The pathology of the thyroid gland among other endocrinopathies occupies a rather serious place. Leadership, undoubtedly, belongs to type 2 diabetes. Any manifestations of dysthyroidism (dysfunction of the thyroid gland) take a confident second place. Hypothyroidism is a condition in which the endocrine function of an organ is impaired. In this case, there is a deficiency of thyroid hormones: T3 and T4. In the absence of any clinical manifestations, this situation is called subclinical hypothyroidism. It is important to know what to do if such a condition is detected.

Causes of hypothyroidism

The subclinical form of hypofunction of the thyroid gland occurs due to a number of diseases. The main proportion of patients with reduced hormone levels is diagnosed with autoimmune thyroiditis (AIT).

This disease is associated with auto-aggression of the body’s own defenses. At a certain stage of life, for reasons yet unknown, immune cells (B-lymphocytes) begin to synthesize antibodies that act on the tissue of the thyroid gland. They act on thyroid cells, causing their destruction and death. Obviously, the level of thyroid hormones is falling.

The next reason is iodine deficiency. Despite the fact that many regions of the Russian Federation are endemic in terms of iodine deficiency , this diagnosis rarely leads to hypothyroidism. An exception is the appearance of a halogen deficiency in a child.

Often, the intervention of doctors leads to the appearance of symptoms of hypothyroidism. This is usually surgery for a goiter or diffuse toxic goiter. Exposure to radioactive iodine can also cause organ hypofunction. These causes are called iatrogenic.

The etiological factors of primary hypothyroidism are described above. There is also hypothyroidism caused by other causes. In this case, the term “secondary subclinical hypothyroidism of the thyroid gland” is appropriate. What are these etiological factors?

• tumors of the pituitary or hypothalamus;
• consequences of irradiation of the hypothalamic – pituitary region of the brain;
• vascular diseases of the pituitary gland;
• isolated insufficiency of secretion of thyroid-stimulating hormone (TSH).

Correction of hypothyroidism in these situations is carried out jointly with oncologists, neurosurgeons and doctors of other related specialties.

Symptoms of hypothyroidism

Despite the fact that the term “subclinical” implies an erased course of the disease with a minimum of symptoms, the described condition may be accompanied by some non-specific signs. Endocrinologists believe that subclinical hypothyroidism is a borderline state between the norm and the manifest manifestation of hypothyroidism.

Most often, hypothyroidism is detected at the stage when the level of hormones is significantly reduced. Usually there are symptoms. Subclinical hypothyroidism is characterized by normal T4 levels and elevated levels of thyroid-stimulating hormone. Sooner or later, the concentration of thyroid hormones will decrease, and clinical signs may appear earlier.

Hypothyroidism has many “masks”. That is, the manifestations of this condition can be easily confused with other somatic and psychogenic diseases. The most common are gastroenterological manifestations. These are constipation, which can alternate with diarrheal syndrome. The occurrence or aggravation of symptoms of gallstone disease is likely.

Cardiologists have to differentiate diseases of their profile with hypothyroidism. It is characterized by:

• dyslipidemia with a predominance of the atherogenic fraction of cholesterol and lipoproteins (hypothyroidism should be excluded if such abnormalities in the lipid spectrum are detected in young patients);
• isolated increase in diastolic blood pressure;
• effusion in the pericardial cavity.

In women, subcompensated hypothyroidism may present with dysfunctional bleeding. Infertility can also be a manifestation of impaired thyroid function.

The progression of the articular syndrome in osteoarthritis or the appearance of polyarthritis in young women is associated with hypothyroidism. Alopecia, changes in the structure of the nails – dermatological “masks” of the described disease.

Of the specific symptoms, one can indicate an increase in the tongue, a coarsening of the voice and swelling, puffiness of the face. An adequate diagnosis requires a differential approach.

Detection methods

There is no screening for this disease to date. However, for internists or endocrinologists, there are so-called hypothyroidism risk groups. What is a risk group and who does it include:

• Persons with an enlarged thyroid gland (goiter), any other diseases of this organ in history are subject to the determination of the thyroid profile or ultrasound if necessary. If there were people with the same problems in the patient’s family, then it is still necessary to examine the level of T3, T4 and TSH in blood serum.
• Autoimmune diseases or endocrinopathies can also coexist with hypothyroidism. These are autoimmune gastritis with pernicious anemia, type 2 diabetes mellitus, adrenal insufficiency, rheumatoid arthritis. They are subject to the same diagnostic procedures as the above group of patients.

Subclinical hypothyroidism is detected in the study of the thyroid profile. Normal levels of T3 or T4 with an increase in the concentration of TSH in the blood are typical laboratory values. The study is supplemented by the determination of antibodies to thyroglobulin , to thyroperoxidase , which increase with autoimmune thyroiditis ( Hashimoto’s goiter ). An ultrasound examination of the organ is indicated when abnormalities in the thyroid profile are detected.

Therapeutic tactics

Subclinical hypothyroidism is not an indication for immediate treatment with hormone replacement drugs. The only situation in which such a measure is required is pregnancy.

Treatment of subclinical hypothyroidism is necessary if the control study of TSH levels reveals its increase (after 6 months). This indicates the persistent nature of hypofunction. Hypothyroidism can hardly be cured, but it is possible to control the state of thyroid function and eliminate the manifestations of the disease.

Monitoring of hypothyroidism is carried out by a general practitioner. For this, the level of TSH and T4 is examined. The criterion for the effectiveness of treatment is stable normalization of TSH.

Levothyroxine is used as replacement therapy . The dose is calculated based on the patient’s body weight. You need 1.8 mcg of the drug per 1 kg of body weight. The drug is taken in the morning, on an empty stomach. It is not recommended to change the dosage on your own in order to avoid the development of hyperthyroidism or an insufficient therapeutic effect.

Clinical examination involves visiting a therapist 2 times a year. If necessary, an endocrinologist is consulted. The question of whether an army is possible is decided collectively, taking into account the patient’s condition.