Subclinical hypothyroidism - symptoms and treatment in women

Hypothyroidism is a clinical syndrome caused by a long-term, persistent lack of thyroid hormones in the body or a decrease in their biological effect at the tissue level.

This endocrine disorder is very widespread. Hypothyroidism can have many causes. The disease can begin at any age, but most often people experience it at the age of 45-50. The prevalence of the disease among women is 4 times higher than among men. Typically, women begin to experience symptoms of hypothyroidism during menopause.

The clinical symptoms of hypothyroidism are very diverse and nonspecific, and replicate many conditions in the body, which leads to a diagnostic search for other diseases. Hypothyroidism in this case is diagnosed completely by accident. It is important to pay attention to all the signs that may indicate a metabolic disorder in the body - cardiovascular pathologies, obesity, high fatigue.

Classification by origin

Primary hypothyroidism

Primary hypothyroidism is a process that leads to the development of hypothyroidism and is localized directly in the thyroid gland. Primary hypothyroidism accounts for the vast majority of cases of this syndrome. Its prevalence affects about 2% of all people, among whom 10% are women and 3% are men. Primary congenital hypothyroidism of newborns is usually recorded in 1 child in 4-5 thousand newborns.

Primary hypothyroidism occurs as a result of autoimmune thyroiditis, during the treatment of thyrotoxicosis, as a result of the spontaneous transition of diffuse toxic goiter into this disease. Congenital hypothyroidism occurs due to dysplasia and aplasia of the thyroid gland and as a result of congenital enzymopathies.

Quite rarely, primary hypothyroidism can occur as a result of replacement of thyroid tissue with pathology in amyloidosis, sarcoidosis, Riedel's thyroiditis or cystinosis.

Secondary form

The secondary form of the disease is directly related to the hypothalamus and pituitary gland, which control the production of thyroid hormones by the thyroid gland. In this case, a completely healthy thyroid gland may produce an insufficient amount of hormones due to the lack or absence of the stimulating effect of thyroid-stimulating hormone (TSH), which will be explained by the dysfunction of three glands at once - the thyroid, pituitary gland and hypothalamus.

There may be several reasons for this failure:

• brain injuries;
• neoplasms in the brain;
• hemorrhages in the brain in the hypothalamus or pituitary gland;
• undergone chemotherapy;
• infections of the hypothalamus or pituitary gland;
• necrosis of the pituitary gland due to blood loss during surgery or trauma.

The secondary form of the disease can occur at any age and in people of both sexes with equal probability, since the above reasons do not depend on gender or age characteristics.

Tertiary hypothyroidism

The pathological process in the hypothalamus, together with reduced synthesis of releasing hormone (TSH-RH) and the lack of stimulation by it of pituitary thyrotrophs, as well as a decrease in the synthesis of thyroid-stimulating hormone and stimulation of TSH thyroid function leads to the occurrence of tertiary hypothyroidism.

It is difficult to differentiate this pathology from the secondary form of the disease, since the content of TSH-RH in the blood is very low and cannot be examined. When identifying this pathology, the TSH-RG test method comes to the rescue, in which, with the introduction of TSH-RG intravenously, a TSH test is taken in parallel, which begins to increase in tertiary hypothyroidism, and behaves calmly in secondary hypothyroidism.

Peripheral hypothyroidism

Hypothyroidism due to impaired transport, metabolism and action of thyroid hormones, that is, the emergence of resistance of the body to the action of thyroid hormones. If the patient's endocrine status is normal, then there will be no symptoms of the disease. As it develops and pathologies increase in the hormonal background, clinical symptoms of the disease will appear.

This form of hypothyroidism is dangerous due to various complications.

Patients with this diagnosis do not have pathology in the hypothalamic-pituitary system and the thyroid gland. The mechanism of occurrence of this form of the disease has not yet been fully studied.

Obvious symptoms of hypothyroidism in women

If the first signs are nonspecific and can be observed in many diseases, then the manifestation of special symptoms characteristic of hypothyroidism indicates the progression of the pathological process, additionally manifesting itself:

• Slow and unexpressive speech;
• Forgetfulness and memory impairment;0
• Macroglossia (enlarged tongue) and alopecia (hair loss);
• Dry and gray-yellow skin;
• Hypotension and shortness of breath;
• Complete apathy towards food and severe weight loss;
• Psycho-emotional disorders;
• Rough timbre of voice;
• Signs of anemia and thrombophlebitis.

The manifestation of primary and subsequent symptoms only indicates the possible development of pathology. To clarify the reasons for such changes, an examination by an endocrinologist and a thorough diagnosis are necessary. Especially when planning a pregnancy, to prevent undesirable consequences already during pregnancy.

What are the features of female hypothyroidism?

In addition to the main symptoms of the disease, which manifest themselves as a result of disturbances in metabolic processes, women exhibit a number of signs that are completely unusual for the disease in men (or are less pronounced).

In women, the overwhelming majority, chronic deficiency of the main thyroid hormones - thyroxine and triiodothyronine (T4 and T3) significantly affects the functioning of their reproductive system:

• As a result of the destruction (inactivation in plasma) of these hormones, their activity is significantly reduced, which leads to a significant increase in the level of steroid hormones (estrogens) synthesized by ovarian follicles.
• The production of pituitary hormones (prolactin) increases.
• The quantitative level of male hormones (testosterone) increases.
• There is an imbalance of hormones produced by the hypothalamus and pituitary gland (follicle-stimulating and luteinizing), which regulate female sex hormones.

As a result of such “metamorphoses”, women experience problems in the menstrual cycle - disruption of their cyclicity with heavy or too little discharge, or its complete absence. Uterine hemorrhages are possible. Sexual desire is noticeably reduced.

Due to hormonal imbalance, ovulation processes are disrupted, resulting in problems conceiving a child. If pregnancy does occur, there is a high risk of miscarriage or various disorders in the development of the fetus.

Causes

Provoking factors

It is known that women are more likely to suffer from hypothyroidism. A severe life-threatening condition is hypothyroid coma, which develops in elderly people who do not receive replacement therapy for long-term severe hypothyroidism when exposed to a number of provoking factors. These factors include:

• severe somatic diseases (heart attacks, strokes);
• hypothermia of the body;
• infectious diseases;
• heart failure;
• injuries of various locations;
• the occurrence of gastrointestinal bleeding;
• taking alcohol or drugs that depress the function of the central nervous system (anaesthetics, tranquilizers, antipsychotics, opioids).

At the same time, in the process of physiological aging of the human body, all metabolic processes slowly fade away, which leads to the formation of various pathologies. Hypothyroidism is one of the most common pathologies of older people, occurring in 2% of cases of examination of such patients and 6 times more often if it were possible to further examine everyone who does not seek medical help.

The disease in older people occurs due to dysfunction of the thyroid gland or regulatory systems - the pituitary gland or hypothalamus. With the disease, the metabolic rate decreases, cells begin to consume significantly less oxygen, the connective tissue elements of internal organs accumulate glycosaminoglycans, and the normal production of energy-dependent cell enzymes, which help organs to function fully, is disrupted.

Congenital hypothyroidism

The disease is based on a complete or partial deficiency of thyroid hormones produced by the thyroid gland, which leads to a delay in the development of all organs and systems. First of all, the central nervous system suffers from a lack of thyroid hormones. A direct connection has been established between the age at which treatment was started and the index of the child’s intellectual development in the future. As well as the manifestation of trophic disorders of the skin, depression of cardiac function, and a reduced level of metabolic processes.

Most often, congenital hypothyroidism is primary. It occurs as a result of abnormal development of the fetal thyroid gland - dystopia, athyroidism, hypoplasia.

The causes of such anomalies can be infectious and autoimmune diseases of the mother, taking toxic medications during pregnancy, contact with chemicals, radiation, iodine deficiency during pregnancy. Sometimes, no more than 2% of all cases of congenital hypothyroidism, the disease can be inherited due to gene mutations. Hereditary forms are most often accompanied by other pathologies - cleft palate, cleft lip, congenital heart defects, kidney defects and others.

Up to 10% of all children with this pathology experience a violation of the synthesis, secretion or interaction of thyroid hormones with each other. Up to 5% of all cases of congenital hypothyroidism have secondary and tertiary forms. They arise due to abnormalities in the formation of the fetal brain, due to cysts, tumors, birth injuries, asphyxia or pituitary aplasia.

Acquired hypothyroidism

Acquired hypothyroidism can occur for the following reasons:

• radiation or radiation irradiation of the neck;
• thyroid surgery (removal of this organ);
• inflammation in the thyroid gland;
• use of radioactive iodine as a medicine;
• use of certain medications.

In this case, the secondary form of hypothyroidism can occur with diseases of the hypothalamus or pituitary gland, which provoke a decrease in the functionality of the endocrine glands.

Medicines as a cause of disease

As noted above, acquired hypothyroidism can also occur when certain medications are used to treat any pathologies. Such drugs include drugs based on adrenal hormones, lithium-containing drugs, iodides, beta-blockers, some antiarrhythmic drugs, drugs with large dosages of vitamin A. All these drugs can cause hypothyroidism, so their prescription and monitoring of use is always in the field of management of specialized doctors.

Psychosomatic causes of the disease

Medical psychology has its own explanation for the occurrence of each disease in the body. These reasons are based on psychological factors and problems of a particular patient.

Experts associate the development of hypothyroidism with the fact that the thyroid gland itself has the shape of a shield and is located in the human neck.

This indicates the key protective role of both the gland itself and the hormones it produces. In the case of hypothyroidism, psychologists say that the patient strives to express and perform more actions, but suppresses his own desires and tries not to demonstrate increasing needs.

