Hypothyroidism (myxedema)

Hypothyroidism (myxedema) - a disease caused by insufficient supply of organs and tissues with thyroid hormones.

Etiology. In primary hypothyroidism - direct damage to the thyroid gland: congenital anomalies, inflammatory - with chronic infections, autoimmune nature, thyroid damage after administration of radioactive iodine, thyroid surgery, lack of iodine in the environment; In the secondary - infectious, tumor or traumatic lesions of the hypothalamic-pituitary system. Overdose of Mercazolilum may lead to a functional form of primary hypothyroidism.

The peripheral form of the disease is caused either by impaired peripheral metabolism of thyroid hormones, or by a decrease in the sensitivity of organs and tissues to thyroid hormones.

Pathogenesis. Decreased secretion of thyroid hormones, leading to a slowdown in all metabolic processes.

Symptoms. Primary hypothyroidism is observed more often in women. Chilliness, drowsiness, lethargy, memory loss, slowing of speech, movements, fatigue, decreased efficiency, arthralgia, swelling of the face and extremities, which have a peculiar character (do not remain with a finger in the area of ​​the anterior surface of the tibia) are characteristic. Skin covers dry, pale, with a yellowish tinge. The tongue is thickened, at the edges - the pressure from the teeth. Hoarseness of voice. Fragility and hair loss on the head, lateral third of the eyebrows, pubis. Decreased body temperature, constipation. Bradycardia, deafness of heart sounds, rarely normal heart rate, rarely tachycardia. Propensity to hypotension, in 10-20% of patients-arterial hypertension, which, as a rule, decreases or disappears against the background of therapy with thyroid medications. ECG changes: low voltage of the teeth, changes in the end part of the ventricular complex.

Primary hypothyroidism of autoimmune genesis can be combined with primary insufficiency of other peripheral endocrine glands: adrenal glands (Schmidt's syndrome), parathyroid, pancreatic. Hypochromic iron deficiency anemia often develops. In some patients, a combination of primary hypothyroidism, lactorrhea and amenorrhea can be observed.

Secondary hypothyroidism is usually combined with a decrease or loss of several or all of the functions of the pituitary gland (panhypopituitarism).

The severity of symptoms and the speed of the development of the disease depend on the degree of thyroid insufficiency and the individual characteristics of the patient. Characteristic decrease in the absorption of iodine by the thyroid gland, levels of protein-bound iodine, thyroxine, triiodothyronine.

With primary hypothyroidism - increase, secondary - a decrease in the level of thyroid-stimulating hormone in the blood; Hypercholesterolemia, high level of lipoproteins. A great diagnostic value, especially with the latent forms of primary hypothyroidism, is a trial with tiroliberin - the reaction of the thyroid-stimulating hormone to tiropiberyrin is much higher than normal. With secondary hypothyroidism of the pituitary genesis, thyroid-stimulating hormone response to tyroliberin is not observed. When primary hypothyroidism is often increased basal and stimulated by thyroliberin levels of prolactin.

Reflexometry reveals an increase in the duration of the Achilles reflex.

Treatment. Substitution therapy with drugs of the thyroid gland or synthetic thyroid hormones (thyroidin, triiodothyronine, thyroxine, thyrotomus, thyrotome-forte, thyreocomb). When tachycardia or arterial hypertension with p-blockers (anaprilin, trazikor). When combined hypothyroidism and hypokorticism - replacement therapy with corticosteroids, preceded or appointed simultaneously with thyroid. Vitamins A, C, B1 with diuretic indications (triampur, veroshpiron), coronary dilatations.