Hypothyroidism. Causes, symptoms, modern diagnosis and effective treatment of the disease. Hypothyroidism symptoms and treatment in women what tests to take Hypothyroidism - what is it? Symptoms, causes and treatment

Hypothyroidism is a common and quite severe disease thyroid gland. Therefore, it is important to promptly identify the pathology and begin treatment. The main thing to start with is to get tested for hypothyroidism to determine hormones, ESR, antibodies, conduct common fence blood to identify abnormalities. And additional methods for diagnosing hypothyroidism will be instrumental studies that will help confirm the disease based on an existing laboratory examination.

What tests need to be taken to determine hypothyroidism?

The endocrinologist will tell you during the examination which tests you need to take for hypothyroidism. As a rule, the patient is prescribed laboratory and instrumental studies. But the main method for detecting thyroid diseases is still blood sampling.

To determine hypothyroidism, the following types of examination are prescribed:

1. General blood analysis.
2. Detection of hormone levels.
3. Total and free T3 and T4.
4. Blood test for antibodies.
5. Instrumental diagnosis of hypothyroidism.

Hormone tests

Hormone tests for hypothyroidism are one of the main ways to diagnose the disease. Everyone knows that hormones are integral and important biologically active substances that participate in many life processes, including determining the function of the thyroid gland.

That is why patients are prescribed hormonal examinations. If, according to the results of the tests, the level of certain hormones does not satisfy the accepted standards, they talk about decreased or increased functioning of the thyroid gland, depending on the indicators, and prescribe a specific treatment.

Basically, tests are performed to identify the following hormones:

1. Thyroid-stimulating hormones are pituitary hormones and, like no one else, indicate a disorder of the thyroid gland. TSH levels are normally 0.4-4 mU/l. If thyroid dysfunction develops in the body and exposure to unfavorable factors occurs, the level of TSH in hypothyroidism decreases significantly and leads to its appearance.
2. Thyroxine hormones are also important to confirm the diagnosis. If they are lacking, disturbances in the functioning of the thyroid gland develop. The deficiency of these hormones can be visually determined by an enlarged goiter.
3. Definition of triiodothyronine - such a hormone is found in the body in a general and free state. In the first case, during the analysis, the entire amount of the biologically active substance will be determined in the blood. The level of free triiodothyronine changes quite rarely; with the development of hypofunction of the thyroid gland, this hormone may be normal. Its quantitative ratio is determined only if it is necessary to detect certain changes in the thyroid gland and determine treatment methods.

Complete blood count for hypothyroidism

What other tests are needed to confirm hypothyroidism? In addition to hormones, patients are prescribed a general blood test to assess the condition of its components, determine ESR, and antibodies.

It is believed that the detection of erythrocyte sedimentation rate is very important for making a diagnosis. Normally, healthy men have slightly lower ESR numbers compared to the female sex.

If their level increases in men and women, one can judge the emergence or onset of endocrine diseases and metabolic pathologies. In this case, patients are prescribed additional methods examinations and further, if reduced thyroid function is confirmed, treatment is determined.

In addition to ESR, a blood test for antibodies is indicated. It should be taken separately from hormones. It shows how the human body behaves during illness. If the antibody level exceeds the norm, this indicates the occurrence of pathological process.

Preparing for tests for hypothyroidism

To ensure the reliability of the results of laboratory and instrumental examinations, it is necessary to prepare for them in advance. To do this, just follow the following recommendations:

1. The day before the expected tests, it is necessary to exclude caffeine from the diet and give up alcoholic beverages and smoking.
2. It is important to normalize the psycho-emotional state. At the time of taking the tests, you should not be nervous, depressed or stressed.
3. During the day, exclude all heavy physical activity, the body should completely rest.
4. It is recommended to donate blood on an empty stomach, so patients are advised not to eat 12 hours before the procedure.
5. You should limit your medications or reduce their dosage as directed by your doctor.
6. Drugs that affect the functioning of the thyroid gland are also excluded in order to assess their independent production.
7. Women are not recommended to take tests during menstruation. The optimal days for the procedure are cycles 4-7.

Additional testing methods for hypothyroidism

If laboratory tests for hypothyroidism are positive, the patient is prescribed instrumental methods examinations:

If such methods also give positive result, in this case, the doctor decides on treatment and prescribes medications and other methods of therapy to the patient, depending on the results of the examination.

Doctors note that in Lately Patients have an increased incidence of thyroid diseases. One such problem is hypothyroidism. Its appearance is largely due to the low iodine content in the external environment, as well as poor ecology. So what is hypothyroidism? What are its symptoms? And what tests should be taken for hypothyroidism?

A list of certain symptoms that appear as a result of an imbalance in the hormonal balance of the thyroid gland is called hypothyroidism. Women are more often susceptible to this disease, but men are not immune from it either.

Symptoms of hypothyroidism

The presence of this disease in a person can be expressed by the following symptoms:

• lethargy, lethargy, decreased performance;
• increased fatigue, decreased memory;
• swelling of the limbs;
• drowsiness;
• deterioration of the condition of the skin, hair and skin.

Tests for hypothyroidism

The attending physician will tell the patient what tests to take for hypothyroidism. One of the main indicators in diagnosing the disease is a blood test, which allows us to determine whether there are malfunctions in the thyroid gland and how correctly it produces hormones.

List of tests required to make a diagnosis:

• ATPO;
• thyroglobulin;
• free and total T4;
• antibodies to TSH receptors;
• free and total T3;
• calcitonin.

TSH for hypothyroidism

Most endocrinologists are guided by the level of TSH present in the blood when making a diagnosis. This hormone is produced by the pituitary gland and is intended to inform the thyroid gland to produce hormones in the required quantities. Therefore, if TSH norm exceeded, this indicates that the pituitary gland forces the thyroid gland to produce more thyroid hormones. The optimal TSH level is considered to be 0.4-4.0 mIU/l. Anything less or more than normal is a sign of hypothyroidism.

The TSH level is one of the most accurate parameters indicating dysfunction of the thyroid gland. But not in all cases this indicator shows the true picture. For example, if a person has a tumor of the pituitary gland, then the production of normal TSH levels is impossible. The same can be said about hypothalamic injuries and strokes. In such circumstances, even if the thyroid gland has low hormone levels, TSH may be normal.

It is better to take this test in the morning, since it is in this interval that the TSH level has an average range.

General and free T4

For a comprehensive examination, you need to take tests to detect T4 levels. Previously, the assessment of total T4 indicators was actively used to determine hypothyroidism, but at the moment this type of study has become less relevant. This is due to the fact that its concentration is interrelated with the amount of binding globulins, and they are affected by pregnancy, kidney and liver diseases. But, as a rule, low total T4 levels indicate the presence of hypothyroidism.

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A more acceptable option from the point of view of determining the disease is a free T4 test. This type of study allows you to detect levels of free thyroxine in the blood. It turns out that low results indicate the presence of hypothyroidism. People with early disease may have elevated TSH and normal free T4 levels, or vice versa.

