What causes hypothyroidism. All causes of hypothyroidism

Hypothyroidism is an endocrine disease, which is characterized by a decrease in the functions of the thyroid gland, as well as a decrease in the production of hormones by it. The extreme degree of manifestation in adult patients is myxedema, and in children - cretinism. The disease can be caused by both pathological disorders that affect hormonal metabolism, and a lack of thyroid hormones.

Classification and causes of hypothyroidism

Depending on the occurrence and complexity of the disease, it is classified into several types.

According to the severity, the following forms of hypothyroidism are distinguished:

• latent or subclinical: its characteristic feature is an increase in the level of TGG (thyroid-stimulating hormone);
• manifest: hypersecretion of TSH occurs;
• compensated;
• decompensated;
• complicated: the most difficult degree of the disease, in which symptoms such as secondary pituitary adenoma, heart failure, cretinism appear. As a rule, this form of the disease is detected when the disease has not been treated for a long time and it is in an advanced stage.

Depending on the causes of the pathology, its forms are distinguished:

1. congenital hypothyroidism. It is diagnosed in the absence or insufficient development of the thyroid gland. There is also a hereditary violation of enzymes that are involved in the synthesis of thyroid hormones.
2. Acquired hypothyroidism. This form of the disease occurs most often after resection of the thyroid gland. The cause of the pathology can be irradiation of the neck organs, exposure to radiation, inflammation of the thyroid gland, the occurrence of tumors on it, the use of medicines such as iodides, lithium preparations, vitamin A (in case of an overdose).

Hypothyroidism is also classified into the following types:

• primary (occurs due to problems in the thyroid gland);
• secondary (insufficient production of thyroliberin by the hypothalamus);
• tertiary (the cause of this disease is the low production of thyroliberin by the hypothalamus);
• peripheral (the cause of the disease is a sharp decrease in the sensitivity of body tissues and cell receptors to the effects of triiodothyronine and thyroxine.

Symptoms of hypothyroidism

It is extremely difficult to diagnose the disease for several reasons. First, the diagnosis of the disease is hindered by the absence of any specific symptoms. Secondly, many of the symptoms of hypothyroidism are very similar to those of other chronic mental and somatic diseases. In general, the clinical picture of hypothyroidism is characterized by polysystemic manifestations. However, some patients still show some specific symptoms of the disease:

• feeling of discomfort and pain in the neck area;
• thinning of the skin;
• increased sweating and body temperature;
• stratification of nails and thinning of curls;
• reduction in lung volume, as well as shortness of breath;
• exophthalmos (increase in size, as well as protrusion of the eyes), swelling of the eyelids without disturbing eye movement;
• problems with cardiac functions: increased blood pressure, tachycardia, arrhythmia, heart failure;
• increased fatigue;
• in men, there may be a decrease in sexual desire, and in women - various menstrual disorders;
• frequent urge to urinate;
• an increase in blood sugar levels, which leads to the appearance of thyroid diabetes;
• appetite disorder, vomiting, diarrhea and nausea, which cause a sharp weight loss;
• patients also complain of chills, internal trembling and heat in the body.

Diagnosis of hypothyroidism

Hypothyroidism of the thyroid gland is diagnosed by the clinical symptoms of its manifestation, as well as by the patient's tests. Namely, first of all, they check the level of T3 and T4 in the blood, which increase in the presence of the disease. In some cases, an increase in the level of these hormones indicates a high sensitivity of tissues to them. At the same time, it is observed that with primary hyperthyroidism, the level of thyroid-stimulating hormone decreases, and with secondary, on the contrary, it increases.

They also carry out tests with radioactive iodine. If the absorption of iodine by the thyroid gland is increased, this indicates an increase in the production of T3 and T4. On the contrary, a decrease in the production of these hormones may indicate the development of diseases such as tumors or thyroiditis. The presence of autoimmune processes may indicate antibodies to thyroid antigens.

Used to diagnose hyperthyroidism ultrasound examination. During it, the size of the thyroid gland and the presence of nodes and other pathological formations on it are determined. To clarify the place of formation of such nodes, as well as their size will help CT scan. Shown in the disease is also an ECG, which determines the presence or absence of abnormalities in the functioning of the cardiovascular system. If necessary, to clarify the diagnosis, they can also prescribe a biopsy of the thyroid nodes and its scintigraphy.

It is worth noting that hyperthyroidism can occur in a variety of forms, and also manifest itself in different ways in men, women and children. As for the forms of the disease, they include the following:

1. subclinical hyperthyroidism. This form of the disease is characterized by a low level of TSH (thyroid-stimulating hormone) and a normal content of the hormones T3 and T4 in the blood. Often the disease occurs without visible symptoms. This form of hyperthyroidism is found most often in older people. Since the pathology has a negative effect on the cardiac activity of patients, they are prescribed therapy aimed at preventing the development of cardiovascular diseases.
2. Autoimmune hyperthyroidism. This is an inflammatory disease in which the body produces antibodies that harm its own thyroid cells. This pathology often occurs at the very beginning of the disease. Autoimmune hyperthyroidism is characterized first by a sharp release of hormones into the blood, and then a decrease in their concentration. Against the background of pathology, hyperthyroidism or hypothyroidism may develop.

Complications of hypothyroidism

Of course, this disease must be diagnosed at its early stage of development, since only in this case it is possible to predict successful and light treatment hypothyroidism. Due to late diagnosis of hyperthyroidism, its unfavorable course, stress, infectious diseases, excessive physical activity thyrotoxic crisis may occur. This complication occurs exclusively in women. It is characterized by a sudden exacerbation of all the symptoms of pathology. Namely, the complications of the disease include severe tachycardia, fever, delirium. In addition, the crisis can progress to a coma or even death. Such a variant of complication is also possible, when the patient feels complete indifference to everything and apathy.

Treatment of hypothyroidism

Hypothyroidism is a complex endocrine disease, the treatment of which must be approached comprehensively. To date, endocrinology uses several methods of treatment that can be used both individually and in combination with each other. Namely, the methods of treating hyperthyroidism include radioiodine therapy, surgery to remove part or all of the gland, medication ( conservative therapy). It is difficult to say which of these methods is best, since the choice of one method or another is determined primarily by the characteristics of a particular case. The choice of method of treatment of the disease is carried out depending on the following factors: the causes of the pathology, the age of the patient, the severity of the disease, allergies to drugs.

1. Conservative treatment of hyperthyroidism
The basis of medical treatment of the disease are antithyroid drugs. However, they are used only if there is a slight increase in the thyroid gland - no more than 40 ml. If a much larger enlargement of the gland is diagnosed, then drug therapy is used to prepare for surgery. The most commonly used antithyroid drugs are drugs from the thionamide group. All these medicines are aimed at suppressing the formation and development of thyroid hormones.

