Hypothyroidism is a condition of the thyroid gland in which its functional ability to produce hormones is reduced. Such a disease manifests itself in a number of symptoms, such as: increased body weight, lethargy, drowsiness, slowing down of thought processes and speech muscles, girls have a violation of menstrual cycles. In severe cases, it can cause dementia in children. In adults, myxedema (mucosal edema) often develops.

This disorder is quite common, it can be acquired or congenital, it occurs primarily (with damage to the thyroid gland itself) and secondarily (with disturbances in the work of the hypothalamic-pituitary system, which regulates the work of this organ). According to the World Health Organization (WHO), diseases associated with the thyroid gland are the second most endocrine disorder. In addition, according to international statistics, every year the number of cases in the world grows by 5%.

Statistics show that 19 out of 1,000 women have hypothyroidism syndrome, while only one out of 1,000 men will have this pathology. This phenomenon may be caused by a shift in the diet of the population towards products that are poor in iodine content, especially in regions remote from coastal zones.

ICD data 10
Disease code: E01, E02, E03. *;

CLASSIFICATION

Hypothyroidism can be classified into three types of origin.

View	Signs
Primary	Primary hypothyroidism is also called thyrogenic . The main factor that causes primary hypothyroidism is the malfunctioning of the thyroid gland – there is a failure in the production of thyroid hormone. This is the problem of the disease. This species is also divided into several subspecies:    A congenital disease provoked by a violation of the development of the thyroid gland during the formation of the body during pregnancy.  Acquired. The main factor in the occurrence could be many factors, due to which the malfunction of the gland occurred. The reason could be surgery, trauma, swelling, lack of iodine in the body, an infectious disease, and so on.  Ideopathic . The exact etiology has not been identified and remains unknown.
Secondary	Secondary hypothyroidism is also called pituitary hypothyroidism. The main cause of pituitary hypothyroidism is a lack of thyroid hormones caused by a malfunction of the pituitary gland. The reason for the malfunction of the pituitary gland is atherosclerosis of the cerebral vessels (GM), ischemic disease and inflammatory diseases in the area of ​​the GM, tumors, as well as medications that toxicly affect the brain. The disease is more severe, in contrast to primary hypothyroidism, – this course is due to the fact that the target organs and some systems, including the cardiovascular system, are damaged .
Tertiary	Tertiary hypothyroidism or, as it is also called, hypothalamic hypothyroidism. It manifests itself in connection with dysfunction of the hypothalamus, the cause of which is a number of factors, namely, such as ischemic disease of the GM, diseases of an inflammatory nature in the area of ​​the GM, GM tumors, head trauma and the negative effects of pharmaceuticals.

SYMPTOMS AND SIGNS

The signs of hypothyroidism do not immediately manifest themselves, they can be rather weak and only an experienced endocrinologist can recognize the pathology of the thyroid gland in them. The clinical picture and first signs differ greatly depending on age and gender.

WHAT DO THE CHILDREN HAVE?

Long-term hormonal disruption of the thyroid gland in a child can lead to the development of a disease called cretinism. This is due to the fact that the breakdown of glucose is slower than it should. As a result, the energy consumed by the body becomes insufficient, which manifests itself in a slowdown in mental processes, a decrease in performance, a decrease in immunity and a decrease in appetite. The subclinical form of hypothyroidism in the initial stages may not give itself out in any way, but later the child will show the following symptoms:

• A delay in physical development – it proceeds together with functional insufficiency of internal organs.
• Lagging mentally and mentally – there is a violation not only of the child’s emotional background, but also of the basic functions of the cerebral cortex, namely, the child cannot read, write, count correctly, navigate in space, and so on. If there is no competent treatment, the child will begin to show symptoms of idiocy.
• Goiter – since the body does not produce enough thyroid hormones, it begins to look for a way to fix it. The only way, according to the body, is to enlarge the thyroid gland, so it will begin to produce more hormones. But this rarely leads to cure and disappearance of symptoms.

Most often, congenital hypothyroidism is a consequence of closely related marriages or infections and intoxications that affected the fetus during pregnancy, therefore, belonging to a particular sex does not play a role in the development of the disease. Nevertheless, the clinical picture of the disease is very characteristic and it is possible to correctly diagnose a child with hypothyroidism in the first months of life – otherwise, if untreated, there is a high probability of developing cretinism, which is accompanied by severe damage to the nervous system and progressive dementia.

