retardation,
• problems with the activity of the central nervous system,
• cretinism.

By the way, cretinism is often directly associated with hypothyroidism, and a strong relationship has developed in society between these concepts.
But if hypothyroidism is a common cause of cretinism, then cretinism as a consequence of the disease is a rare complication.
In adults, the characteristic complications of the disease belong to other groups.

There are no statistics on the frequency of occurrence of each of them, so here is a single list of them:

• impaired cardiac and respiratory function due to the presence of fluid in pleural cavity and areas of the pericardium;
• violation of sexual function and subsequent infertility (typical for men and women);
• problems with the immune system, manifested by frequent infectious diseases and impaired autoimmune processes;
• oncological diseases.

A separate line should be highlighted hypothyroid coma. This complication is often mentioned when talking about the disease.
Hypothyroid coma is a common complication of hypothyroidism in the elderly. Its causes: lack of treatment and related health problems.

This complication is characterized by the following symptoms:

• confused mind,
• slowdown in the work of the central nervous system,
• dyspnea,
• heart and respiratory problems
• intestinal obstruction.

These signs are often called the usual manifestations of aging of the body, without giving them due importance. Therefore, the diagnosis of hypothyroidism and hypothyroid coma, as well as their proper treatment in the elderly, is rarely carried out at all.

Prevention of hypothyroidism

There is no special prevention of the development of pathology. It is impossible to completely protect yourself from this disease. But there is an opportunity to reduce the risk of getting sick. To do this, doctors recommend adhering to three postulates:

• complete nutrition,
• sufficient amount of iodine in the diet,
• control of hormonal balance.

A balanced diet is the basis for the prevention of hypothyroidism.
To understand what the right diet is in our case, here is a table of the main elements that the thyroid gland needs:

Component	Relationship with hypothyroidism	Products containing
Iodine	The most important component for the thyroid gland. Without it, the hormonal balance of the body is impossible. Participates in the secretion of thyroxine and triiodothyronine.	Seafood.
Tyrosine	Along with iodine, the most important component of sufficient production of thyroid hormones. Amino acid. Participates in the creation of four forms of thyroid hormones.	Seafood, red meat, chicken and fish.
Selenium	A mineral that is considered the foundation of thyroid health. Selenium is a key factor in the conversion of thyroxine and triiodothyronine.	Red meat, liver, poultry and fish, spinach.
B vitamins	Vitamins of this group perform several important functions at once: they deliver iodine to the thyroid gland, they are involved in the secretion of thyroid-stimulating hormone.	Red meat, liver, beets, cabbage.
Iron	Converts iodine that comes into the body from food into the form of iodine that is useful for the thyroid gland.	Veal, poultry, seafood, dark green leafy vegetables.
Omega 3 fatty acids	An important element in the transport of hormones that are produced by the thyroid gland to the cells.	Seafood: tuna, mackerel, sardines.
Group A vitamins	They participate in the process of transformation of T4 hormones into T3, and also help triiodothyronine enter the cells.	Apricots, pumpkin, carrots.
D vitamins	Like vitamins of group A, they are involved in the transport of triiodothyronine to cells.	Fatty fish meat, fish oil, pork meat.
Zinc	Participates in the production of thyroid hormones and their transport to cells.	Red meat, chicken meat, liver, meat products.

These components in the diet in sufficient volume are the key to the health of the thyroid gland and its full-fledged work. Taking into account the fact that thyroid disorders are the main cause of the development of the disease, filling the diet with these nine components is the basis for its prevention.

Hypothyroidism is a symptom complex that occurs when the thyroid gland does not function properly due to a deficiency of hormones that are synthesized in it. This pathology affects about 2-3% of the population of Russia, and its latent form is found in another 10% of adults and 3% of children. It occurs mainly in women of mature and elderly age - 50-60 years old, but can be diagnosed in both men and children, including newborns, as well as in women after childbirth.

About why and how this syndrome develops, about its clinical manifestations, the principles of diagnosis and treatment you will learn from our article.

