Hyperfunction thyroid gland(hyperthyroidism) - increased activity of the thyroid gland associated with excessive production of hormones. There are three types of hyperthyroidism. Primary hyperfunction of the thyroid gland is associated with disorders of the gland itself, for example, an increase in size, autoimmune reactions, inflammation of the thyroid gland.

The cause of secondary hyperthyroidism is a dysfunction of the pituitary gland, as a regulator of hormonal balance, sending incorrect signals to organs that synthesize hormones. And tertiary hyperfunction of the thyroid gland is associated with pathology of the functioning of the hypothalamus.

Sometimes subclinical hyperthyroidism of the thyroid gland, if this does not apply to hyperthyroidism in pregnant women, can be treated with folk remedies or use drugs prescribed by a specialist in appropriate dosages.

The peculiarity of simultaneous subclinical hyperthyroidism and pregnancy is that treatment is carried out only in inpatient conditions with regular monitoring of the concentration levels of the relevant hormones.

Conservative treatment of hyperfunction of the thyroid gland is usually aimed at suppressing the increased synthesis of hormones. This is achieved through the use of drugs that counteract the accumulation of iodine in the body, which interferes with the secretion of thyroid hormones. For these purposes wide application drugs based on methimazole and propylthiouracil are found. Diagnosis of the thyroid gland comes down to determining its size and the presence of nodules of a different density.

With hyperthyroidism, the symptoms are due to the fact that all processes in the body are significantly accelerated due to the excessive synthesis of various hormones.

The acceleration of all processes primarily affects the functioning of the cardiovascular system - arrhythmia, rapid heartbeat, which often results in high blood pressure, which causes additional concern in case of hyperthyroidism in pregnant women.

Another feature of the disease is fever, constant feeling of heat, profuse sweating even in a cool room. This is often observed with hyperthyroidism in pregnant women. Another feature of hyperthyroidism in pregnant women is slight trembling of the limbs and fingers.

Despite the accelerated processes in the body, the patient often becomes drowsy, phlegmatic, and lethargic. Despite high physical activity in hyperthyroidism, symptoms are accompanied by increased fatigue and weakness.

Increased appetite is another symptom of hyperthyroidism, but not everything is so simple, since the patient’s bowel movements are disrupted, they become frequent, and stomach upsets appear. Subclinical hyperthyroidism in children is always accompanied by diarrhea.

In this regard, a feature of the treatment of the disease is a specially adjusted diet that reduces the discomfort of such manifestations (dysfunction of the gastrointestinal tract). Hyperthyroidism in such cases should be treated comprehensively, using anti-diarrhea drugs and folk remedies.

Subclinical hyperthyroidism in children and with hyperthyroidism in pregnant women, cases of visual impairment and general eye problems are common. This is often expressed in a painful attitude to bright light; with hyperthyroidism, pregnant women experience profuse lacrimation, accompanied by swelling of the eyelids.

Patients experience abnormal widening of the eye openings and a “bulging” of the eyeball, which looks as if the patient is extremely surprised or in a state of horror or experiencing severe pain. In severe cases, such overstrain of the optic nerve can lead to partial or complete loss of vision.

Increased activity in the synthesis of hormones by the thyroid gland causes serious disturbances in the activity of the central nervous system. Patients experience a number of mental disorders of varying severity - emotional imbalance, extreme irritability, resentment, and quarrelsomeness.

Sometimes patients experience unreasonable feeling fear, anxiety, which leads to insomnia. Often elevated mental activity and confusion of thought processes lead to incoherent or excessively accelerated speech.

Subclinical hyperthyroidism has symptoms such as fragility, thinning and loss of hair, impaired nail growth, and the skin becomes moist and thin.

Disturbances in salt and protein balance cause the patient to constantly feel thirsty and, due to abundant fluid consumption, the patient experiences a frequent urge to urinate. This symptom may be mistakenly diagnosed as one of the kidney or urinary tract diseases.

Diagnosis of dysfunction of the synthesis of hormones by the thyroid gland reveals various signs of disorder of the reproductive and reproductive systems in men and women. Pathological disturbances in the reproduction of sex hormones can affect deviations in the sexual development of adolescents; this can be either premature or delayed sexual development.

Deviations in the synthesis of sex hormones in women can cause menstrual irregularities, and in severe cases, lead to infertility. In men, an imbalance of androgens and testosterones is characterized by erectile dysfunction and a significant decrease in potency.

Subclinical hyperthyroidism during pregnancy can often be “masked” and not show the above symptoms. The usual signs of the disease may be absent, and hyperthyroidism is diagnosed based on a study of the hormonal background of the patient.

Reasons

The most common cause of hyperthyroidism is a disease called toxic goiter. This is a common autoimmune disease that affects women more often than men. Toxic goiter is the cause of 75% of cases of diseases associated with hormonal imbalance, including such as hyperfunction of the thyroid gland.

Subclinical hyperthyroidism, which is treated in this case by repairing damage to the thyroid gland, can cause other disorders, such as inflammation of the gland (thyroiditis).

The form of hyperthyroidism caused by thyroiditis is characterized by inflammatory foci of thyroid tissue, which are easily detected by ultrasound. But there is another more important and unpleasant factor in this course of the disease - a violation of the structure of the thyroid tissue, progressing, can cause, following the hyperfunction of hormone synthesis, a decrease in hormone production.

Fortunately, such a subclinical case is rare and more common is the normal restoration of gland activity after surgical or conservative treatment, after which the use of anti-inflammatory drugs and numerous folk remedies will be prescribed for some time.

Plummer's disease is also a common cause of hyperthyroidism, the symptoms of which are manifested in the excessive synthesis of hormones by the pancreas. In this case, the activity of the gland is associated with regulatory disorders of the pituitary gland, which controls the balance of hormones in the body.

Such pathologies of the pituitary gland can be caused by a number of reasons, ranging from mild traumatic brain injuries to damage as a result of surgical intervention. Plummer's disease should be treated only by resorting to complex therapy with constant monitoring of hormonal levels.

Tumor diseases of the pituitary cortex are secondary causes of hyperthyroidism and are much less common. Diagnosis of hyperthyroidism in such cases is significantly difficult, especially since there is no visible damage to the thyroid gland itself.

Pituitary tumors cause a decreased receptor ability of the brain to function as a regulator of hormone concentrations, which can cause both decreased and increased activity of thyroid hormone synthesis by the thyroid gland. In such cases, medications and attempts to treat conservatively rarely bring the expected effect, so surgical removal of the tumor is most often used.

Diet for illness

In the treatment of hyperthyroidism, diet plays an important role. Patients almost always have increased appetite, despite the fact that patients often lose weight due to disruption of the gastrointestinal tract.

The patient's increased hormonal activity, the acceleration of all biochemical and biological reactions in the body, will certainly make itself felt by frequent feelings of hunger. Such a hormonal “fire” requires high-quality nutrition in the form of high-calorie foods, this is not surprising and does not contradict the recommendations of nutritionists.

Patients with hyperthyroidism are advised to stop smoking and drinking alcohol, at least for the duration of treatment. The diet is designed taking into account the need for increased protein, carbohydrates and vitamins in the diet. We should also not forget that among the symptoms of the disease, diarrhea and other gastrointestinal disorders are most often observed, so the selection of food products should help normalize stool.

The saturation of nutrition with mineral salts and vitamins is important. Foods that cause stimulation of the nervous system and cardiovascular system should be excluded. During the period of illness, these systems are already wearing out in emergency mode. Such prohibited products include tea, coffee, chocolate. For the same reason, you should not abuse spicy foods and foods richly flavored with herbs and spices.

Thyroid gland refers to the endocrine glands as well as the hypothalamus, pituitary gland, parathyroid (parathyroid) glands, adrenal glands, islet part of the pancreas, gonads - ovaries in women and testes in men.

The thyroid gland is a small organ located in the neck in front and on the sides of the trachea, just below the thyroid cartilage, and consists of two lobes connected by an isthmus. Normally, the thyroid gland is almost not palpable.

The thyroid gland consists of connective tissue penetrated by nerves, blood and lymphatic vessels; in the thickness of the connective tissue there are tiny vesicles - follicles. On inner surface Their walls contain follicular cells - thyrocytes, which synthesize thyroid hormones.

Thyroid hormones are necessary for protein synthesis and growth hormone secretion; they promote the utilization of glucose by cells, stimulate the heart, respiratory center, enhance fat metabolism, etc.

The activity of the thyroid gland is regulated as follows. When the body, for one reason or another, needs to increase metabolism, a signal about this is sent to the hypothalamus. The hypothalamus synthesizes the so-called thyroid-stimulating releasing factor, which, entering the pituitary gland, stimulates the production of thyroid-stimulating hormone (TSH). Thyroid-stimulating hormone activates the activity of the thyroid gland and increases the synthesis of its “personal” (thyroid) hormones - thyroxine, or tetraiodothyronine (T 4) and triiodothyronine (T 3). Most of the thyroid hormones - T 4 and T 3 - are in the blood in a bound inactive state, in complex with certain proteins. Only when “released” from these proteins do hormones become active.

