The physician should suspect hypothyroidism and test the patient's thyroid-stimulating hormone level if the patient complains of symptoms such as dry skin, alopecia, loss of appetite, weakness, memory loss, and other, in his opinion, age-related changes. Lack of timely treatment or inadequate therapy can lead to hypothyroid coma, which is an extremely serious condition with high mortality. Therefore, a doctor of any specialty should have an idea about the algorithms for the treatment of hypothyroidism and the drugs used for this.
Clinical symptoms of hypothyroidism
Hypothyroidism – this is a symptom complex of changes in various organs and systems, due to 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. The doctor should suspect that the patient has hypothyroidism syndrome 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, memory problems should be the reason for the exclusion of hypothyroidism in the patient.
Hypothyroidism diagnosis errors
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, the manifestations of hypothyroidism are considered by the doctor and the patient as signs of normal age-related changes. Indeed, symptoms such as dry skin, alopecia, loss of appetite, weakness, memory loss, etc., are similar to the manifestations of the aging process. Typical symptoms of hypothyroidism are detected only in 25-50% of people, while the rest have either extremely mild symptoms, or hypothyroidism is clinically manifested as some kind of monosymptom.
Clinical symptoms of hypothyroidism
| General symptoms | Musculoskeletal system |
| Fatigue, fatigue, weakness | Muscle weakness |
| Weight gain, chilliness | Muscular atrophy |
| Cardiovascular symptoms | Skeletal disorders in children |
| Sinus bradycardia | Gastrointestinal tract |
| Heart failure | Lack of appetite |
| Cardiomegaly | Constipation, megacolon, ileus |
| Pericarditis | Genital organs |
| Hypotension | In women: cycle disorder like amenorrhea or menorrhagia |
| or paradoxical hypertension | Infertility |
| Respiratory Organs | In men: lack of libido, decrease |
| Respiratory failure, | potency, gynecomastia |
| hypercapnia | Metabolism |
| Leather and its derivatives | Reduction in basal metabolism |
| Dry skin, hair loss | Weight gain, obesity |
| Nail thickening | High cholesterol, hypoglycemia |
| Prolapse of the lateral parts of the eyebrows | Fluid retention with volume increase |
| Skin color is pale | of the tongue, swelling of the face, especially the eyelids |
| with a yellowish tinge | Lab data |
| Nervous system | Hyponatremia |
| Apathy, drowsiness, disturbance | Anemia |
| attention | Increased creatine kinase |
| Memory deterioration | Thyroid |
| Depressive psychoses | Goiter or lack thereof |
| Stupor and coma | |
| Hyporeflexion |
Treatment of hypothyroidism
Since HC is the result of either untreated hypothyroidism or inadequate therapy for this syndrome and is an extremely serious condition with high mortality, a doctor of any specialty should be aware of the algorithms for treating hypothyroidism and the drugs used for this.
The main goal of GC treatment is to restore the 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 treatment.
The more severe the 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.
Main treatment measures for GC:
- Thyroid hormone replacement therapy (levothyroxine).
Use of glucocorticoids. - Combating hypoventilation and hypercapnia, oxygen therapy.
- Hypoglycemia elimination.
- Normalization of the activity of the cardiovascular system.
- Elimination of severe anemia.
- Hypothermia elimination.
Treatment of concomitant infectious and inflammatory diseases and elimination of other causes that led to the development of coma.
GK 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 by drip or intramuscular injections.
The goal of hypothyroidism treatment is stable normalization of TSH levels within the normal range (0.4-4.0 μU/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 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 T4, is advisable in each trimester of pregnancy. The dose of the drug should maintain a low-normal TSH level.
In postmenopausal hypothyroid women who are 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 selected dose of a hormonal drug are recommended to have their TSH levels checked annually. The TSH level is not affected by the time of blood sampling and the interval after taking levothyroxine. If free T4 is also used to assess the adequacy of therapy, the drug should not be taken in the morning before blood sampling, because for about 9 hours after taking levothyroxine, the level of free T4 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. You may need to increase the dose of this drug if you are taking rifampin and anticonvulsants that change hormone metabolism.
Thus, 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.
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