Fear of action is caused by lack of confidence in one's own abilities. A person is only sure that all his endeavors will fail, and he does not have enough strength and agility to achieve success. A patient with hypothyroidism is distinguished by the fact that psychologically he completely loses the relationship with his own creativity.

Hypofunction of the thyroid gland in women

Hypothyroidism is a complex syndrome caused by a decrease in the level of thyroid hormones in the blood serum due to hypofunction of the thyroid gland. There are 2 main types of hypothyroidism – primary and secondary hypothyroidism. Primary hypothyroidism is based on various thyroid pathologies, as well as external factors:

1. Thyroid dysgenesis/ectopia (developmental abnormalities).
2. All types of thyroiditis (primarily autoimmune).
3. Irradiation of the thyroid gland or therapy with a radioactive isotope of iodine.
4. Complete or partial removal of the thyroid gland.
5. Iodine deficiency, iodine deficiency diseases (for example, cretinism).
6. Long-term use of certain hormonal or iodine-containing drugs.
7. Long-term use of antiviral drugs to treat hepatitis.

Secondary hypothyroidism occurs due to TSH deficiency caused by abnormalities in the pituitary gland or hypothalamus. Its reasons may be:

1. Pituitary microadenomas, in which part of its tissue responsible for the production of TSH is replaced by tumor tissue.
2. Head injuries in which the hypothalamus or pituitary gland was damaged.
3. Poor blood circulation in the brain, especially in the pituitary region.
4. Hemorrhagic strokes (bleeds in the brain), which spread to the hypothalamus and pituitary gland.
5. Surgical interventions in which the pituitary gland was damaged or removed.
6. Excessive blood loss, because they can cause the death of individual lobes of the pituitary gland.
7. Inflammatory pathologies of the pituitary gland: histiocytosis, encephalitis, abscess, etc.
8. Uncontrolled intake of glucocorticoids, dopamine, as well as drugs or other toxic substances.
9. Radiation, chemotherapy for oncology.
10. Mutations or congenital underdevelopment of the pituitary gland (extremely rare).
11. Pathology of the adrenal cortex.

Also, secondary hypothyroidism can occur if treatment for the primary one is not started in time. In this case, the lack of thyroid hormones will lead to active production of TSH by the pituitary gland. Due to prolonged overstrain of the pituitary gland, a cyst may form on it, hemorrhage may occur, or other pathology may occur. Therefore, it is so important to promptly recognize the symptoms of hypothyroidism in women.

Symptoms of pathology

Experts include the main symptoms of hypothyroidism:

• depressive and apathetic states, fatigue, weakness, insomnia, loss of concentration;
• complete intolerance to cold by the body, increased dry skin, hyperkeratosis of the knees and elbows, hair loss and brittle nail plates;
• arthralgia, muscle weakness, paresthesia, excessive weight gain;
• severe swelling of the limbs and face due to water-salt imbalance, anemia, bleeding;
• prerequisites for the occurrence of atherosclerosis (high cholesterol levels), interruptions in lipid metabolism;
• development of secondary diabetes mellitus, impaired glucose tolerance, decreased appetite, constipation, gas;
• disruption of the menstrual cycle in women, including infertility and amenorrhea;
• bradycardia, arrhythmia, angina pectoris.

All symptoms can be either single or widespread. Their occurrence may indicate the development of the disease, therefore, with the complex of the above characteristics, it is extremely important to seek medical help.

Symptoms

Patients with hypothyroidism have decreased performance and are often bothered by headaches.
They constantly feel weak and tired. Hypothyroidism is characterized by multiple organ involvement, that is, the simultaneous presence of symptoms indicating the pathology of various organs. A single symptom of hypothyroidism is always nonspecific, which makes diagnosing this condition difficult. One patient will not necessarily have all the symptoms at the same time. Usually a few of them predominate, and the rest are present either in an erased form or are not present at all. The severity of individual symptoms also varies, sometimes they are simply mistaken for a manifestation of senile changes in the body (since hypothyroidism is more common after 55-60 years).

The main symptoms of hypothyroidism are:

• asthenic syndrome. Patients with hypothyroidism are concerned about general weakness, lethargy, fatigue, or a constant feeling of tiredness. Memory and speed of thought processes decrease, and performance decreases. Drowsiness is noted even with sufficient sleep per day. Interest in life is lost, emotional dullness and indifference to everything that happens develops. Numerous unpleasant sensations are often observed throughout the body: crawling sensations, numbness, tingling, burning, and the like. May cause headaches, muscle and joint pain;
• metabolic and trophic disorders. First of all, this is dry skin (sometimes with a jaundiced tint), swelling (especially in the face and peripheral parts of the limbs, which gives the appearance of a person, excuse me, who woke up after a heavy libation the day before), fragility and increased hair loss. The nails become thinner, flake, and have transverse or longitudinal striations. Such patients are usually overweight, although they may eat quite little. This occurs due to excessive fluid retention in the body and a decrease in the rate of metabolic processes. Patients with hypothyroidism are constantly cold, even in the warm season, and generally do not tolerate frost well. Body temperature is often below 36.6°C;
• swelling of tissues. In addition to the puffiness of the face and limbs, with hypothyroidism the voice often becomes rougher due to swelling of the laryngeal ligaments, nasal breathing is impaired (becomes difficult and snoring) due to swelling of the nasal mucosa, hearing deteriorates (due to swelling of the auditory tube and middle ear), lips thicken, teeth marks remain on the tongue, speech slows down a little (due to the slowness of the swollen tongue). As you can see, many of the symptoms seem to echo the natural process of aging of the body, and therefore are not perceived as pathology either by the patient himself or by those around him;
• decreased heart rate (bradycardia) and decreased blood pressure (hypotension). When examining such patients, systolic blood pressure (“upper”) often turns out to be low or normal, and diastolic (“lower”) blood pressure is elevated. The ECG is characterized by the so-called low voltage (the amplitude of all waves is low), a negative T wave. Fluid effusion between the membranes of the heart is possible. In this case, pericarditis develops. A common manifestation of hypothyroidism is heart failure with shortness of breath and pain in the heart area;
• problems with the gastrointestinal tract. Motility of the stomach and intestines with hypothyroidism slows down, food is retained for a long time in each section, which leads to heaviness in the stomach, belching, loss of appetite, flatulence, constipation, and nausea. It is possible to increase the size of the liver (hepatomegaly) due to fluid retention in the connective tissue of the liver, the phenomenon of biliary dyskinesia of the hypotonic type;
• problems with the gonads. The functioning of the thyroid gland is closely related to the secretion of sex hormones. With hypothyroidism in women, the menstrual cycle is disrupted up to the complete absence of menstruation, uterine bleeding is sometimes observed, and the likelihood of becoming pregnant approaches zero. It is possible to secrete secretions from the mammary glands like breast milk and develop mastopathy. Sexual desire decreases;
• anemia. Both the total number of red blood cells and the hemoglobin content decrease;
• increased cholesterol levels in the blood and early vascular atherosclerosis;
• tendency to frequent infections due to decreased immunity.

The most dangerous complication of hypothyroidism is hypothyroid (myxedematous) coma. It can develop if hypothyroidism is not treated, or in extremely advanced cases. Myxedematous coma is provoked by increased demands on the body when mobilization of forces is necessary. These may be infectious diseases, psycho-emotional stress, hypothermia, taking antipsychotics and barbiturates, physical trauma, surgery, food intoxication, and the like.

Hypothyroid coma develops gradually. When it occurs, all the symptoms of hypothyroidism intensify: consciousness is depressed from drowsiness to coma, the heart rate slows down and breathing weakens, blood pressure drops even more, body temperature drops to 35°C and even lower, the body swells, urination decreases, dynamic intestinal obstruction develops, effusion appears in the pleural, pericardial and abdominal cavities, glucose levels in the blood decrease, hair falls out on the head and in the armpits. With increasing symptoms of respiratory and cardiovascular failure, without adequate treatment, the patient may die. The mortality rate for hypothyroid coma reaches 80%.

Degrees of severity and development of the primary type

Subclinical form or compensated hypothyroidism

Subclinical hypothyroidism (the same as the compensated form of hypothyroidism) characterizes a condition when the disease is hidden and does not manifest itself in any way. A similar diagnosis can be made based on the results of blood tests for thyroid hormones and the pituitary hormone thyrotropin, the level of which should be elevated in the case of this form of the disease. Reduced activity of the thyroid gland leads to a similar hormonal surge of thyroid-stimulating hormone, with which the pituitary gland signals it about the lack of iodine concentration in the body.

A subclinical form of the disease affects 8% of the entire population of the planet, mainly women during menopause, that is, after 50 years.

A subclinical form can also occur during frequent stressful conditions in the body, when the concentration of cortisol in the blood increases, which suppresses the production of iodine-containing hormones. Also in women, this disease can be the result of the use of oral contraceptives, which contain a lot of estrogen. The subclinical form can occur in the presence of chronic diseases of the patient and the patient is taking medications, which, together with the existing comorbid background, led to the development of subclinical hypothyroidism.

In the initial stages, the subclinical form can not be treated, but the concentration of hormones can be adjusted with proper nutrition and lifestyle. However, most often this pathology is diagnosed in patients only when it has already become manifest and requires immediate hormone replacement therapy.

Decompensated hypothyroidism

Decompensated hypothyroidism is understood as that form of the disease in which all the clinical symptoms of the disease are clearly expressed and the examination clearly shows a lack of thyroid hormones. To treat this disease, hormone therapy is used with a dosage of active ingredients depending on the stage of decompensation. The stage of decompensation is determined by the patient’s well-being, the severity of symptoms and hormonal levels.

In parallel with the decompensated form of hypothyroidism, it is often necessary to treat concomitant diseases that arise due to a lack of thyroid hormones. Most often this is manifested by anemia, cholesterol metabolism disorders are present, and liver and heart function are impaired.