Among the reasons for the development of this pathology, it should be noted:

• malformations characterized by the complete absence of thyroid tissue, the so-called agenesis, as well as hypoplasia or ectopia of the gland – congenital underdevelopment of the thyroid gland and its placement in an atypical place;
• genetic enzymopathies, manifested by a defect in enzyme systems that are responsible for the synthesis of thyroid hormones;
• the effect of strumogens during embryonic development, which is observed in cases when a pregnant woman takes antithyroid drugs, as well as preparations containing iodine in large quantities;
• birth trauma, which causes the development of secondary hypothyroidism;
• Infections, tumors, or trauma to the brain that disrupt the pituitary gland
• a decrease in the amount of thyroliberin of the hypothalamus, which reduces the synthesis of TSH in the pituitary gland;
• autoimmune lesions of the thyroid gland ( autoimmune thyroiditis), including those arising from diffuse connective tissue diseases (systemic collagenoses);
• surgical treatment of hyperthyroidism.

WHAT ARE ADULTS?

In the older generation, the disease proceeds in a completely different way. This is due to the fact that the body has already developed and spends its resources on other needs, such as: mental and physical work, stress resistance, stable work of internal organs.

On the left, the thyroid gland is normal. On the right – the III degree of increase is shown, at which a person experiences a constant feeling of suffocation, and nodes may also occur.

Women over 50 have a high risk of getting myxedema.

Also, in patients with hypothyroidism , a large number of systems fail:

• Central nervous system (CNS) – due to the great need for glucose and its decay products, the nervous system is under threat and often suffers first. Disorders of the central nervous system are manifested in the form of drowsiness, depression, lethargy, apathy, poor memory, polyneuropathy, not preparedness for stressful situations. 
• The cardiovascular system shows violations of its functions in a number of symptoms: headaches, in the flesh up to migraines, hypotension and bradycardia (a decrease in the heart rate below 60 beats), a decrease in blood pressure to 100/60 mm Hg , acute and intense pain for sternum in an active state, anemia. 
• Digestive system – manifests itself in the form of strong stool retention, decreased appetite, diarrhea, gas, enlarged liver. 
• Muscular – due to a lack of glucose in muscle fibers, lactic acid begins to accumulate, as a result of which nerve endings are irritated. The patient experiences severe pain in the muscles, in protracted stages everything can turn into muscle atrophy. 
• Symptoms in women are manifested in the form of menstrual irregularities, the inability to get pregnant, and poor condition of nails and hair.

HYPOTHYROSIS AND EXCESS WEIGHT

When hypothyroidism develops, atherosclerosis is common and excess weight (obesity) is gained. This process becomes more intense if patients take L-thyroxine under the condition of its negative interaction with other drugs or food products that make up the patient’s daily diet. You should limit the amount of soy products, as well as drugs that contain calcium. You should not use contraceptives that contain estrogens.

CAUSES OF DISEASE

The main factor in the occurrence of hypothyroidism is the presence of a chronic inflammatory process in the thyroid gland. A number of other reasons are also distinguished against the background of which the disease develops:

• Heredity
• Thyroid malformation
• Surgical interventions
• Lack of iodine in the body
• Irradiation with ionizing particles
• Infectious diseases such as tuberculosis
• Trauma
• Brain hemorrhage
• Necrosis

DIAGNOSTICS

To establish a diagnosis, it is necessary to conduct a thorough examination of the patient by an endocrinologist, who assesses the patient’s complaints, clinical symptoms of the disease, data from diagnostic procedures, analyzes laboratory blood tests and prescribes the necessary additional examination.

• The composition of the blood is checked for the presence of autoantibodies to the thyroid gland (AT-TG, AT-TPO).
• They look at the biochemical composition of the blood for elevated cholesterol levels.
• Determine the level of T4, T3, TSH in the patient’s blood. With the disease, thyroid hormones will be lowered, and TSH levels will vary in an increased or decreased level.
• An ultrasound examination is performed (to clarify the size and structure of the gland)
• If necessary, an X-ray is performed with coloring substances or biological material of the thyroid gland nodes is taken for research (fine-needle biopsy).

In hypothyroidism, studies of the hormonal profile of the thyroid gland in the vast majority of patients show a low content of thyroxine and triiodothyronine, while the level of thyroid-stimulating hormone can be both increased and sharply reduced (based on this analysis, it is possible to establish the type of hypothyroidism in the patient – primary or secondary). In addition, they must carry out: 

• studies of the level of autoantibodies to the tissues and cells of the thyroid gland to exclude thyroiditis;
• biochemical blood test with the study of cholesterol levels and lipid metabolism indicators.

If you suspect congenital hypothyroidism, it is imperative to determine the level of thyroid-stimulating hormone already in the first week of a child’s life – with a disease, the level of the pituitary hormone decreases.

TREATMENT

ETIOTROPIC THERAPY

Treatment of this kind is aimed at eliminating the provocateur of the disease, but it is often useless after the development of the disease has already begun. Even if it is possible to influence the cause of the disease, the effect of such treatment may never come.

