Hypothyroidism
Summary/Definition
Hypothyroidism is a disease that occurs when the level of thyroid hormones required by the body decreases due to insufficient production of thyroid hormones. In hypothyroidism, the metabolic process is disturbed, and patients complain of lethargy, drowsiness, swollen limbs, increased body weight with decreased appetite, dry skin and a feeling of chilliness.
Hypothyroidism is divided into primary hypothyroidism (caused by a thyroid gland malfunction) and secondary hypothyroidism (caused by a TTH-secreting hypophysis adenoma ).
Causes of hypothyroidism
* Primary hypothyroidism
- Primary autoimmune thyroiditis (Hashimoto’s thyroiditis);
- Subacute thyroiditis (transient);
- Postpartum thyroiditis;
- Thyroid surgery, radioactive iodine treatment, radiation therapy;
- Treatment with antithyroid drugs;
- Excess iodine;
- Congenital disorder of thyroid hormone production, underdevelopment of the thyroid gland.
* Secondary hypothyroidism
- Hypophysis adenoma
- Sheehan’s syndrome
- Treatment of pituitary adenoma, radiation therapy, trauma
Symptoms
Often the symptoms of hypothyroidism are slow and subtle and are difficult to distinguish from those of other diseases, such as fatigue, swelling of the lower limbs or face, sluggish thinking, poor memory, digestive system disorders, decreased appetite, constipation, etc. The thyroid hormones are essential for energy production in the human body, so their deficiency reduces basic metabolic functions. A slowed metabolic process leads to frequent colds, sweating, and skin becoming dry, pale or yellow. The symptoms include fatigue, memory loss, concentration problems and decreased motivation. Disruption of gastrointestinal peristalsis can cause GI upset and constipation, as well as numbness and muscle pain in the extremities. Menstrual discharge is increased in women, and oedema does not even form a dimple when a finger is pressed on the skin.
Diagnostics
Clear symptoms do not appear immediately; the disease progresses slowly over a long period, so in many cases, patients may not even realise they have hypothyroidism. Patients who have concomitant symptoms, who have previously undergone thyroid surgery or radioactive iodine treatment, or who have even the slightest suspicion of hypothyroidism are recommended to undergo a diagnostic examination.
The specialists feel the thyroid gland and by palpation determine its size, and symmetry of the nodes, determine the presence or absence of signs of hypothyroidism on the skin, hair, and abdomen, and check the heart rate. In the presence of hypothyroidism, the results of the initial examination of the doctor are confirmed by the data of diagnostic studies, which measure the level of thyroid hormones, as well as the level of thyroid hormone (TTH) in the blood. A significant increase in antibodies to thyroperoxidase in the patient indicates an autoimmune disease – Hashimoto’s thyroiditis, the diagnosis can be made without additional biopsy. If a thyroid mass (nodule) is detected during examination, biopsy results may be required for differential diagnosis.
Treatment and course of the disease
Hypothyroidism can be cured by replenishing insufficient thyroid hormones. However, in most cases, hypothyroidism is a chronic disease and requires a lifetime of hormone medication. When thyroiditis is diagnosed, thyroid function can recover completely after the necessary period of treatment, then the patient can stop taking hormones altogether. The patients who do not have concomitant serious diseases, hypothyroidism develops rapidly, from the very beginning of therapy, the necessary amount of hormones is prescribed. For people of middle and older age, as well as those treated for hypothyroidism for a long time, the introduction of thyroid hormone begins with a small amount with subsequent blood tests after 2 months. The amount of hormone should be gradually increased until the required level is reached.