General and free T3

Total T3 levels are not an accurate symptom of the disease, but the information obtained is used to general diagnostics. Periodically determining the level of free T3 helps in making a medical opinion. People suffering from hypothyroidism quite rarely have low T3 levels; as a rule, it is normal.

Antibody test

The immune system The human body is designed in such a way that during illness it begins to reproduce antibodies. However, if the disease is autoimmune in nature, then autoantibodies are produced that fight the patient’s body tissues. In this case, the thyroid gland may become a target for their attack. Consequently, as a result of such an attack, the production of antibodies will begin. It is quite simple to detect their presence in the blood, but analysis is necessary to prove the course of the pathological process. An autoimmune disorder in the body will trigger the production of antibodies to TPO.

An experienced endocrinologist, when diagnosing hypothyroidism, will not trust only a TSH hormone test, since this does not reflect the full picture. For a comprehensive examination, at a minimum, an analysis of free T3 and T4 will be required.

Preparing for tests

In order for the analyzes to show the most reliable information, you must adhere to the following rules:

1. About a month before the examination, you need to stop using thyroid hormones. However, this must be done after consultation with an endocrinologist.
2. Three days before the test, avoid taking medications containing iodine.
3. The day before the test, refuse physical activity, stress, alcohol and nicotine consumption.
4. Blood is drawn on an empty stomach. Immediately before taking the test, the patient must remain at rest for half an hour.

In general, methods for determining tests for hypothyroidism are the task of an endocrinologist. It is he who will prescribe all the necessary studies and tell you how to carry them out correctly.

What are the risks of hypothyroidism?

The adequate functioning of almost all body systems depends on the proper functioning of the thyroid gland. Therefore, it is very important to carefully monitor the condition of the thyroid gland and, if there is any suspicion, visit an endocrinologist. Hypothyroidism is especially dangerous for pregnant women and diabetics. Also, disruptions in the functioning of the endocrine system can cause infertility.

The longer this disease lasts, the more likely the irreversibility of the changes that have occurred due to a violation of the normal levels of hormones in the blood. This is why testing your hormone levels is very important.

It still seems like it’s not easy to cure your thyroid?

Considering that you are now reading this article, we can conclude that this illness still haunts you.

You've probably also thought about surgery. This is clear, because the thyroid gland is one of the most important organs, on which your well-being and health depend. And shortness of breath, constant fatigue, irritability and other symptoms clearly interfere with your enjoyment of life...

But, you see, it is more correct to treat the cause, not the effect. We recommend reading the story of Irina Savenkova about how she managed to cure her thyroid gland...

Hypothyroidism is a disease caused by a long-term deficiency of thyroid hormones in the body or a decrease in the biological effect of these hormones on organs. Currently, hypothyroidism is a pressing medical problem and the most common pathology of the thyroid gland and, according to research, 10% of some population groups suffer from this disease.

Hypothyroidism can be acquired or congenital. The frequency of the latter is 1 in 3-4 thousand newborns. In pediatric endocrinology, this is a leading and serious disease. In order not to miss a developing problem, you need to pay attention to its first symptoms. So, our task is to recognize and treat hypothyroidism. Go!

Primary

With insufficiency of thyroid hormones, all organs and systems of the body undergo pathological changes. The main task of thyroid hormones is to support basic metabolism in the body, and with a deficiency of hormones, a decrease in oxygen consumption in tissues and a decrease in energy consumption occur.

Due to disturbances in other metabolisms (heat exchange, BJU exchange, etc.), a universal change occurs - myxedema, which is most pronounced in connective tissues, and more precisely, in their edema.

The primary form of hypothyroidism can be caused by the following factors:

• underdevelopment of the thyroid gland;
• hereditary enzymopathies affecting the gastrointestinal tract;
• surgeries on the thyroid gland (complete or partial removal);
• exposure to ionizing radiation;
• therapy with radioactive iodine medications;
• thyroiditis of various types;
• overdose of drugs that slow down the synthesis of thyroid hormones;
• conditions accompanied by iodine deficiency;
• thyroid tumors.

In addition, hypothyroidism can be:

1. Subclinical– characteristic symptoms absent or too weakly expressed. The TSH level is elevated, and the T4 concentration is within normal limits.
2. manifest– has obvious clinical manifestations, at this degree there is an increase in TSH and a decrease in T4 levels. In addition, manifest hypothyroidism is divided into compensated and decompensated subgrades.
3. Complicated– Occurs with long-term hypothyroidism. At this degree, lesions of the cardiovascular system, pituitary tumors, myxedema, and coma develop.

Secondary

Secondary hypofunction of the thyroid gland occurs due to various violations in the pituitary gland. The pituitary gland produces thyroid-stimulating hormone, which controls the functioning of the thyroid gland and also has a stimulating effect on the synthesis of T3 and T4.

Violations can be caused by the following factors:

• brain injuries;
• hemorrhages in the pituitary gland;
• viral, fungal or bacterial infection of the pituitary gland;
• benign or malignant neoplasms GM;
• circulatory disorders in the brain;
• pathologies of the adrenal cortex;
• abnormalities of brain development;
• massive blood loss that caused necrotization of the pituitary lobes;
• radiation or chemotherapy;
• poisoning with hormonal drugs;
• toxic effects of chemicals;
• tissue immunity to the action of TSH.

The manifestations of secondary hypothyroidism are practically no different from primary or tertiary hypothyroidism. Characteristic feature This form is a gradual appearance of symptoms, one after another, and not all together, as with other hypothyroidism. This occurs due to the fact that, despite the disruption in the connection between the pituitary gland and the thyroid gland, the thyroid gland still continues to produce hormones.

Secondary hypothyroidism can occur in latent, manifest or complicated form. In the latent form, it is practically impossible to detect the presence of the disease without testing, since there are no characteristic features diseases.

The manifest form is distinguished by a standard set of symptoms that are sufficiently pronounced. If the disease occurs in a complicated form, various malfunctions in the functioning of organs and systems occur.

Assorted palette: reduced thyroid function with its “charms”

The clinical picture of hypothyroidism is very diverse and directly depends on the severity and duration of the presence of insufficient hormone levels, on the age of the patient and the presence of concomitant diseases.

Manifestations of hypothyroidism in adults

The main problem of an incorrect diagnosis by a doctor in a suffering person is the combination of many symptoms and an insufficiently deep examination to determine and eliminate the cause. In this case, one of the mass of manifestations predominates, others are less pronounced. However, has hypothyroidism external signs, which can be found out with sufficient information.

Table 1: Symptoms of acquired hypothyroidism from different organ systems:

It is important to know! Anemia is a blood pathology, which consists of a decrease in the level of hemoglobin and red blood cells, due to which oxygen starvation of organs occurs, and pallor of the skin and mucous membranes appears outwardly. Frequent view anemia - iron deficiency.

Features of the course of the disease in children

It begins to appear immediately after birth, since at this age the disease is congenital. During intrauterine development of the fetus, the mother's body completely compensates for the deficiency of thyroid hormones. But after the birth of the baby, the deficiency of this type of biologically active substances has a clearly defined pattern.