All these complex mechanisms are necessary to ensure that the blood constantly contains as many active thyroid hormones as the body requires at the moment.

The thyroid gland also produces the hormone calcitonin. Its main effect is to reduce elevated blood calcium levels.

Classification of thyroid diseases

- congenital anomalies (absence of the thyroid gland or its underdevelopment; incorrect location; non-closure of the glossothyroid duct);

- endemic goiter (associated with a lack of surrounding nature iodine);

- sporadic goiter (a goiter that occurs in a small number of people living in areas where iodine is sufficient);

- Graves' disease (in other words, diffuse toxic goiter or thyrotoxicosis), associated with increased thyroid function;

—hypothyroidism (decreased thyroid function);

- inflammatory diseases - thyroiditis;

- tumors and damage to the thyroid gland. Damage may be open (when the integrity of skin) and closed (when it is not broken; such damage may not be noticeable in appearance).

How do you know if the thyroid gland is enlarged?

Normally, we do not see or feel this organ.

At the first degree of enlargement, the thyroid gland is clearly palpable, but invisible to the eye.

With the second degree of enlargement, the iron can be easily palpated and visible to the eye when swallowing.

With the third degree of enlargement, the thyroid gland can be seen even by a person far from medicine; it looks like a “thick neck”, but may not bother the patient much.

With the fourth degree of enlargement of the thyroid gland, the goiter sharply changes the shape of the neck.

At the fifth degree, the goiter reaches large, sometimes gigantic sizes. The appearance of such a patient attracts attention; a person may suffer from shortness of breath, a feeling of heaviness, tightness in the chest, a sensation of a foreign body; A goiter can disrupt the functioning of blood vessels, nerves and internal organs.

In Russia, doctors used the above classification for a long time. However highest value have exact dimensions glands identified by ultrasound. External inspection is of much less importance, since errors are possible. It is sometimes difficult for a doctor to determine the thyroid gland in young people with well-developed muscles. At the same time, in thin people it can be clearly visible. In addition, the ability to determine the size of the thyroid gland in each individual patient depends on the structure of the neck, the thickness of the muscles and the fat layer, and the location of the thyroid gland in the neck also plays a role.

Emphasizing the approximate value of determining the size of the thyroid gland during examination, in 1992 World organization Healthcare has proposed a simpler classification of goiter:

0 degree - the thyroid gland is palpable (that is, determined by the fingers during examination), the size of the lobes corresponds in size to the last (ungual) phalanges of the patient’s fingers.

I degree—the size of the lobes exceeds the size of the last phalanges of the patient’s fingers.

Grade II—the thyroid gland is palpable and visible.

Ultrasound is not the very first examination method that a doctor prescribes for every patient. But, if a patient has an enlarged organ, the doctor usually prescribes an ultrasound of the thyroid gland. The volume of the thyroid gland in this case is calculated as follows: it is calculated by measuring the three main sizes of each lobe of the thyroid gland. First, calculate the volume of each lobe separately using the formula:

lobe volume = length x width x thickness x 0.479.

Before this, the dimensions of each lobe of the thyroid gland are measured (length, width and thickness); the dimensions of the isthmus are not given diagnostic importance. After this calculation, the volumes of the lobes are added to each other and the volume of the entire thyroid gland is obtained.

It is believed that in women the volume of the thyroid gland should not exceed 18 ml, and in men - 25 ml. Anything more than this is an enlarged thyroid gland, or goiter. In children, the size of the gland is determined using special tables.

With varying degrees of enlargement of the thyroid gland, its functions may not be changed (this condition is called euthyroid goiter, or euthyroidism), decreased (this is called hypothyroidism) or increased (in this case, the functional state of the thyroid gland is characterized as hyperthyroidism). The level of function of the gland depends on the level of its hormones: the more hormones are released into the blood, the higher the function.

Research methods

1. Medical examination. The doctor not only examines the patient, but also clarifies the nature of his complaints, finds out when they first appeared, intensified or decreased over time. After examination and conversation with the patient, the doctor makes a presumptive diagnosis and prescribes necessary tests or sends the patient to the hospital for examination.

2. General blood test.

3. General urine test - both of these studies belong to the so-called “mandatory diagnostic minimum”, which the doctor usually prescribes to all patients.

4. Determination of basal metabolism. Basal metabolic rate is the level of energy that the body needs to maintain vital functions at complete rest after a 12-hour fast. The method is based on determining oxygen consumption and carbon dioxide emissions over a certain period of time. Then the body's energy expenditure is calculated in kilocalories per day. The study is carried out using special instruments—the so-called “metabolimeters.” In this case, the indicators of special tables are taken into account, which are compiled based on a specific gender, age, weight and body length of a person. The local therapist, of course, will not carry out all these calculations. As a rule, the basal metabolism is determined by an endocrinologist, often when the patient is hospitalized in a specialized department.

5. Determination of biochemical blood parameters (liver enzymes, bilirubin, blood protein, urea, creatinine, etc.). Allows you to identify changes in organs and tissues that often occur in various diseases of the thyroid gland.

6. Determination of blood cholesterol. With increased thyroid function, cholesterol levels are lowered, and with low thyroid function, cholesterol levels are increased. However, the method is not 100% effective, since many elderly patients experience an increase in cholesterol levels in the blood associated with atherosclerosis, and not with thyroid disease. The method is more informative in children.

7. Determining the duration of the Achilles reflex can serve as an additional method for assessing thyroid function. The method is quite simple, harmless, and affordable.

8. Ultrasound examination of the thyroid gland allows you to determine its size, degree of enlargement, the presence or absence of nodes in it, etc.

9. X-ray examination also allows you to determine the size and degree of enlargement of the thyroid gland. In children, in addition to a chest x-ray, an x-ray examination of the hands is often also performed, which makes it possible to determine the so-called “bone age”: in some diseases of the thyroid gland, it may lag behind the passport age or be ahead of it. Bone age reflects physical development, the rate of which may vary in children due to various diseases.

10. Computed tomography and magnetic resonance imaging of the thyroid gland. With its help, you can determine the position of the thyroid gland, its contours, size, structure, and determine the density of the nodes.

11. Determination of iodine bound to serum proteins. Characterizes the functional activity of the thyroid gland.

12. Radioimmunological methods for determining thyroid hormones. The content of thyroxine and triiodothyronine is determined, and sometimes more detailed analyzes are performed. The determination of thyroid-stimulating hormone in blood serum is considered highly informative. Currently, a method such as the determination of antithyroid antibodies is also used (more about them is written in the section “Diffuse toxic goiter”).

13. The study of radioactive iodine absorption by the thyroid gland is not widely used. In children, this method is used only according to strict indications (that is, if necessary)!

14. A puncture biopsy of the thyroid gland consists of a puncture of the thyroid gland, then its structure is studied under a microscope.

15. X-ray lymphography of the thyroid gland is an X-ray examination associated with the introduction of contrast agents into the thyroid gland. An oily iodine-containing drug, lipiodol, is usually administered.

16. Additional research methods: electrocardiography, electroencephalography, etc. It is worth remembering that not all methods must be used in every patient, but only one, universal method There is no test that would allow us to determine a particular thyroid disease with 100% accuracy. The doctor chooses those research methods that are most suitable for this particular patient, taking into account the capabilities of the medical institution.

Diagnostics

Blood tests

The main and most sensitive method for diagnosing thyroid diseases is to determine the level of thyroid-stimulating hormone (TSH), hormones T 4 and T 3 in the blood.

Thyroid-stimulating hormone (TSH)

Thyroid-stimulating hormone of the pituitary gland controls the activity of the thyroid gland. If its concentration is increased, this indicates a decrease in thyroid function. That is, the thyroid-stimulating hormone is, as it were, “with all its might” trying to spur its activity. Conversely, when the function of the thyroid gland increases, thyroid-stimulating hormone “can rest”, and accordingly its concentration in the blood is reduced.

If the function of the thyroid gland is impaired, the content of its own hormones in the blood is also measured.

Thyroxine (T 4), total serum T 4

Normal: 50-113 ng/ml; 5-12 µg% (4-11 µg%); 65-156 nmol/l (51-142 nmol/l) - depending on the method.

Thyroxine T 4 is a form of thyroid hormone; it is formed in the thyroid gland, but does not have much effect on metabolism. A more active form of the hormone is triiodothyronine (T 3). T 4 is converted to T 3 in the liver.