Those patients suffer from a decompensated form in whom the subclinical form of the disease was not identified in a timely manner, or with serious complications due to infectious, oncological and other processes in the body.

Manifest form

With this form of hypothyroidism, timely early diagnosis is important, since this pathology can lead to severe degrees of hypothyroidism and heart disease, which are a consequence of hypofunction of the thyroid gland.

Manifest hypothyroidism is divided into two stages of the disease. During the compensation stage, the body is able to cope with the lack of hormones on its own, and its symptoms are extremely rare and mildly expressed. The decompensated stage of manifest hypothyroidism has clear manifestations in the form of severe symptoms; it can constantly progress, leading to serious health consequences and even death.

Complicated course

Complicated hypothyroidism is quite severe and is usually accompanied by pathologies such as cretinism, secondary pituitary adenoma, serious heart rhythm disturbances, myxedema coma and death.

Female and male complications of severe hypothyroidism may vary slightly; in women, this pathology is most often accompanied by constant galactorrhea, changes in the structure of the mammary gland, infertility, severe heart failure, and hypothyroid coma with a fatal outcome in 80% of cases. In men, as complications of severe hypothyroidism, the thyroid gland may grow in volume and form a secondary adenoma. People of both sexes are often diagnosed with thyroid cancer, patients often lose consciousness, and death is not excluded for anyone, but it happens more often in women.

Types and stages of the disease

How does hypothyroidism occur, what is it, what types are there? People are either born with a disease that has an autoimmune genesis (congenital), or it appears during a person’s life (acquired). According to the degree of damage, thyroid hypothyroidism is divided into primary and secondary. According to the degree of complexity, they are distinguished: latent, manifest, complicated.

By etiology

Thyroid hypothyroidism is classified into congenital and acquired. In the first case, the disease manifests itself from birth due to diseases of the thyroid gland, damage or underdevelopment of the organ during intrauterine development, or genetic predisposition. Poor nutrition during pregnancy and iodine deficiency have an effect. Acquired thyroid hypothyroidism appears and develops during a person’s lifetime. The disease occurs as a result of neck injuries, inflammatory processes, lack of vitamins and iodine, medication, and as a result of removal of the thyroid gland.

By degree of damage

Hypothyroid dysfunction of the thyroid gland has different pathogenesis depending on the degree of damage. The disease is diagnosed all over the world, but it is almost always detected very late. There are 2 stages of hypothyroidism. They differ in the severity of changes in the structure of the thyroid gland and the ability of the organ to perform its functions. Primary thyroid hypothyroidism occurs due to changes in the structure and decrease in the mass of the glandular tissue of the thyroid gland. As a result, the organ stops synthesizing the hormones T3 and T4. Symptoms of primary thyroid hypothyroidism:

• swelling of the face and limbs;
• decreased body temperature;
• appetite suppression;
• yellow skin, hair loss;
• hoarseness of voice;
• an increase in the size of the thyroid gland;
• excess weight;
• sore throat, difficulty swallowing.

Secondary hypothyroidism is associated with decreased thyroid function. The organ is anatomically healthy, but is not able to produce thyroxine. This occurs due to loss of functions of the pituitary gland and hypothalamus. There are no symptoms of thyroid disease. Signs of secondary thyroid hypothyroidism:

• swelling of the body, face;
• problems with nasal breathing;
• sleep problems, memory loss;
• kidney failure;
• difficulty swallowing, decreased taste;
• low body temperature;
• retarded growth and development in children.

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By severity

Thyroid hypothyroidism can progress. The earlier in age it develops, the more complications it causes. Without proper treatment of thyroid hypothyroidism in children, the development of the central nervous system is disrupted, and physical and mental development is delayed. In the working population, myxedema develops without proper therapy. According to severity, thyroid hypothyroidism is divided into the following types:

1. Latent (subclinical). Symptoms are blurred, the thyroid gland is of normal size. Laboratory blood tests show elevated TSH and normal T4.
2. Manifest thyroid hypothyroidism. Characterized by a decrease in the level of thyroid hormones and an increase in TSH. Divided into compensated and decompensated. In the first case, the indicators are within normal limits due to the correct and timely intake of pills. In the second, normal indicators cannot be achieved even with treatment.
3. Complicated. This form of hypothyroidism occurs if the disease is not treated. Complications are typical: cretinism, developmental delays (in children), heart failure.

Diagnostic methods

Thyroid-stimulating hormone (TSH) analysis

The main test to suspect the presence of hypothyroidism is to determine the level of thyroid-stimulating hormone in the blood serum. The TSH norm is 0.4-4.0 µU/ml. When TSH rises, the synthesis of thyroid hormones decreases, and the pituitary gland is forced to produce more hormones to stimulate thyroid function.

If the TSH level is low, this indicates that the pituitary gland is not producing an additional dose of its hormones, since the thyroid gland is already actively functioning. This situation can, however, be observed in a number of cases - during pregnancy, in the case of pathologies of the pituitary gland, in certain diseases. It is important to understand that there is a feedback relationship between TSH and thyroid hormones, which is designed to maintain the body’s basic metabolism.

In the case of newborns and the possibility of asymptomatic hypothyroidism, each infant is examined for congenital hypothyroidism on days 5-7 of life. If the TSH value is elevated, babies undergo a routine ultrasound, since in this situation the presence of pathology is already suspected.

Ultrasound diagnostics

If a doctor suspects that a patient has hypothyroidism, a routine ultrasound examination is recommended as an additional study to determine the possible cause of hypothyroidism or to assess the total mass of the thyroid gland. The data do not always reflect hypothyroidism in the presence of altered levels of thyroid hormones. However, ultrasound is always part of the diagnostic procedures when making this diagnosis. Ultrasound for hypothyroidism can detect signs of autoimmune thyroiditis, which is often what causes it. Local or extensive thickening of the thyroid gland is observed. It can be either increased - with hypertrophy, or decreased - with atrophy. If the patient shows only nodularity on ultrasound, and there are no other symptoms of hypothyroidism, then the diagnosis is not made. An assessment of the clinical picture and laboratory data of thyroid hormones is required.

Differential diagnosis

Making such a complex diagnosis as hypothyroidism requires differential diagnosis, since the symptoms of the disease are also characteristic of many other pathologies in the body. In this case, it is important to pay attention to the leading clinical symptom inherent in a particular disease. Based on these symptoms, it is important to differentiate hypothyroidism from the following pathologies with a similar clinical picture:

• chronic ischemic heart disease, complicated by circulatory failure, in which, as with hypothyroidism, swelling of the subcutaneous tissue, shortness of breath, inversion of the T wave, hypercholesterolemia may be observed, but unlike the pathology under consideration, a rapid heart rate will be observed here, and not bradycardia, on in edema there will be a trace of pressure due to poor blood circulation;
• chronic kidney disease, which arises from various kidney diseases, in which, by analogy with hypothyroidism, swelling of the limbs and puffiness of the face, anemia, pale skin, but there will be no amyia and lethargy, arterial hypotension, and there will be signs of uremia in the blood;
• anemia, which is similar to hypothyroidism in pallor, lack of red blood cells and hemoglobin in a blood test, but differs from it in the absence of psychomotor retardation, rigidity to antianemic drugs, and bradycardia;
• differential diagnosis is also carried out with the following diseases: hepatitis, polyserositis, polyarthritis, depression, dyskinesia of the gastrointestinal tract.

What is subclinical hypothyroidism

To make a diagnosis of subclinical hypothyroidism, sometimes called subclinical thyroid disease, a blood test must show that peripheral thyroid hormone levels are within normal limits, but thyroid-stimulating hormone (or TSH) levels are slightly elevated.

What does it mean if your TSH level is elevated? Thyroid hormone is produced in the pituitary gland, which is stimulated by the hypothalamus in the brain. TSH instructs the thyroid gland to produce more hormones when levels drop too low. This means that elevated TSH levels are a sign that the body is trying to produce more thyroid hormones.

T3 and T4 enter the bloodstream and are then distributed throughout the body, controlling metabolism and the body's use of energy. This means that people with subclinical hypothyroidism and clinical hypothyroidism typically experience symptoms associated with a slow metabolism.

Some women with subclinical hypothyroidism have no or very mild symptoms. When they occur, signs and complications of subclinical hypothyroidism may include:

• fatigue,
• depression, anxiety and moodiness,
• increased sensitivity to cold,
• constipation,
• dry skin,
• weight gain,
• swollen face,
• muscle weakness, pain, stiffness,
• painful or irregular menstruation,
• thinning and hair loss,
• slowing down heart rate,
• memory impairment,
• low libido,
• enlarged thyroid gland (goiter),
• higher risk of progression to overt hypothyroidism. One study found that these symptoms occur in approximately 28% percent of women with subclinical hypothyroidism over age 55 ().
• A possible decrease in quality of life may be associated with anxiety, low libido, low energy levels and sleep problems.
• Higher risk of cardiovascular disease, including high blood pressure, high cholesterol and heart failure, especially in people under 70 (studies show that people in their 70s and 80s have no additional risk).

In case you were wondering, the difference between hypothyroidism and hyperthyroidism is this: hypothyroidism describes an underactive thyroid gland, while hyperthyroidism describes an overactive thyroid gland. These two thyroid disorders often cause opposing symptoms.

Related articles:

• Treatment of thyroid hyperthyroidism in women
• What is the difference between hypothyroidism and hyperthyroidism?

Is it possible to have normal TSH levels with subclinical hypothyroidism? Yes it is possible. Low T4 levels (below 5 to 13.5 mcg per deciliter) but normal TSH levels may indicate that you have hypothyroidism. On the other hand, subclinical hypothyroidism is defined as normal free thyroxine (T4) levels combined with elevated TSH levels.