Signs of congenital hypothyroidism in children:

• prolonged jaundice;
• dry skin;
• dense swelling on the feet and hands;
• swelling of the face and lips;
• general lethargy, lack of interest in the outside world;
• decreased skeletal muscle tone;
• weak sucking reflex;
• rare crying;
• rough hoarse voice;
• large tongue;
• bloated stomach;
• umbilical hernia;
• delayed closure of the posterior fontanel;
• enlargement of the thyroid gland;
• insufficient weight gain;
• noisy breathing, often difficult nasal breathing.

If hypothyroidism in a baby is not detected in time and adequate treatment is not started, then by the age of six months, serious external abnormalities and disturbances in the functioning of internal organs begin.

This is interesting! In children, hypothyroidism leaves a noticeable mark on health in the form of body disproportions: a wide bridge of the nose, the hands are also wide with short fingers, a long forehead, hypertelorism - an increase in the distance between paired organs (between the inner edges eyeballs, nipples on the chest).

Diagnostics

A quick, accurate diagnosis plays an important role in making further decisions. Hypothyroidism, namely its symptoms, in a comprehensive diagnostic approach indicates the correct treatment.

Patient Interview

Previous presence of operations, neoplasms on the thyroid gland, or other thyroid diseases; taking antiarrhythmic, diuretic drugs, using iodized salt in food, the onset and development of symptoms of hypothyroidism.

Objective assessment of the patient's condition

A medical procedure as simple and primitive at first glance as an examination can help to suspect that a patient has hypothyroidism. It is necessary that the doctor is able to competently examine the patient.

Visually, with hypothyroidism, multiple waxy, widespread, dense and cold-to-touch swellings attract attention. When listening to the heart, the tones are weakened, sometimes there are noises (especially in the presence of dry deposits in the pericardial sac due to its inflammation).

Laboratory methods

The most accurate analysis is to determine the level of thyroid-stimulating hormone, which increases most often. At the beginning of the development of hypothyroidism, triiodothyronine may be within normal limits. This is a compensatory reaction to maintain the normal hormonal state of the thyroid gland.

Normal levels of thyroid hormones should be as follows:

• T3 – total 1.3-2.7 pmol/l, free 2.3-6.3 pmol/l;
• T4 – total 54-156 nmol/l, free 10.3-24.4 pmol/l;
• TSH – 0.2-3.5 µIU/ml.

Important! These indicators may differ from the results of your laboratory, since different reagents and different equipment are used for the analysis.

When the level of thyroid-stimulating hormone is higher than normal, but hypothyroidism still appears with normal hormones T3 and T4, we can judge subclinical hypothyroidism. In this case, there are no external symptoms, or they have not yet begun to appear.

When the TSH level is up to 10 times higher than normal and the level of free T4 is reduced, they speak of primary hypothyroidism. If TSH levels are normal or reduced, and at the same time free T4 is reduced, then such indicators indicate secondary hypothyroidism.

Thyroid hormones act according to the principle feedback. Accordingly, with an increase in TSH levels, the concentration of thyroxine and triiodothyronine in the blood decreases. And if T4 and T3 increase, the concentration of thyroid-stimulating hormone decreases.

Hypothyroidism hormone levels also affect other indicators, for example:

• the level of sodium in the blood decreases;
• serum calcium increases;
• the amount of creatine kinase and myoglobin in the blood serum increases;
• the concentration of serum cholesterol and AST increases;
• anemia is present.

In addition, one can think about hypothyroidism if the level of TPO AT is increased and TG AT is detected, which indicates autoimmune hypothyroidism.

Creatine phosphokinase

It is an enzyme produced by muscle fibers. It increases due to the destruction of muscle tissue fibers.

It is important to know! In patients with hypothyroidism, the amount of creatine phosphokinase, which is also considered a cardiac biologically active substance, increases. This sometimes leads to misdiagnosis of myocardial infarction. Therefore, it is necessary to take into account the clinical picture and the ECG picture.

Biochemical blood test: high cholesterol levels due to slow metabolism and intense release of cholesterol into bile.

A general blood test is an indispensable examination from the “tests for hypothyroidism” group. The picture is as follows: many lymphocytes, high ESR, anemia due to iron deficiency and reduced absorption of B12 in the stomach and intestines.

Instrumental examination methods

• , organs of the abdominal and thoracic cavities;
• electrocardiogram;
• X-ray examination.

It is important to know! X-ray of the hand with the wrist joint is a mandatory examination in children with suspected hypothyroidism. Delayed bone development, supported by relevant data from other diagnostic methods, confirms the presence of the disease.

Pathology under the guise of other diseases: what masks does hypothyroidism wear?

Nonspecific symptoms of hypothyroidism often resemble other diseases, the course of which drags on for many years, and treatment does not bring the desired result. And all because the real reason is mysteriously hidden in the form of various diseases.

It is difficult to understand the situation not only for a young doctor, but even for an experienced specialist. But there is a way out. A careful survey, correctly prescribed tests and instrumental studies help to identify the hated pathology.

Table 2: Successful disguise of hypothyroidism as other diseases:

Modern views of experts on the provision of medical care

Modern medicine offers many approaches to the treatment of hypothyroidism.

Basic step - eliminating the cause

The main method of treating hypothyroidism is hormone replacement therapy of the affected organ. Treatment is lifelong.

The drug of choice is L-thyroxine. Doses are selected individually, taking into account the degree of functional insufficiency of the gland, duration of the disease, age category and weight of the person. L-tetraiodothyronine can be used, but its disadvantage is that it requires frequent use to maintain the desired level of the hormone.

This is interesting! The older the patient, the lower the required dose of thyroid hormone drug becomes. Endocrinologists take these subtleties into account when selecting a medicine.

L-thyroxine. Instructions:

• Active ingredient: levothyrosine.
• Pharmacological group: thyroid hormones.
• Release form: tablet 25; 50; 100 mg.
• Indications:

1. hypothyroidism of various origins, this also applies to post-operative - constant use;
2. prevention of hypothyroidism after surgery associated with nodular goiter (i.e., increased thyroid function in the past);
3. autoimmune inflammation of the gland is a component of complex treatment;
4. hormone-dependent neoplasms of the thyroid gland - as replacement and suppressive therapy;
5. a diagnostic drug to confirm or exclude hypothyroidism.

• Doses: for children - 12.5-25 mcg - initial dose; for adults 25-100 mcg/day, gradually increasing every 2-3 weeks by 25-50 mcg until a maintenance dose is created.

Contraindications:

• severe course of hypertension and chronic heart failure;
• cardiac ischemia;
• heart defects.

It is important to know! Almost all contraindications are relevant to depressive therapy. The only contraindication to replacement treatment is individual immunity to the components of the drug.

Side effects: restlessness, hair loss, weight loss or gain, coldness and tremors of the extremities.

Drug interactions:

• L-thyroxine enhances the effectiveness of antidepressants;
• diuretics and blood thinners increase blood levels active substance;
• Estrogens (drugs of female sex hormones) reduce the effectiveness of levothyrosine.

Price: 130-150 rubles.

This is interesting! The effect of replacement therapy is assessed every 3 months based on TSH levels. If its level becomes less than 2 IU/ml, and the patient’s well-being improves, then the treatment is beneficial.