Features of drug therapy

Drug therapy for hyperthyroidism is carried out according to the following principle. First, high doses of drugs are prescribed - at least 30-50 mg twice a day. High doses of drugs are indicated to normalize euthyroidism. At the same time, during therapy, tests are periodically prescribed for the level of hormones in the blood. To achieve a state of euthyroidism, it is necessary to undergo treatment for 4-6 weeks. When thyroid function returns to normal, maintenance therapy is prescribed. For this, a course of thiamzol is usually chosen at intervals of 10 mg once a day. Such maintenance treatment is recommended for one year, since more than 30% of patients experience remission of the disease.

Negative effects of drug treatment

It should be noted that in the process of drug treatment in some patients, side effects. The most common of these include allergic reactions(dermatitis, angioedema, urticaria), as well as a decrease in the level of leukocytes and platelets in the blood (thrombocytopenia, agranulocytosis). In especially severe forms of the disease, carbimazole is often prescribed, which has a prolonged effect. Carbimazole has an effective effect on the thyroid gland, and also promotes the conversion of the hormone T4 to T3.

Non-drug therapy

An important role in the conservative treatment of patients is also assigned to non-drug therapeutic methods, in particular hydrotherapy and diet therapy. Patients with hyperthyroidism are prescribed sanatorium treatment, in which special attention is paid to the prevention of diseases of the cardiovascular system. It is also important to adhere to a certain diet: consume a sufficient amount of BJU, vitamins, mineral salts, as well as limit the use of coffee, tea, spices and chocolate.

2. Treatment with radioactive iodine
Method of treatment of hypothyroidism with radioactive iodine is considered one of the most effective. Radioactive iodine is able to be absorbed very quickly into the thyroid gland, and also accumulate in it, which leads to a rapid decrease in its size. The breakdown of iodine leads to the destruction of thyroid cells. Take this remedy in the form of sodium salt. It is worth noting the high efficiency of this treatment method, since remission occurs in more than 90% of cases.
3. Surgical treatments
If a severe degree of the disease is diagnosed, surgical treatment may be prescribed. Namely, indications for resection of the thyroid gland are an increase in the size of the goiter, an allergy to antithyroid drugs, a relapse of the disease after undergoing drug therapy. In such cases, a subtotal resection of the gland is recommended, in which at least 3 millimeters of tissue is left. Before surgery, the patient must undergo preparatory therapy. Also drug treatment prescribed after surgery to prevent the occurrence of hypothyroidism.
4. Alternative Methods
For the treatment of pathology, alternative methods can also be used, in particular, ß-blockers, which block the effect of thyroid hormones on the body. After such a procedure, the patient feels better within a few hours. The most used ß-blockers are metoprolol, atenolol, inderal-la, nadolol. However, it should be noted that all these medications cannot be used as the main method of treatment. They are used exclusively in combination with other methods.

Prognosis for hypothyroidism

It is extremely important to identify the disease at an early stage, because only then it will be possible to hope for a favorable prognosis for its treatment. Severe hypothyroidism can cause a number of complications, including psychosis, hypothyroid coma, and accumulation of fluid in the serous cavities. Patients with hypothyroidism also have an increased tendency to develop atherosclerosis. The most severe forms of the disease require complex long-term treatment.

Even despite the presence of complications, the prognosis for the patient may be favorable, since most of them are treatable. Unfortunately, with congenital hypothyroidism, the prognosis for the mental health of the patient is very unfavorable. Therefore, treatment with thyroid drugs should be started within the first year of the patient's life. However, if cretinism has been diagnosed, thyroid drug therapy will only slightly improve the patient's mental health.

Prevention of hypothyroidism

There are certain risk factors that can affect the occurrence and development of the disease. Namely, at risk are patients with autoimmune diseases, as well as people who have had infections, mental trauma and stress. As for the prevention of hypothyroidism, it primarily includes iodine therapy, which can be individual, mass and group. The most effective is mass iodine prophylaxis, which involves the introduction of iodine salts into such common foods as water, salt and bread. Studies show that regular consumption of 100-150 micrograms of iodine reduces the likelihood of developing the disease by 50-65%.

Individual iodine prophylaxis is based on the use of food supplements and drugs that contain a large amount of iodine. With regard to group prophylaxis, it provides for the intake of iodine-containing drugs by certain population groups that are at risk. Namely, group prevention is indicated for adolescents, children, pregnant women, and lactating women.

Most effective method iodine prevention is considered to be eating table salt with the addition of iodine. Today, salt with a potassium iodate content of 40 ± 15 mg per kilogram is used for this purpose. The main advantages of this substance are that it does not volatilize even during long-term storage of salt, does not change the color and taste of products, which is very important when salting them. In addition, potassium iodate does not volatilize even during the heat treatment of food. The shelf life of iodized salt is 9-12 months.

In addition, to eliminate iodine deficiency, foods such as bread, butter, sweets, milk, and confectionery can be added to the diet. It is worth paying attention to the conditions for the absorption of iodine by the body. Namely, the full assimilation of the substance is possible only with a sufficient content of iron, protein, zinc, vitamins E and A in the diet.

For the prevention of hypothyroidism, it is extremely important to introduce foods rich in iodine into the diet. These primarily include spinach, beets, lettuce, seaweed. At the same time, it is recommended to purchase kelp in a dry form, in order to then use it as a seasoning for food or dilute it in a glass of water, and then add it to food. As fortifying agents, vitamin-nutritional mixtures based on nuts, lemons and honey are shown. In addition to correcting nutrition, attention should also be focused on normalizing mental health, since the thyroid gland reacts very sharply to nervous tension, stress, insomnia and emotional breakdowns.

Good day, dear readers!

In today's article, we will look at hypothyroidism, as well as its symptoms, causes, types, diagnosis, treatment and prevention. So...

What is hypothyroidism?

Hypothyroidism – pathological condition body, due to a chronic lack of thyroid hormones (thyroid hormones) in it.

The cause of hypothyroidism lies mainly (in 99% of cases) in hypofunction (insufficient production) of thyroid hormones - triiodothyronine, thyroxine and calcitonin, this is in the case of primary hypothyroidism. The cause of hypofunction itself is usually thyroiditis - an inflammatory disease of the thyroid gland. Another cause of hypothyroidism, but the most rare, is a malfunction of the hypothalamus or pituitary gland, which are involved in regulating the production of thyroid hormones. There are other factors / diseases of the thyroid gland that contribute to the lack of hormones, but we will talk about this later in the article.

Hypothyroidism is a serious disease of the endocrine system, so its consequences are very complex. For example, the extreme degree of hypofunction of the thyroid gland in adults is myxedema (mucous edema of the skin), and in children - cretinism. In addition, metabolic processes are disturbed in the body - energy, protein and mineral metabolism, the synthesis of sex hormones, normal development, structure and functioning of the brain, cardiovascular, digestive and musculoskeletal systems. When the required dose of the missing hormones enters the body, the symptoms usually disappear, however, this must be done on time.