Hypothyroidism Treatment Methods

Traditional methods

The goal of hypothyroidism therapy is clinical remission and laboratory compensation of hypothyroidism. Hormone replacement therapy is used to treat hypothyroidism of any etiology.

Replacement therapy is usually carried out using the drug Levothyroxine. This remedy is excellent for subclinical hypothyroidism for pregnant women or those women who are planning a future pregnancy. If hypothyroidism is secondary, there is a need to monitor thyroxine levels. Depending on its level, hormonal therapy is prescribed in the appropriate dosage.

In complex pathologies, hypothyroid coma can develop, which is often a consequence of improper treatment. Also, such a coma occurs due to injuries, hypothermia, intoxication processes, acute viral and infectious diseases. In this case, in addition to thyroid hormones, glucocorticoids and medications are prescribed to correct electrolyte and hemodynamic disorders.

ethnoscience

There is no non-drug treatment for hypothyroidism. As an auxiliary therapy, some methods of alternative treatment for hypothyroidism can be used. For example, given that this pathology reduces digestive function, you should choose a low-calorie diet, completely eliminate fatty meats, and introduce fresh fruits, vegetables, and a lot of seafood into your diet.

Traditional recipes can also be used to correct the functioning of the thyroid gland.

For this purpose, special recipes are used:

1. A drink is prepared from vegetables. For it, potato, beet and carrot juices are mixed in equal proportions, and then this mixture is taken 50 milliliters three times a day before meals.
2. As a natural source of iodine, you can eat 1 kilogram of cucumbers every day.
3. To replenish Omega-3 fatty acids in the body, you need to consume fish oil.
4. To adjust the functioning of the gastrointestinal tract, you can take 1 teaspoon per day of flaxseed oil on an empty stomach.
5. To normalize the level of thyroxine and the entire complex of thyroid hormones, it is recommended to eat white cinquefoil.
6. To overcome hypothyroidism, you need to use a decoction of elecampane root, birch buds, St. John's wort and rowan fruits, which are taken in equal proportions, poured with a liter of boiling water and brewed over low heat for 5 minutes. Then the decoction is infused for 12 hours and consumed three times a day before meals.
7. Beetroot tincture also works effectively, for which freshly squeezed juice of this root vegetable is mixed with a glass of vodka and infused for 2 weeks in a closed container. The finished infusion is taken 2 tablespoons, which must be washed down with clean water, 3 times a day.

How to treat hypothyroidism of the thyroid gland

The prognosis is favorable only with timely consultation with a specialist and a correct diagnosis. For treatment, hormonal medications and medications containing iodine, and homeopathy are prescribed. Good success is achieved if taking medications is combined with diet, folk remedies, and exercise. When diagnosed with hypothyroidism, the symptoms and treatment in women and men are in some ways similar to the symptoms and treatment of goiter.

Replacement therapy

It involves the patient taking medications to compensate for the lack of hormones. As a rule, tireotome, levothyroxine, eutyrox, ioditirox are prescribed. Replacement therapy for thyroid hypothyroidism is lifelong. Start with small doses of medications and gradually increase them. First, they compensate for the lack of hormones in the body, then maintain an acceptable dose. The main criterion for this is the patient’s well-being.

Therapeutic diet

Nutrition for hypothyroidism of the thyroid gland is recommended to be balanced, dietary, with a low energy value of the diet. Doctors strongly advise patients to reduce the amount of fat and carbohydrates in food, and exclude foods with a lot of salt. For hypothyroidism, it is advisable to eat foods that stimulate the production of gastric juice and have “laxative” properties (they promote weight loss). Contraindicated:

• fatty meat dairy products;
• products containing soy;
• bakery;
• sugar, honey, jam;
• refined foods (rice, sugar, white flour).

Recommended:

• all berries and fruits;
• broths cooked with bones;
• greenery;
• fish, seafood;
• dried fruits;
• one-day fermented milk products (yogurt, cottage cheese).

Folk remedies

Taking juices (vegetables) and various herbal infusions have a beneficial effect on the thyroid gland. They do not replace the main treatment with hormonal drugs, but create favorable conditions for the functioning of the organ, mitigate the manifestations of hypothyroidism, and enhance the effect of medications. Folk remedies are varied and are not suitable for treating every person. Here are some methods:

1. Treatment of hypothyroidism with cucumber. You must eat at least 1 kilogram of root vegetables per day. They contain iodine, which is well absorbed by the body. Reviews and impressions from this “therapy” are only positive.
2. Treatment of hypothyroidism with herbs. One of many options: take an equal amount of birch buds, St. John's wort, elecampane root, and rowan berries. Brew all the ingredients with 1 liter of boiled water, keep on low heat for a while and leave for half a day. Drink the resulting mixture of herbs three times a day before meals.

Prevention of hypothyroidism

Preventive measures in case of the threat of acquired hypothyroidism involve early diagnosis, timely initiation of replacement therapy, as well as the use of iodine as additional medications for the prevention of iodine deficiency or nutrition with sufficient iodine intake.

It is impossible to completely prevent the development of hypothyroidism, however, knowing the possible causes and risk factors for secondary hypothyroidism, as well as endocrinological heredity, this disease can be identified at an early stage and timely therapy can begin.

When considering family history, diseases of immediate family members deserve special attention, such as adrenal disease, diabetes mellitus, pernicious anemia, and diseases and conditions of the thyroid gland.

The patient’s laboratory tests deserve close attention from the endocrinologist to prevent the development of hypothyroidism if they reveal:

• hyponatremia (low sodium levels);
• dyslipidemia (impaired fat metabolism);
• increased levels of lactate dehydrogenase, creatine phosphokinase, prolactin.

An ultrasound examination of the thyroid gland will help to see structural changes in this organ and inflammatory processes in it, which can serve as prerequisites for the development of hypothyroidism.

Non-specific measures to prevent the disease include a balance of work and rest regimes, combating physical inactivity, maintaining an active lifestyle, long and sound sleep at night, maximizing positive emotions, which will stabilize higher nervous activity. It is also very important to eat right, not to go on starvation diets, and to consume large amounts of various microelements necessary for stable thyroid function.

Hypothyroidism therapy

Unfortunately, in most cases it is not possible to get rid of this disease forever. This is primarily supportive therapy.

But speaking in general terms, treatment of hypothyroidism, as a rule, includes, depending on the diagnosis, the following points;

• etiotropic therapy;
• replacement therapy;
• elimination of symptoms;
• treatment with dietary nutrition.

Important! Medicines for the treatment of this disease, Endorm and drugs like Eutirox, as well as their dosage regimen and dosage, are selected exclusively by an endocrinologist. Only this specialist can, based on the type of illness, its severity, clinical manifestations, concomitant diseases and age category, correctly establish a diagnosis and prescribe quality treatment!

Etiotropic treatment

This therapy refers to the treatment of primary and concomitant diseases that provoked the development of hypothyroidism. For example, it could be thyroiditis, which, in most cases, is the root cause of thyroid hypofunction.

Endemic goiter and other inflammatory processes that develop in the thyroid gland, pituitary gland and hypothalamus can also contribute to the development of such a disease.

If the disease was caused by a deficiency of iodine in the body, then the patient is prescribed medications that contain iodine. This could be Betadine, Iodide, etc. In addition to such therapy, patients are treated with iodized salt and seaweed.

Replacement therapy

This type of treatment is characterized by taking hormone-based medications that are substitutes for natural thyroid hormones. As a rule, such drugs are well tolerated by patients.

True, sometimes the therapeutic effect is achieved only with lifelong medication.

So, among such hormonal drugs, doctors identify the following:

• "Euthirox";
• "Endonorm";
• "Bagotirox";
• "Levothyroxine."

Treatment of symptoms

In order to improve the course of the disease and, accordingly, the patient’s quality of life, the endocrinologist prescribes symptomatic therapy. In this case, it is possible not to cure the disease, but only to stop the symptoms of its course, and also to maintain the full functioning of other organs, the activity of which can be inhibited by hypothyroidism.

Treatment of the symptoms of this thyroid disease involves the use of the following medications:

1. Cardioprotectors. They help normalize heart rate, blood pressure and other areas that improve the functioning of the cardiovascular system. These include:
   "ATP";
2. "Mildronat";
3. "Preducal";
4. Trimetazidine.
5. Cardiac glycosides. Prescribed if the patient has heart failure. This could be Digoxin, Korglykon, Strophanthin.
6. Nootropic drugs and neuroprotectors. Helps normalize metabolic processes in the central nervous system and brain.
7. Medicines that are made on the basis of female sex hormones. They help normalize the menstrual cycle and ovulation processes. If a woman has previously been treated by other specialists, then before using such medications you should definitely consult with your doctor.
8. Vitamin and mineral complexes. Aimed at improving the functioning of all organs and systems of the patient: “Aevit”, “Milgama”, “Gesavit” and “Undevit”. The last 2 representatives belong to multivitamin complexes.

Medicines usually need to be taken until complete recovery. For example, Endorm is taken until the body can independently produce the required amount of hormones.

Diet food

Traditional medicine recipe.

Dietary foods, like medications, are prescribed directly by the attending physician. The diet in the presence of a history of such a disease is aimed at excluding from the patient’s menu foods that are rich in cholesterol and saturated fatty acids.

In addition, you need to minimize the consumption of foods that are rich in fast carbohydrates, foods that are difficult to digest and that increase acidity in the stomach.

The list of prohibited and permitted products is selected by an endocrinologist and nutritionist on an individual basis.

As for the method of cooking, it is better to give preference to steamed, boiled or, in extreme cases, stewed or oven-baked dishes. They do not burden the stomach and intestines, thereby not creating difficulties in metabolic processes. But it is better to increase the daily intake of protein products.