Both T 4 and T 3 circulate in the blood mainly in a bound state, and in this form the hormones are not active. Therefore, the total level of thyroxine says little about the hormonal activity of the thyroid gland. The level of thyroxine changes with changes in the content of carrier proteins, and their concentration, in turn, changes under many conditions: pregnancy, taking medications, and many diseases.

The hormonal activity of the thyroid gland is determined by the concentration of free T3 and T4.

An increase in the concentration of total thyroxine in the blood serum is nevertheless observed with increased function of the thyroid gland (hyperthyroidism), sometimes with acute thyroiditis or acromegaly.

A decrease in this indicator occurs with primary and secondary hypothyroidism (decreased thyroid function), as well as with a decrease in the concentration of thyroxine binding protein (carrier protein).

Free serum thyroxine

Normal: 0.8-2.4 ng% (0.01-0.03 nmol/l).

The activity of the thyroid hormone T4 depends on the concentration of free T4.

A decrease in this indicator occurs with hypothyroidism (low thyroid function).

Triiodothyronine (T 3)

Normal: 0.8-2.0 ng/ml.

T 3, like T 4, is associated with proteins in the blood, so changes in the content of serum proteins affect the level of total triiodothyronine in the same way as the level of thyroxine.

Serum thyroxine binding globulin (TBG)

Normal: 2-4.8 mg%.

TSH is the main carrier protein for the thyroid hormones T 3 and T 4 in the blood plasma. When the concentration of the carrier protein changes, the concentration of T4 changes accordingly. Due to this, regulation and maintenance of this level occurs free hormones, which is required for the normal functioning of the body at the moment.

The concentration of TSH increases during pregnancy and viral hepatitis; Sometimes an increased concentration of TSH is due to heredity. In addition, the level of TSH is increased if a woman takes contraceptive hormonal drugs or any estrogen drugs in general.

Narcotic drugs and some medications (eg, clofibrate, methadone) also increase the level of TSH in the blood.

A decrease in TSH concentration is observed in the following diseases and conditions:

• nephrotic syndrome;
• cirrhosis;
• active phase of acromegaly (increased pituitary function);
• Cushing's syndrome (increased adrenal function);
• lack of estrogen;
• congenital TSH deficiency;
• any conditions associated with a decrease in protein content (for example, prolonged fasting).

Medicines that reduce the level of TSH in the blood are aspirin and furosemide, anabolic steroids, and other steroid drugs in large doses.

Antibodies to thyroglobulin

Antibodies are substances that the immune system produces to fight antigens. Strictly defined antibodies act against a certain antigen, so their presence in the blood allows us to draw a conclusion about what kind of “enemy” the body is fighting. Sometimes antibodies formed in the body during illness remain forever. In other cases—for example, with autoimmune diseases—antibodies against certain of the body's own antigens are detected in the blood, on the basis of which an accurate diagnosis can be made.

If it is necessary to confirm the autoimmune nature of the thyroid disease, then the level of antibodies in the blood to its cells is used - antithyroid antibodies, or antibodies to thyroglobulin.

Instrumental ultrasound examinations of the thyroid gland

There is probably no such area modern medicine, in which ultrasound examination would not be used. The ultrasound method is harmless and has no contraindications. Based on the results of an ultrasound, it is possible to determine the size and shape of many organs, altered areas and fluid in the pleural or abdominal cavity, and the presence of stones in the kidneys and gall bladder.

When most thyroid diseases are suspected, ultrasound can mainly determine whether a thyroid nodule is (or is not) a cyst. As a rule, other, more complex diagnostic methods are also required.

Uptake of radioactive iodine by the thyroid gland

This study is based on the ability of the thyroid gland to take up iodine I 131 . With normal thyroid function, iodine absorption is 6-18% after 2 hours, 8-24% after 4 hours and 14-40% after 24 hours. With reduced thyroid function, the absorption of radioactive iodine is reduced. You need to know that the same results can occur if the patient took medications containing iodine or bromine or simply lubricated the skin with iodine. The study is carried out one and a half to two months after discontinuation of such drugs.

Thyroid scintigraphy

Scintigraphy is a scan of the thyroid gland using radioactive iodine or technetium.

When a technetium thyroid scintigraphy is performed, a liquid containing radioactive technetium, a substance that, like iodine, accumulates in the thyroid gland, is injected into a vein in the arm. Thanks to this, instruments are used to determine the size and functional activity of the thyroid gland. Functionally inactive nodes - they are called “cold” - are recorded on the scanogram as rare streaks. The accumulation of I 131 in them is reduced. In the area of ​​functionally active - “hot” - nodes, the accumulation of I 131 is enhanced, and on the scanogram they are recorded as densely shaded areas. The radiation dose during this examination is small.

Thermography of the thyroid gland

Thermography is the recording of infrared radiation, which makes it possible to suspect the malignancy of a node more confidently than scintigraphy: cancer cells have a more active metabolism and, accordingly, a higher temperature than benign nodes.

Biopsy

Fine-needle aspiration biopsy of the thyroid gland - taking cells from the “suspicious” part of the gland for subsequent histological and cytological analysis - is used when the presence of a neoplasm is suspected and allows you to determine whether it is benign or malignant.

The doctor inserts a very thin needle into the thyroid gland and, by pulling back the plunger of the syringe, takes a sample of gland tissue - either from a single node, or from the largest node (in case of a multinodular goiter), or from the densest part of the gland. This tissue sample is then examined in the laboratory.

The only possible complication is a slight hemorrhage in the thyroid gland, which goes away quite quickly. Serious bleeding may only occur in people with reduced clotting blood, so if you belong to this category, you need to warn your doctor about this.

Symptoms of thyroid diseases

Symptoms of any disease are caused by changes in the function of the affected organ and (or) changes in the organ itself.

Disturbances in the normal functioning of the thyroid gland can manifest themselves in two forms: hypothyroidism - a decrease in its function and, accordingly, the level of thyroid hormones in the blood, and hyperthyroidism (thyrotoxicosis) - an increase in the level of thyroid hormones.

Sometimes diseases of the thyroid gland occur without noticeable changes in the level of its hormones.

Changes in the thyroid gland itself are usually expressed in the formation of a goiter - an enlargement of the gland. Goiter can be diffuse (with uniform enlargement of the gland) or nodular - with the formation of separate compactions in it.

A goiter can be associated with hypothyroidism or hyperthyroidism, but often the thyroid gland becomes enlarged in order to produce required quantity hormones, in other words, so that the function of the gland remains normal.

It must be emphasized that hypothyroidism and hyperthyroidism are not diseases, but functional states thyroid gland (more precisely, the whole body) at a given moment in time.

Pseudothyroid dysfunction

This is the name for a specific condition when test results indicate that the function of the thyroid gland is impaired, but in fact it works completely normally. Most often this happens in people who are seriously ill, exhausted, or who have undergone major surgery. In this condition, the inactive (bound) form of T3 accumulates in excess in the body.

There is no need to treat the thyroid gland with pseudodysfunction. After curing the underlying disease laboratory parameters return to normal.

Looking for a woman

Any diseases of the thyroid gland occur in women many times more often than in men. The thyroid gland in women is highly heavy loads during pregnancy. Naturally, the fetus can obtain iodine for the production of thyroid hormones only “through” the mother’s body. And for this expectant mother should receive virtually twice as much iodine as before pregnancy.

However, among non-pregnant women and even those who have never given birth, there are also many who suffer from thyroid diseases.

Women are several times more likely than men to suffer from so-called autoimmune diseases. At least two thyroid diseases are autoimmune in nature: Hashimoto's thyroiditis (manifesting hypothyroidism) and diffuse toxic goiter, or Graves' disease (manifesting hyperthyroidism).

The essence of an autoimmune reaction is that the immune system “attacks” the body’s own tissues.

Hypothyroidism

Hypothyroidism is a condition caused by a long-term, persistent lack of thyroid hormones.

Hypothyroidism can be primary, secondary and tertiary. Primary hypothyroidism is associated with pathology of the thyroid gland itself, secondary - with pathology of the pituitary gland, tertiary - with pathology of the hypothalamus.

The most common causes of primary hypothyroidism are Hashimoto's thyroiditis, partial or complete removal of the thyroid gland, treatment with radioactive iodine, and iodine deficiency in the diet. A rarer cause is congenital defects in the development of the thyroid gland.

Secondary hypothyroidism is rare. It is caused by a lack of TSH (thyroid-stimulating hormone) production due to insufficiency of the anterior pituitary gland.

Tertiary hypothyroidism is even less common.

Symptoms

With hypothyroidism, regardless of its cause and whether it is primary, secondary or tertiary, all metabolic processes in the body slow down and its overall energy decreases. Symptoms develop gradually:

• General lethargy and lethargy, drowsiness.
• Swelling of the face, especially the eyelids; the eyes seem to be half-closed.
• Hoarseness, slow speech.
• Weight gain.
• Poor tolerance to cold.
• Hair becomes dry and thin.
• The skin is dry, often peels, and thickens.
• Tingling and pain in the hands.
• Changes in the menstrual cycle in women.
• Slightly slow pulse.