Disease statistics

Hypothyroidism in women, especially after 60 years, usually occurs most often - 19 women out of 1000, while among men, this figure is only 1 out of 1000. These thyroid problems are also seen in people living in regions remote from the sea. If we talk about global statistics, then doctors note that the total population who have a lack of thyroid hormones is about 2%.

The insidiousness of the pathology lies in the difficulty of self-diagnosing it. So, the onset of the disease can proceed with a simple manifestation of chronic fatigue.

For the first time, the disease hypothyroidism was discussed and described in 1873.

Hypothyroidism - ICD

ICD-10: E03.9;
ICD-9: 244.9.

Symptoms of hypothyroidism

The first signs of hypothyroidism are:

• General weakness, increased fatigue;
• The appearance of dense swelling of soft tissues on the skin;
• , after which ;
• (decrease in heart rate below 59 bpm);
• Violation of mental activity;
• Sexual dysfunction.

The main symptoms of hypothyroidism:

• , lethargy, fatigue, drowsiness or;
• Edema on the skin, sometimes mucous membranes of the nasopharynx and middle ear;
• Oppression of mental activity, deterioration of memory and attentiveness;
• Disorders of the gastrointestinal tract -, lack of appetite;
• A set of extra pounds,;
• Menstrual irregularities in women, up to complete absence;
• Sexual dysfunction and decreased sexual desire in men;
• with slight yellowness,;
• Increased hair loss, as well as their dryness and brittleness;
• Thinning of the nail plate, delamination and increased fragility of nails;
• Severe tolerance of heat and cold;
• Muscle pain, sometimes accompanied by cramps;
• Stiffness of movements, some numbness of the limbs;
• , bradycardia, cardiomegaly, arterial hypotension;
• Violation of the functioning of the adrenal glands;
• Decrease in the level of hemoglobin in the blood;
• , B12-deficient, macrocytic and megaloblastic anemia;
• Decrease in the protective properties of the body ( immune system).

Specific symptoms:

• yellowing of the scalp;
• Oppression of auditory function;
• Oppression of visual function;
• Oppression of the vocal function, as if the tongue were tangled, hoarse voice;
• Galactorrhea;
• carpal tunnel syndrome;
• Development of biliary dyskinesia;

Complication of hypothyroidism

Complications of hypothyroidism include:

• Growth of the thyroid gland in volume;
• thyroid cancer;
• Formation of a secondary adenoma;
• Formation of an "empty" Turkish saddle;
• Changes in the structure of the mammary glands, constant galactorrhea;
• Due to ovarian dysfunction - infertility;
• The birth of a child with a disorder in the development and functioning of the nervous system;
• Loss of consciousness;
• Hypothyroid (myxedematous) coma, mortality in which is up to 80%;
• Fatal outcome.

The most common cause of hypothyroidism is the presence of chronic autoimmune thyroiditis, which is an inflammatory disease of the thyroid gland, against the background of impaired functioning of the immune system.

Other causes of hypothyroidism include:

• hereditary predisposition;
• Congenital anomaly of the thyroid gland - its increase or decrease in size;
• Postponed surgical treatment of the thyroid gland;
• Acute deficiency in the body for a long period;
• Treatment of goiter with the use of radioactive iodine (iodine-131);
• Ionizing radiation of the thyroid gland;
• The presence of tumors;
• Pathological effects on the body of certain drugs (Levodopa, Parlodel, serotonin preparations and others);
• The presence of infection in the body - actinomycosis and others;
• Injury to the pituitary gland or hypothalamus;
• hemorrhages;
• Necrosis;
• Violations of the functions of the kidneys and liver for the conversion of enzymes;

Types of hypothyroidism

The classification of hypothyroidism includes the following types ...

By etiology:

Primary (thyroid) hypothyroidism. The determining factor that leads to a lack of thyroid hormones in the body is a malfunction of the thyroid gland. Consider its subspecies:

• Congenital hypothyroidism, caused mainly by a violation of the development of the thyroid gland, as well as the transformation of enzymes involved in the production of hormones by the gland.
• Acquired hypothyroidism, due to many factors due to which the thyroid gland malfunctioned - these are operations, and radiation, and injuries, various tumors, the presence of infectious diseases, autoimmune processes, an acute persistent lack of iodine in the body, removal of the gland, and others.
• Idiopathic hypothyroidism - the exact cause of hypothyroidism cannot be determined.

Secondary (pituitary) hypothyroidism. The disease is caused by a malfunction in the production of thyroid hormones due to disturbances in the functioning of the pituitary gland (a gland located in the brain). The factors that lead to this usually become -, ischemic damage and inflammatory diseases in the brain area, autoimmune processes, tumors, as well as the poisoning effect on the pituitary gland of certain drugs. If we talk about the clinical picture of secondary hypothyroidism, then unlike primary, it is more difficult, because. it is accompanied by damage to other organs, in particular, the ovaries, adrenal glands, cardiovascular and other systems.

Tertiary (hypothalamic) hypothyroidism. The failure is associated with malfunctions of the hypothalamus, which in turn is usually due to factors such as trauma, tumors, ischemic processes and inflammatory infectious diseases (meningoencephalitis, etc.) in the brain area, as well as the effects on the body of certain drugs, such as serotonin .

Tissue (transport, peripheral) hypothyroidism. Violations are usually associated with the transformation of hormones and their distribution throughout the body. This is often facilitated by factors such as autoimmune processes, disturbances in the structure of receptors in body tissues, metabolic disorders, as well as liver and kidney fermentopathy, which are involved in the conversion of thyroxine to triiodothyronine.

Primary hypothyroidism is also classified according to severity:

Latent (subclinical) hypothyroidism- is characterized by an increased level of thyroid-stimulating hormones (TSH) against the background of a normal level of thyroxine (T 4).

manifest- characterized by an increased level of thyroid-stimulating hormones (TSH) against the background of a reduced level of thyroxine (T 4), with obvious clinical manifestations (symptoms). May be:

• Compensated;
• Decompensated.

Complicated hypothyroidism (severe course)- accompanies such complications as - cretinism, disorders of the heart, secondary pituitary adenoma and others, up to myxedematous coma and death.

Diagnosis of hypothyroidism

Diagnosis of hypothyroidism includes the following examination methods:

• Visual examination of the patient, anamnesis (including family history);
• for thyroxine, triiodothyronine and thyroid-stimulating hormone (TSH);

Additionally, it can be assigned:

• Thyroid scintigraphy;
• Puncture fine needle biopsy.

The diagnosis of "hypothyroidism" can only be established.