If there are problems with stool, then an increased amount of fiber is introduced into the menu. And, of course, instead of regular table salt during cooking, it is better to use iodized salt. But it is better to avoid butter and sunflower oil or at least reduce their consumption to a minimum.

Important! The daily water intake is no more than 1.5 liters. Exceeding this level can lead to increased swelling.

Duration of illness

Temporary or transient (reversible) forms of hypothyroidism are observed in cases of prematurity, intrauterine growth retardation, functional immaturity, intrauterine infections, and in children from mothers with thyroid pathology. With age, the function of the thyroid gland in such children is restored, hormones begin to be produced in sufficient quantities and there is no need for treatment. To confirm this, a special analysis is carried out. To implement this, L-thyroxine is no longer administered to the patient for up to a month and a half, and after that a test for hormonal concentrations is done. If the test results are good, a conclusion is drawn about the transitional nature of the pathology. In this case, the child is stopped taking hormones. If the tests do not confirm the transitory form of the disease, then L-thyroxine must be used by the patient for life.

Hypothyroidism, which occurs during pregnancy in women, can also be completely cured. After giving birth for 6 months, there is a high probability that the thyroid gland will completely resume its functions on its own.

Other forms of hypothyroidism cannot be completely cured; they can only be brought to the stage of compensation and try to maintain in this form for a long time. When the disease passes into a decompensated form, treatment should be reviewed to prevent complications.

What do the statistics tell us?

Hypothyroidism in women after 50 years of age develops most often - in 1 woman out of 50, while in the stronger sex this disease is much less common - 1 man out of 1000 suffers from hypothyroidism.

As statistics show, an increased incidence of this disease is observed in people who live in regions remote from the maritime climate.

As for global statistics, doctors note that the total population that needs treatment for hypothyroidism is about 2.1%.

Many people are interested in whether hypothyroidism can be cured? Yes, hypothyroidism can be treated, but the insidiousness of the pathology lies in the difficulty of diagnosing it independently. For example, in the first stages of the development of the disease, only chronic fatigue may be felt.

Who among us isn’t tired now? Yes, everyone is always tired! Therefore, in order not to waste precious time, you need to pay attention to absolutely all changes in the body’s behavior.

Pregnancy and breastfeeding

Hypothyroidism is a relatively common pathology among women of reproductive age and pregnant women, which is often diagnosed accidentally due to nonspecific clinical signs of the syndrome and the lack of strict recommendations for screening hypothyroidism and women of reproductive age and pregnant women. Often in the case of manifest and subclinical hypothyroidism, women experience menstrual irregularities and even infertility. This is due to the fact that increased thyroid-stimulating hormone also entails an increase in prolactin, which can inhibit the maturation of oocytes in the ovarian region. In this case, ovulation does not occur during the menstrual cycle and the woman cannot become pregnant.

With hormonal imbalance, the formation of the endometrium, the tone of the fallopian tubes and the components of the cervical secretion are disrupted. A mature egg under such conditions becomes unable to carry out fertilization and does not attach to the fallopian tubes.

In order to understand whether pregnancy with hypothyroidism is possible in each specific case, it is important to promptly seek medical help and undergo a course of effective treatment. If a woman does not know about her own pathology, this can also negatively affect sudden pregnancy, which can still occur even with hypothyroidism. Therefore, before planning a conception, it is better to be fully examined so that you do not have to sacrifice your own health and the life of the unborn child when treating hormonal changes.

Effect on the fetus

Hypothyroidism of any severity can cause a number of severe complications in both the mother and the fetus, manifested in miscarriage, early termination of pregnancy, intrauterine fetal death, and frozen pregnancy.

A woman who does not know her diagnosis can discover the presence of problems with the endocrine system if she systematically experiences involuntary abortions. Miscarriage serves as a signal of even the mildest stage of subclinical hypothyroidism.

At the end of pregnancy, with this diagnosis, a new danger arises for the fetus and mother - post-term pregnancy up to 42 weeks. For a child, this is fraught with all sorts of birth injuries and disruptions in the functioning of the nervous system. Thus, the presence of hypothyroidism in a pregnant woman is an absolute indication for the immediate initiation of replacement therapy, which is prescribed immediately and in full dose, without the preliminary gradual increase adopted in some cases of treatment of hypothyroidism outside pregnancy

Is it possible to give birth

Childbirth with compensated hypothyroidism is usually carried out naturally, but preliminary preparation for it is necessary. Indications for delivery by cesarean section usually arise in the presence of serious obstetric complications. Hypothyroidism itself does not complicate childbirth if hormone levels are stabilized.

Is it possible to breastfeed

Hypothyroidism also negatively affects the condition and health of the mammary glands in women. However, when treating this pathology with medications, breastfeeding is quite acceptable. Breastfeeding is also acceptable if there is a frequent complication of the pathological condition in the postpartum period - diffuse enlargement of the thyroid gland (goiter) and its drug therapy.

To reduce the likelihood of endocrine disorders in the body during pregnancy and the lactation period, it is necessary to carry out iodine prophylaxis of the body. Only pathological hypothyroidism does not accept iodine prophylaxis, so it cannot be carried out in this case.

If thyroid pathology is detected in a timely manner, then you can become pregnant and breastfeed a child, since this pathological process may have a physiological basis that will not negatively affect pregnancy and breastfeeding.

Causes of subclinical hypothyroidism

The main causes of subclinical hypothyroidism are the same as those of hypothyroidism (). The most common cause of elevated TSH levels is autoimmune thyroid disease, also known as Hashimoto's disease. Research shows that antithyroid antibodies, related to Hashimoto's antibodies, can be found in approximately 80% of women with subclinical hypothyroidism. Other causes may include: radioiodine therapy, radiation therapy, thyroid surgery, granulomatous thyroiditis, iodine deficiency, pregnancy and severe postpartum. Chronic stress, lack of sleep, poor gut health and nutritional deficiencies may also be contributing factors.

Is it worth treating subclinical hypothyroidism?

Doctors diagnose subclinical hypothyroidism using blood tests that show elevated levels of the hormone TSH. Because thyroid disorders can be complex, it is recommended that patients have a complete hormone panel (a more detailed test showing the levels of all thyroid hormones) to determine the best type of treatment for the patient's condition.

Can subclinical hypothyroidism be cured once diagnosed?

There is no “cure” for a diagnosis of hypothyroidism, but there may be ways to naturally increase thyroid hormone production. Clinical hypothyroidism is usually treatable with a combination of lifestyle changes and medications. However, it is controversial whether subclinical hypothyroidism should be treated in the same way. Clinicians have varying opinions regarding the best approach to treating subclinical hypothyroidism because not all women deal with symptoms that affect their quality of life.

The exact upper limit of a “normal” serum TSH level remains a matter of debate. The current standard approach to treating hypothyroidism is to treat people with a sustained serum TSH level greater than 10.0 mIU/L. In this case, it is common to use medications, including levothyroxine, to keep thyroid hormone levels within normal limits.

For people with TSH levels less than 10.0 mIU/L, individualized treatment for subclinical hypothyroidism in women is recommended based on symptoms, medical history, risk of developing hypothyroidism, age, and other factors.

Studies show that about 80% of patients with subclinical hypothyroidism have a serum TSH less than 10 mIU/L. Some experts believe that the upper limit of normal for serum TSH levels should be 3.0 to 5.0 mIU/L, or perhaps even up to 2.5 mIU/L ().

Drug treatment is often not the best approach to treating patients with subclinical hypothyroidism. A 2007 analysis of studies found evidence that levothyroxine replacement therapy for subclinical hypothyroidism does not lead to improvement - it does not improve quality of life, mood, anxiety or cognition.

How dangerous is this disease?

The negative consequences in patients with hypothyroidism are very different. All of them are dangerous, so their occurrence should be prevented. The consequences of hypothyroidism vary depending on the age of the patient. So, in children the main consequences of pathology can be:

• slow mental and physical development, development of cretinism, infantilism;
• absence of secondary sexual characteristics for a long period;
• heart diseases;
• low immune resistance of the body, frequent colds, the likelihood of numerous chronic diseases;
• increased weakness, inability to perform physical labor.

Among the consequences of hypothyroidism that adult patients often experience are:

• decreased cognitive abilities;
• cardiovascular diseases;
• long-term, often chronic, infectious diseases;
• menstruation disorders;
• ovarian atrophy, dysfunction of the mammary glands, infertility;
• change in the appearance of the external genitalia;
• impotence, sexual impotence.

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Also, in adult patients, such a severe consequence of the pathology in question may occur as hypothyroid coma, during the period of which the hormonal level of the body reaches a critical state. In this case, metabolism is disrupted, cardiac arrest and brain dysfunction are possible.

Signs of the disease and their symptoms

Often the signs and symptoms of thyroid hypothyroidism are interpreted as clinical manifestations of other pathologies. Patients are observed for a long time by a cardiologist, nutritionist, therapist, psychologist, receive incorrect diagnoses and are treated unsuccessfully. Signs of thyroid hypothyroidism develop unnoticed and slowly (no changes are visible in the photos of patients with mild degrees). for this reason, people are in no hurry to go to clinics.

In adults

Let us list the general signs and symptoms of thyroid hypothyroidism, characteristic of adults. The degree of severity depends on the individual characteristics of the organism, form, type of disease, age and gender. So, the symptoms:

1. From the nervous system: constant drowsiness, lack of vital energy, memory impairment, inability to concentrate.
2. From the gastrointestinal tract: tendency to constipation, increased appetite, biliary dyskinesia;
3. From the cardiovascular system: shortness of breath, slow pulse, high blood pressure (arterial and diastolic), edema in the evening.
4. From the reproductive system: libido is significantly reduced. In women, the menstrual cycle is disrupted, problems appear with childbirth, and in men, erectile function is impaired.
5. An increase in the size of the thyroid gland (barely noticeable in the initial stage, pronounced in subsequent stages).
6. Change in voice or its complete absence.
7. Dry skin.
8. Reduced body temperature (36.0-36.1).
9. Muscle cramps.