Symptomatic therapy

This technique consists of eliminating the symptoms of the disease: prescribing decongestants (diuretics), immunostimulating drugs, laxatives, etc.

Diet for hypothyroidism

With this disease of the thyroid gland, a slowdown in metabolism most often occurs, as a result of which a person develops excess weight. All you can do with your own hands to get rid of the disease is to adjust your diet to improve metabolic processes.

The number of calories consumed should also be reduced. Of course, the number will depend on the lifestyle, age and physical activity of the person.

• vegetables (exclude the cruciferous family);
• fruits (kiwi, persimmon, cherries, grapes, bananas);
• sea ​​fish;
• tea with lemon and milk, herbal infusions, natural juices, brewed rose hips;
• low-fat dairy and fermented milk products;
• egg dishes without yolk;
• cereals (buckwheat, barley, millet);
• yesterday's bread.

The disease does not require a strict diet; you can prepare a variety of dishes from permitted foods, but you should limit the consumption of the following ingredients:

• sausages, sausages;
• fatty meat and offal;
• spicy dishes;
• canned food;
• salted and smoked fish;
• rich broths;
• honey and jam;
• margarine and lard;
• strong coffee and tea, soda;
• mushrooms;
• rice and pasta.

In ancient times, treatment was carried out thanks to knowledge of the properties of medicinal plants. A lot of healthy recipes has survived to this day. You can easily create medicines with your own hands.

We offer several simple recipes:

1. Leaves of a medium bunch of fresh parsley pour 200 ml cold water, boil over low heat for 5 minutes, strain and take a tablespoon with meals.
2. Ginseng tincture is an excellent remedy for stimulating the activity of the immune system and the thyroid gland. A handful of fresh flowers of the plant is poured with 50 ml of 40% vodka, left for 1 week in a dark, cool place and taken 30 drops 3 times a day.
3. A mixture of freshly squeezed vegetable juices in equal proportions: beetroot, carrot, potato, cabbage. Use before each meal 3 times a day.

Thanks to the video in this article, you will receive additional information with simple tips on how to test yourself for hypothyroidism before undergoing laboratory tests. Also, once again, but briefly, repeat the basic methods of research and treatment that are practiced by endocrinologists - narrow specialists in the diagnosis and treatment of hormonal disorders in our body.

Forecast

If for some reason a patient with hypothyroidism does not receive therapy, there is a high risk of complications:

• The heart suffers greatly and its normal functioning is disrupted (tachycardia, atrial fibrillation, heart failure).
• Excess thyroid hormones reduce the ability to absorb calcium into the bones. The result is brittle bones (osteoporosis).
• Deterioration of vision up to its complete loss.
• Thickening and redness of the skin of the ankle.
• Thyrotoxic crisis. Dangerous condition, in which a person needs immediate medical attention.

It is possible to restore the patient’s normal well-being and thyroid function if the regimen and doctor’s recommendations are followed.

Iodine prophylaxis: what is the meaning and what are the goals?

Prevention of thyroid diseases consists of consuming seafood, medicines or table salt fortified with iodine.

Depending on the scale of the event, it can be mass, group or individual. According to statistics, more than half of the territory of Russia is considered an area where people at high risk of iodine deficiency live and requires correction.

Interesting facts have been proven: with adequate prevention of iodine deficiency in newborns, the frequency of violations in preparation during the newborn period drops by 15%, cases of infectious infection - by 20%, the number of premature newborns decreases by 10%.

In adolescents, when the level of iodine in the body is normalized, the risk of developing chronic diseases decreases by 20%, the frequency of mental disorders decreases by 1.5 times compared to the experimental group where such measures were not carried out. The information speaks for itself and is worthy of attention.

Every person knows his body better than the most professional doctor

Hypothyroidism is an insidious pathology with a wide range of symptoms that can bother a person for many years. Of significant importance in diagnosing the disease is laboratory test thyroid hormone levels. Fortunately, replacement treatment for hypothyroidism is not only effective in most cases, but also causes virtually no harm to the patient’s financial situation and quality of life.

Due to these characteristics and the high concentration of the active substance in the blood, the hormonal drug L-thyroxine is considered the “gold standard” for the treatment of hypothyroidism. True, it is easier to prevent a disease than to eradicate it. Therefore, be attentive to your body, and it will thank you with good health and good mood. Enjoy life and don't get sick!

IN last years There has been an increase in the number of people with thyroid diseases. The most common disease in women is hypothyroidism - the production of thyroid hormones in insufficient quantities.

This disease also occurs among men, but much less frequently. In this publication we will describe how the differential diagnosis of hypothyroidism is carried out. We will describe in detail what tests you need to take and how to properly prepare for them.

Hypothyroidism occurs when the thyroid gland produces insufficient amounts of its hormones for a long time. Depending on the level of damage to the thyroid gland, there are several types of hypothyroidism.

Let's look at the difference between them and what causes lead to this disease.

Primary hypothyroidism

It occurs due to disruption of the structure and functioning of the thyroid gland, which leads to the production of insufficient amounts of thyroid hormones.

The cause of the development of pathologies may be infections after pneumonia, sore throat or other diseases that enter the thyroid gland through the bloodstream. Another reason is the development of tumors in the thyroid gland or the presence of metastases in it.

Definition of the term.

The following therapeutic measures can provoke the development of the disease:

1. As a result surgery part of the thyroid gland was removed.
2. Toxic goiter was treated with radioactive iodine.
3. Applied radiation therapy for oncological diseases of organs that are located near the neck.
4. The patient took too many medications containing iodine.

Another provocateur of primary hypothyroidism is hyperplasia - underdevelopment of the thyroid gland during the intrauterine development of a child. This pathology is observed in children from birth to 2 years of age.

Treatment started on time gives quick results. While the lack of therapy leads to serious problems, including irreversible changes in intelligence.

Secondary hypothyroidism

This type is associated with damage to the pituitary gland, which synthesizes thyroid-stimulating hormone (TSH).

The following intracerebral pathological processes lead to damage to the pituitary gland:

• head injuries;
• circulatory disorders in cerebral arteries after strokes;
• development of pituitary tumors.

What a woman looks like BEFORE and AFTER treatment.

Thus, secondary hypothyroidism is not associated with pathologies of the thyroid gland. It is provoked by disturbances in the regulation of its activity by the pituitary gland. When the pituitary gland produces less TSH, the thyroid gland reduces the synthesis of thyroid hormones.

There is also tertiary hypothyroidism, which is associated with dysfunction of the hypothalamus, a part of the brain. The hypothalamus synthesizes the hormone thyrotropin-releasing hormone, which regulates the activity of the production of TSH hormones by the pituitary gland.

In tertiary hypothyroidism, the following chain is observed: the hypothalamus does not synthesize thyroid hormone-releasing hormone - the pituitary gland does not produce TSH - the thyroid gland does not reproduce thyroid hormones.

How is the disease diagnosed?

In order to conduct a differential diagnosis between all types of hypothyroidism and confirm a preliminary diagnosis (for example, secondary hypothyroidism), the endocrinologist will need:

To establish an accurate diagnosis, none of the above points should be ignored. We will dwell on them in detail.

