Hypothyroidism is a collection of symptoms the main cause of which is considered to be a reduced level of thyroid hormones or problems with their consumption in the body.
- 1 How common is hypothyroidism, what are its forms and causes?
- 2 What are thyroid hormones, and what are they for?
- 3 processes occurring in the body when there is deficiency of T3 and T4
- 4 Symptoms of hypothyroidism
- 5 As revealed hypothyroidism?
- 6 Treatment of hypothyroidism
- 7 How do you know whether the treatment is effective?
- 8 Levothyroxine and simultaneous reception of other drugs
- 8.1 concise and accessible and hypothyroidism (video)
- 9 Do I need a combination therapy?
- 10 Contra combined treatment of hypothyroidism
- 11 Indications for combined treatment of hypothyroidism
How common is hypothyroidism, what are its forms and causes?
Hypothyroidism occurs in the population almost 4% of the world's inhabitants. Hypothyroidism in women is more common
- thyroid gland (thyroiditis) autoimmune inflammation;
- after surgery on the thyroid gland;
- during treatment with radioactive iodine.
These causes of primary hypothyroidism occurs in 95% of patients with this form of the disease.
There is also a secondary hypothyroidism (HT), which is most often associated with disruption of the pituitary and hypothalamus, located in the brain.
Rare forms of hypothyroidism, we give tissue GT.This GT is the result of the insensitivity of the body tissues to thyroid hormone, ie thyroid hormone.
addition, it meets and congenital hypothyroidism .This form of the disease may be both primary and secondary, and tissue.
What are thyroid hormones, and what are they for?
Because thyroid hormones are major thyroxine (T4) and triiodothyronine (T3).Both substances are formed in the follicles of the thyroid gland (TG).In each of them includes iodine.Iodine
enters the active thyroid cells by energy-consuming, so the cells of thyroid iodine ten times greater than in the extracellular space and blood plasma.
After getting iodine to the destination, it is activated and leads to iodinated tyrosine molecules.After a few chemical reactions and form the main hormones T3 and T4.After the formation of hormones is their accumulation in the thyroid follicles.This so-called repository.Usually it occurs in the thyroid T4 education.Its amount in the range of T3 thyroid greater amount more than 10 times.Further
T3 and T4 into the blood and bind to proteins.Meager their amounts are in the blood in a free state.T3 is much more free and, therefore, this hormone is rapidly excreted from the body.T4 in the blood is longer and acts later.
biological effect have only those hormones that are unrelated free state.Typically, the action has only T3, because it is more active, and T4 is its source, that is, with a lack of T3 turns to him.
controls the production of thyroid hormone thyroid-stimulating hormone, which is synthesized in the pituitary gland of the brain.The secretion and synthesis are regulated by thyrotropin-releasing hormone.Thyroid hormones also themselves have inhibitory effect on the release of thyroid stimulating hormone.The more thyroid hormone is produced, the less the synthesized thyroid hormone and thus a reduction in the production of the thyroid hormones - the principle of feedback is realized.
processes occurring in the body when there is deficiency of T3 and T4
From basic effects can be distinguished:
- decrease the rate of biochemical reactions;
- decrease in metabolic processes, aimed at both the decay and the building of new structures;
- accumulation of metabolic products.
All these changes lead to disruption of the internal organs and systems:
In hypothyroidism myxedema develops swelling due to accumulation of mucous membranes in the excess liquid.
Symptoms of hypothyroidism
Symptoms of the disease can be of different severity.And it depends on the degree of disruption of the thyroid gland.In this case the disease exacerbate the comorbidities and older age.
Often hypothyroidism can be hidden behind the masks of diseases such as:
- anemia and depression;
- amenorrhea and infertility;
- coronary heart disease;
- kidney disease.
immediate symptoms of hypothyroidism are:
- swelling of the face, hands and feet;
- dry skin, yellowness;
- swelling around the eyes;
- hair loss on the head;
- roughness of the skin in the area of the knee and elbow joints.
also sick note at:
- weakness and malaise;
- drowsiness and loss of memory;
- hearing loss and hoarseness;
- muscle pain;
These symptoms can be symptoms of many other diseases, the causes of which are completely different.Not identified hypothyroidism thyroid often treated under the guise of a disease cardiologists, hematologists, neurologists and other doctors narrow profile.
