Hypothyroidism is a clinical syndrome caused by insufficient production of thyroid hormones thyroxine and triiodothyronine. Characterized by neuropsychiatric disorders, metabolic disorders, swelling of the face, limbs, body, as well as slowing heart rate - bradycardia. A pronounced form of hypothyroidism is called myxedema, or mucous edema, since one of its main symptoms is the common mucous edema of the skin and subcutaneous tissue. The occurrence of hypothyroidism is often associated with a pathological process in the thyroid gland itself (primary hypothyroidism) and less often with dysregulation of the biosynthesis of thyroid hormones in infectious, tumor, traumatic lesions of the pituitary and hypothalamus (secondary hypothyroidism). The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis , followed by atrophy of the thyroid gland. Hypothyroidism can also develop as a result of surgery on the thyroid gland, treatment with iodine radionuclide or iodine-containing drugs. In addition, hypothyroidism may be due to an overdose of antithyroid drugs in the treatment of diffuse toxic goiter, environmental iodine deficiency or congenital disorders of the thyroid hormone biosynthesis.
Clinical picture. General weakness, chilliness, lethargy, sluggishness, drowsiness, decreased intelligence, memory and hearing, and performance are noted. The appearance of the patients is characteristic: puffy, pale face with swelling around the eyes, dry, cold, thick, flaky skin. Observed hair loss, brittle nails, weight gain. The so-called hypothyroid heart develops: shortness of breath , nagging pain in the heart area without typical irradiation, expansion of the borders of the heart, deafness of tones, usually bradycardia , hypotension, but arterial hypertension is noted in 10-15% of patients. In severe hypothyroidism, anemia, polyserositis and pericarditis develop, and fluid accumulates in the abdominal and pleural cavities. Severe, untreated hypothyroidism may be complicated by hypothyroid coma, characterized by progressive weakness, drowsiness, adynamia, bradycardia, seizures, hypothermia (body temperature below 35 ° C). In hypothyroid coma, the skin is pale, with an icteric tint, rough, dry, cold, puffy face, swollen eyelids, blood pressure is reduced, breathing is rare, superficial; oliguria is noted, reflexes are absent. Hypercooling, infections, injuries, sedatives and hypnotics are provoking the development of coma.
The diagnosis of hypothyroidism is based on the characteristic clinical symptoms, a decrease in the content of thyroid hormones in the blood, an increase in the concentration of thyroid stimulating hormone and cholesterol in primary hypothyroidism and a decrease in their level in the secondary. In old age, the diagnosis of hypothyroidism is difficult, since many of its symptoms are mistaken for manifestations of natural aging.
Treatment consists of replacement therapy with thyroid drugs, which begins with small doses of thyroid hormones; the longer the hypothyroidism and the older the patient, the gradual the increase in the dose of hormonal drugs should be. Treatment of patients usually continues throughout life: thyroxine is used, as well as thyroidin, triiodothyronine, thyrocomb, thyrotome. Treatment, especially in the first months, is carried out under strict medical supervision and ECG control.
In hypothyroid coma, L-thyroxin is the drug of choice due to its minimal negative effect on the myocardium: 250 μg is administered intravenously every 6 hours during the day. Then go on maintenance therapy - 50-100 mg per day. According to another method, up to 100 μg of triiodothyronine is administered to the patient through the gastric tube every 12 hours until the body temperature is normalized, then 20–50 μg every 12 hours until the condition improves. Intravenously, 500-1000 ml of a 5% glucose solution and up to 300 mg of hydrocortisone are administered (glucocorticoid therapy is necessary to prevent adrenal insufficiency in the treatment of thyroid gland). The patient should be in the ward with an air temperature of 20-22 ° C, enhanced warming of the patient's body (heaters, etc.) is absolutely contraindicated. Oxygen therapy is used.
Prevention of acquired hypothyroidism is to improve the techniques of surgical interventions on the thyroid gland, the correct selection of doses of antithyroid drugs in the treatment of diffuse toxic goiter, targeted and timely treatment of thyroiditis, as well as the use of rational doses when using elemental iodine or its compounds as drugs.