Kinds

The most acceptable experts consider the division of hypothyroidism into the following forms:

• primary (occurs as a result of a congenital or acquired violation of the synthesis of thyroid hormones);
• hypothalamic-pituitary, or central (develops in pathology (this is secondary hypothyroidism) or hypothalamus (and this is a tertiary form of pathology));
• peripheral (thyroid hormones are present, but body tissues are insensitive to them);
• subclinical (thyroxine and triiodothyronine levels are normal, and the amount of thyroid-stimulating hormone that stimulates their production is increased);
• transient (may occur with some other diseases or while taking a number of medications; after the elimination of the causative factor, it disappears by itself, without treatment).

Causes and mechanism of the development of the disease

Primary hypothyroidism can be caused by:

• removal of the thyroid gland by surgery;
• radioactive iodine treatment;
• congenital underdevelopment of the thyroid gland;
• birth defects in the synthesis of its hormones;
• iodine deficiency, excess iodine in the body;
• exposure to toxic substances (thyreostatics, lithium preparations, and others).

Causes of central hypothyroidism can be:

• tumors of the hypothalamus and pituitary gland;
• surgical interventions, radiation therapy of this zone;
• circulatory disorders (both ischemic and hemorrhagic), cerebral aneurysm;
• chronic lymphocytic hypophysitis;
• congenital underdevelopment of some brain structures;
• infectious diseases (, abscess and others) of the hypothalamic-pituitary region.

Transient hypothyroidism, as a rule, is a consequence of asymptomatic thyroiditis, as well as the treatment of chronic inflammatory diseases with cytokines.

Subclinical hypothyroidism occurs with autoimmune thyroiditis, after removal of the thyroid gland, as a result of treatment with radioactive iodine.

The cause of peripheral hypothyroidism is a genetic mutation that causes insensitivity of receptors to thyroid hormones.

According to statistics, more than 95% of cases of hypothyroidism are represented by the primary form of pathology arising from autoimmune thyroiditis, thyroid surgery and therapy of various forms of goiter with radioactive iodine.

The pathogenetic basis of this pathology is a violation of energy processes that arose due to a lack of thyroid hormones. Many body systems are affected. Let's take a closer look.

1. Metabolism. Decreased oxygen consumption by tissues. The intensity of metabolic processes becomes less by 35-40%. This, of course, leads to an increase in the body weight of the patient. The synthesis and metabolism of proteins and lipids decreases, as a result of which the level of serum albumin and cholesterol in the blood increases, and hyperlipidemia is noted.
2. Nervous system. Severe, long-term untreated hypothyroidism leads to atrophy of nerve cells, the appearance of foci of degeneration.
3. The musculoskeletal system. The processes of bone formation slow down, skeletal muscles hypertrophy. This is combined with muscle weakness and slowness of movement.
4. Heart and blood vessels. The heart rate decreases, the contractility of the heart muscle and cardiac output decrease. That is, the heart cannot expel such a volume of blood from itself as in a healthy state, therefore, organs and tissues, especially those located remotely from it, are deficient in nutrients. There is some increase in blood pressure, myocardial hypertrophy. With severe hypothyroidism, heart failure develops.
5. Respiratory system. The vital capacity of the lungs decreases, hypoventilation of the alveoli is noted. These changes are associated with weakness of the diaphragmatic muscle that occurs with hypothyroidism.
6. Digestive system. In a person suffering from this pathology, due to a decrease in the metabolic rate, the body's need for energy decreases, which is manifested by a decrease in appetite up to its complete absence. It also slows down intestinal peristalsis, which, together with the lack of food intake in the intestine, causes constipation. Reduced contractility biliary tract, dyskinesia develops, which leads to the development of cholelithiasis.
7. Urinary system. Violation of the heart and a decrease in the volume of circulating blood leads to a decrease in blood flow to the kidneys, which causes an increase in the level of creatinine in the blood. Sodium is retained in the body, but not an increase, but a decrease in its level is determined in the blood.
8. Sexual system. The production, metabolism is reduced and the effects of sex hormones are changed. The level of estradiol and testosterone decreases, and prolactin increases. Clinically, this is manifested by the syndrome of hyperprolactinemic hypogonadism, the symptoms of which we will describe below - in the appropriate section.
9. The blood system. Hematopoiesis in the bone marrow is inhibited, which leads to anemia and a decrease in the aggregation properties of platelets. The latter increases bleeding, which is manifested by frequent bleeding, and they, in turn, are the second cause of anemia.