Thyroid diseases, even if not completely cured, are at least well controlled. If you do not take care of the thyroid gland, it will have a bad effect on the condition of the heart.

Hypothyroid coma

This is one of the most dangerous complications of hypothyroidism, which can be triggered by cold, infection, injury, taking certain tranquilizers and sedatives. At the same time, breathing slows down, convulsions occur, and insufficient blood supply to the brain occurs. Hypothyroid coma is a life-threatening condition that requires immediate hospitalization!

Already during a general examination of patients with hypothyroidism, anemia, increased cholesterol in the blood, and an increase in ESR are often detected.

There is a decrease in the level of total and free T4 in the serum and an increase in the level of TSH. An increase in TSH levels with a normal T4 level is characteristic of hidden “subclinical” hypothyroidism.

For secondary hypothyroidism TSH level may be reduced.

Uptake of I 131 by the thyroid gland is reduced (less than 10%), but if the cause of hypothyroidism is autoimmune thyroiditis or iodine deficiency, then iodine uptake may, on the contrary, be increased.

Severe hypothyroidism affects 2-5% of the population of our country, and in another 20-40% hypothyroidism manifests itself with a few mild symptoms. In women, this condition is observed 5-7 (and according to some data - 10) times more often than in men; Older people suffer from hypothyroidism more often than younger people. But despite its high prevalence, hypothyroidism often remains undetected. This is due to the fact that many of its symptoms (lethargy, drowsiness, slowness, brittle hair, swelling of the face, chilliness, etc.) are not characteristic and can be mistaken for manifestations of other diseases. Sometimes the diagnosis can be made only from laboratory data.

Iodine deficiency

Iodine deficiency is the most common and perhaps the simplest cause of decreased thyroid function. Iodine is required for the synthesis of thyroid hormones, and the body can only obtain it from the environment - with food and water. This means that there should be enough iodine in the water and soil of the area where the food we consume grows and “runs”.

Endemic goiter of the I-II degree (“endemic” means “common in a certain area”) affects 20-40% of Russians, III-IV degrees - 3-4%. In St. Petersburg, the average intake of iodine from water and food is 40 mcg, while the norm is 150-200 mcg.

Euthyroid goiter

Uniform, without nodular formations, enlargement of the thyroid gland (diffuse non-toxic goiter) is the most common manifestation of insufficient iodine intake in the body.

In moderate stages of the disease, the hormonal system, through compensatory mechanisms, copes with iodine deficiency: the pituitary gland begins to intensively synthesize TSH, thereby stimulating the function of the thyroid gland. The concentration of thyroid hormones in the blood remains at a more or less normal level, which is why this form of goiter is sometimes called “euthyroid” (“correct hormonal”).

Euthyroid goiter often develops at the beginning of puberty, during pregnancy and postmenopause.

Not only a lack of iodine in the diet can cause such a goiter, but also factors such as, for example, the consumption of goitrogenic foods, in particular turnips.

In addition, quite a few drugs can inhibit the synthesis of thyroid hormones and, as a result, lead to the development of goiter: aminosalicylic acid, sulfonylureas (antidiabetic drugs), lithium drugs, and iodine in large doses.

Another common manifestation of iodine deficiency in adults is nodular goiter. Under conditions of iodine deficiency, some thyroid cells may become partially or completely independent of the regulatory influence of the pituitary thyroid-stimulating hormone (TSH) and grow into one or more nodules. Autonomous nodules in the thyroid gland most often occur in people over the age of 50-55 years.

Is iodine food for the mind?

The health consequences of iodine deficiency are not limited to the development of goiter. The lack of thyroid hormones in the tissues - the main stimulants of all metabolic processes - affects the entire body, especially those organs and tissues that need accelerated metabolism, and primarily the brain. This is especially important in childhood. Iodine deficiency during fetal development and in the first years of a child’s life can lead to severe forms of dementia (cretinism). In adults, a consequence of iodine deficiency in environment there may be a moderate decrease in intellectual potential.

How much iodine do we need

Adults and adolescents - 100-200 mcg (micrograms) per day;

Infants and children under 12 years of age - 50-100 mcg;

Pregnant women and breastfeeding mothers - 200 mcg;

For people who have undergone surgery for goiter - 100-200 mcg per day.

Intermediate level iodine consumption in the USA is 500 mcg, in Japan - up to 1000 mcg.

Where is goiter most common?

Goiter is common among residents of the highlands, in parts of Central Asia, Egypt, Brazil, Congo, and India. In these areas, nature (water, air and soil) lacks iodine. As a result, the body receives less iodine than needed, and the thyroid gland enlarges. Initially, enlargement of the gland is beneficial for the body, as it improves its function. However, over time, thyroid function may become impaired. Nodular forms of goiter are dangerous when the gland tissue takes the form of nodes: this can degenerate into a tumor.

Goiter practically does not occur in coastal areas and in areas with chernozem soil: in such places there is enough natural iodine for the body.

The iodine content in the atmosphere is of great importance. Most likely, this is why people in coastal areas do not suffer from this disease: when seawater evaporates, iodine enters the air, then enters the soil, lakes, streams and rivers. The altitude of the area above sea level and its character also matter. In high mountain areas, the iodine content is reduced not only in the soil, but also in the air. You can correct the current state of affairs with the help of nutrition. Unfavorable social and living conditions play a role, as well as a hereditary predisposition to the formation of goiter.

There is no iodine deficiency in the USA, Canada, Australia, and Scandinavian countries.

Iodine deficiency is a serious problem in Congo, Bangladesh, Bolivia, Afghanistan, and Tajikistan.

Despite the fact that Russia is not yet on this list, the problem of iodine deficiency is very relevant for our country! The fact is that the majority of those who live in an iodine-deficient region do not have significant complaints about their health, so they often remain unattended. And a lack of iodine may not necessarily be severe.

Areas with mild iodine deficiency include Moscow, St. Petersburg, Lipetsk, Krasnodar, Sakhalin; as well as the USA and Japan.

Areas with severe iodine deficiency include the Republic of Tuva (more than 30% of the population suffers from goiter), the Arkhangelsk region (more than half of the people suffer from goiter), and the Republic of Sakha (Yakutia)—up to 39% of the population suffers from goiter here. There is little iodine in Africa, Madagascar, and most Asian countries.

Areas with moderate iodine deficiency include the Moscow, Nizhny Novgorod, Yaroslavl regions, as well as many other cities and regions of Russia; Portugal, Spain, Italy, South America, Iberian Peninsula.

Why is iodine starvation dangerous?

In the worst case, a person will face cretinism - a sharp lag in mental development, up to the complete inability to care for oneself and navigate the environment. But there are few complete cretins among patients - no more than 10%. Up to a third of patients complain of brain disorders. And the remaining 60-70% is just a decrease in mental and physical performance.

How does it manifest itself? In adults - fatigue, weakness, especially at the end of the week and working day; drowsiness, lethargy; There may be a decrease in mood, potency, and libido. The person becomes passive and has little interest in anything.

Adolescents may not only have mood and behavior disorders, but also poor academic performance. Children sit over books for a long time, but still do not learn the material. Many of them get sick often. Girls' periods are delayed and come later; boys lag behind their peers in growth and physical development.

Development is also disrupted in children. And for them this is especially important: the developing body does not receive enough iodine, which means it cannot absorb the information necessary for development. Such children later begin to speak, walk, and run; are less inclined to play outdoor games and are more likely to get sick when entering nurseries and kindergartens.

But this all happens if the woman was able to bear and give birth to a child. After all, pregnant women with iodine deficiency often experience miscarriages and stillbirths; children are more often born with defects and deformities. Many women have been treated for infertility for years, not knowing that the cause is iodine deficiency.

Severe forms of iodine deficiency associated with hypothyroidism (cretinism) are easy to identify even for people who are far from medicine. It is most dangerous if severe iodine deficiency accompanies the child from early childhood. Such children are inactive, their skin is swollen, they have a dull expression on their face, their tongue is large and does not fit in their mouth, their breathing is noisy and heavy. Hair is dry and brittle, teeth grow incorrectly. Appetite is reduced, body proportions are disturbed. There is a severe lag in mental development. With a sharp lack of iodine in the environment, signs of the disease may appear in initially healthy children: over time, the child becomes less active, begins to lag in growth, and his mental development is inhibited.

Severe iodine deficiency in the region is evidenced by an increase in the number of sick men in relation to the number of women (since goiter is a more “female” disease, a ratio of 1:3 is considered unfavorable), an increase in morbidity (up to 60% of the population in such regions may suffer from goiter) , an increase in the most dangerous - nodular forms of goiter.