In children

Children are given a differential diagnosis already in the first 2-3 months after birth. Children suffering from hypothyroidism are born with high weight. Characterized by yellowness of the skin, swelling, drowsiness, and slow pulse. In some newborns, the umbilical wound does not heal well. The intestines work poorly, lethargy is observed. Older children complain of poor memory and loss of strength. You should be wary if the child shows excessive aggressiveness or inhibition.

Recommendations for patients

If you experience complaints such as weakness, drowsiness, fatigue, memory loss, depressed mood, dry skin, brittle nails, active hair loss, moderate weight gain, chilliness, infertility, decreased potency, immediately contact an endocrinologist.

Children with developmental delays must be observed by an endocrinologist to study the function of the thyroid gland. Pregnant women should contact an endocrinologist to study thyroid function in the 1st and 3rd trimesters of pregnancy and after childbirth.

Treatment

Due to the fact that the development of hypofunction is caused by hormonal deficiency, basic treatment is based on taking hormonal drugs (Eutyrox, L-thyroxine). Sometimes the activity of the thyroid gland is restored within 3-4 months after starting to take medications, in other cases, treatment for hypofunction continues for several years or a lifetime.

On palpation, an enlargement of the thyroid gland is noted. By palpation, its size and hardness, mobility, the presence of nodes and pain when compressed are determined.

Symptomatic therapy is aimed at relieving the general symptoms of the disease - drugs are prescribed that normalize the functioning of the brain, heart, vascular system, and intestines.

If iodine deficiency is detected, medications containing iodine are used (Iodomarin, Iodide, Iodbalance).

Surgical intervention consists of partial or complete removal of the thyroid gland in the presence of nodular goiter or oncological tumors. Treatment of hypofunction with stem cells involves introducing donor stem cells into the patient’s body, which restore the affected organs. But this method is expensive and has not gained much popularity.

If iodine deficiency is detected, medications containing iodine are used (Iodomarin, Iodide, Iodbalance).

Folk remedies

Traditional methods of treating hypothyroidism are based on herbal medicine and the use of various herbal compresses. The use of certain herbal decoctions normalizes the activity of the gland and metabolism, eliminates associated symptoms, while having no side effects.

The following medicinal herbs have healing properties for hypothyroidism:

• decoctions from a collection of herbs (yarrow, shepherd's purse, birch leaves, St. John's wort, centaury, chamomile, peppermint and knotweed) with the addition of blueberries;
• infusion of nettle leaves;
• feijoa fruit compote;
• tincture of ivy leaves;
• a collection of angelica, rose hips, licorice, celandine, fucus, pink radiola and St. John's wort;
• a collection of rose hips, chamomile, elecampane, and mordovnik flowers.

Lemon decoction with the addition of 1 tbsp is useful. flax seeds and 1 tbsp. honey To replenish iodine deficiency during hypofunction, seaweed salad or buckwheat porridge with the addition of kelp is effective.

To restore the menstrual cycle and treat ovarian dysfunction due to endocrine hypofunction, use licorice in the form of a tincture with the addition of yarrow, St. John's wort, aromatic rue, and juniper fruits. A warm compress made from oak bark infusion has a beneficial effect on the thyroid gland; it stimulates secretory activity.

FAQ

Joining the army with hypothyroidism

The clinical picture of hypothyroidism can be hidden or obvious, however, in any form and stage of the disease, conscription into the army is not carried out if the hormonal balance is disturbed.

To obtain a military ID, a conscript must confirm his own illness. To do this, it is necessary to undergo an additional examination at the military commissariat, having previously submitted to the therapist at the military medical commission the documents accompanying the current disease, confirming the diagnosis. During an additional examination, the conscript will be prescribed an ultrasound examination and may be given a referral for a thyroid biopsy, blood tests for hormones, and other diagnostic procedures.

After such an examination, a doctor from the commission fills out a report and submits it to a meeting of the military commission. A conscript whose diagnosis is confirmed receives a military ID and is not called up for military service. Only a conscript whose diagnosis of hypothyroidism has been previously removed by the treating endocrinologist can be called up for service.

Diagnostics

On palpation, an enlargement of the thyroid gland is noted. By palpation, its size and hardness, mobility, the presence of nodes and pain when compressed are determined. Laboratory tests involve a biochemical blood test to determine the patient's hormonal levels.

Instrumental examinations:

• scintigraphy - analysis of the functioning of the gland using radioisotopes (used to study the ability of the organ to absorb iodine particles);
• Ultrasound and computed tomography (CT) of the organ.

Hypothyroidism: symptoms

The clinical picture of hypothyroidism is directly related to the characteristics of its etiology (the conditions and causes that provoked the disease), the speed with which the patient’s current deficiency of thyroid hormones develops, as well as how old he is.

The following are considered the main problems arising in the diagnosis of the disease:

• absence of specific symptoms (that is, symptoms that occur exclusively in the disease of interest to us);
• increased prevalence of symptoms similar to those of hypothyroidism, noted within the general population when associated with other types of chronic diseases (mental or somatic);
• the absence of a direct relationship between the current degree of hormonal deficiency and the severity of the clinic (in some cases, symptoms with an explicit diagnosis of hypothyroidism may not appear, while subclinical hypothyroidism and the symptoms that appear with it are characterized, accordingly, by their own severity).

The clinical picture of hypothyroidism is generally characterized by a multisystem nature, but in some cases there is a predominance among patients of symptoms and complaints related to any one of the systems, which is why in frequent cases the diagnosis of the disease is made in favor of “mask diseases”. Let's move directly to the manifestations that are observed with hypothyroidism.

The long and severe course of hypothyroidism leads to the fact that patients acquire an appearance quite characteristic of this disease, which in particular consists of myxedema with it. Accordingly, this determines pronounced swelling, in which the face becomes puffy and the skin has a pale jaundiced tint. The face resembles a mask due to the paucity of facial expressions; aloofness is noted in the gaze.

In addition, patients' hair becomes dull and thinning, and increased hair loss is noted. Also characterized by apathy and lethargy. Speech becomes slow, and in some cases (due to the characteristic slurring of the tongue), it seems that something in the mouth is preventing the person from clearly reproducing speech. Due to the fact that the mucous membrane of the larynx also becomes swollen, the timbre of the voice becomes hoarse and quite low. Pronunciation of certain words can lead to a person stuttering on them, after which, after applying certain efforts to their reproduction, it will be possible to reproduce them more clearly. A classic symptom of hypothyroidism is swelling of the tongue, in which teeth marks can be seen on it.

Against the background of swelling of the mucous membrane of the Eustachian tube, patients may experience some hearing loss. Dry skin is also often mentioned among patient complaints.

As for the changes that occur with hypothyroidism in the nervous system, here, as you can determine from the descriptions of the disease already provided, there is a decrease in intelligence. In addition, memory decreases, depression and drowsiness occur. Children from 3 years of age, like adults, experience changes associated with the nervous system in a different way compared to the congenital form of the disease in newborns. Thus, for these two age categories, the changes are not irreversible; moreover, it is possible to completely eliminate them through the implementation of adequate replacement therapy measures. Congenital hypothyroidism, the symptoms of which we will consider below, is characterized, respectively, by physical and neuropsychic disorders on an irreversible scale.

Due to the general decrease in the level inherent in the basal metabolism, patients with hypothyroidism are prone to weight gain, while hypothyroidism itself never acts as a cause leading to pronounced manifestations of obesity. An extremely severe form of hypothyroidism can provoke hypothermia. Patients often experience a symptom such as chilliness, in other words, they are constantly cold, the reason for this is the centralization of blood circulation characteristic of this disease.

Hypothyroidism: photo of the patient with the disease (left) and photo after treatment (right)

The most common manifestation of symptoms in terms of manifestations from the cardiovascular system is a tendency to slightly increased blood pressure and 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 symptoms such as frequent constipation. In addition, dyskinesia and hepatomegaly often develop, and appetite decreases somewhat. A severe form of hypothyroidism can be characterized by the development of hypochromic anemia.

Quite often (this is especially true for women), changes related to the reproductive system are identified as part of the advanced symptoms of the disease. Thus, hypothyroidism can be characterized by a variety of disorders related to the menstrual cycle, ranging from amenorrhea (lack 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 its severe form, hypothyroidism in almost all cases is combined with infertility, however, with a less obvious lack 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, this possibility is comparable to a significant risk of its possible interruption or the birth of a baby with obvious disorders in the development of the nervous system.

Possible symptoms of hypothyroidism

How is the disease diagnosed?

To correctly diagnose hypothyroidism, you should contact an endocrinologist at the slightest suspicion, he will examine the patient and prescribe the necessary diagnostics.

The patient must undergo the following tests:

• clinical blood to determine hemoglobin (in the presence of hypothyroidism it decreases);
• blood for the presence of the hormones TSH, T3 (with hypothyroidism, the level of T3 and T4 decreases; during primary hypothyroidism, the level of TSH is increased, secondary - decreased);
• the blood is tested for the presence of antibodies;
• Ultrasound of the thyroid gland to determine any changes in its structure and size;
• Thyroid biopsy;
• Blood for biochemistry to determine creatinine and cholesterol (they increase in hypothyroidism), as well as sodium (its level decreases).