Treatment for hypothyroidism usually includes, depending on the diagnosis, the following items:

1. Etiotropic therapy;
2. Replacement therapy;
3. Symptomatic treatment;
4. Diet.

Important! Medicines and their dosages are selected by the endocrinologist, based on the type of disease, its severity, clinical manifestations comorbidities and age of the patient.

1. Etiotropic therapy

Etiotropic therapy implies the treatment of primary and concomitant diseases that led to hypothyroidism. This may be thyroiditis, which in most cases is the cause of hypothyroidism, endemic goiter and other inflammatory diseases of the thyroid gland, pituitary gland or hypothalamus.

If the cause of hypothyroidism lies in an insufficient amount of iodine in the body, the patient is prescribed drugs based on iodine - Betadine, Iodide.

Additionally, iodized salt, seaweed can be prescribed.

2. Replacement therapy

Replacement therapy involves taking hormonal drugs that are substitutes for natural thyroid hormones. Usually these drugs are well tolerated, but their use can be lifelong in some cases.

Hormone replacement drugs include:"Bagotiroks", "Levothyroxine" (L-T4), "Eutiroks".

3. Symptomatic treatment

To improve the course of the disease and the quality of life of the patient, symptomatic treatment, which is aimed at stopping the symptoms of hypothyroidism, as well as maintaining the normal functioning of other organs, the activity of which can be inhibited in this disease.

Symptomatic treatment of hypothyroidism may include the use of the following drugs:

Cardioprotectors- aimed at normalization heart rate, and other areas that improve the functioning of the cardiovascular system: ATP, Mildronate, Preductal, Trimetazidine.

cardiac glycosides- are used for heart failure: "Digoxin", "Korglikon", "Strophanthin"

Nootropics and Neuroprotectors- are prescribed to normalize metabolic processes in the nervous system, brain:

Drugs based on female sex hormones- aimed at normalizing the course of menstruation and ovulation.

Vitamin and mineral complexes, which contribute to the improvement of the activity of all organs and systems: "Aevit", "Milgama", multivitamin complexes ("Geksavit", "Undevit").

The diet for hypothyroidism is based on the exclusion from the diet of foods rich in cholesterol and saturated fatty acids. In addition, it is necessary to reduce to a minimum the use of "fast" carbohydrates, which are difficult to digest and increase the secretion in the stomach of products.

It is best to cook dishes for a couple, such food will be easy on the stomach, as well as with minimal loss. Products can also be baked. The amount of protein food should be increased.

With constipation, you need to increase the amount of fiber in food.

As salt, it is better to use the iodized version.

The use of butter or sunflower oil in cooking is best excluded, or at least minimized.

The amount of water per day should be limited to 1.5 liters, otherwise swelling may increase. As a drink, the use of mineral water, especially enriched with iodine, has a beneficial effect on the body.

What can you eat with hypothyroidism?

Meat and fish: beef, veal, chicken, sea fish (salmon, herring, mackerel), cod liver, eggs.

Kashi: buckwheat, millet.

Dairy products: milk, cottage cheese, cheese, kefir, natural yogurt.

Vegetable products: seaweed, cabbage, beets, potatoes, carrots, tomatoes, cucumbers, eggplants, zucchini, bell peppers, spinach, onions, as well as apples, currants, cherries, grapes, persimmons, tangerines, kiwi, bananas, dates and.

It is advisable to do 1 day a week, in which to focus on eating fresh vegetables and fruits.

What can not be eaten with hypothyroidism?

Nutrition for hypothyroidism excludes foods such as spicy, fatty, fried, smoked meats, fast food (fast food), pickles, sauces and marinades, pastries, sugary juices, polished rice, alcoholic beverages, wheat and corn flour.

- a disease caused by a decrease in thyroid function and insufficient production of hormones by it. It is manifested by a slowdown in all processes occurring in the body: weakness, drowsiness, weight gain, slowness of thinking and speech, chilliness, hypotension, in women - disorders menstrual cycle. In severe forms, myxedema develops in adults and cretinism (dementia) in children. Complications of the disease are hypothyroid coma, damage to the heart and blood vessels: bradycardia, atherosclerosis of the coronary vessels, coronary artery disease. Treatment of patients with hypothyroidism is carried out with artificially synthesized thyroid hormone.

General information

The most common form of functional disorders of the thyroid gland, which develops as a result of a long-term persistent deficiency of thyroid hormones or a decrease in their biological action at the cellular level. Hypothyroidism may not be detected for a long time. This is due to the gradual, inconspicuous onset of the process, the satisfactory well-being of patients with mild and moderate disease, erased symptoms, regarded as overwork, depression, pregnancy. The prevalence of hypothyroidism is about 1%, among women of reproductive age - 2%, in old age it increases to 10%.

The lack of thyroid hormones causes systemic changes in the body. Thyroid hormones regulate energy metabolism in the cells of organs, and their deficiency is manifested in a decrease in oxygen consumption by tissues, a decrease in energy consumption and the processing of energy substrates. Hypothyroidism disrupts the synthesis of various energy-dependent cellular enzymes necessary for the normal functioning of the cell. In the case of advanced hypothyroidism, mucinous (mucous) edema occurs - myxedema, most pronounced in connective tissue. Myxedema develops as a result of excessive accumulation of glycosaminoglycans in tissues, which, having increased hydrophilicity, retain water.

Classification and causes of hypothyroidism

Hypothyroidism can be acquired and congenital (it is diagnosed immediately after birth and can have any genesis). The most common is acquired hypothyroidism (more than 99% of cases). The main causes of acquired hypothyroidism are:

• chronic autoimmune thyroiditis (direct damage to the thyroid parenchyma by its own immune system). Leads to hypothyroidism years and decades after its onset.
• iatrogenic hypothyroidism (with partial or complete removal of the thyroid gland or after treatment with radioactive iodine).

The above reasons most often cause persistent irreversible hypothyroidism.

• treatment of diffuse toxic goiter (reception of thyreostatics);
• acute iodine deficiency in food, water. Mild to moderate iodine deficiency in adults does not lead to hypothyroidism. In pregnant women and newborns, mild to moderate iodine deficiency causes transient disturbances in the synthesis of thyroid hormones. In the case of transient hypothyroidism, the dysfunction of the thyroid gland may disappear during the natural course of the disease or after the disappearance of the factor that caused it.

In women, against the background of hypothyroidism, disorders of the reproductive system develop, which is associated with a malfunction of the menstrual cycle (amenorrhea, dysfunctional uterine bleeding), the development of mastopathy. A pronounced deficiency of thyroid hormones threatens infertility, less obvious hypothyroidism in some women does not prevent pregnancy, but threatens it high risk spontaneous miscarriage or the birth of a child with neurological disorders. Both men and women experience a decrease in sex drive.