Symptoms, clinical manifestations

The disease develops gradually, slowly. At first, there are no external signs of it at all, and changes characteristic of subclinical hypothyroidism can be accidentally detected in the blood. Then, one after another, certain symptoms appear and gradually become more pronounced. Often, patients get used to their not quite satisfactory state of health and cannot even say when they first experienced this or that unpleasant symptom.

Upon detailed questioning, patients complain of:

• general weakness;
• slowness;
• lethargy;
• drowsiness;
• deterioration of memory, ingenuity;
• decrease in intelligence;
• constant feeling of cold, chilliness;
• coarsening of the voice;
• hearing loss;
• difficulty in defecation - constipation;
• numbness of the hands, a feeling of crawling (paresthesia), violations of all types of sensitivity;
• frequent prolonged pneumonia and bronchitis;
• pain in the joints;
• compaction of the structure, soreness, muscle weakness, their increase in volume; it is difficult for the patient to open his mouth or unclench his fist;
• women have uterine bleeding, become abundant and prolonged menstruation;
• a woman cannot get pregnant;
• milk begins to flow from the mammary glands.

With an objective examination of the patient, the doctor can detect such symptoms that testify in favor of hypothyroidism:

• the skin is very dry, yellowish in color, cool to the touch, flaky (especially in the elbows and knees);
• often the skin is edematous, poorly collected in a fold, when pressed on it, a hole does not form;
• puffiness is also determined on the face, especially around the eyes; his skin is pale with a yellowish tint, there may be a blush on his cheeks;
• the color of the hair on the head is dull, they are dry and brittle, fall out intensely;
• hair also falls out on other parts of the body - eyebrows, pubis, in the armpits;
• body temperature below normal values;
• speech is difficult, slowed down due to an enlarged, edematous tongue;
• voice as if hoarse;
• heart rate below normal;
• heart sounds are weakened, it is increased in size;
• diastolic arterial pressure increased;
• the intestines are swollen, its peristalsis is weakened;
• in severe hypothyroidism, ascites can be detected;
• swelling of the lower extremities.

There are 3 degrees of severity of hypothyroidism:

• mild (the patient becomes slow, thinking is disturbed, intellectual potential is reduced, the heart rate is reduced; working capacity remains within the normal range);
• medium (bradycardia is noted, the patient's skin is dry, he complains of constipation, drowsiness, irritability for no reason; women experience; working capacity is moderately reduced; in general analysis blood is detected);
• severe (the patient's body is edematous (this condition is referred to as "myxedema"), the skin is pale with an icteric tinge, dry, there are areas of pronounced peeling; a person notes difficulties in defecation (permanent constipation) and coarsening, a change in the timbre of the voice (it becomes low) ; working capacity is significantly reduced; in especially severe cases, the development of hypothyroid coma is possible).

hypothyroid coma

It can be the outcome of long-term untreated hypothyroidism. The provoking factors are:

• acute respiratory diseases;
• hypothermia;
• surgical interventions and anesthesia;
• food poisoning;
• drug intoxication;
• taking medications that have an inhibitory effect on the central nervous system (tranquilizers, neuroleptics, and others).

Coma develops gradually. The patient notes an increase in weakness, indifference to what is happening around him, he is drowsy, lethargic, movements are slowed down. If at this stage there is no health care, the patient falls into a stupor, which then goes into a coma.

Hypothyroidism and pregnancy

As mentioned above, a woman suffering from hypothyroidism is unlikely to get pregnant (hyperprolactinemic hypogonadism occurs, due to which ovulation is blocked). If a woman receives treatment, as the level of thyroid hormones normalizes, her reproductive function is restored.

