What you need to know about hypothyroidism syndrome? Part 1

In clinical practice, there are quite often cases when a person has a lot of symptoms that are very different and not similar to any other symptom, disease or pathology. In such cases, further examination reveals thyroid disease. Most often, this disease is hypothyroidism.

Hypothyroidism syndrome is a clinical syndrome caused by a deficiency of thyroid hormones. Hypothyroidism is classified as primary, central, secondary, and tertiary. Consider the causes of each of them.

What thyroid conditions can cause hypothyroidism?

There are many reasons for the development of hypothyroidism. Knowing these causes is essential to prevent severe hypothyroidism.

Thyroid disorders that lead to primary hypothyroidism:

1. Lack of functionally active thyroid tissue or its destruction:

• Radioactive iodine therapy.
• Surgical removal of the gland.
• Autoimmune thyroiditis.
• Transient hypothyroidism in subacute thyroiditis.
• Dysgenesis, agenesis of the gland.

2. Impaired synthesis of thyroid hormones:

• Toxic or drug effects.
• Birth defects of thyroid hormones.
• Excess or deficiency of iodine.

Causes of central hypothyroidism:

1. Lack or destruction of cells that secrete TSH and/or thyroliberin:

• Tumors of the hypothalamus – pituitary region.
• Vascular pathologies (hemorrhagic or ischemic lesions, aneurysms of the internal carotid artery).
• Radiation or traumatic injury (proton therapy, surgery).
• Infiltrative and infectious processes (tuberculosis, histiocytosis, abscess).
• Chronic pituitary hypophysitis.
• Congenital disorders (hypoplasia of the pituitary gland).

2. Impaired thyroliberin and/or TSH synthesis.

The most common cause of hypothyroidism is a thyroid disease such as autoimmune thyroiditis. Thyroid surgery and radioactive iodine therapy can also lead to a state of hypothyroidism.

Clinical symptoms of hypothyroidism. "Hypothyroidism masks"

Symptoms of hypothyroidism are described using the following terms: "slow", "overweight", "heavy", "inhibited", "masky", "dispassionate", "depressive".  The appearance of patients is changing. The face becomes amimic and puffy, becomes pale – yellow tint, palpebral fissures become narrower.

Speech slows down in severe hypothyroidism. Often the speech of a person with hypothyroidism is confused with the speech of a drunk. The timbre of the voice becomes low and hoarse due to swelling of the tissues of the larynx. Symptoms of hypothyroidism include swelling of the tissue of the tongue, which increases its size, and teeth marks are clearly visible on such a tongue. The Eustachian tube also swells and hearing is reduced.

The presence of epidermal syndrome can significantly spoil a person's appearance. With it, the hair becomes thin, dry, brittle, and falls out profusely when combed. Thinning of eyelashes and eyebrows is also possible. Eyebrows thinning and protruding from the lateral edge, which is a sign of "Queen Anne symptom".

The skin on the elbows may take on the form of hyperkeratosis – Baer's symptom. All the symptoms of hypothyroidism individually are often diagnosed as separate pathologies of each body system.

A hypothyroidism condition can hide behind many "hypothyroidism masks":

• Cardiology – hydropericardium, dyslipidemia, diastolic hypertension.
• Gastroenterology – bile – stone disease, biliary dyskinesia, chronic hepatitis with jaundice.
• Rheumatology – osteoarthritis, polysynovitis, polyarthritis.
• Hematological – hypochromic iron deficiency anemia or macrocytic B12 deficiency anemia.
• Gynecological – infertility, menstrual disorders (amenorrhea, polymenorrhea, dysfunctional uterine bleeding).
• Psychiatric – dementia, depression.
• Neurological – tunnel syndrome.
• Respiratory – sleep apnea syndrome, chronic laryngitis, pleural effusion of unknown origin.

Chilliness is noted in the general state of health, which is a sign of a decrease in the level of metabolism. Symptoms of hypothyroidism appear already in the early stages of the process, and require attention primarily from the patient.

It is important for a specialist to understand the mechanisms of development of hypothyroidism for timely diagnosis and successful treatment.

Mechanisms of pathogenesis, schemes of diagnostics and treatment read in the second part.

To be continued.