Clinical manifestations of congenital hypothyroidism often cannot help in its early diagnosis. TO early symptoms include bloated abdomen, umbilical hernia, muscle hypotension, large tongue, enlarged posterior fontanelle and thyroid gland, low voice. If treatment is not started in a timely manner, then at 3-4 months of life, difficulty in swallowing, loss of appetite, small weight gain, flatulence, constipation, pallor and dry skin, hypothermia, and muscle weakness develop. At the age of 5-6 months, a delay in the psychomotor and physical development of the child is manifested, a growth disproportion is observed: late closure of fontanelles, a wide bridge of the nose, an increase in the distance between paired organs - hypertelorism (between the inner edges of the orbits, breast nipples).

Complications of hypothyroidism

A complication of congenital hypothyroidism is a violation of the central nervous system and the development of oligophrenia in a child ( mental retardation), and sometimes its extreme degree - cretinism. The child lags behind in growth, sexual development, is prone to frequent infectious diseases with a long chronic course. An independent chair is difficult or impossible for him. Hypothyroidism during pregnancy manifests itself in various anomalies in the development of the fetus (heart defects, developmental pathologies internal organs), the birth of a child with functional thyroid insufficiency.

The most severe but rare complication of hypothyroidism is hypothyroid (myxedematous) coma. It usually occurs in elderly patients with long-term, untreated hypothyroidism, severe comorbidities, low social status, or lack of care. The development of hypothyroid coma is facilitated by infectious diseases, trauma, hypothermia, taking drugs that depress the activity of the central nervous system. The manifestations of hypothyroid coma are: progressive CNS inhibition, confusion, low body temperature, shortness of breath, decreased heart rate and blood pressure, acute urinary retention, swelling of the face, hands and body, intestinal obstruction.

The accumulation of fluid in the pericardial and pleural cavity sharply disrupts cardiac activity and respiration. A significant increase in the level of cholesterol in the blood provokes the early development of coronary artery disease, myocardial infarction, cerebral atherosclerosis, ischemic stroke.

Men and women with hypothyroidism may suffer from infertility, their sexual function is impaired. With hypothyroidism, serious immune disorders occur, which are manifested by frequent infections, the progression of autoimmune processes in the body, the development oncological diseases.

Diagnosis of hypothyroidism

To diagnose hypothyroidism, an endocrinologist establishes the fact of a decrease in thyroid function based on the examination of the patient, his complaints, and the results of laboratory tests:

• determining the level of thyroxine - T4 and triiodothyronine - T3 (thyroid hormones) and the level of thyroid-stimulating hormone - TSH (pituitary hormone) in the blood. With hypothyroidism, there is a reduced content of thyroid hormones in the blood, the content of TSH can be either increased or decreased;
• determination of the level of autoantibodies to the thyroid gland (AT-TG, AT-TPO).
• biochemical analysis of blood (with hypothyroidism, the level of cholesterol and other lipids increases);
• Ultrasound of the thyroid gland (to determine its size and structure);
• thyroid scintigraphy or fine needle biopsy.

Diagnosis of congenital hypothyroidism is based on neonatal screening (determination of the level of TSH on the 4th-5th day of a newborn's life).

Treatment of hypothyroidism

Thanks to the achievements pharmaceutical industry, allowing artificial synthesis of thyroid hormone, modern endocrinology has effective method treatment of hypothyroidism. Therapy is carried out by replacing the thyroid hormones missing in the body with their synthetic analogue - levothyroxine (L-thyroxine).

Manifest (clinical) hypothyroidism requires the appointment of replacement therapy, regardless of the patient's age and comorbidities. The variant of the beginning of treatment, the initial dose of the drug and the rate of its increase are individually assigned. In case of latent (subclinical) hypothyroidism, the absolute indication for substitution therapy is its diagnosis in a pregnant woman or planning a pregnancy in the near future.

In most cases normalization general condition patient with hypothyroidism begins in the first week of the start of treatment medicinal product. Complete disappearance clinical symptoms usually occurs within a few months. In the elderly and debilitated patients, the reaction to the drug develops more slowly. Patients with cardiovascular diseases need to carefully select the dose of the drug (excessive intake of L-thyroxine increases the risk of angina pectoris, atrial fibrillation).

In the case of hypothyroidism resulting from the removal of the thyroid gland or radiation therapy, synthetic hormones are indicated throughout life. Lifelong treatment of hypothyroidism is also necessary in the setting of autoimmune thyroiditis (Hashimoto's disease). During treatment, the patient must regularly visit a doctor to adjust the dose of the drug, control the level of TSH in the blood.

If hypothyroidism occurs against the background of other diseases, the normalization of thyroid function most often occurs in the process of curing the underlying pathology. Symptoms of hypothyroidism caused by taking certain medications are eliminated after the withdrawal of these drugs. If the cause of hypothyroidism is a lack of iodine intake with food, the patient is prescribed iodine-containing drugs, eating iodized salt, seafood. Treatment of hypothyroid coma is carried out in intensive care units and resuscitation with the appointment intravenous injections large doses of thyroid hormones and glucocorticosteroids, correction of the state of hypoglycemia, hemodynamic and electrolyte disorders.

Prediction and prevention of hypothyroidism

The prognosis for congenital hypothyroidism depends on the timeliness of the initiated replacement therapy. With early detection and timely replacement treatment of hypothyroidism in newborns (1-2 weeks of life), the development of the central nervous system practically does not suffer and corresponds to the norm. With late compensated congenital hypothyroidism, the pathology of the child's central nervous system (oligophrenia) develops, the formation of the skeleton and other internal organs is disrupted.

The quality of life of patients with hypothyroidism receiving compensatory treatment usually does not decrease (there are no restrictions, except for the need for daily intake of L-thyroxine). Mortality in the development of hypothyroid (myxedematous) coma is about 80%.

Prevention of the development of hypothyroidism consists in good nutrition with sufficient intake of iodine and is aimed at its early diagnosis and timely start of replacement therapy.

Symptoms of hypothyroidism are a combination of signs and clinical manifestations that occur in the body when the level of thyroid hormones decreases due to a lack in the body, the influence of radioactive iodine-131, the absence of the thyroid gland due to organ surgery or congenital pathology, autoimmune diseases of the thyroid gland. If you do not pay attention to the symptoms of hypothyroidism and do not treat this condition, serious consequences can occur, including myxedema coma, leading to death. Thyroid is responsible for the full functioning of the whole organism, therefore, when there is a shortage of hormones synthesized by it, a very diverse symptomatology occurs.