What are the symptoms of the disease?

Manifestations of hypothyroidism from different systems.

All symptoms of the disease can be combined into groups, taking into account their influence on one or another system of the female body:

1. Nervous: drowsiness, forgetfulness, and some lethargy appear. The lady is subject to frequent depression. She is not resistant to stress and is often apathetic. On late stages Speech slows down due to illness; the woman feels as if she is “tongue-tied.”
2. Cardiovascular: frequent headaches that can become constant, decreased blood pressure (average 100/60 mmHg), pain to the left of the sternum that does not go away after taking nitroglycerin.
3. Digestive – possible diarrhea or stool retention, enlarged liver, nausea.
4. Integumentary – the skin becomes dry and prone to peeling, nails peel, hair falls out rapidly.
5. Reproductive – there is a decrease in libido, the menstrual cycle is disrupted, and mastopathy is possible. With a significant deficiency of thyroid hormones, infertility occurs.

In addition to the indicated effect on the body’s activity, symptoms appear in appearance ladies. The face becomes puffy and the eyelids swell. The skin color takes on a yellowish tint. Limbs swell.

Secondary hypothyroidism has no symptoms of organ damage internal secretion(ovaries and adrenal glands) is a distinctive feature of the primary type of disease. The lady will have the following symptoms: excessive hair growth, decreased intelligence, intimate disorders, insomnia and others.

Hypothyroidism does not have its own specific symptoms. Its symptoms are similar to those of other mental and somatic diseases. Therefore, if a woman detects the indicated symptoms, she should immediately contact an endocrinologist to establish an accurate diagnosis.

What tests will be required?

If hypothyroidism is suspected, what tests should be done first? The doctor will give the lady a referral for tests after the examination.

However, there is a list of standard tests that must be taken to confirm a preliminary diagnosis.

Hormone tests

You need to undergo the following tests for hypothyroidism:

Expert opinion

Alexandra Yurievna

Doctor general practice, associate professor, teacher of obstetrics, work experience 11 years.

When a doctor diagnoses suspected hypothyroidism, he must prescribe all the blood tests indicated above.

Much needed analysis

During illness, the human immune system produces antibodies. Autoimmune diseases produce autoantibodies that destroy the body's own tissues. In hypothyroidism, they will “attack” the cells of the thyroid gland.

The lady's immune response will be the production of antibodies.

Thus, an antibody test can confirm that an autoimmune disorder is occurring in the woman’s body. After all, it was this that triggered the production of antibodies. An antibody test is a type of test that confirms the presence of an autoimmune disease.

We are preparing to take tests according to all the rules

You need to prepare in advance for donating blood for tests.

External symptoms.

Experts have developed appropriate rules:

1. 3 days before donating blood, you need to stop taking medications containing iodine.
2. The day before blood sampling, do not drink alcohol, coffee or smoke.
3. If the lady is taking any medications, then it is necessary to consult with her doctor. If possible, stop taking medications the day before the test, including hormone replacement therapy. When a woman cannot refuse to take medications, the doctor will take this fact into account when studying test results.
4. A day before the test, a woman should avoid sports, intense physical activity, and sexual contact.
5. You should donate blood only when you are calm. Therefore, you should exclude all stressful situations at least a day before the procedure.
6. A woman should get a good night's sleep.
7. The test is taken on an empty stomach in the morning. Doctors recommend not to eat at least 12 hours before blood sampling.
8. If, in case of hypothyroidism, the TSH level is determined repeatedly, then you need to donate blood at the same time of day. So, the readings will allow the doctor to select the optimal dose of the medicine.

The reliability of the results is affected by the day of the menstrual cycle. As a rule, the date for donating blood for analysis is set from 4 to 7 days of the cycle. In order to obtain more reliable data, the doctor may prescribe the woman to take the test on other days of the cycle.

Bottom line

In order to identify the disease hypothyroidism, it is necessary to undergo comprehensive diagnostics. It includes: examination by an endocrinologist, donating blood for tests, ultrasound of the thyroid gland and other studies as prescribed by the doctor.

Tests must be taken in accordance with specially developed rules. Then the results will be extremely reliable, and the doctor will be able to select the optimal drugs for treatment. We wish you good health!

What do you know about the nuances of diagnosing hypothyroidism?

If you suspect that you have symptoms of the disease, then the question arises, which tests are required for hypothyroidism. This article will tell you what you need to know when taking tests, and will also highlight the main points of this disease.

It is necessary to donate blood for analysis in case of hypothyroidism to determine the quantitative content of thyroid hormones (T3 and T4), TSH, TRH and antibodies to thyroid peroxidase.

Tests for hypothyroidism can answer three main questions:

1. Does the person have hypothyroidism?
2. What is the severity of hypothyroidism?
3. What is to blame for hypothyroidism: the thyroid gland, pituitary gland, hypothalamus or immune system?

Detection of any form of hypothyroidism

So, what tests should be taken for hypothyroidism to detect it? The first question is answered by the content of T3 and T4, as well as TSH. Hypothyroidism is a condition when the thyroid gland produces insufficient hormones or does not produce them at all. . Interestingly, the biological activity of T3 is greater than that of T4, but less iodine is needed for its production. This is what the body uses when there is not enough iodine - T4 becomes less, but T3 increases.

A person can live in this state for quite a long time, but this will not noticeably affect his well-being. Very nonspecific symptoms are possible: decreased performance, brittle hair, nails, lethargy... Common hypovitaminosis or fatigue, isn't it? This form of hypothyroidism does not interfere with a person’s life; therefore, he does not go to the doctor and, accordingly, does not receive treatment.

If both T3 and T4 are reduced, this is already full-fledged hypothyroidism. Its severity can be determined by the severity of symptoms and the level of hormones in the analysis.

The classical classification divides hypothyroidism into:

• Latent – ​​subclinical, hidden, mild).
• Manifest – corresponds to moderate severity.
• Complicated – the most severe, maybe even coma. This form includes myxedema, myxedema coma (myxedema + coma caused by hypothyroidism) and infantile cretinism.

What do TSH and TRH mean?

But even normal levels of thyroid hormones in all tests do not guarantee that a person does not have hypothyroidism! For early diagnosis or detection of subclinical hypothyroidism, it is necessary to take a TSH test. This hormone, also called thyroid-stimulating hormone, is produced by the pituitary gland to stimulate the hormonal activity of the thyroid gland. If TSH is elevated, it means the body does not have enough thyroid hormones. In this case, even the normal concentrations of T3 and T4 according to analyzes do not satisfy the body’s needs. This type of hypothyroidism is also called hidden hypothyroidism.

For a subclinical, latent form of hypothyroidism, TSH in the analysis should be in the range from 4.5 to 10 mIU/l. If TSH is higher, then this is also hypothyroidism, but more severe. By the way, the norm of up to 4 mIU/l is old, but in the new recommendations on hypothyroidism for doctors it was reduced to 2 mIU/l.