According to ITAR-TASS in 2001, the number of children with intellectual disabilities in Russia has increased by 20% over the previous 5 years. Psychological disorders are detected in 15% of all children. It cannot be said unequivocally that these sad statistics are associated with iodine deficiency in the environment. But this factor cannot be neglected. It has been proven that with a lack of iodine, the level of intelligence of both adults and schoolchildren decreases. This means that it will be more difficult for young people to study at school, college, and university, and it will be more difficult for them to learn new professions and skills.

Based on their shape, they distinguish between diffuse, nodular and mixed goiter. The thyroid gland is enlarged in all cases. But in the first case, it is affected evenly, in the second, nodes form in its tissue, and in the third case, both are combined.

How to treat

In ancient times, goiter was treated with seafood, seaweed And sea ​​salt. Now such measures are taken mainly for prevention. Although, in any case, with endemic goiter, patients require a certain diet. Sea foods contain large amounts of iodine. Iodine is also contained in: feijoa (feijoa has especially a lot of iodine), barberry (roots, berries, leaves), cranberries, onions, leeks, asparagus, beets, cod liver, lettuce, melon, mushrooms, green peas, radish, radish, strawberries, tomatoes, turnips, walnut, garlic, egg yolk, bananas, spinach, rhubarb, potatoes, peas, apple seeds, dark berries (aronia, black currants, blackberries, blueberries). These products cannot completely compensate for iodine deficiency, but in regions not rich in iodine, they must be consumed. However, most of these products also contain vitamins and minerals, so they are healthy in any case.

For normal functioning of the thyroid gland in the body, in addition to iodine, the presence of other elements is desirable: zinc, molybdenum, vanadium, zirconium. A lot of molybdenum is found in cabbage, carrots, oat grains, radishes, rowan berries, and garlic. There is a lot of zinc in wheat bran, wheat germ, barberry, valerian, ginseng, nettle, raspberry, carrot, parsley, radish, black currant, sorrel, gooseberry, legumes, and animal liver. Vanadium and zirconium can be obtained from foods such as cucumbers, melons, and watermelons. Widely known soothing herbs mint and lemon balm also contain vanadium and zirconium. It is believed that these herbs are useful to put in tea - both to enrich it with vitamins and to improve the taste.

In the treatment of goiter, iodine and thyroidin preparations are used. Thyroid hormone medications are usually prescribed for diffuse forms of goiter (in which there are no nodes in the thyroid gland), accompanied by a decrease in thyroid function. Endemic goiter can only be treated with the assistance of a doctor. Self-medication is under no circumstances allowed!

Traditional methods of treating goiter

It’s worth mentioning right away: these methods do not replace iodine-containing drugs and treatment with a doctor. They can only be used as an addition to treatment. It is believed that traditional medicine improves the patient’s condition - if, of course, he uses them not instead, but together with the remedies recommended by the endocrinologist.

Lemons and oranges can be helpful for enlarged thyroid glands. Citrus fruits are used as follows: one lemon and one orange (without seeds) are minced in a meat grinder with the peel, then a spoonful of honey is added to this mixture, all this is infused for 24 hours and taken with boiling water, 1 teaspoon 3 times a day.

For goiter, herbs such as marsh iris, tenacious bedstraw, common grass, and knotty cinnamon are used. Marsh iris is used in the form of a tincture: the herb infused with 70% alcohol is taken 2 tablespoons 3 times a day. Tenacious bedstraw is used as an infusion: 2 tablespoons of raw material are poured into 2 cups of boiling water and infused. The infusion is used half a glass 3 times a day. An infusion of European sage grass is also used: 30 g of herb is poured into a glass of boiling water and infused; apply 2 tablespoons 3 times a day. Cinnamon nodosum can be used for goiter as follows: 1 teaspoon of roots is infused in 1 glass of boiling water until cooled. Then the infusion is drunk gradually throughout the day, on day 1 - 1 glass.

It is believed that the functioning of the thyroid gland is stabilized by such a well-known plant as hawthorn. An infusion of dried hawthorn fruits (at the rate of 1 dessert spoon per glass of boiling water) is taken half a glass 2 times a day.

Prevention

A special commission under the WHO recommended adding 2 parts of potassium iodide per 100,000 parts of table salt to salt to prevent iodine deficiency. Mass iodine prophylaxis, organized centrally in goiter-prone regions, can reduce the incidence of goiter among both adults and children. However, even after prevention, the danger of goiter in these regions does not disappear: natural and climatic data remain the same, which means that there will still be a lack of iodine in the environment. Therefore, some time after the cessation of iodine prophylaxis, the number of goiter patients will increase again. The task of local and central authorities and health authorities is to carry out preventive measures again and again and not leave the region unattended.

You can find out whether your area is iodine deficient from your local physician. If your region is iodine deficient, then you need to artificially make up for what nature lacks. There are three ways: take iodine preparations, natural products rich in iodine, and also what our industry produces—iodized bread and iodized salt. In nature, seafood contains a lot of iodine: mussels, shrimp, crabs; the most inexpensive and accessible to the general consumer is seaweed (seafood is not common in our cuisine, so at the end of our book we provide recipes for dishes made from these products). But you need to eat seafood regularly, day after day, and not occasionally, otherwise you won’t be able to cover the deficit. Not everyone can afford it.

It is much easier to purchase special iodine preparations sold at pharmacies and take them in courses. You just need to buy a MEDICINE, and not a dietary supplement: it is difficult to trace the true content of all components, and an overdose of iodine is just as dangerous as its deficiency. It is believed that children and pregnant women living in iodine-deficient regions should receive such medications MANDATORY: no matter how hard you try, their daily requirement cannot be met with food.

For whom are iodine preparations dangerous?

- for older people with signs of goiter.

— for patients with nodular forms of goiter.

—for unexamined people making complaints. Such people should NOT take iodine supplements without consulting a doctor.

Iodized bread is rarely found in our stores. But here is iodized salt - as much as you like, please. But almost no one uses it: according to doctors, only from 2.7 to 20.4% of families regularly eat iodized salt. Meanwhile, in disadvantaged regions everyone should do this! Iodized salt is not dangerous, and overdose is completely excluded. The fact is that the thyroid gland contains a special blocker that comes into effect if too much iodine enters the body. In general, doctors believe safe dose up to 300 mcg of iodine per day.

Most people, unfortunately, think differently. The salary is small, the pension is small, a pack of regular salt costs two rubles less than iodized salt. At first glance, it seems that cheaper means more profitable. Meanwhile, each of us eats only one pack of salt per year. Maximum - two. It turns out - four rubles a year for your own health. Is it cheap or expensive? It's up to us...

During pregnancy, a woman's need for iodine increases sharply. For the development of the child’s nervous system, thyroid hormones are necessary, which the baby receives while in the womb. Therefore, the load on a woman’s thyroid gland increases during pregnancy. If enough iodine enters the body, then the woman will not have any consequences. If little iodine enters the body, then a pregnant woman may develop goiter. In this case, the amount of iodine that enters a woman’s body not only during pregnancy, but also before, is important. In other words, if a woman constantly did not receive enough iodine before pregnancy, the consequences of this may appear later. In this case, a goiter can form not only in the woman herself, but also in the child.

Thus, according to the Belgian researcher D. Glinoer, in a region with moderate iodine deficiency, the volume of the thyroid gland in women by the end of pregnancy increased by 30%, while in 20% of all pregnant women the volume of the thyroid gland was 23-35 ml (instead of 18 ml, which should be normal). Even after childbirth, the size of the thyroid gland in many women did not return to what it was before.

Similar data were presented by another foreign researcher, P. Smith. According to his data, with iodine deficiency, the volume of the thyroid gland in pregnant women increased by almost half, while under normal conditions it increased by only 20%. Researchers note that a slight enlargement of the thyroid gland towards the end of pregnancy occurs in almost all women. This is considered a variant of the norm.

In addition, the researchers found that women who received iodine prophylaxis during pregnancy had children with a smaller thyroid gland than those women who did not receive iodine prophylaxis. On average, the volume of the thyroid gland in such infants was almost a third larger. An enlarged thyroid gland is detected on average in every tenth newborn if his mother did not receive iodine during pregnancy—this means families living in iodine-deficient regions.

Replenishing iodine deficiency

The most sensitive to iodine deficiency are infants, adolescents during puberty, pregnant women, and nursing mothers. In general, women are more susceptible to iodine deficiency diseases than men.

In addition, a sufficient intake of iodine, like any other nutrients, into the body is only one side of the coin; the other side is the degree of absorption from the intestines. In addition, the individual characteristics of the body also matter.

The absorption of iodine by the body depends on the presence or absence of other substances in food products. Some plant foods contain substances that interfere with the supply of iodine to the thyroid gland or inhibit the activity of an enzyme necessary for the synthesis of thyroid hormones. To such plant products include cabbage, radish, rutabaga, sunflower, dill, and beans.

