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Different Types Of Hypothyroidism And Its Symptoms Thyroid gland problems are among the most common problems faced today. I frequently hear people asking “Why are thyroid conditions on the rise?” The question is unanswerable most of the times even by the thyroid specialists. However, it is estimated that some million people are suffering from thyroid problem every year across the world and the reason to the question is unknown. Among these, the major part of the people have hypothyroidism – a condition which is characterized by the low thyroid hormone production. What is Hypothyroidism? Hypothyroidism usually referred to as a condition where body’s thyroid gland doesn’t produce enough of thyroid hormone as per the body’s need/requirement. This hormone is essential in order to regulate the body’s metabolic behavior and also has many profound effects on many physiological processes. There are many health disorders that result in hypothyroidism and the thyroid gland is directly or indirectly involved in this. This is because thyroid gland is responsible for producing thyroid hormone. Thyroid hormone deficit also has a great impact on growth and development of the body and other cellular processes that has a widespread of consequences on the human health. Thyroid gland, one of the largest endocrine glands, found in lower part of the neck is the master gland of metabolism. The thyroid gland uses iodine as the main compound to produce thyroid hormone which is available mainly from the diet you usually follow. Seafood, bread and salt are some of the rich sources of iodine. Less commonly hypothyroidism is also caused with excess amounts or sometimes with too little iodine in the diet. The principal hormones are the triiodothyronine and thyroxin and the hormonal output is regulated by TSH (thyroid stimulating hormone). Different Types of Hypothyroidism As hypothyroidism is because of a variety of causes, there are 4 different types of hypothyroidism. They are usually referred as follows: Hashimoto’s Thyroiditis: Hashimoto’s thyroiditis, also referred to as autoimmune thyroid disorder or chronic lymphocytic thyroiditis, which is one of the most common type of hypothyroidism. This is usually caused by the chronic inflammation of the thyroid gland. Our immune system is known to protect our body from foreign invaders, like bacterial and viral disease causing infections. But in the case of such autoimmune diseases this is quite different. Here the immune system attacks the body’s own cells and organs where thyroid gland being the vital part in this, is now affected. It now interferes with the natural ability of thyroid gland in producing thyroid hormones which affects the entire human body. Thyroiditis: In general terms, inflammation of thyroid gland is referred to as thyroiditis. There are several types of thyroiditis: - Subacute Granulomatous Thyroiditis: Subacute granulomatous thyroiditis or subacute thyroiditis is a viral and bacterial infection, which results in the painful inflammation and enlargement of thyroid gland leading to this condition. Experts don’t actually know what exactly causes this condition and it is usually fades away within few months. - Subacute Lymphocytic Thyroiditis: Subacute lymphocytic thyroiditis or silent thyroiditis features a small goiter without causing any pain or tenderness. It falls under the category of autoimmune disease and the chances are that it may develop into permanent hypothyroidism and may occur in any age. - Drug Induced Hypothyroidism: Drug induced hypothyroidism may be caused in people infected with predisposed reactions caused by treatment with iodides and lithium. Drugs used for treating hyperthyroidism such as radioactive iodine, potassium iodide, propylthiouracil, and methimazole may cause this type of hypothyroidism. The severe form of hypothyroidism is called myxedema coma, which