TSH is produced by the pituitary gland. In order for it to do this, the hypothalamus stimulates it through TRH. Doctors use this fact to prove/rule out pituitary disease as a cause of hypothyroidism. TRH is administered to a person with low TSH and changes in the tests are observed. If the pituitary gland responds to the TRH command to increase the concentration of thyroid-stimulating hormone and does this on time, then the cause of hypothyroidism is not in it. If there is no reaction to the injection of TRH according to the tests, then you should look for the cause of the inability of the pituitary gland - as a rule, an MRI is prescribed.

Indirectly, pituitary disease is indicated by insufficient concentrations of its other hormones, for which additional tests can be taken.

The level of TRH, or thyroid hormone-releasing hormone, indicates the activity of the hypothalamus.

Antibodies to thyroid peroxidase and other tests

Thyroid peroxidase, thyroperoxidase, thyroid peroxidase, TPO are all different names for the same enzyme. It is necessary for the synthesis of T3 and T4. Antibodies destroy the enzyme peroxidase, therefore, if you donate blood for thyroid hormones, their deficiency will be revealed. If these antibodies are present in the blood, then this implies an autoimmune process in the body; hypothyroidism is caused by autogression of the immune system.

The autoimmune process is also an inflammation, so it is often characterized by inflammatory phenomena in the blood. A routine general blood test will indicate at least an increase in ESR; leukocytosis is quite possible, but not necessary. It depends on how active the autoimmune process is.

Diagnostically significant level anti-TPO is 100 U/ml or more.

Hypothyroidism is a condition of the entire body, even asymptomatic hypothyroidism is harmful to health.

• Thus, cholesterol and triglycerides increase - this causes atherosclerosis, which narrows blood vessels and impairs blood supply.
• Hypothyroidism causes various forms of anemia. Hypochromic anemia with a lack of hemoglobin, normochromic with an insufficient number of red blood cells.
• Creatinine increases.
• The mechanism for the increase in AST and ALT enzymes in hypothyroidism has not been reliably established, but this occurs in almost every person with this diagnosis.
• Hypothyroidism also affects other components of the endocrine system, causing disturbances in the sexual sphere in both sexes, more often in women. The amount of prolactin increases, which reduces the effectiveness of gonadotropic hormones.

Peripheral or receptor hypothyroidism

Rare form. Due to changes at the gene level from birth, humans have defective receptors for thyroid hormones. In this case, the endocrine system conscientiously tries to provide the body with hormones, but the cells are not able to perceive them. The concentration of hormones is increasing in an attempt to “reach” the receptors, but, of course, to no avail.

In this case, thyroid hormones in the blood are elevated, the pituitary gland tries to stimulate the already overactive thyroid gland, but the symptoms of hypothyroidism do not disappear. If all receptors for thyroid hormones are defective, then this is incompatible with life. A few cases have been recorded in which only some of the receptors are changed. In this case, we are talking about genetic mosaicism, when some of the cells in the body have normal receptors and a normal genotype, and some have defective ones and an altered genotype.

This interesting mutation is rare and its treatment has not been developed today; doctors can only adhere to symptomatic therapy.

Hypothyroidism is a disease of the thyroid gland, which is one of the stages of a generalized attack of the immune system on the body of the gland. Sometimes the disease occurs in monophase without developing into other pathologies. One of the methods for diagnosing hypothyroidism is laboratory blood tests to determine the concentration of hormones in it.

Symptoms

Hypothyroidism may not manifest itself for a long time and only in advanced cases manifest a clear clinical picture. Greatest influence Tests for hypothyroidism provide a definitive diagnosis.

Among the expressed clinical picture hypothyroidism should be noted:

• Weakness, lethargy;
• Indifference to everything that happens;
• Rapid fatigue, decreased performance;
• Drowsiness;
• Absent-mindedness, poor memory;
• Swelling of the arms and legs;
• Dry skin, brittle nails, hair.

All these are the consequences of a lack of thyroid hormones of the thyroid gland in the body. Besides laboratory diagnostics appointed ultrasonography glands, a biopsy may also be prescribed if malignant nodules are suspected. Let's take a closer look at what tests show for hypothyroidism.

Thyroid-stimulating hormone

Most endocrinologists rely specifically on the level of thyroid-stimulating hormone in the patient's blood, or TSH. This hormone is produced by the pituitary gland and is designed to stimulate the thyroid gland.

If the level of this hormone in the blood is high, we can conclude that the pituitary gland is working to activate the gland, and accordingly, the body does not have enough thyroid hormones.

• For Russia, the normal level of TSH in a patient’s blood varies in the range of 0.4-4.0 mIU/l.
• American endocrinologists adopted a new range, according to the results of their research, which corresponds to a more realistic picture - 0.3-3.0 mIU/l.

Previously, the normal TSH range was 0.5-5.0 mIU/L - this was changed to the first 15 years ago, which led to an increase in the diagnosis of thyroid abnormalities.

In our region, it is worth focusing on the first indicator. A TSH above four mIU/L indicates hypothyroidism, and below - hyperthyroidism.

On the other hand, TSH concentration depends on many other factors. For example, low concentrations of thyroid-stimulating hormone are observed in cancer of the pituitary gland, since it is not able to produce hormones. A similar picture is observed after a stroke or injury affecting the hypothalamus.

The time of blood sampling has a great influence on the result of the study. Early in the morning, the level of TSH in the blood is average, by lunchtime it decreases, and by the evening it rises again above the average range.

T4

T4 hormone can be tested in the following forms:

• Total T4 – concentration of bound and free forms of the hormone T4;
• Free - a hormone that is not bound to a protein molecule and is available for use in the body;
• Bound - the concentration of the T4 hormone, which is already bound by a protein molecule and cannot be used by the body. Most of the T4 in the body is bound.

A comprehensive laboratory diagnosis of hypothyroidism cannot be based only on a concentration study, since it illuminates the problem only from one side - how much the brain stimulates the thyroid gland. For a complete study, tests are prescribed for free forms of the hormones T3 and T4.

Total T4 directly depends on bound T4. But recently, less attention has been paid to it, since the binding of T4 by a protein molecule also depends on the amount of the protein itself in the blood. And since protein concentration can increase with kidney and liver diseases, during pregnancy and lactation, measuring total T4 is not always effective enough.

More attention is paid to free T4 - this is the form of the hormone that must subsequently enter the cells and be converted into T3. The latter is the active form of thyroid hormone.

If free T4 - thyroxine - is below normal, while TSH is elevated, the picture really suggests hypothyroidism to the endocrinologist. These indicators are often considered in conjunction.

T3

As mentioned above, T3 is formed in the cells of the body from T4. This hormone is called triiothyronine and is the active form of thyroid hormone.

As with T4, total, free and bound forms of triiodothyronine are tested. Total T3 is not an accurate indicator of hypothyroidism, but can complement the diagnostic picture.

Free T3 is of greater importance for diagnosis, although in hypothyroidism it is often observed to remain in the normal range. This is due to the fact that even with a deficiency of thyroxine, the body produces more enzymes that transform T4 into T3, and therefore residual concentrations of thyroxine are converted to triiodothyronine, maintaining normal T3 levels.

