To diagnose hypothyroidism, you need to know what are the symptoms of hypothyroidism. In addition, for successful and timely diagnosis and effective treatment, it is important to know the mechanisms of development of pathological processes that occur with a deficiency of thyroid hormones.
Pathogenesis of hypothyroidism. Why is thyroid hormone deficiency dangerous?
The pathogenesis of hypothyroidism is based on a deficiency of thyroid hormones, after which mucinous edema develops. This edema is also called myxedema and is most pronounced in connective tissue structures. This is due to the accumulation of hyaluronic acid and other glycosaminoglycans in the interstitial tissues. These substances retain water due to their hydrophilicity.
Basal metabolic rate can be reduced by up to 40% with thyroid hormone deficiency. This reduces tissue oxygen consumption. Appetite decreases, protein synthesis becomes less intense, which is manifested by an increased content of albumin. A decrease in the synthesis of fatty acids and the intensity of their metabolism is characteristic, and the level of cholesterol rises. Hypothyroidism increases the level of homocysteine, which increases the risk of atherosclerosis, arterial and venous thromboembolism.
How does hypothyroidism affect the systems of the human body
Hypothyroidism affects almost all systems of the human body. In the nervous system, with a long-term deficiency of thyroid hormones, neuronal atrophy, degeneration foci, and gliosis develop. Decreased activity of the central nervous system – 5 hydroxytryptamine leads to the development of depression.
In the support – motor system, Hoffmann's syndrome is observed, which is manifested by moderate muscle weakness and slowness of movement. This is due to slow bone remodeling and skeletal muscle hypertrophy.
From the side, cordially – vascular system of the human body, mild arterial hypertension and bradycardia are observed. Stroke volume, contractile function of the myocardium, and heart rate decrease. With severe hypothyroidism, heart failure develops.
In the respiratory system, the maximum capacity of the lungs decreases due to weakness of the muscles of the diaphragm.
Decreased contractility of the stomach – intestinal tract, leading to gallstones and constipation.
The glomerular filtration rate decreases in the excretory system due to a decrease in cardiac output. Serum sodium is reduced due to a syndrome of inappropriate ADH production, manifested by hyperosmolarity.
Hypothyroidism leads to a change in the synthesis and transport of sex hormones, depresses bone – cerebral hematopoiesis. Thus, all systems of the human body suffer from a deficiency of thyroid hormones.
Deficiency of thyroid hormones. How to make a diagnosis?
If you suspect a deficiency of thyroid hormones, you should first check the level of TSH. At TSH concentrations of 4 to 10 mIU/L, free T4 should be additionally investigated. If T4 is normal, there is no hypothyroidism. If it is lowered, this indicates manifest primary hypothyroidism.
When TSH level is more than 10mIU/l, no further tests are required, this indicates primary hypothyroidism.
If your TSH levels are low, you should also check your free T4 levels. With a decrease in its concentration, this indicates central hypothyroidism. For clarification, a test with TRG is carried out. With an increase in TSH after the test, this indicates tertiary hypothyroidism. If after the test there is no reaction – this is secondary hypothyroidism.
Thyroid hormone testing is mandatory in the monitoring of patients with thyroid disease.
The feasibility and methods of treating hypothyroidism. Hypothyroidism and pregnancy
Hypothyroidism is treated with thyroid hormone replacement therapy. Replacement therapy is carried out with levothyroxine sodium. Primary hypothyroidism requires maintaining a TSH level of 0.5 – 1.5 mIU/l. Treatment of hypothyroidism in the subclinical form should not be carried out immediately after detection. It is necessary to repeat the studies in six months.
Hormone administration is advisable only after persistent detection of elevated TSH or antibodies to thyroid peroxidase. Pregnant women are an exception. After the first detection of elevated TSH, they are prescribed L-thyroxine. This is because during pregnancy, all the hormones are taken over by the fetus, and if a woman has a deficiency, then her body may “not have enough” hormones, which is manifested by a sharp deterioration in well-being and can have dangerous consequences.
A comprehensive examination and a carefully collected medical history at the appointment with any specialist makes it possible to suspect the development of hypothyroidism in the early stages.
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