The pregnancy of a woman suffering from this pathology must be planned. Fertilization must occur against the background of a normal level of thyroid hormones in the blood. When pregnancy is confirmed, the dose of the hormonal drug is increased by at least a third. This approach ensures the physiological course of pregnancy and the normal development of the fetus.

In the case when the disease is detected already at the stage of pregnancy, the woman is immediately prescribed hormone replacement therapy and the level of thyroid hormones is monitored every 1-1.5 months. If necessary, the dose of the drug is adjusted.

Hypothyroidism in the elderly and senile

The cause of it in this category of the population is autoimmune thyroiditis, which leads to atrophy of the thyroid gland. The disease develops very slowly and is manifested by swelling of the feet and legs, severe snoring. In the blood of such patients, anemia, high ESR, elevated level cholesterol. Patients rarely go to the doctor with these complaints, perceiving their condition as age - a manifestation of old age.

Diagnostics

The doctor can confirm the diagnosis of hypothyroidism after determining the level of thyroid hormones in the blood.

The doctor will suspect hypothyroidism in a patient based on a large number of diverse, seemingly unrelated complaints. Also at this stage, some facts from the patient's life that could lead to hypothyroidism can be clarified - thyroid surgery, taking toxic drugs, and others. Conducting an objective examination, the doctor will detect signs of dysfunction of various organs and systems - they are described in the previous section. After that, to confirm or refute the diagnosis, the specialist will refer the patient for further examination.

The main laboratory analysis is the determination in the blood of the level of thyroid hormones - thyroxine and triiodothyronine, as well as pituitary thyroid-stimulating hormone (TSH). With hypothyroidism, the level of the latter will be increased, and thyroid hormones, respectively, will be reduced (moreover, of the two, thyroxine has more diagnostic value - it is synthesized directly by the cells of the thyroid gland). If the level of TSH is elevated, and thyroxine is within the normal range, this indicates latent hypothyroidism.

To assess the condition of the thyroid gland, an ultrasound examination is performed. It allows you to assess the size and structure of the organ, to detect nodes or other signs of the disease.

These two studies are enough to make a final diagnosis. Other laboratory and instrumental diagnostic methods can be recommended to the patient, depending on the characteristics of the symptoms of his pathology, to clarify the nature of the lesion of a particular organ. This may be a biochemical blood test, ECG, ultrasound of the abdominal organs or other studies.

An analysis for congenital hypothyroidism is carried out directly in the maternity hospital, using special filter paper.

Differential Diagnosis

Since hypothyroidism can occur under the guise of many other diseases, it is important for a doctor to distinguish them from each other, because the success of treatment and the patient's quality of life depend on it.

Edema syndrome, in addition to hypothyroidism, occurs with kidney pathology - chronic nephritis, as well as with. If there is a pathology of the thyroid gland, the edema regresses against the background of replacement therapy.

Thyroid anemia differs from its other types by changes in the blood levels of thyroid hormones and the effectiveness of treatment with L-thyroxine.

A lesion of the peripheral nervous system similar to hypothyroidism can occur with (diabetic polyneuropathy), alcoholism, vibration disease and intoxication with salts of mercury, lead, and arsenic. However, in case of thyroid pathology, in addition to neurological symptoms, the patient will be disturbed by many other signs of the disease - a typical clinic of hypothyroidism.

Principles of treatment

The main therapeutic measure is replacement therapy with thyroid hormones - L-thyroxine and L-triiodothyronine - separately from each other or as part of combined preparations.

Minimum daily dose L-thyroxine - 25 mg. Increase it if necessary, gradually - every 14 days by 2 times, bringing it to the most effective (usually 100-150 mg per day). After a few weeks from the start of therapy, the symptoms of the pathology regress and completely disappear after 2-3 months. daily intake drug at the correct dosage. Take the drug 1 time per day, in the morning, half an hour before breakfast.