First manifestations

Each person needs to periodically examine the area of ​​​​the thyroid gland. Normally, it can be felt on the lower front of the neck under the Adam's apple. In relation to the internal organs, it is located below the larynx, in front of the thyroid cartilage, thanks to which it got its name. In the normal state of the organ, it is not at all visible externally. If a person notices a minimal change in the size of the gland, or another deformation in this area, then this should be the reason for contacting specialists. First clinical signs hypothyroidism can be - general weakness, increased fatigue, the appearance of dense swelling of soft tissues on the skin, low blood pressure, after which arterial hypotension, bradycardia, impaired cognitive function, and disorders in the genital area are formed.

All these symptoms are a reason for consulting a specialist, taking tests and identifying a problem, especially when they occur in a complex manner.

Main features

The thyroid gland is an organ that is rightfully called the "conductor" of the whole organism. Although this element cannot boast of large size, it is responsible for the full functioning of the whole organism. It is designed to carry out the orders of the brain and control the work of internal organs. Under the influence of the main glands, such as the pituitary gland, hypothalamus, the thyroid gland provides the synthesis of hormones that are responsible for a number of processes in the body.

External signs

Hypothyroidism is one of the few diseases in the diagnosis of which clinical symptoms are not of decisive importance and are secondary. Errors in the diagnosis of hypothyroidism are usually associated with the polymorphism of the manifestations of the syndrome, its numerous "clinical masks" often serve as the basis for an erroneous diagnosis, and sometimes inadequate treatment. Hypothyroidism syndrome can occur, mimicking diseases of almost all body systems.

To detect hypothyroidism in time, it is important to know its external signs. Violation of the function of the gastrointestinal tract in hypothyroidism is accompanied by the appearance of constipation or diarrhea, nausea and pain in the abdomen. On the part of the cardiovascular system, there is a violation of the rhythm and conduction, lability of blood pressure, the occurrence of pericarditis. General immunity is reduced, a person is susceptible to infectious and viral diseases more often than in the general population. However, the most obvious behavior in hypothyroidism is the skin and ENT organs. The skin often becomes cold, pale, dry, areas of the skin on the elbows and knee joints hair loss is noted. There may be a decrease in hearing and vision, the timbre of the voice changes slightly. The latter is due to swelling of the vocal cords in the throat. All these signs are very obvious and if they are present, it is absolutely not worth postponing a visit to the doctor.

Neurological signs

Neurological symptoms of primary hypothyroidism usually proceed quite mildly, without leading to social disadaptation of the patient or disability. However, the quality of life when it occurs worsens so much that this is the reason for a separate therapy when contacting a doctor. When subclinical hypothyroidism occurs, all parts of the nervous system are involved in the process of dysfunction. It is often possible to observe a combination of damage to the peripheral and central nervous system with severe clinical picture. A mild deficiency of thyroid hormones leads to a syndrome complex, the manifestations of which are:

1. Neurosis-like syndrome, asthenia and other disorders of the psycho-emotional sphere. Patients experience an increase in fatigue, irritability, drowsiness (or interruptions in sleep at night), anxiety, periodically occurs to everything and. The inconstancy of apathy is caused by the activation of metabolism or disruption of hormonal compensation, which is typical for hypothyroidism.
2. Headache. This is a very common syndrome in this pathology, which is explained by sheath-hypertensive, venous, vertebrogenic and mixed mechanisms of occurrence. Insufficiency of thyroid hormones leads to myxedematous edema in the connective tissue, weak cardiac function in conditions of increasing peripheral vascular resistance, and reduced blood flow velocity. As a result, patients complain of heaviness in the head area, an internal feeling of pressure, and discomfort. Often this is accompanied by severe periorbital edema with complaints of pressure in the eye area in the morning or in the evening in an inclined position. Rarely there are nocturnal bursting headaches with vomiting.
3. Cognitive impairment, which manifests itself in the inability to concentrate, delve into something, show attention. Sometimes there is such a symptom as forgetfulness, but this is noted much less frequently.
4. Autonomic disorders in the form of paroxysmal conditions similar to panic attacks. Also a frequent symptom is the vegetative-vascular-trophic syndrome, manifested by hyperhidrosis, progression of autonomic failure. Patients complain of weakness, dizziness, when changing from a lying position to a standing position.
5. Focal neurological symptoms. It can be determined by a doctor during examination, when he sees paresis of convergence, underexposure of the eyeball, increased periosteal and tendon reflexes, staggering in the Romberg position, a slight intention during the knee-calcaneal and finger-nose tests. Some patients also suffer from mild polyneuropathy. upper limbs, combined with the clinical picture of tunnel syndromes. When questioning the patient, the doctor often finds out that there are complaints of "crawling all over the body", a feeling of numbness in the hands at night or in the morning.
6. Myopathic syndrome and myotonic phenomenon in very rare cases. These are mild manifestations of weakness of the proximal leg muscles, which can be verified by means of a needle. Also likely in the foot or lower leg, less often in the area of ​​​​the hands.

Psychological condition

With hypothyroidism, the metabolism of brain cells suffers greatly, which is manifested by a decrease in the patient's intelligence, his ability to perform mental work, attentiveness and creativity.

Intellectual decline is very pronounced, however, with the help of psychological techniques, it is possible to determine the degree of decline in such abilities in relation to the average indicators. Patients themselves notice their inability to concentrate, find a way out, solve a problem. It also fails the human memory, especially short-term. A person ceases to remember faces, dates, what is happening here and now. Long-term memory is not affected by hypothyroidism.

A decrease in the level of thyroid hormones in the body leads to apathy and lack of will of a person, which is important to take into account for all his relatives, since such a psychological state will lead to the fact that the patient will not even have the strength to apply for medical care. The emotional side of life also suffers, a person acquires pessimistic views on the future, his mood is always depressed, he is dejected. Interest in family, friends, all the people around is also lost. They often give referrals to their patients for consultations to or in order to identify the scope of depression in which a person is due to hypothyroidism. Severe depressive states with hypothyroidism can be observed in 5-12% of all patients.

Symptoms of the disease in women

It is no secret that women are more susceptible to hypothyroidism, since their hormonal background under the influence of natural processes changes much more often than men. It is necessary to deal with the signs and symptoms of female hypothyroidism in special conditions - during menopause and during pregnancy.

Features of symptoms in menopause

The problem in identifying the symptoms of hypothyroidism during menopause is the high similarity of these symptoms with the manifestations of menopause itself, since both conditions are closely related to the functioning of the thyroid gland. Menopause is characterized by a decrease in the production of sex hormones in a woman's body.

Hormone deficiency in hypothyroidism can lead to fatigue, lethargy, alopecia - the same signs that are characteristic of early menopause.

In order to independently distinguish the onset of menopause from problems with a lack of thyroid hormones in the body, you need to pay attention to the conditions that arise in the body due to metabolic inhibition as a result of hypothyroidism, for example, a decrease in mental activity, slowing down of speech, pastosity of the face, cold intolerance.