is seldom, a drug related emergency. Postpartum Hypothyroidism: Postpartum hypothyroidism, a form of thyroiditis occurs in women after pregnancy. This usually causes thyrotoxicosis – a condition where there is too much thyroid in blood and later hypothyroidism – a condition where too little hormone is found in blood and is usually referred as an autoimmune disease. As many new mothers are generally fatigued this disease in them often misdiagnosed. Infants born to these mothers must be taken extra care as it may affect even their health and development. Congenital Hypothyroidism: Congenital hypothyroidism is a condition found in infants where the thyroid is neither fully developed nor does function properly. If untreated for several months it may lead to permanent mental retardation and growth failure. Early treatments for such complications can be prevented with the screening of newborns for hypothyroidism. Though both men and women are likely to suffer from these types of hypothyroidism, the risk factors are high in woman between the age of 20- 50. Once occurred hypothyroidism can be cured and people need to undertake thyroid hormone replacement for the rest of their lives. This medication is only able to relieve you from symptoms and other affects caused by hypothyroidism but not completely from this disorder. About the Author Christine As a women who has hypothyroidism, I would like to share all of my knowledge to all of you about hypothyroidism and how can you make change of your life.
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Autor: dr. Nenad Bićanić Štitnjača je žlijezda koja izgleda poput leptira smještenog sprijeda, u donjoj polovici vrata, ispod grkljana, a ispred dušnika. Građena je od dva režnja koji su međusobno spojeni središnjim suženim dijelom. Svoje hormone tiroksin (T4) i trijodtironin (T3) izlučuje u krv. Radom štitnjače u fiziološkim okolnostima upravljaju hipotalamus i hipofiza. U nadzoru rada štitnjače najvažnija je hipofiza, koja pomoću tireotropina (TSH) potiče štitnjaču na stvaranje hormona, ali i na rast, što može dovesti do povećanja štitnjače, odnosno gušavosti (strume). Štitnjača voli jod Hormoni štitnjače utječu na funkciju svih organa. Bez njih nema normalnoga razvoja ni rada središnjeg živčanog sustava. Važni su za održavanje tjelesne temperature i normalne aktivnosti centra za disanje, kontrolu potrošnje energije i potrošnje kisika. Na srce djeluju tako da dovode do povećanja kontraktilnosti srčanoga mišića i ubrzanja rada srca, a pojačavaju i pokretljivost crijeva, utječu na pregradnju kosti, homeostazu šećera i masnoća u krvi. Za stvaranje hormona štitnjače nužan je jod. Nedostatak joda u organizmu dovodi do uvećanja štitnjače (gušavosti/strume). U hranu bogatu jodom ubrajamo morsku ribu, alge, jaja, jogurt, sir i dr. Hrani koja smanjuje apsorpciju joda iz crijeva pripadaju cvjetača, kelj, prokulice, repa, kikiriki i dr. Uz anamnezu i klinički pregled, u dijagnostici bolesti štitnjače koriste se: TSH, slobodni tiroksin (fT4), slobodni trijodtironin (fT3), autoantitijela protiv tiroidne peroksidaze (anti-TPO), odnosno protiv tireoglobulina (anti-TG), antitijela na TSH-receptor, ultrazvuk štitnjače, uz eventualnu citološku punkciju i scintigrafiju štitnjače. Cilj je liječenja postizanje eutireoze, odnosno normalizacija vrijednosti TSH i hormona štitnjače u krvi; kod hipertireoze to se postiže lijekovima koji blokiraju rad štitnjače, operativnim odstranjenjem žlijezde ili primjenom radioaktivnoga joda, a kod hipotireoze nadomjesnim liječenjem (sintetski hormon levotiroksin). Sve se usporava Hipotireoza je stanje smanjenog stvaranja, izlučivanja i djelovanja hormona štitnjače. Može se javiti u bilo kojoj životnoj dobi, a posebno je česta u starijih osoba – javlja se u 10% žena i 6% muškaraca starijih od 65 godina. Najčešći uzrok hipotireoze je kronična autoimuna upala štitnjače (Hashimotov tireoiditis), koja nastaje zbog poremećaja