Hypothyroidism is a syndrome resulting from a lack of thyroid hormones in the body. Distinguish between primary (develops as a result of disorders in the thyroid gland) and secondary (damage to the hypothalamus or (and) the pituitary gland) hypothyroidism. The most severe complication of the disease is hypothyroid coma. In the vast majority of cases (about 95%), primary hypothyroidism is diagnosed. The extreme form of hypothyroidism in adults is myxedema disease, in children – cretinism. Causes of hypothyroidismThe causes of primary hypothyroidism: complications arising after the treatment of various endocrine diseases;the use of drugs containing iodine, as well as the intake of estrogens, sulfa drugs, androgens and glucocorticoids;thyroiditis;acute and chronic infections, tumors of the thyroid gland;tuberculosis;hypoplasia, etc.The causes of secondary hypothyroidism: traumatic or inflammatory lesions of the pituitary gland / hypothalamus (hemorrhage, tumor, surgery, necrosis);general pituitary pathology in combination with hypogonadism and an excess of growth hormone.Symptoms of hypothyroidismThe most characteristic symptom of the disease is an increase in the size of the thyroid gland. The presence of the disease is also characterized by the following changes in the body: the skin ages faster, becomes cold and thick, nails are brittle, hair is dry and thick, the face becomes pale and puffy, eyebrow hair falls out, vocal cords swell, as a result of which the timbre of the voice changes;blood pressure and heart rate decrease (hypotension, bradycardia, respectively), shortness of breath, pain and discomfort appear in the left half of the chest;hypoventilation;gastrointestinal disorders (flatulence, nausea, lack of appetite, etc.);the kidneys secrete less fluid;disorders of the nervous system (drowsiness, lethargy, nervousness, memory impairment, etc.);muscle fatigue and joint pain;decreased libido;violation in the blood, etc.Clinical manifestationsComplaints are often scanty and nonspecific, the severity of the patient’s condition usually does not correspond to their complaints: lethargy, sluggishness, decreased performance and fatigue, drowsiness, memory loss. Many patients complain of dry skin, puffiness of the face and swelling of the limbs, a rough voice, brittle nails, hair loss, weight gain, a feeling of chilliness, note paresthesias, constipation, etc. The severity of hypothyroidism symptoms largely depends on the cause of the disease, the degree of thyroid insufficiency and the individual characteristics of the patient. Diagnosis of hypothyroidismDifferential diagnosis is based on clinical studies of the patient, in particular, the levels of thyroid hormones over time. Determine the level of thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3). In hypothyroidism, the level of T4 and T3 decreases in proportion to the severity of the disease, the level of TSH is sharply increased. Certain changes in the levels of thyroid hormones are possible under the influence of unfavorable environmental conditions, under the influence of factors of professional activity (chemicals, radiation). There are the following types of hypothyroidism: Primary (thyrogenic)Secondary (pituitary)Tertiary (hypothalamic)Tissue (transport, peripheral)By severity, primary hypothyroidism is subdivided into: Latent (subclinical) – increased TSH level with normal T4.Manifest – TSH hypersecretion, with a reduced T4 level, clinical manifestations.Compensated.Decompensated.Severe course (complicated).There are severe complications such as cretinism, heart failure, serous effusion, secondary pituitary adenoma. As a rule, these are neglected, not diagnosed in a timely manner, cases that end with myxedema comma without the intervention of a specialist. The greatest severity in the treatment of hypothyroidism lies precisely in the selection of the correct dose of drugs. This process should take place smoothly and gradually, taking into account the patient’s age and the severity of his illness, as well as the presence of various concomitant diseases. Treatment of patients with heart disease requires even greater caution from the doctor. If a person is over 50 years old, and he has never been tested for the presence of this disease, then it is important to exclude any risk of coronary heart disease. Hypothyroidism is a lifelong disease, and a lot depends on the right treatment. It is much more difficult for children to endure it. If an adult can live more or less normally with appropriate therapy, then it is almost impossible to restore the functionality of the brain in children with congenital hypothyroidism. In addition, the disease can negatively affect the growth of the child.
ONCOLOGYGlobally, thyroid cancer is a rare malignant tumor – it accounts for about 1% of all malignant neoplasms. In the world, 122 thousand people fall ill every year, and usually young adults get sick, diseases in children were very rare. After the accident at the Chernobyl nuclear power plant, the incidence of thyroid cancer among children in areas exposed to radiation increased 35 times (and in some areas, for example, in Gomel and the Gomel region – 100 times). In addition to the effects of ionizing radiation (radioactive iodine, which, when ingested under conditions of iodine deficiency, takes part in the synthesis of thyroid hormones), thyroid cancer can develop against a background of hormonal imbalance. In addition, there are hereditary syndromes in which the risk of developing certain types of thyroid cancer is very high. Based on the histological structure, thyroid cancer is divided into the following types: Thyroid cancer is papillary, follicular, poorly differentiated, undifferentiated (anaplastic), squamous, mucoepidermoid, mucous, medullary. Also in the thyroid gland there are benign and malignant tumors that do not develop from thyroid cells: teratoma, lymphoma, thymoma, angiosarcoma, tumors from muscles and membranes of peripheral nerves, paragangliomas, as well as metastases of other tumors. The prognosis and treatment methods for these neoplasms can vary significantly. Usually, the patient complains of an enlarged neck, swallowing problems. The doctor examines and palpates the area of the thyroid gland and regional lymph nodes, and if a tumor is suspected, a set of studies is performed. To assess the condition of the thyroid gland and lymph nodes of the neck, the size of the tumor, ultrasound is used. Under the control of ultrasound, a puncture biopsy of the tumor is performed, which makes it possible to make a preliminary diagnosis and determine the tactics of treatment. Also, if you suspect a metastatic lesion of the lymph nodes, their puncture or biopsy can be performed. Radiography or computed tomography of the neck, mediastinum and thoracic cavity, possibly magnetic resonance imaging, is mandatory. Radioisotope study with Thyroid cancer with iodine -131 or technetium -99m can reliably determine distant metastases of thyroid cancer. If there is a suspicion that thyroid cancer involves nearby organs, then esophagoscopy (examination of the esophagus), laryngoscopy (examination of the larynx), bronchoscopy (examination of the trachea and bronchi) are performed. Treatment of thyroid cancer – surgical (the scope of the operation depends on the prevalence of the tumor, its morphological variant and the patient’s age) in combination with courses of radioiodine therapy and hormone suppressive therapy with levothyroxine (large doses of thyroid hormones reduce the stimulating effect of the pituitary gland on the thyroid tissue, which prevents relapses) … In most cases, this approach to treatment leads to a complete cure of patients.