All of the above must be taken into account, but if little iodine enters the body, then it will have to be added artificially.

ATTENTION! Just don’t take alcohol tincture of iodine or Lugol’s solution orally! These medications are intended for external use; they contain iodine in huge quantities, and its overdose is just as dangerous as its deficiency.

The main way to treat and prevent disorders caused by iodine deficiency is to include iodine-rich foods in the diet. And the cheapest way to prevent and treat iodine deficiency is to consume iodized salt. Iodine is also included in many modern multivitamin preparations with micronutrient supplements.

Foods rich in iodine

Most iodine is found in seafood, including fish. However, different types of fish vary greatly in this regard. In most fish species, the iodine content ranges from 5 mcg to 50 mcg per 100 g.

In shrimp - 110 mcg, in pinniped meat - 130 mcg. Squids, mussels and other shellfish are rich in iodine. And, of course, the highest iodine content in seaweed is kelp.

Sea kale is sold in canned, frozen, and dried form. The dried product must first be cleaned of mechanical impurities, then soaked for 10-12 hours in cold water(for 1 kg of cabbage 7 - 8 liters of water), then rinse thoroughly. Frozen cabbage is thawed in cold water, then also washed.

Cook seaweed like this: pour cold water, quickly bring to a boil and keep on low heat for 15 - 20 minutes. After this, the broth is drained, the cabbage is poured warm water(45 - 50 °C) and after boiling, cook for another 15 - 20 minutes. The broth is drained, poured with warm water and boiled a third time, after which the broth is drained again. After boiling seaweed this way three times, its taste, smell and color are significantly improved.

It must be said that the above products (except, of course, mineral waters) may contain very different amounts of iodine depending on the area.

In grain, iodine is contained in the germinal part, therefore the varieties of bread made from low-grade flour, with bran, are richest in iodine.

At culinary processing The iodine content in food products decreases quite significantly.

Special iodized products

• Iodized products were developed by the Institute of Nutrition of the Russian Academy of Medical Sciences.
• Processed cheese iodized - 50 g contain 500 mcg of iodine.
• Iodized bread bars - 300 g contain 150-200 mcg of iodine.
• And of course, iodized salt, thanks to which in most developed countries iodine deficiency is no longer even considered the most common cause of hypothyroidism.
• Iodized salt contains about 40 micrograms of iodine per gram. The physiological need for iodine in an adult is 150 mcg per day, and a dose of up to 500 mcg per day is considered safe.

Nutrition for hypothyroidism

For hypothyroidism, a diet with a moderately reduced energy value is recommended - by 10-20% compared to the physiological norm. The diet should reduce the content of carbohydrates and, especially, fats. Protein content is within the physiological norm.

The calorie content of the diet is no more than 2100 kcal.

First of all, you should limit saturated fats and foods rich in cholesterol.

Product name
Oatmeal
Hercules
Corn
Lentils
Bakery and flour products
Rye bread
Hearth table bread
Wheat bread
Wheat bread made from 2nd grade flour
Sliced ​​loaf
Cream crackers
Premium pasta
Chicken broiler
Chicken egg
Egg powder
Tomato paste
Grape juice
Apple juice
Mineral waters
"Slavyanovskaya"
"Narzan"
"Essentuki" No. 4
"Mirgorodskaya"

Exclude: fatty meat and dairy products, hydrogenated fats, hard margarine.

It is necessary to consume in sufficient quantities foods that have laxative properties, in particular vegetables and fruits, berries, juices, and dairy products.

Physical activity also helps to cope with constipation.

Sample menu for hypothyroidism

2368 kcal First breakfast Meat balls - 110 g Buckwheat porridge - 280 g Tea - 180 ml Lunch Calcined cottage cheese - 100 g Dinner Vegetarian noodle soup – 400 g Beef stroganoff – 110 g Mashed potatoes – 200 g Sugar-free apple compote – 200 ml Afternoon snack Meatballs - 110 g Rosehip decoction - 180 ml Dinner White omelette – 110 g Tea – 180 ml For the night Kissel from grape juice xylitol - 200 ml All day White bread - 200 g Sugar - 30 g

Belip

With hypothyroidism, calcium metabolism is almost always also impaired, so people with insufficient thyroid function will find belip (a protein-lipid product) very useful. It is a combination of low-fat unleavened cottage cheese, cod and vegetable oil. Thus, belip contains deficient amino acids, polyunsaturated fatty acids, easily digestible calcium and many trace elements, including iodine.

To prepare unleavened cottage cheese, calcium lactate or calcium chloride is used. Calcium lactate is added to skim milk at the rate of 5-7 g per 1 liter of milk, or to skim milk heated to 25-30 ° C, add 2.5 ml (about 1/2 teaspoon) of a 40% solution calcium chloride. The cottage cheese is pressed to a moisture content of 65%.

Belip

Cod (fillet) - 58 g Low-fat cottage cheese - 50 g Wheat bread - 20 g Vegetable oil - 10 g Onion - 12 g Salt, pepper to taste Water - 15 ml

Peel the cod fillet, rinse with cold water, pat dry and squeeze lightly. Soak the bread in water; Chop the onion and fry in oil. Pass the fish through a meat grinder 2 times and mix with cottage cheese, bread, onions, then pass through the meat grinder again, add salt, pepper and stir well. Cutlets, meatballs, etc. are prepared from the resulting minced meat; you can use it as a pie filling.

Thyroid hormone preparations

Thyroid hormone preparations—thyroid hormones—are used primarily as replacement therapy for hypothyroidism. In addition, they are prescribed for suppressive therapy for diffuse non-toxic goiter and thyroid tumors, to prevent goiter relapse after partial removal of the thyroid gland.

IN clinical practice drugs levothyroxine, triiodothyronine, as well as combination drugs are used. The main drug (the so-called drug of choice) for maintenance therapy is levothyroxine.

In case of primary hypothyroidism and endemic goiter, during treatment with thyroid hormones it is necessary to monitor the level of TSH (thyroid-stimulating hormone); in secondary hypothyroidism - the level of free T4. TSH levels should be determined 2 months after selecting a maintenance dose, and then every 6 months.

In older people, small doses (25 mcg) are initially prescribed, which are then increased to the full maintenance dose over 6-12 weeks.

With extreme caution, thyroid hormones are prescribed to people with coronary heart disease, arterial hypertension, and impaired liver and kidney function. If a patient has cardiovascular diseases, it is necessary to monitor the state of the cardiovascular system (ECG, Echo-CG).

ATTENTION! Only an endocrinologist under close clinical supervision can select a maintenance dose, since a sick person may have angina attacks.

During pregnancy, the need for thyroid hormones increases by 30-45%, so the dose is increased. In the postpartum period, the dose is reduced.

Levothyroxine sodium, L-thyroxine 50 (or 100), Euthyrox

Available in tablets of 0.05 and 0.1 mg (50 and 100 mcg).

Indications. Hypothyroidism (as replacement therapy), diffuse non-toxic (euthyroid) goiter (for treatment and prevention), endemic goiter, autoimmune thyroiditis, thyroid cancer (after surgical treatment).

It is also used for diagnostic purposes - to assess the function of the thyroid gland.

Directions for use and doses. Take orally 1 time per day, in the morning, at least 30 minutes before breakfast; washed down with water. A dose of more than 150 mcg is recommended to be divided into 2 doses.

For hypothyroidism, start with a dose of 50 mcg (0.05 mg) per day, in some cases (elderly people with coronary artery disease) 25 mcg (0.025 mg) per day are prescribed. The usual maintenance dose is 75-150 mcg (0.75-0.15 mg) per day.

Every 2-3 weeks the condition is monitored, the level of TSH in the blood is determined and, if necessary, the dose is increased. The drug acts slowly, the effect is observed after 4-5 weeks from the start of treatment.

For nodes, 150-200 mcg (0.15-0.2 mg) per day is prescribed for 3 months, with incomplete effect - up to 6 months.

Maximum doses. In most cases, the effective dose for the treatment of hypothyroidism does not exceed 200 mcg (0.2 mg) per day.

Side effects. Adverse reactions are rare, mainly due to overdose and represent symptoms characteristic of hyperthyroidism:

• weight loss;
• palpitations, tachycardia, arrhythmias;
• angina pectoris;
• headache;
• increased irritability;
• insomnia;
• diarrhea;
• stomach ache;
• increased sweating;
• heat intolerance;
• hand trembling;
• increased levels of T 4 and T 3 in the blood.

If these symptoms appear, the dose must be reduced.

In case of acute, pronounced signs of overdose, symptomatic therapy is carried out: gastric lavage is performed, beta-blockers, glucocorticoids, etc. are prescribed.