Such therapy includes a number of the following activities:

• Prescribing iodine-containing preparations;
• Treatment of inflammatory diseases and other pathologies that caused hypothyroidism;
• X-ray treatment;

HORMONAL REPLACEMENT THERAPY

Such therapy is effective only when synthetic analogues of thyroid hormones are taken until the gland normalizes or the hormones are used for life. Usually drugs of this kind are well absorbed in the body, the 3 most effective drugs ” Eutirox “, ” Bagotyrox ” and ” Levothyroxine ” are isolated .

For the treatment of diagnosed hypothyroidism, an effective substitution therapy must be prescribed – patients must take a synthetic analogue of the hormone, the drug L-thyroxine, for life.

Particular attention is paid to the selection of the dose of the drug – the normalization of the condition usually begins in the first two weeks of hormone replacement therapy, and the symptoms of hypothyroidism completely disappear after 5-6 months of treatment. In patients who have concomitant diseases of the heart and blood vessels, the initial dose of the drug should be minimal – if it is unreasonably overestimated, angina pectoris and rhythm disturbances may develop.

PATHOGENETIC AND SYMPTOMATIC THERAPY

Symptomatic treatment is aimed at stopping (reducing) the clinical manifestations of hypothyroidism. It is also necessary to maintain the normal functioning of internal organs. Such therapy may include the use of hormone-free pharmaceuticals such as:

• Cardioprotectors – their work is to stabilize the processes of the cardiovascular system;
• Cardiac glycosides – prescribed for symptoms of heart failure;
• Nootropics and neuroprotective drugs – the effect of medications is to stabilize the central nervous system and improve its metabolic processes;
• Preparations with female sex hormones – their action is to normalize the menstrual cycle;
• Vitamin complex preparations – help to improve the functioning of all organs and systems in the body.

Compliance with the diet

In food, it is necessary to reduce foods with high levels of cholesterol and fatty acids, it is also necessary to cut back on fast carbohydrates and hard-to-digest foods in the diet. It is better to use the steam method in cooking – this way the food will turn out lighter, but it will also preserve almost all the vitamins in it. You can also eat baked foods. It is necessary to increase the amount of protein in the diet.

Salt is best used with a high iodine saturation. It is better to exclude butter and sunflower oil from the diet or reduce to a minimum. To avoid puffiness, it is necessary to maintain a water-salt balance and limit fluid intake to 1.5 liters. You should also consume a mineralized liquid with a high iodine content.

The diet should include foods such as:

• Fish and meat: beef, chicken, mackerel, herring;
• Buckwheat and millet porridge;
• Dairy products;
• The place for sweets is to eat dried fruit or jelly dessert;
• There are more fruits and vegetables;

Once a week, you need to arrange a rest for your body – on this day, it is advisable to eat more fruits and vegetables, to avoid overeating. For a better diet, you can contact a nutritionist – he will make an individual diet, relying on your body and diseases.

Strictly exclude from the diet: fatty, fried, spicy, instant foods, alcohol, corn and wheat flour.

COMPLICATIONS OF THE DISEASE

There are some of the most common complications of hypothyroidism:

• Development of a malignant tumor;
• Change in the size of the gland;
• The birth of a child with pathological development and a disturbed nervous system;
• Infertility;
• Hypothyroid coma, the mortality rate for this complication is 80 percent.

Particular attention should be paid to complications in pregnant women with hypothyroidism. The table below shows the options for the development of possible pathologies.

For pregnant	For a child
miscarriage pregnancy	Increased infant mortality
Anemia	Low birth weight
Preeclampsia	Respiratory distress syndrome
Placental abruption	Impaired neurointellectual development
Premature birth	Attention deficit disorder (ADD) and hyperactivity disorder
Postpartum bleeding	Autism

It is important to remember that the absence of treatment greatly increases the likelihood of developing a severe complication of hypothyroidism – myxedema coma, in which even intensive resuscitation and the appointment of intravenous hormones do not guarantee the patient’s salvation (mortality reaches 80%). 

PREVENTION OF HYPOTHYROSIS

Preventive measures to combat hypothyroidism are as follows:

• Compliance with the diet – it should be rich in iodine, vitamins and other trace elements;
• Do not give up the treatment of the brain and thyroid gland;
• Do not use various medications without consulting a specialist;
• Give up nicotine addiction;
• In autumn, winter and spring, consume an additional mineral complex of vitamins.

As a rule, the drugs required for treatment are not too expensive – their price ranges from one hundred to several hundred rubles. An appointment with an endocrinologist is also not very expensive, since it costs several hundred or a thousand rubles.

In conclusion, we can say that hypothyroidism is a dangerous and unpleasant disease. Those who are at risk should take preventive measures, monitor their health, nutrition, and periodically visit a doctor. This will avoid the unwanted consequences caused by this ailment.