Hypothyroidism in pregnant women

Sometimes a woman notices hypofunction of the thyroid gland due to changes in hormonal levels when carrying a child. Although when this disease is diagnosed before pregnancy, the symptoms of hypothyroidism can intensify after conception.

If there is no or untimely treatment, the possibility of death increases to 80%. The most risky thing is the presence of congenital childhood hypothyroidism; it should be determined in the process of preparing for childbirth. In the future, it will be possible to perform an operation and begin adequate treatment.

Classification

The thyroid gland is responsible for the production of T3 (triiodothyronine), T4 (thyroxine) and helps increase the pituitary hormone (TSH).

These biologically active compounds regulate all types of metabolism, control the activity of most organs and systems, are responsible for the growth and development of the body as a whole, strengthen the immune system and have an anti-stress effect. Please note: due to a lack of hormones of this group, women often experience menopause prematurely and menopausal disorders worsen. Hypothyroidism is usually divided into 3 groups:

• Primary;
• secondary;
• central.

The primary form is caused by disruption of the activity of the endocrine gland itself and, as a consequence, a decrease in the secretion of its hormones. The secondary form is determined by malfunctions in the functioning of the pituitary gland or hypothalamus - these areas of the brain are responsible for regulating the production of TSH.

There is also hypothyroidism of central origin (tertiary). It is caused by the toxic effects of hormonal drugs, as well as a decrease in the number of cells producing thyroid hormonal compounds. In the latter case, tumors and viral infections may be possible causes. The central form of hypothyroidism accounts for up to 5% of clinical cases.

Complications

Delayed diagnosis, inadequate therapy or refusal of treatment will provoke the following complications of hypothyroidism:

• a significant impairment of the immune system, in which a woman will often suffer from infectious diseases;
• decreased libido;
• reproductive dysfunction;
• high cholesterol;
• early development of coronary heart disease;
• increased likelihood of myocardial infarction;
• risk of ischemic stroke;
• threat of development of cerebral atherosclerosis.

If a pregnant woman has hypothyroidism, then the doctors' prognosis is as follows: the child may be born with a heart defect, pathologies of internal organs, or functional insufficiency of the thyroid gland.

In some cases, hypothyroidism can lead to quite severe complications: acute or chronic heart failure, cretinism, hypothyroid coma.

A very serious, but fortunately rare complication is hypothyroid coma. Most often it is observed in women and older men who have:

• long-term hypothyroidism, which was not treated;
• low social status;
• severe concomitant diseases.

Hypothyroid coma can be triggered by cold, acute infectious and other diseases, intoxication, and trauma.

What do blood tests and ultrasounds show?

If a hypothyroid condition is suspected, the endocrinologist prescribes an examination, which includes:

• Ultrasound of the gland. Hypothyroidism is indicated by the hypoechogenicity of the organ, associated with a decrease in the density of its tissues. If it is caused by Hashimoto's thyroiditis, there is a decrease in the volume of the thyroid lobes.
• Test for other hormones. With hypothyroidism, testosterone levels decrease in men, and estradiol levels in women.
• Blood test for thyroid hormones. A decrease in thyroid activity is indicated by low levels of tri- and tetraiodothyronine.
• Blood chemistry. Due to metabolic disorders, the level of creatinine, cholesterol and triglycerides in the blood increases.
• Immunological analysis. The autoimmune nature of the disease is indicated by the presence of autoantibodies to the thyroid gland in the blood.

In case of complications, an ECG, CT or MRI of the brain, and X-ray contrast examination of the thyroid gland are additionally prescribed.

Diagnosis of secondary hypothyroidism

How to treat secondary hypothyroidism? Diagnosis of pathology begins with collecting complaints and examining the patient. Patients often note constant fatigue and drowsiness, and weight gain. You should pay attention to chilliness and swelling. In some cases, hypothyroidism is discovered by chance, for example, when menstruation is delayed, not related to pregnancy.

On examination, a decrease in heart rate and hypotension is revealed. Swelling can be located on any part of the body, most often on the face. Upon palpation, it is discovered that they have a soft mucous consistency (myxedema).

The final diagnosis can be made after laboratory tests. Patients experience an increase in TSH levels and a decrease in the amount of thyroid hormones. To identify the source of the disease, radiography of the sella turcica and CT scan of the brain are performed.

The main reasons for the development of pathology

The development of secondary hypothyroidism can be provoked by various factors, among which the most common are:

• inflammatory processes occurring in the pituitary gland with the addition of viruses and bacteria;
• necrosis of the pituitary gland due to internal hemorrhage;
• circulatory disorders in the brain;
• congenital anomalies of the pituitary gland, which cause its underdevelopment or complete absence;
• oncological diseases of the pituitary gland;
• ionizing radiation used as a therapeutic therapy for cancer.

It is impossible to determine the true cause of the development of secondary hypothyroidism by eye, so to identify it you need to undergo a comprehensive examination, which includes not only laboratory blood tests, but also modern diagnostic methods - MRI, CT, and so on.

Diagnosis

Diagnosis of the disease we are considering is quite simple. It requires confirmation of the fact that the functions characteristic of the thyroid gland are subject to decline. This, accordingly, requires determining the blood level of thyroid-stimulating hormone (or TSH), as well as T4. In an isolated increase in TSH, subclinical hypothyroidism is determined, while with a simultaneous decrease in T4 and TSH, obvious (acquired manifest) hypothyroidism is identified.

Considering the fact that the disease has a significant number of manifestations that are nonspecific to it, difficulties arise only in determining against their background the appropriate indications for conducting appropriate diagnostics for the level of thyroid hormones. Subclinical hypothyroidism is often diagnosed as part of a preventive medical examination.

Algorithm for diagnosing hypothyroidism for adults

General information

Hypothyroidism is not a disease, but a condition in which the human body has very low levels thyroid hormones . In this case, we are talking about insufficient functions of the gland, or about the development in the body of certain pathological processes that affect hormonal metabolism. The disease is defined exclusively by the external manifestations of hypothyroidism. Its symptoms were first described back in 1873. A little later, in 1878, the definition of “ myxedema ” appeared, denoting the presence of mucous edema of the skin in severe forms of hypothyroidism. Hypothyroidism most often affects women (the disease is diagnosed in approximately 1 in 50 women and 1 in 1,000 men). In most cases, the disease is detected in adult women, and its prevalence increases with age.

Kinds

The classification of hypothyroidism includes the following types:

Congenital hypothyroidism

Congenital hypothyroidism - this form is rarely familial; isolated cases are more common. They are caused by a mutation in the gene responsible for the formation of the thyroid gland, or a congenital defect of this organ.

An insufficient amount of thyroid hormones in congenital hypothyroidism leads to persistent disruption of the development of the child’s central nervous system, including the cerebral cortex, which causes mental retardation, abnormal structure of the musculoskeletal system and other important organs.

Acquired

Acquired hypothyroidism can occur before the age of 18 or in adulthood. Hypothyroidism in adults is referred to as myxedema. It develops as a result of diseases of the thyroid gland that arise during a person’s life. For example:

• after surgical removal of part of the thyroid gland;
• when its tissue is destroyed by ionizing radiation (treatment with radioactive iodine preparations, irradiation of the neck organs, etc.);
• after taking certain medications: lithium preparations, beta-blockers, adrenal hormones, vitamin A in large doses;
• with iodine deficiency in food and the development of certain forms of endemic goiter.

According to the mechanism of development, hypothyroidism is distinguished:

1. Primary (thyroidogenic). occurs as a result of a congenital or acquired disorder of the synthesis of thyroid hormones
2. Secondary (pituitary). The regulation of thyroid function is disrupted, usually due to damage to the pituitary gland, which produces thyroid-stimulating hormone.
3. Tertiary (hypothalamic) - occurs when the functional activity of the hypothalamus is impaired.

In rare cases, secondary and tertiary types of hypothyroidism develop as a result of radiation, hemorrhage, traumatic factors, operations and tumors.

Separately, we can distinguish peripheral hypothyroidism (also called transport or tissue), caused by impaired transport of thyroid hormones in the body or tissue resistance.

List of sources

• Dedov I.I., Melnichenko G.A., Fadeev V.V. Endocrinology / Textbook for students. honey. universities M.: Medicine, 2000;
• Fadeev V.V., Melnichenko G.A. Hypothyroidism / Guide for doctors. M.: RKI “Severo-press”, 2002;
• Thyroid diseases. Edited by L.I. Braverman. M.: Medicine, 2000;
• Clinical endocrinology: manual / ed. N. T. Starkova. — 3rd ed. -SPb. : Peter, 2002;
• Cattail V.M., Arki R.F. Pathophysiology of the endocrine system. / Per. from English - St. Petersburg. - M.: Nevsky Dialect - Publishing House "Binom", 2001.

Causes

A direct connection exists between the type and treatment of hypothyroidism, since the causes and medical strategy depend on the form of the disease. There are many factors in the development of pathology, some are genetic - this is especially true for severe forms with impaired absorption of hormones by the body. The source of the problem can be either the thyroid gland itself or the pituitary gland, which causes it to produce the necessary substances. Also, pathologies sometimes occur at the cellular level.

There are three main types of hypothyroidism:

• primary;
• secondary;
• tertiary.

The reasons for each of them are different. The most common is the primary subtype of the disease, which is provoked by the following factors:

1. Nutritional features - lack of iodine, necessary for the normal functioning of the thyroid gland. There are entire regions where hypothyroidism is considered a common disease.
2. A congenital disorder of hormone synthesis is a thyroid pathology that can be detected in the first days of life.
3. Autoimmune thyroiditis, also called Hashimoto's thyroiditis, is a chronic inflammatory disease of the thyroid gland.
4. Other types of inflammatory diseases of the thyroid gland that have passed from the acute to the chronic stage. Many of them develop as complications of tonsillitis and viral diseases.
5. Manipulation of the thyroid gland - removal, suppression of activity with drugs.