Contraindications

• Untreated thyrotoxicosis.
• Prescribe with caution to patients with cardiovascular diseases (arterial hypertension, angina pectoris, myocardial infarction, etc.).
• Patients with diabetes mellitus, diabetes insipidus, and adrenal insufficiency who are taking levothyroxine must carefully select appropriate treatments, since levothyroxine may aggravate the course of these diseases.
• Pregnant women with hypothyroidism should continue treatment with levothyroxine; however, the use of the drug in combination with thyreostatic drugs during pregnancy is contraindicated. During lactation, levothyroxine is used with caution.

Interaction with other drugs

With the simultaneous use of levothyroxine and antidiabetic drugs, it may be necessary to increase the doses of the latter.

With the simultaneous use of levothyroxine and anticoagulants, it is sometimes necessary to reduce the dose of the latter.

When used simultaneously with estrogens (including estrogen-containing oral contraceptives), an increase in the dose of levothyroxine may be required.

Phenytoin, salicylates, clofibrate, furosemide (in high doses) may enhance the effect of levothyroxine.

Liothyronine, Triiodothyronine

Available in tablets of 0.05 mg (50 mcg).

Indications. Primary hypothyroidism and myxedema, cretinism; cerebral-pituitary diseases occurring with hypothyroidism; obesity with symptoms of hypothyroidism, endemic and sporadic goiter, thyroid cancer.

Directions for use and doses. Doses are set individually, taking into account the nature and course of the disease, the patient’s age and other factors.

Since triiodothyronine (T 3) is rapidly degraded in the body, it is prescribed in fractions - 3-4 times a day.

The starting dose for adults is 20 mcg (0.02 mg) per day. The dose is increased over 7-10 days to a full replacement dose of 60 mcg (0.06 mg) per day, in 2-3 doses.

Side effects. In case of overdose, symptoms of thyrotoxicosis are possible:

• tachycardia;
• heart pain;
• sweating;
• weight loss;
• diarrhea.

Contraindications

• Use with caution in secondary hypothyroidism with adrenal insufficiency - due to the possibility of developing Addisonian crisis (see Addison's disease).
• Particular caution is required when prescribing triiodothyronine to patients with coronary atherosclerosis, as attacks of angina are possible. Initial doses should be no higher than 5-10 mcg per day; a gradual increase is permissible only under the control of an electrocardiogram.

Combination drugs

Tyreocomb

1 tablet contains 0.01 mg of triiodothyronine, 0.07 mg of L-thyroxine and 0.15 mg of potassium iodide. Indications for use are the same as for triiodothyronine. Prescribed orally on average 1/22 tablets per day.

Thyrotome

1 tablet contains 0.04 mg of triiodothyronine and 0.01 mg of L-thyroxine. Due to the presence of T 3 (triiodothyronine), the effect occurs quickly; due to the presence of T, (L-thyroxine), the effect is longer than with treatment with triiodothyronine alone. The initial dose is 1 tablet per day, gradually increase the dose to 2-3 tablets per day. The daily dose for older people is 1 - 11/2 tablets.

Yodtirox

1 tablet contains 0.1 mg (100 mcg) levothyroxine sodium and 0.1308 mg (130.8 mcg) potassium iodide (100 mcg iodine).

Polyglandular deficiency syndromes

Polyglandular insufficiency syndrome is characterized by a decrease in the function of several endocrine glands and there is a deficiency of several hormones in the body.

The cause of polyglandular deficiency syndrome may be genetic predisposition to this state; often it is a consequence of an autoimmune reaction; sometimes the activity of the endocrine gland is suppressed as a result of infection; in other cases, the cause is impaired blood supply or a tumor.

Usually, one endocrine gland is affected first, followed by others. Symptoms naturally depend on which glands are affected. In accordance with this, and also taking into account the age of the patients, polyglandular insufficiency syndromes are divided into three types.

Polyglandular deficiency syndrome type I

Usually begins in childhood. This type of polyglandular insufficiency is characterized by decreased function of the parathyroid glands (hypoparathyroidism) and adrenal glands (Addison's disease), as well as fungal infections, in particular chronic candidiasis. Obviously, it occurs due to impaired immunity.

Quite common manifestations of this type of polyglandular deficiency syndrome are cholelithiasis, hepatitis, malabsorption (poor absorption in the intestine) and early baldness.

Quite rarely, there is a decrease in insulin secretion by the pancreas, which leads to the development of diabetes mellitus.

Polyglandular deficiency syndrome type II

It most often develops in people around 30 years of age. With this type of polyglandular insufficiency, the function of the adrenal glands is always reduced, and very often the function of the thyroid gland is impaired, often reduced, but occasionally, on the contrary, increased. More often than with type I polyglandular insufficiency, the function of pancreatic islet cells decreases and, as a result, diabetes mellitus develops.

Polyglandular deficiency syndrome type III

This type of polyglandular deficiency is sometimes considered a precursor to type II. It also develops in adults. It can be suspected in cases where the patient has at least two of the following symptoms:

• hypothyroidism (low thyroid function);
• diabetes mellitus;
• pernicious anemia;
• vitiligo (depigmented spots on the skin);
• baldness.

If, in addition to two of these symptoms, there is adrenal insufficiency, then a diagnosis of polyglandular insufficiency syndrome type II is made.

Treatment of polyglandular insufficiency syndromes is only symptomatic - replacement therapy with appropriate hormones: thyroid - for hypothyroidism, corticosteroids - for adrenal insufficiency, insulin - for diabetes.

Hyperthyroidism (thyrotoxicosis)

Hyperthyroidism, or thyrotoxicosis, is a condition in which the thyroid gland is overactive and produces too much thyroid hormone. Hyperthyroidism occurs 5-10 times more often in women than in men. At the age of 20 to 40 years, its cause is most often diffuse toxic goiter (Graves' disease, Graves' disease), and after 40 years - toxic multinodular goiter.

A less common cause of hyperthyroidism is toxic adenoma thyroid gland. In addition, subacute thyroiditis in the initial stage is usually accompanied by hyperthyroidism (the so-called “leak thyrotoxicosis”). A thyroid disease such as asymptomatic (or painless) thyroiditis also leads to hyperthyroidism. Finally, there may be artificial thyrotoxicosis - for example, with an overdose of thyroid hormones, and sometimes with their deliberate use.

Quite rarely, the causes of hyperthyroidism are diseases not of the thyroid gland, but of other organs, usually tumors:

• TSH-producing pituitary tumor;
• metastatic embryonal testicular cancer;
• choriocarcinoma (a specific neoplasm of the uterus originating from embryonic tissue);
• struma of the ovaries.

Metastatic follicular thyroid cancer is also a rare cause of hyperthyroidism.

Symptoms

In hyperthyroidism, an excess of hormones leads to an acceleration of all metabolic processes: oxygen consumption by tissues increases, which causes an increase in basal metabolism, the release of nitrogen (hyperazoturia), calcium, phosphorus, magnesium, water increases, the sugar content in the blood increases (hyperglycemia), which may pass into urine (glucosuria). Since everything in the endocrine system is interconnected, dysfunction of other endocrine glands occurs.

Regardless of the cause, the condition of hyperthyroidism is characterized by the same very specific symptoms:

• Palpitations, sometimes arrhythmia.
• Weight loss due to increased appetite.
• Nervousness and fatigue with increased physical activity.
• Sleep disorders.
• Feeling hot (even in cool weather) and poor heat tolerance.
• Profuse sweating, skin moisture.
• Minor hand tremors.
• Frequent bowel movements, sometimes diarrhea.
• Eye symptoms - swelling of the eyelids, watery eyes, eye irritation, increased sensitivity to light.
• Menstrual irregularities and other sexual dysfunctions.
• Decreased sex drive and ability to conceive. Men may experience slight enlargement of the mammary glands.

Usually only some of these symptoms are more or less pronounced. In older people, there may be no significant symptoms at all, a condition called latent hyperthyroidism. Its only manifestation may be atrial fibrillation.

Hyperthyroidism, if it continues for a long time and is poorly compensated, increases the risk of developing osteoporosis.

Diffuse toxic goiter (Graves' disease; Graves' disease)

This is the most common cause of thyrotoxicosis, although diffuse toxic goiter cannot be called a common disease. Nevertheless, it occurs quite often, with women getting sick almost 10 times more often than men. The disease can develop at any age, but most often between 30 and 50 years of age.

This is a multisystem disease characterized by an enlargement of the thyroid gland (diffuse goiter), increased function of the thyroid gland, which leads to thyrotoxicosis (hence the “toxic”), as well as a number of other typical symptoms (in particular, bulging eyes - exophthalmos).

The cause of the disease is unknown. There is a clear family predisposition. Very often the disease is preceded by mental trauma. The trigger mechanism can be pregnancy, childbirth, breastfeeding, menopause. Of no small importance are long-term neuroses such as vegetative-vascular dystonia, emotional outbursts, infections (especially sore throat, flu), traumatic brain injuries, and excessive prolonged overheating of the body.