AT-TPO

Any disease in the body, caused by an infection, bacteria or virus, causes an immediate response from the immune system in the form of the release of antibodies that should destroy foreign body- the cause of the disease.

When suffering from autoimmune hypothyroidism, the immune system somewhat incorrectly identifies the pathogen, attacking the person’s own thyroid gland with antibodies.

During an autoimmune attack on the gland, specific and nonspecific antibodies are produced. Specific – antibodies to thyroid peroxidase, also known as AT-TPO.

Such antibodies attack gland cells, destroying them. Since the cells have the structure of follicles, after their destruction the membranes enter the blood. The immune system detects foreign bodies - membranes - in the blood, determines their source and begins the attack again - thus, the production of AT-TPO occurs in a circle.

It is quite simple to detect these antibodies in the blood, and they become the gold standard for diagnosing autoimmune thyroiditis. If test results show an increased amount of AT-TPO in the blood, hypothyroidism is likely one of the stages of thyroiditis, and this stage can last for years.

Other indicators

These indicators are complex and are often checked together, and when deciphered, they are associated with each other. In addition, the doctor may prescribe an immunogram, a gland biopsy and a general urine test.

• A general urine test remains without deviation from the norm.
• The immunogram shows a decrease in the concentration of T-lymphocytes below normal limits, an increase in the concentration of immunoglobulins, a similar picture with a biopsy - there are a lot of antibodies in the gland cells.
• General blood test - shows an increase in erythrocyte sedimentation rate, relative lymphocytosis - a decrease in the number of lymphocytes.
• A biochemistry study shows a decrease in the albumin fraction of protein, an increase in the concentration of triglycerides and cholesterol, globulins and low-density lipoproteins.

The results of laboratory diagnostics are deciphered by an endocrinologist who refers to this study. Any laboratory does not take responsibility for self-medication of patients, since the results of tests for hypothyroidism, even if the described picture coincides with the received one, are not a clinical diagnosis, but only an aid for it.

Related Posts

Hypothyroidism is a symptom complex that occurs when the thyroid gland functions insufficiently due to a deficiency of the hormones that are synthesized in it. This pathology affects about 2-3% of the Russian population, and its latent form is found in another 10% of adults and 3% of children. It occurs mainly in mature and elderly women - 50-60 years old, but can be diagnosed in both men and children, including newborns, as well as in women after childbirth.

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

Kinds

Experts consider the most acceptable division of hypothyroidism into the following forms:

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

Causes and mechanism of development of the disease

Primary hypothyroidism can result from:

• autoimmune thyroiditis;
• surgical removal of the thyroid gland;
• treatment with radioactive iodine;
• congenital underdevelopment of the thyroid gland;
• congenital defects in the synthesis of its hormones;
• iodine deficiency, excess iodine in the body;
• exposure to toxic substances (such as thyreostatics, lithium preparations and others).

The causes of central hypothyroidism can be:

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

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

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

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

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

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

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

Symptoms, clinical manifestations

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

Upon detailed questioning, patients complain of:

• general weakness;
• slowness;
• lethargy;
• drowsiness;
• deterioration of memory, intelligence;
• decreased intelligence;
• constant feeling of cold, chilliness;
• deepening of the voice;
• hearing loss;
• difficulties with bowel movements - constipation;
• numbness of the hands, crawling sensation (paresthesia), disturbances of all types of sensitivity;
• frequent prolonged pneumonia and bronchitis;
• pain in the joints;
• compaction of the structure, soreness, muscle weakness, increase in volume; it is difficult for the patient to open his mouth or unclench his fist;
• women experience uterine bleeding, menstruation becomes abundant and prolonged;
• a woman cannot become pregnant;
• Milk begins to be released from the mammary glands.

During an objective examination of the patient, the doctor may detect the following symptoms that indicate hypothyroidism:

• the skin is very dry, yellowish in color, cool to the touch, flaky (especially in the elbows and knees);
• often the skin is swollen, does not fold well, and does not form a dimple when pressing on it;
• there is also swelling on the face, especially around the eyes; his skin is pale with a yellowish tint, there may be a blush on his cheeks;
• the color of the hair on the head is dull, it is dry and brittle, and falls out rapidly;
• hair also falls out on other parts of the body - eyebrows, pubic area, armpits;
• body temperature is below normal values;
• speech is difficult, slow due to an enlarged, swollen tongue;
• the voice seemed hoarse;
• heart rate is below normal;
• heart sounds are weakened, it is increased in size;
• diastolic blood pressure is increased;
• the intestines are swollen, their peristalsis is weakened;
• in severe hypothyroidism, ascites may be detected;
• swelling of the lower extremities.

There are 3 degrees of severity of hypothyroidism:

• mild (the patient becomes sluggish, thinking is impaired, intellectual potential is reduced, heart rate is reduced; performance remains within normal limits);
• moderate (bradycardia is noted, the patient’s skin is dry, he complains of constipation, drowsiness, irritability for no reason; women experience uterine bleeding; performance is moderately reduced; a general blood test reveals anemia);
• severe (the patient’s body is edematous (this condition is referred to as “myxedema”), skin pale with a icteric tint, dry, with areas of pronounced peeling; a person notes difficulties with bowel movements (constant constipation) and a roughening, change in the timbre of the voice (it becomes low); performance is significantly reduced; in particularly severe cases, hypothyroid coma may develop).

Hypothyroid coma

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

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

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

Hypothyroidism and pregnancy

As mentioned above, a woman suffering from hypothyroidism is unlikely to get pregnant (hyperprolactinemic hypogonadism occurs, as a result of which ovulation is blocked). If a woman receives treatment, her reproductive function is restored as her thyroid hormone levels normalize.

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

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

Hypothyroidism in elderly and senile people

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

Diagnostics

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

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

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

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

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

Testing for congenital hypothyroidism is carried out directly in maternity hospital using special filter paper.

Differential diagnosis

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

In addition to hypothyroidism, edema syndrome occurs in kidney pathologies - chronic nephritis, pyelonephritis, as well as in heart failure. If there is a pathology of the thyroid gland, swelling will regress with replacement therapy.

Anemia of thyroid nature differs from its other types by changes in the level of thyroid hormones in the blood and the effectiveness of treatment with L-thyroxine.

Peripheral damage similar to hypothyroidism nervous system may occur when diabetes mellitus(diabetic polyneuropathy), alcoholism, vibration disease and intoxication with mercury salts, lead, and arsenic. However, with pathology of the thyroid gland, in addition to neurological symptoms, the patient will be bothered by many other signs of the disease - a typical clinical picture of hypothyroidism.

Principles of treatment

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

The minimum daily dose of L-thyroxine is 25 mg. Increase it if necessary, gradually - every 14 days by 2 times, bringing it to the maximum effective (usually 100-150 mg per day). A few weeks after the start of therapy, the symptoms of the pathology regress and completely disappear after 2-3 months of daily use of the drug. the right dosage. Take the drug once a day, in the morning, half an hour before breakfast.