Several factors may overlap. For example, against the background of a lack of iodine in the diet, an inflammatory process develops, which becomes a trigger for the main form of the disease.

Unlike primary hypothyroidism, secondary hypothyroidism is not directly related to the thyroid gland. The source is in the brain, or more precisely, the pituitary gland or hypothalamus.

The reasons will be:

1. Hypopituitarism is an endocrine disorder in which the production of TSH is reduced or completely stopped.
2. Stopping or reducing the production of TRH - thyrotropin-releasing hormone, which is responsible for transmitting information about the endocrine status of the body from the hypothalamus to the pituitary gland.
3. Diabetes insipidus, or a lack of antidiuretic hormone, is also caused by pathologies of the hypothalamus and pituitary gland.

If in the first case the problem lies in the thyroid gland, then if the subcortical centers are disturbed, this organ simply does not receive the correct “commands” to produce the necessary substances.

There is also a tertiary form of hypothyroidism, it is caused by:

1. Inactivation of hormones T4 and T3 against the background of pancreatitis, shock, sepsis.
2. Reduced sensitivity of receptor cells to specific substances of the thyroid gland.
3. Iodine is poorly absorbed for some reason, and this microelement is necessary for the correct functioning of the endocrine system.

The specific cause is determined depending on the clinical manifestations and associated features. The most common reasons remain the characteristics of a person’s diet and lifestyle.

Possible consequences

Untreated hypothyroidism leads to a rapid and steady deterioration in the patient’s general condition and the emergence of serious complications. In elderly and senile people, hypothyroid coma can cause death. In children, this pathology leads to irreversible retardation of physical growth and mental development. One of the possible consequences may be a serious disorder - cretinism. An endocrinologist talks about the symptoms, causes of development, methods of diagnosis and treatment of hypothyroidism in this video review:

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Congenital hypothyroidism: symptoms

Congenital hypothyroidism is a chronic disease, the course of which is characterized by dysfunction of the thyroid gland in newborn infants with a simultaneous decrease in the content of hormones produced by the thyroid gland in their blood. Hypothyroidism, symptoms in newborns in which can appear under the influence of a variety of reasons, ranging from exposure to infections and ending with genetic mutations, etc., manifests itself, first of all, in developmental delays, which concerns both physical and mental development. In addition, the disease is also characterized by late closure of the fontanel in children, dry skin and late teething.

According to statistics on congenital hypothyroidism, it occurs in 1-2 cases out of 5000 infants. In addition, it was revealed that congenital hypothyroidism is most often diagnosed in girls, and data in this case indicate that in boys this disease is diagnosed half as often.

The thyroid gland acts as an organ that promotes the harmonious development and growth of children, and its effect is especially important 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 physical and mental development of the baby.

The following variants are identified as causes that provoke hypothyroidism, the symptoms of which we will consider in children below:

• Heredity. For the most part, congenital hypothyroidism develops due to a disruption in the formation of the thyroid organ even before the child is born, that is, during intrauterine development, which is caused by certain genetically determined mutations.
• Pathology of hormone formation in the thyroid gland. This reason is due to the fact that, for example, the cells of the thyroid gland lose sensitivity to iodine, the fact that the process of transporting substances required for the production of hormones is disrupted, as well as the fact that disturbances occur in metabolic processes associated with iodine, etc.
• Actual damage to the hypothalamus. This pathology indicates secondary hypothyroidism, while the hypothalamus acts as the center of the nervous system, which ensures the regulation of the functions of the thyroid gland, as well as other types of endocrine glands in the body. Against the background of damage to the hypothalamus, severe forms of endocrine disorders also often develop.
• Reduced sensitivity (or resistance) to thyroid hormones. This option is mainly relevant when the expectant mother uses antithyroid medications during pregnancy, which is possible, for example, with goiter in a pregnant woman, etc.

So, let us now dwell on the symptoms accompanying hypothyroidism in children. It is important to note here that the congenital form of this disease does not manifest itself in any way during the first weeks of the baby’s life, therefore the first symptoms of hypothyroidism in children in this case can be noticed only a few weeks after their birth. Detection of this disease becomes possible by identifying signs indicating a child’s developmental delay. As for the possibility of detecting 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 main signs of congenital hypothyroidism in children in the first days of their life:

• significant weight of the newborn (exceeding 3,500 g);
• half-open mouth;
• swelling of the face;
• the presence of edema in the area of ​​the supraclavicular fossa, resembling “dense pads”;
• prolonged jaundice;
• cyanosis of the nasolabial triangle area;
• roughness of voice noted when crying.

The characteristic symptoms of the congenital form of hypothyroidism in children during the period of 3-4 months of life include the following:

• chronic constipation;
• hair fragility;
• poor appetite;
• low body temperature;
• peeling of the skin.

As for the later periods, they are characterized by the following symptoms of hypothyroidism:

• mental retardation;
• delay in physical development;
• delay in teething.

It is important to note that due to the early detection of congenital hypothyroidism and its simultaneous early treatment, there is a significant chance of subsequently ensuring the normal development of the child. If there is a lack of hormones produced by the thyroid gland during the first weeks after the birth of the baby, there is a risk of developing irreversible disorders affecting the nervous system. That is why it is important to begin treatment of hypothyroidism in children no later than the first month after birth. Cretinism, which develops when this need is ignored and implies a lag not only in the usual mental development, but also in physical development, manifests itself in the form of the following signs: curvature of the limbs, deformity of the face, short stature, susceptibility to chronic diseases, low level of intelligence .

The Apgar scale makes it possible to diagnose the congenital form of hypothyroidism in newborns; in particular, it is based on the following indicators (signs) for comparison:

• swelling of the face – 2 points;
• constipation – 2 points;
• presence of umbilical hernia – 2 points;
• pale skin – 1 point;
• duration of jaundice exceeding 3 weeks – 1 point;
• birth weight more than 3,500 g – 1 point;
• muscle weakness – 1 point;
• posterior fontanel open – 1 point;
• tongue enlarged – 1 point;
• duration of pregnancy exceeding 40 weeks. – 1 point.

The basis for suspicion regarding the presence of hypothyroidism is the sum indicator for the listed characteristics exceeding 5 points.

Prevention

Measures to prevent the development of hypothyroidism are aimed at:

• maintaining proper and nutritious nutrition while following a diet;
• regular examination of the thyroid gland;
• timely treatment of the disease;
• maintaining a healthy lifestyle;
• reduction of emotional stress;
• taking vitamin complexes containing iodine.

It is better to prevent a disease than to treat it long and hard. Thyroid dysfunction can have dangerous and undesirable consequences, so it is important to pay close attention to your own health and lifestyle.

Maintenance therapy

People with hypothyroidism need to take multivitamin complexes, which include vitamins A, C, and group B. If anemia develops, taking iron supplements, vitamin B12, and antianamine is indicated. In this case, the choice of remedy depends on the reason for the decrease in the level of red blood cells in the blood. Physiotherapeutic procedures help alleviate the patient's condition: carbon dioxide baths, swimming in the river or sea, showering.

Patients with hypothyroidism need a complete and balanced diet, limiting foods containing cholesterol and table salt. If the disease develops against the background of obesity, then the calorie content of the daily diet should be reduced. Experts recommend stopping smoking, which negatively affects the functionality of the thyroid gland.

Important! Even with drug treatment for hypothyroidism, the functionality of the thyroid gland may decrease further, so patients need to annually examine the level of T4 and TSH in the bloodstream.

Complications of hypothyroidism

If you ignore medical instructions and do not take therapy seriously, there is a possibility of developing various complications.

These include the occurrence of:

• problems with the myocardium, for example, arrhythmias, possible development of a heart attack;
• due to an increase in the size of the thyroid gland, respiratory and swallowing function becomes difficult;
• mental activity decreases;
• development of hypothyroid coma is possible.

Coma is characterized by its own symptoms:

• body temperature decreases to less than 36o;
• the presence of constant increasing drowsiness;
• confusion of speech;
• depression of consciousness;
• decreased blood pressure;
• decreased heart rate;
• accumulation of fluid in the pleural area.

With this condition, the risk of death increases if the necessary therapy is not available.

How does under-functioning of the thyroid gland manifest?

Signs of glandular deficiency do not depend on the degree of thyroid hormone deficiency. In some patients they are sometimes absent even in the clinical phase, while in others they appear in a subclinical course.

A distinctive feature of hypothyroidism is the absence of symptoms characteristic exclusively of hypothyroidism.

Symptoms of low thyroid function:

• puffiness of the face;
• swelling of the eyelids;
• dry skin;
• dullness of hair;
• lethargy;
• weight gain;
• alopecia (hair loss).

In severe cases, decreased thyroid function is manifested by a change in voice timbre and slow speech. Patients often complain of disorders of the nervous system:

• memory impairment;
• apathy;
• decreased cognitive activity;
• sleep disorders.

When thyroid function is reduced, metabolic reactions slow down. Due to a violation of energy metabolism, body temperature decreases, chilliness and cold intolerance occur. If hypothyroidism occurs in children over 3 years of age, most symptoms disappear with the prescription of HRT - hormone replacement therapy.

With persistent insufficiency of the thyroid gland, the functioning of other organs and systems is disrupted. Deficiency of iodine-containing hormones leads to:

• bradycardia;
• pericarditis;
• headaches;
• anemia;
• bowel disorders;
• flatulence;
• liver enlargement.

Patients with hypofunction of the gland exhibit disorders of the reproductive system - mastopathy, absence of menstruation, intermenstrual bleeding. Severe deficiency of T3 and T4 leads to endocrine infertility.