During pregnancy

During pregnancy, under the influence of a complex of specific factors, a significant stimulation of the thyroid gland occurs, mainly this occurs in the first half of pregnancy, i.e. during the period when the fetus does not yet have its own thyroid gland, and all embryogenesis is provided by the mother's thyroid hormones.

The symptomatology of hypothyroidism in an explicit form is identical to the manifestations in the general population, simulating diseases of almost all body systems. On the other hand, subclinical hypothyroidism has practically no clinical symptoms and is diagnosed most often by an accidental measurement of TSH, including during pregnancy.

Thus, hypothyroidism developed for the first time or insufficiently compensated during pregnancy can be associated with serious and irreversible complications for both the fetus and the pregnant woman herself.

Factors provoking complications during pregnancy can be banal hypothermia, stress.

Features of symptoms in infants

In infants, hypothyroidism may be present at birth. This indicates a congenital form of the disease.

According to statistics, each of 5 thousand newborns suffers from it, and there are 2 times more girls with pathology than boys.

With intrauterine development of the fetus, the maternal thyroid gland or replacement therapy should fully cover the need for appropriate hormones. But when a child is born, his thyroid becomes unable to synthesize the required amount biologically. active substances, which is expressed in specific symptoms.

Infants with congenital hypothyroidism may experience:

• persistent jaundice;
• profuse swelling of the feet and hands, lips, face;
• dry skin;
• lethargy, weak and rare crying, weakened sucking reflex;
• the tone of the skeletal muscles decreases;
• the child has a large tongue, umbilical hernia,;
• rendered;
• delay in closing the fontanel on the head;
• difficult and noisy nasal breathing;
• poor weight gain.

If hypothyroidism is not detected in time in infants by the age of six months, the child will lag behind in physical and mental development, and the work of internal organs will begin to be disrupted.

Even if congenital hypothyroidism has a transient form, was detected in a timely manner and disappeared by the age of two, a child may have noticeable disproportions in the development of the body for the rest of his life - wide hands, a wide bridge of the nose, lengthening of the forehead, hypertelorism (increased gaps between paired organs on the body ).

It is not difficult for an experienced specialist to diagnose congenital hypothyroidism, usually such babies are large, weighing more than 4 kilograms, have swelling, and sometimes hydrocephalus (a disproportionately large head). It is also important to pay attention to the fact that in some cases the symptoms may be hidden, leading to late diagnosis and delayed treatment.

Signs of hypothyroidism can manifest themselves in a slow metabolic process in the baby's body, which is why he is too calm and lethargic.

Due to the serious consequences of hypothyroidism for newborns in modern conditions, screening is carried out in maternity hospitals, which makes it possible to immediately identify a number of hereditary pathologies, including problems with thyroid function. Blood is taken by percutaneous puncture (usually from the heel) 4-5 days after birth in full-term and 7-14 days in premature babies. The interpretation takes into account the level of TSH. If its value is less than 20 mIU / l, the child is considered healthy, at a level of 20-50 mIU / l, a second examination is carried out, and at a level of more than 50 mIU / l, hypothyroidism is suspected.

Sometimes hypothyroidism in children can also be acquired, and the disease can start at any age. It manifests itself, first of all, with a delay in intellectual development, which parents need to pay close attention to.

Medvedeva Larisa Anatolievna

Speciality: therapist, nephrologist.

General experience: 18 years .

Place of work: Novorossiysk, medical center "Nefros".

Education:1994-2000 Stavropol State Medical Academy.

Training:

1. 2014 - "Therapy" full-time advanced training courses on the basis of the State Budgetary Educational Institution of Higher Professional Education "Kuban State Medical University".
2. 2014 - "Nephrology" full-time advanced training courses on the basis of Stavropol State Medical University.

Catad_tema Anesthesiology-reanimatology - articles

Catad_tema Diseases of the thyroid gland - articles

Life-threatening complications of hypothyroidism

E.A.Troshina, M.Yu.Yukina
FGU Endocrinological science Center Rosmedtekhnologii, Moscow

Hypothyroidism is a symptom complex of changes in various organs and systems, caused by a decrease in the level of thyroid hormones.

The quality of life of patients with hypothyroidism who constantly receive replacement therapy with levothyroxine differs slightly from that of patients without hypothyroidism. Hypothyroidism itself becomes a way of life for the patient, not a disease.

However, in the absence of timely adequate treatment of hypothyroidism, the risk of complications increases. Hypothyroid coma (HC) is a rare, life-threatening complication of hypothyroidism. First of all, it develops in elderly patients for a long time un- or poorly treated. Patients with GC die predominantly from respiratory and heart failure, in some cases from cardiac tamponade. Even with promptly initiated vigorous therapy, 40% of patients die.

Clinical symptoms of hypothyroidism develop in a patient with a gradual increase. Most often, hypothyroidism is characteristic of patients operated on the thyroid gland (primary postoperative hypothyroidism).

The doctor should suspect the presence of hypothyroidism syndrome in an elderly patient and determine the level of thyroid-stimulating hormone (TSH) in the blood serum if the patient had any history of thyroid disease or received medications that can provoke the development of hypothyroidism. In addition, the presence of constipation resistant to conventional treatment, cardiomyopathy, anemia of unknown origin, dementia, should be a reason to rule out hypothyroidism in an elderly patient.

Laboratory diagnostics

Laboratory parameters for the diagnosis of hypothyroidism are the determination of basal (not stimulated) TSH and free T 4 and T 3 values. A normal basal TSH level rules out hypothyroidism. With elevated basal TSH, the diagnosis is confirmed by the detection of low concentrations of free T 4 and T 3 .

Mistakes in diagnosing hypothyroidism

The diagnosis of hypothyroidism is often untimely, since in its initial stage the detected symptoms are extremely non-specific. In addition, hypothyroidism syndrome can imitate various non-thyroid diseases, which is associated with multiple organ lesions found in conditions of thyroid hormone deficiency. Very often, manifestations of hypothyroidism in the elderly are considered by the doctor and patient as signs of normal aging. Indeed, symptoms such as dry skin, alopecia, loss of appetite, weakness, dementia, etc., are similar to the manifestations of the aging process. Typical symptoms of hypothyroidism are detected only in 25-50% of older people, while the rest have either extremely mild symptoms, or hypothyroidism is clinically manifested as some kind of monosymptom.

Clinical diagnostics

hypothyroid coma

Resolving factors are severe comorbidities, surgery, trauma, sedatives and drugs, and hypothermia.

The basis of the pathogenesis of GC is alveolar hypoventilation followed by hypoxia of vital organs, resulting in a decrease in body temperature, bradycardia and hypoglycemia. With untimely assistance, a fatal outcome is possible. Mortality in HC ranges from 60 to 90%.

All symptoms of hypothyroidism increase in the patient. Drowsiness, disorientation, coma are expressed. Body temperature is reduced to 34-35 ° C, bradycardia occurs. The skin is cold, pasty.