Conclusion

Hypothyroidism is not an independent pathology, but a complex of symptoms that accompanies a particular disease of the thyroid gland or the hypothalamic-pituitary region of the brain. In the vast majority of cases, it develops against the background of autoimmune thyroiditis or after surgery to remove the thyroid gland.

The symptoms of the pathology are varied, because almost all systems of the patient’s body are affected.

The main thing in diagnosis is to assess the level of thyroxine and thyroid-stimulating hormone of the pituitary gland in the blood, as well as to conduct an ultrasound of the thyroid gland. Rest diagnostic measures are auxiliary and depend on the characteristics of the disease.

Treatment is thyroid hormone replacement therapy. After just a few weeks of taking the drug, the patient notices an improvement in well-being. Unfortunately, many diseases accompanied by hypothyroidism require a person to take medications for life. This is not difficult to do - these drugs are quite affordable and are taken only once a day.

Which doctor should I contact?

We draw the reader's attention to the fact that you should not make a diagnosis yourself based on the materials in the article - the symptoms of the pathology are nonspecific and can occur in others, even more serious illnesses! Seek advice from a general practitioner or endocrinologist - they will help you understand the reasons for your poor health.

Additional assistance in recognizing and treating all manifestations of the disease will be provided by doctors of specialized specialties: neurologist, cardiologist, pulmonologist, gynecologist, andrologist, nephrologist. For hypothalamic-pituitary disorders, treatment is often carried out with the participation of a neurosurgeon.

The first symptoms of thyroid problems that should not be ignored

Health-saving channel, endocrinologist talks about hypothyroidism:

Causes and symptoms of hypothyroidism are a lack of thyroid hormones. Symptoms

A specialist from the Siena-Med clinic talks about hypothyroidism:

Hypothyroidism Treatment of hypothyroidism Clinic and diagnosis of hypothyroidism

Signs of thyroid disease in women

Millions of people on the planet eke out a miserable existence due to low thyroid function (hypothyroidism). Many people do not even suspect that hypothyroidism is stealing their energy and joy of life.

What is the reason for such a deplorable situation?

It turns out that it all starts with an unqualified diagnosis of hypothyroidism. Most doctors rely on the level and in some cases the thyroxine (T4) level.

The situation with the diagnosis of hypothyroidism is aggravated by different approaches to the criteria of norm and pathology, which are used by different laboratories, as well as different approaches to norms from official and alternative medicine.

TO OBTAIN A COMPLETE PROFILE OF THYROID FUNCTION, TESTS SHOULD BE CARRIED OUT:

general T4,

free T4 (thyroxine),

free T3 and reverse T3.

A little explanation of these indicators is necessary to understand their meaning.

The thyroid gland produces about 7% of the hormone triiodothyronine (T3) and 93% of the hormone thyroxine (T4).

Thyroxine (T4) is the inactive form of thyroid hormones. It waits in the wings to be converted into the active form, triiodothyronine (T3).

About 99% of T4 circulating in the blood is bound to a protein (thyroxine binding globulin, TBG). And only 1% of T4 walks around without protein accompaniment - the so-called “free T4”. Only the free hormone is active and has a physiological effect.

If normal T4 is combined with low free T4, then we conclude that most T4 is bound. This situation is possible due to increased amount, progesterone deficiency or ineffective liver function.

Accordingly, less free T4 will be available for conversion to free T3.

Triiodothyronine (T3) is formed by the removal of one iodine atom from thyroxine (T4). This single step separates the joyful life of existence from fatigue and apathy.

Similarly, only 1% of triiodothyronine (T3) is in a free state - the so-called “free T3”.

Free T3 is the catalyst for excess weight loss, warm extremities, good mood, healthy cholesterol profile, glowing skin, shiny hair, muscle strength and normal (not low) body temperature.

If free T3 is low at a time when other laboratory parameters are normal, then a “failure” has occurred in the conversion phase of T4 to T3.

Reverse T3 (revT3,reverseT3) is an inactive metabolite of T4. ObT3 slows down metabolism to conserve energy. Unlike obT3, free T3 accelerates metabolism.

In a healthy body, T4 is converted to T3, and only a small amount of T4 is converted to obT3. However, if the body finds itself in a stressful situation (in the broad sense of this), then the T3:obT3 ratio changes in favor of obT3.

The body perceives as a stressor not only major troubles, but also, for example, influenza, extreme cold or heat, injury, serious calorie restriction if you want to lose excess weight, etc.

As a defense against stress, metabolism slows down by increasing obT3 production. This is another example of the pointlessness of low-calorie eating for the purpose of losing weight.

When the level of circulating obT3 increases, the body's cells stop responding to signals from free T3. Clinically, this manifests as symptoms of hypothyroidism despite normal levels of TSH and other thyroid hormones (functional hypothyroidism).

Official medicine believes that the situation with high level reverse T3 is a rare occurrence. Therefore, due attention is not paid to the analysis of obT3 levels. But in real life, elevated obT3 levels are quite common.

Other reasons for increased obT3 levels include deficiency of selenium, zinc, Iron-deficiency anemia And low level vitamin B12.

Magazine The Journal of Endocrinology and Metabolism emphasizes that TSH and T4 levels do not reflect what is happening inside cells .

STRESS MAKES THYROSTROGING HORMONE DIAGNOSTICALLY UNRELIABLE

There is an opinion that the NORMAL LEVEL of vT3 IS A PRINCIPAL INDICATOR OF WELL-BEING AND LONGEVITY.

On the other hand, low free T3 and high free T3 are harbingers of premature and joyless old age.

THE BIG PICTURE OF HYPOTHYROIDIS DIAGNOSIS SHOULD BE COMPLETED BY EXAMINATION FOR THE AUTOIMMUNE NATURE OF HYPOTHYROIDIS (autoimmune thyroiditis, Hashimoto's disease).

The importance of this survey is that

IN OUR TIME, ABOUT 80-90% OF ALL CASES OF HYPOTHYROIDIS ARE OF AN AUTOIMMUNE NATURE.

Testing for thyroid antibodies is usually met with resistance from doctors.

"What for?" - the doctor thinks. After all, treatment of both autoimmune and non-autoimmune origin of decreased thyroid function comes down only to hormone replacement therapy.

Meanwhile, it is known that antibodies to thyroid tissue are registered much earlier than clinical and laboratory signs of impaired thyroid function appear. If it were up to me, I would test all women of childbearing age for antibodies.

Early differential diagnosis of autoimmune and non-autoimmune hypothyroidism will allow differentiated measures to be taken. They are known in alternative medicine. This means it is possible to start treatment in a timely manner and save the thyroid gland from destruction.

COMPETENT EXAMINATION PLAN FOR DIAGNOSIS OF HYPOTHYROIDSIS AND CONTROL OF PRESCRIBED TREATMENT:

• Complete thyroid hormone profile: thyroid stimulating hormone, free T3 (triiodothyronine), total T4, free T4 (thyroxine), reverse T3.
• Antibodies to thyroid tissue: antithyroglobulin and antibodies to thyroid peroxidase.

In addition, it is advisable to check:

• • Presence of antibodies to gluten: determination of immunoglobulin G by ELISA.
  • Screening for iron deficiency and pernicious anemia.