As revealed hypothyroidism?
main method of diagnosis is to determine the serum blood levels of thyroid hormones. Most often the information obtained by the detection of thyroid stimulating hormone.T3 and T4 is determined not great need because their levels are dependent on many additional factors.
Increased thyroid-stimulating hormone is typical for primary symptomatic (with the presence of symptoms) hypothyroidism.Hypothyroidism central origin, that is, when disrupted the pituitary and hypothalamus, thyroid-stimulating hormone level is reduced.
If laboratory findings indicate the presence of hypothyroidism, be sure to start replacement therapy in order to compensate for the missing quantity of biologically active substances.
Further diagnostic methods are ultrasound thyroid scintigraphy.
Treatment of hypothyroidism
In order to ensure proper treatment of hypothyroidism, is used levothyroxine, which was first obtained in 1915, and used was the only 70s as a full treatment of the drug, because it was open at the time the conversionthyroxine (T4) into triiodothyronine (T3).
absorption of thyroxine to the most food.It is 80%.After eating the drug's effectiveness is greatly reduced, because it reduces its absorption in the body.After receiving the maximum concentration of drug in the blood reaches after 3-4 hours.
In any form and etiology of hypothyroidism using levothyroxine. In most cases, medication is enough to take 1 time a day, to maintain the level of thyroid hormones necessary to normal levels.This replacement therapy is appointed until the end of life of the patient.
Levothyroxine is taken 30 minutes before meals and drink small amounts of water.The daily dose is taken at one time, as has been said.dosage calculation is conducted based on the fact that 1 kg of body weight should take between 1.6 and 1.8 micrograms.Initial dose averages 75-100 mg per day for women and 100-150 mg per day for men.All doses should select and appoint a qualified expert in the field of endocrinology.
How do you know whether the treatment is effective?
effectiveness of the treatment is evaluated based on the results of blood analysis on hormones, and more specifically on the thyroid-stimulating hormone.The values it should always remain within the 0.4-4.0 mIU / L.A single blood test will not be enough.The level of thyroid-stimulating hormone is determined every 2-3 months after the full replacement dose and every six months after that, as the level of thyroid-stimulating hormone reached the normal values were assigned.Upon reaching his normal numbers often require increasing levothyroxine dosage.Eventually, control of hormone levels is performed 1 time per year.
You have to understand, if the patient there is a concomitant compensate hypothyroidism thyroid disease heart , ie cause hormone levels to the normal range, is a very, very difficult to measure.
Levothyroxine and simultaneous reception of other drugs
impact on the effectiveness of levothyroxine have other medications taken by the patient.For example, using levothyroxine suction efficiency of estrogens in the intestines is greatly reduced.The drug appears in large quantities from the body and so increase the dosage required.
Pregnancy also often requires an increase in the dose of levothyroxine.In addition to pregnancy may be noted malabsorption of nutrients in the intestine (malabsorption, celiac disease).
Older patients may be necessary to reduce the dose of levothyroxine, because of its slow elimination from the body.
concise and accessible and hypothyroidism (video)
whether combination therapy necessary?
in 2012 were made public recommendations for the combination therapy of hypothyroidism, levothyroxine monotherapy although at the moment is the main method of treatment.About 16% of patients who received only levothyroxine do not feel any improvement.Many clinical studies of combination therapy did not lead to any result.At the moment, there is no evidence that combined treatment of hypothyroidism is an effective and appropriate.
Note, however, that the experts do not give up the use of combination therapy as an experimental technique while maintaining the complaints against treatment with levothyroxine.
Contra combined treatment of hypothyroidism
Combination therapy should not be used during pregnancy and heart rhythm disturbances in the form of tachycardia, extrasystoles and other similar conditions.
Indications for combined treatment of hypothyroidism
The use of combined treatment is appropriate in the case of violation of T3 in the peripheral blood T4 conversion.In other situations, you should use only levothyroxine.