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Hypothyroidism… When The Secretions Are Low Hypothyroidism is a common condition of which the body produces insufficient quantities of the thyroid hormone. This condition occurs when the thyroid cells become under active and secrets too little T3 and T 4 hormones. This hormone’s main function is to regulate the body metabolism. People with hypothyroidism have a slow metabolism and most of the problems they experience are as a result of this. Hypothyroidism is more common in women. What Are The Symptoms Of Low Thyroid? Initial Symptoms A symptom of hypothyroidism begins gradually and vague that women cannot realize that they are affected by hypothyroidism. Initial symptoms are observed as tiredness and heaviness of the body. They may feel early morning puffiness of face and gradual gain in weight. They are unable to bear the cold weather and often switch off the air conditioners. Hypothyroid patients initially have difficulty in thinking, loss of memory and emotionally depressed without reasons. Constipation is an additional complaint observed in many patients. Women show menstrual changes like irregularity, heavy periods, or loss of periods. The low level metabolic activity in the cellular level would give muscular cramps in many patients. Later Symptoms Additionally, physical changes like puffiness of face increase and affect around the eyes gives medically the “Myxedema”. The impaired metabolic activity makes the skin dry and flaky. They become more lethargic in activities, which irritate their family members. Voice may become deeper with hoarseness. Elderly women often complaints mimic the classic menopausal symptoms such as weight gain, lethargy, and painful joints, confusion and depression. The signs and symptoms of thyroid deficiency can be dismissed in men and women as inevitable aspects of aging. Some Common Features of Hypothyroidism - Weight gain - Puffy face and hands - Extreme tiredness - Irregular periods - Hair loss – Female pattern Baldness - Dry skin - Sluggish, depression and mood swings - Cold intolerance - Slow pulse Polycystic ovarian Disease and hypothyroidism often come as a package deal in some younger generations. Mostly they are pituitary origin, which is a secondary cause for hypothyroidism, makes them to suffer with unwanted hair growth over lips and chin Hair loss is a usual complaint in hypothyroid patients, when it accompanies PCOD, the female pattern baldness. The key complaint of menstrual irregularity would make these individuals less fertile because it could change the entire hormonal regulation. Arthritis, High blood pressure and Diabetes mellitus develop as a parallel disease gradually monitoring with the weight and make them to say, “I take too little food, but I gain lot of weight”. Additional strain to the heart and blood vessels are also exerted by weight gain; make vessels atherosclerotic and heart with ventricular enlargement. The risk factors for heart attack and stroke are observed in hypothyroid individuals as the Bad cholesterol developers “LDL” Hypothyroidism patients has low heart and pulse rate. What causes hypothyroidism? Heredity Heredity plays an important influential role. If relatives have an autoimmune disease this significantly increases the odds of a person developing hypothyroidism. But anyone can suffer. Age is also an influential factor. The elderly are more susceptible. Auto Immune reaction It is the most common cause of hypothyroidism. The immune system is a complex network that normally defends the body against "invading" organisms and other foreign substances. When the immune system detects a foreign substance in the body, it responds to this by producing antibodies against the invaders. These antibodies will recognize and attack this foreign substance when they next encounter. Some times the immune system mistakenly directs an immune "attack" against its own healthy cells. Antibodies are manufactured and misdirected against the thyroid gland. This reaction is medically termed as Hashimoto's Thyroiditis. Indurations Sometimes the thyroid gland gets indurated with sequel to other diseases like respiratory infections. But it is mild and only temporary hypothyroidism. When swelling in the neck with pain is noticed with other disease mostly “Sub acute thyroiditis” would be the diagnosis This disorder is very common after pregnancy, particularly in the months after a baby is born, because the postpartum thyroiditis can begin around the time. Swellings The medical term “Goiter” usually with Iodine deficiency, but the Auto immune thyroiditis, sub acute thyroiditis and postpartum thyroiditis may cause diffuse swelling. Sometimes a nodule in the thyroid gland could develop and affect the function of thyroid in some occasions. They usually appear irregular in shape. Drugs Some drugs given for nonthyroid conditions have the side effect of inhibiting production of thyroid hormone within the thyroid gland. If these drugs are taken in large dosages or for a long time, hypothyroidism may result. Radiation also found as a cause for disturbance in the thyroid functioning. Malfunctioning Pituitary malfunctions which act as a secondary culprit and in some individuals hypothyroidism can also develop due to a problem in other parts of the thyroid hormone production line, the brain or pituitary gland. These cases of hypothyroidism, which do not originate in the thyroid gland, almost all of these cases are due to failure of the pituitary gland to produce or release the hormone TSH, which is responsible for stimulating the production of thyroid hormone in the thyroid gland. How To Find? Diagnosis of hypothyroidism is based on a person's medical history, physical examination, and blood tests. The signs and symptoms will be a clue to the doctor to evaluate very easily. A swelling with rubbery consistency would give a clue on Auto immune thyroiditis and painful during examination could be sun acute thyroiditis. However thyroid scan studies would give clear picture to differentiate the nodules. A blood test for the thyroid hormones would make the correct diagnosis. Abnormally low levels of T4 and T3 indicate hypothyroidism is present. The TSH (thyroid-stimulating hormone) level is especially important in determining whether the condition is due to a problem in the thyroid gland or in the part of the brain that stimulates thyroid function. If the TSH level in the blood is high, the abnormality is within the thyroid gland. A high TSH level suggests that the thyroid gland is not responding properly to the stimulating effect of the TSH on the thyroid gland. If the TSH level in the blood is low, the abnormality is within the brain or pituitary gland in the brain. It suggests that the pituitary is not releasing adequate amounts of TSH to stimulate the thyroid gland, despite levels of thyroid hormone low enough that it should do so. Other blood tests include an antibody test, which is a blood test to detect antithyroid antibodies. High levels of these antibodies suggest that a person may have Hashimoto's thyroiditis. How To Treat? 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.