imunološkog sustava, uz genetsku predispoziciju. Može nastati nakon liječenja hipertireoze lijekovima koji koče stvaranje hormona štitnjače ili radioaktivnim jodom, ili nakon operacije štitnjače. Uzrok hipotireoze može biti i manjak joda, poremećaj u stvaranju i izlučivanju hormona štitnjače, bolest hipofize, odnosno hipotalamusa te smanjen periferni odgovor na hormone štitnjače. S obzirom na to da hormoni štitnjače utječu na sve stanice u tijelu, prisutni su simptomi i znakovi različitih organa i organskih sustava: koža je suha, nokti zadebljali i lomljivi, kosa je tanka i prorjeđuje se. S napredovanjem bolesti lice postaje podbuhlo, javlja se otok kapaka, zadebljanje jezika, glas postaje dubok, govor usporen. Javljaju se kroničan umor i iscrpljenost, poremećaji živčanoga sustava, poremećaji pamćenja i raspoloženja, depresija te mišićna slabost, bolovi u mišićima i zglobovima, kao i zatvor. Dolazi do umjerenog povećanje tjelesne mase, uglavnom zbog zadržavanja tekućine. Kod žena dolazi do poremećaja menstrualnog ciklusa, neplodnosti, spontanih pobačaja i prijevremenih poroda, a javljaju se i smetnje libida u oba spola. Simptomi se obično razvijaju postupno. U primarnoj hipotireozi (bolest same štitnjače) vrijednost TSH je povišena, dok je kod sekundarne ili tercijarne hipotireoze (bolest hipofize ili hipotalamusa) vrijednost TSH obično snižena ili normalna, uz snižene koncentracije tiroksina (T4) u krvi. U svim hrvatskim rodilištima radi se probir novorođenčadi na kongenitalnu hipotireozu, kako bi se, u slučaju da ona postoji, što ranije započelo liječenje i tako spriječio razvoj teške mentalne retardacije i zastoja u rastu i razvoju djeteta. Liječenje hipotireoze nadomjesno je – nadoknada hormona koji nedostaje. Cilj je postići nestanak simptoma i normalizaciju laboratorijskih pokazatelja. Kod nas postoji sintetski hormon - levotiroksin, koji se uzima u obliku tablete, natašte, 30-45 minuta prije jela ili drugih lijekova. Doza se individualno prilagođava. Prognoza bolesti odlična jeako se nadomjesna terapija uzima redovito, u dozi koju propiše liječnik. Liječenje hipotireoze levotiroksinom najčešće je doživotno. Mršavljenje uz pojačan apetit Hipertireoza je stanje pojačanog stvaranja hormona štitnjače, koje dovodi do povišene razine hormona štitnjače u krvi, a tireotoksikoza je širi pojam, koji označava stanje izloženosti organizma povišenim razinama hormona štitnjače koja, osim pojačanog rada štitnjače, obuhvaća i druga stanja koja su praćena povišenom razinom hormona štitnjače u krvi (npr. subakutni tireoiditis, prekomjerna doza nadomjesne terapije levotiroksinom). Hipertireoza se može javiti u bilo kojoj životnoj dobi, a posebno je česta u žena između 20. i 50.godine života. Najčešći uzrok hipertireoze je autoimuna bolest štitnjače (Basedowljeva ili Gravesova bolest, rijetko Hashimotov tireoiditis), a ostali sučešći uzroci bolesti TSH receptora: toksična multinodozna struma i toksični adenom. Do suviška hormona štitnjače dovode i subakutna upala štitnjače, tihi tireoiditis, postpartalni tireoiditis te (rijetko) lijek amiodaron. Bolesnici se žale na nervozu, razdražljivost, umor, lupanje srca, ispadanje kose. Unatoč pojačanom apetitu, oni mršave. Mokrenje i stolica su učestali. Mogu se javiti poremećaji menstrualnog ciklusa i smanjen libido. Česte su promjene na očima: ukočen pogled, vlažne i sjajne oči, ispupčene očne jabučice. Srčani ritam je ubrzan, a ponekad se javlja i nepravilan ritam (osobito u starijih osoba). Laboratorijski dokaz hipertireoze je nalaz povišene vrijednosti hormona štitnjače, uz suprimiran (jako snižen) TSH. Hipertireoza se u početku liječi lijekovima (tireostaticima i beta-blokatorima), a kasnije, ako je potrebno, operacijom ili radioaktivnim jodom. Izvor: Narodni zdravstveni list, dvomjesečnik za unapređenje zdravstvene kulture, god. LVIII, br. 672-673, Nastavni zavod za javno zdravstvo PGŽ u suradnji s HZJZ, Rijeka, siječanj-veljača 2016, str.