The main symptom of GC is a decrease in body temperature. Coma is accompanied by progressive changes in the central nervous system, inhibition of all types of reflexes. Changes in the central nervous system lead to an increase in bradycardia, a decrease in blood pressure and hypoglycemia.

Cardiovascular disorders that develop in a patient with GC are often the cause of death. Peripheral hemodynamic parameters are among the first to respond to changes in the concentration of thyroid hormones. Hypothyroidism is accompanied by a decrease in heart rate (HR). The bradycardia that occurs with hypothyroidism is reversible when euthyroidism is achieved.

Another effect in hypothyroidism is a change in total peripheral vascular resistance (OPVR). Hypothyroidism causes an increase in peripheral vascular resistance, with which, to a certain extent, the development of diastolic arterial hypertension(AG). Diastolic hypertension in hypothyroidism is common. In patients with hypothyroidism and the presence of hypertension, the content of aldosterone and renin in the blood plasma is reduced, i.e. diastolic hypertension in hypothyroidism is hyporeninic in nature.

The proposed causes of impaired vasodilating function in hypothyroidism are: decreased generation of vasodilating substances and/or resistance to them of vascular smooth muscle cells; decrease in the concentration of atrial Na-uretic peptide.

The state of hypothyroidism is characterized by a decrease in the number of β-adrenergic receptors, which is associated with a lower likelihood of developing arrhythmias. However, it has been established that norepinephrine secretion and its content in blood plasma are increased in persons with hypothyroidism. Norepinephrine, being mainly an adrenergic stimulant, can contribute to spasm of the coronary arteries.

Hypothyroidism is characterized by a decrease in myocardial contractility, a decrease in ejection fraction, and the development of heart failure. The state of hypothyroidism is also accompanied by prolongation of diastole, an increase in the time of isovolumetric relaxation of the left ventricle.

Treatment of hypothyroidism

Since GC is the result of either the lack of treatment of hypothyroidism or inadequate therapy for this syndrome and is an extremely serious condition with high mortality, a doctor of any specialty should have an idea about the algorithms for treating hypothyroidism and the drugs used for this.

It is very important to recognize hypothyroidism in time, which can be diagnosed by only one indicator of hormonal analysis - TSH, and prescribe replacement therapy with Euthyrox. Its difference from other thyroid hormone preparations is the ability to easily select the desired dosage - 25,50,75,100, 125 or 150 mcg, which greatly facilitates the replacement therapy for hypothyroidism.

Dosing regimen of the drug
EUTHIROX (levothyroxine sodium)
Set individually depending on the indications, the effect of treatment and laboratory data. All daily dose take 1 time / day in the morning, at least 30 minutes before breakfast and drink liquid.
With hypothyroidism at the beginning of treatment, a dose of 50 mcg / day is prescribed. The dose is increased by 25-50 mcg every 2-4 weeks until signs of a euthyroid state are achieved.
In patients with long-term hypothyroidism, myxedema and, especially, in cases where there are diseases of the cardiovascular system, the initial dose of the drug should not exceed 25 mcg / day. In most patients, the effective dose does not exceed 200 mcg / day. The lack of an adequate effect when prescribing 300 mcg / day indicates malabsorption or that the patient does not take the prescribed dose of Euthyrox. Adequate therapy usually leads to normalization of the level of thyroid-stimulating hormone and thyroxine (T 4) in plasma after 2-3 weeks of treatment.

A summary of the manufacturer's information on dosage of drugs in adults is provided. Before prescribing the drug, carefully read the instructions.

Treatment of GC
The main task of the treatment of GC is the restoration of normal physiological functions of all organs and systems that are impaired due to hypothyroidism. The criterion for the adequacy of treatment is the disappearance of clinical and laboratory manifestations of hypothyroidism.

The severity and duration of hypothyroidism are the main criteria that determine the doctor's tactics at the time of initiation of treatment.

The more severe hypothyroidism and the longer it has not been compensated, the higher will be the general susceptibility of the body to thyroid hormones, especially for cardiomyocytes.

The main therapeutic measures for GC:

1. Replacement therapy with thyroid hormone preparations (levothyroxine).
2. The use of glucocorticoids.
3. The fight against hypoventilation and hypercapnia, oxygen therapy.
4. Elimination of hypoglycemia.
5. Normalization of the activity of the cardiovascular system.
6. Elimination of severe anemia.
7. Elimination of hypothermia.
8. Treatment of concomitant infectious and inflammatory diseases and elimination of other causes that led to the development of coma.

GC treatment is carried out in a specialized intensive care unit and is aimed at increasing the level of thyroid hormones, combating hypothermia, and eliminating cardiovascular and neurovegetative disorders.

The treatment of GC is based on the principle of maximum administration of thyroid hormones, primarily levothyroxine, through a tube, either drip or intramuscular injections.

The goal of the treatment of hypothyroidism is stable normalization of the TSH level within the normal range (0.4-4.0 mcU/l). In adults, euthyroidism is usually achieved with levothyroxine at a dose of 1.6-1.8 µg/kg body weight per day. The initial dose of the drug and the time to reach the full replacement dose is determined individually, depending on age, body weight and the presence of concomitant heart disease. It is possible to gradually achieve a full replacement dose of levothyroxine - an increase of 25 mcg every 8-10 weeks. The need for levothyroxine decreases with age. Some older people may receive less than 1 mcg/kg of the drug per day.

The need for levothyroxine increases during pregnancy. Evaluation of thyroid function in pregnant women, which involves the study of the level of TSH and free T 4 , is appropriate in each trimester of pregnancy. The dose of the drug should ensure the maintenance of a low-normal TSH level.

In postmenopausal hypothyroid women on estrogen replacement therapy, an increase in the dose of levothyroxine may be necessary to maintain normal TSH levels.

The level of TSH, after changing the dose of levothyroxine, is examined no earlier than after 8-10 weeks. Patients receiving a titrated dose hormonal drug, it is recommended to examine the level of TSH annually. On the TSH level the time of blood sampling and the interval after taking levothyroxine do not affect. If, in addition to this, the determination of the level of free T 4 is used to assess the adequacy of therapy, the drug should not be taken in the morning before blood sampling, since for about 9 hours after taking levothyroxine, the level of free T 4 in the blood is increased by 15-20%. Ideally, the drug should be taken on an empty stomach at the same time of day and at least 4 hours apart before or after taking other drugs or vitamins. Taking drugs and compounds such as cholestyramine, ferrous sulfate, soy proteins, sucralfate and antacids containing aluminum hydroxide reduces the absorption of levothyroxine, which may require an increase in its dose. Increasing the dose of this medicinal product may be needed when taking rifampin and anticonvulsants that alter hormone metabolism.