Symptoms typical of hyperthyroidism:

• increased mental excitability, irritability, resentment, sleep disturbances;
• changes in behavior: fussiness, talkativeness, inconsistency, etc.;
• sweating, feeling hot, increased thirst; the skin is warmer to the touch, “velvety”; sometimes - darker skin pigmentation;
• palpitations and shortness of breath;
• muscle weakness - general or in individual muscle groups;
• pronounced weight loss with preserved or even increased appetite;
• protrusion of the eyeballs, rare blinking, “feeling of sand” in the eyes, “double vision”;
• dense swelling of the skin on the legs;
• hair loss above the temples;
• changes on the skin - depigmented spots (vitiligo) or, conversely, increased skin pigmentation.

“Nodular goiter” is a collective concept. This disease requires special attention from doctors. The fact is that nodular goiter can develop not only due to a lack of iodine in the environment. In addition, thyroid tumors, both benign and malignant, can be mistaken for nodular goiter. Therefore, nodular goiter in an unexamined patient is a preliminary, not a final diagnosis. But even in examined patients, it requires close attention: it is believed that the nodes can degenerate into various tumors. Therefore, for nodular goiter, more often than for other forms of goiter, it is used surgical treatment. Surgical treatment is used in the following cases: suspected cancer; thyroid cancer; follicular adenoma of the thyroid gland; node more than 2.5-3 cm; the presence of multinodular toxic goiter; presence of a cyst larger than 3 cm; presence of thyroid adenoma; retrosternal nodular goiter.

Manifestations of this disease can be different. First of all, the patient’s complaints depend on the level of thyroid hormones in the body. With a decrease in function (hypothyroidism), weakness, fatigue, decreased memory, performance and interest in the environment, dry skin, fragility and hair loss, swelling on the face, chilliness, lethargy, and constipation are noted. With increased thyroid function, on the contrary: weight loss, sweating, palpitations, trembling, fatigue, short temper, inappropriate reactions. With normal thyroid function (euthyroidism), patients complain primarily of a goiter—a formation in the neck. There may be complaints about headache, irritability, pain in the heart, a feeling of heaviness and discomfort in the neck. If the goiter is located retrosternally, then the disease can manifest itself as cough, shortness of breath, difficulty swallowing and breathing. Sometimes the nodule becomes inflamed or bleeding occurs into the thyroid nodule. In such cases, complaints of pain in the neck are added to the patient’s usual complaints. The goiter grows rapidly. With inflammation, there may be an increase in body temperature.

To make an accurate diagnosis, you must undergo certain examinations.

1. Medical examination.

2. Study of the level of thyroid hormones.

3. Ultrasound examination of the thyroid gland.

4. Fine needle needle biopsy thyroid gland. A biopsy is the only method of confirming or refuting the diagnosis of a thyroid tumor, so it must be performed in patients with nodular goiter.

5. Radioisotope study (scanning) of the thyroid gland. This method allows you to evaluate the size, shape of the thyroid gland, and the activity of its nodules. It is believed that this method can suggest the presence of cancer in the thyroid gland. However, it is impossible to accurately determine the presence of a tumor and its nature using this method.

6. X-ray examination of the chest. Allows you to assess the condition of internal organs (trachea and esophagus) in patients with goiter. The fact is that a goiter can put pressure on internal organs, in which case the internal organs will be displaced. It is carried out only with large degrees of enlargement of the thyroid gland, as well as with a retrosternal location of the goiter.

7. Computer and magnetic resonance imaging of the thyroid gland.

It is believed, however, that only those patients in whom thyroid nodules are identified during a medical examination, and not just by ultrasound, should be subjected to a detailed examination. According to ultrasound, nodules in the thyroid gland of an adult should exceed 1 cm in diameter. Anything less than this is considered non-hazardous.

According to statistics, almost 10% of the population has lesions of the thyroid gland, and only a part of them is associated with a lack of iodine in the body.

Iodine deficiency in the environment leads to the fact that the entire thyroid gland is forced to work in increased mode. In this case, most often, either a diffuse goiter (without nodes) or a multinodular goiter is formed: due to the fact that the entire thyroid gland works with “overload”, the process of nodule formation is not limited to any one area of ​​the gland, but, as a rule, involves it fully.

Nodular goiter (multinodular goiter) and pregnancy. Nodular colloid goiter, the diagnosis of which is confirmed by cytological examination, is not a contraindication for planning pregnancy, except in cases aggravated by compression of the trachea (with large nodes and a retrosternal location of the goiter).

Nodular and multinodular euthyroid colloid proliferating goiter, first identified during pregnancy, is not an indication for termination of pregnancy.

To exclude a neoplasm, a fine-needle aspiration biopsy of the node is performed. If a nodular formation is detected in the second half of pregnancy, then the biopsy, in the most emotional patients, can be delayed and carried out immediately after birth.

The only indication for surgical treatment of the thyroid gland, if a nodule is detected in a pregnant woman, is the detection of cancer. The optimal time for surgery is the second half of pregnancy.

Treatment of nodular forms of goiter in pregnant women is carried out with thyroxine preparations and physiological doses of iodine, under the control of the level of thyroid hormones.

Sporadic goiter

This is an enlargement of the thyroid gland, which occurs in residents of “prosperous” regions - where the iodine content in nature is sufficient. In another way, this disease is sometimes called simple, not toxic goiter. Like endemic goiter, the form of sporadic goiter can be nodular (when nodules form in the gland tissue), diffuse (when the gland tissue is completely affected) and mixed (when the patient has both areas in the gland).

It is believed that sporadic goiter occurs in 4-7% of the adult population, more often in women. In children, sporadic goiter is recorded in less than 5% of cases. The causes of the disease can be very different. Unfavorable heredity plays a significant role: for example, there are families in which people from generation to generation suffer from goiter. Harmful external influences also matter: magnetic field, radiation, pesticides, phenols - all this does not have the best effect on our health. It happens that goiter develops as a result of exposure to certain medications on the body.

What kind of medicines are these?

- some hormonal drugs;

- some antibiotics, antipyretics and painkillers, including aspirin;

— thyreostatics: thiamazole, methizol, mercazolil, lithium preparations, etc.;

- certain drugs used to treat patients with tuberculosis.

Under the influence of these drugs, the ability of the thyroid gland to bind iodine decreases and the formation of hormones is inhibited. To stimulate the gland and compensate for the lack of its hormones, the pituitary gland begins to intensively produce thyroid-stimulating hormone. As a result, the size of the thyroid gland increases. However, this does not happen for all people. We all live in the same unfavorable environment, and we take a variety of medications, and there are few among us with sporadic goiter. Scientists believe that for the disease to occur, a certain predisposition is necessary, associated with congenital disorders of iodine metabolism and the peculiarities of the formation of hormones in the body.

Sporadic goiter may not show any signs for a long time. Thyroid function is usually not impaired. Over time, patients pay attention to the appearance of a goiter and a change in the shape of the neck. If the enlargement of the thyroid gland is very large, then there may be a cough, hoarseness, difficulty breathing and swallowing. But this is only in extreme cases. However, you should not sit and indifferently watch how the neck changes. The fact is that a goiter, especially a nodular one, can always degenerate into a tumor, including cancer. Therefore, any goiter necessarily requires a visit to an endocrinologist and examination. The research methods used are the same as for other forms of goiter. For the treatment of diffuse goiter, they are usually used synthetic drugs thyroid hormones, for example L-thyroxine. Nodular goiter requires especially careful examination and treatment.

Diffuse toxic goiter

This disease is called differently Graves' disease, or thyrotoxicosis. The function of the thyroid gland is increased, which is why the disease is sometimes also called hyperthyroidism.

The exact and unambiguous cause of this disease has not yet been found. In both adults and children, the disease is associated with for various reasons.

Many researchers note the role of infectious diseases in the occurrence of diffuse toxic goiter. In children, it quite often develops after childhood infections, in adults - after influenza and ARVI. In some patients, the onset of the disease is preceded by an exacerbation chronic tonsillitis- long-term inflammation of the tonsils. There are indications of physical and mental trauma, overheating in the sun, and in children, parental alcoholism is important. Mental stress and stress play a big role. Some researchers note that patients with diffuse toxic goiter have certain character traits even before the disease: they are often quick-tempered, excitable, touchy, irritable, and are ready to perceive any external irritation as a personal insult and translate it into a conflict situation. It is not surprising that the psyche of such people is more susceptible to various types of trauma, which is why their illness sometimes occurs more easily. Another famous doctor S.P. Botkin wrote: “The influence of mental factors not only on the course, but also on the development of Graves’ disease is not subject to the slightest doubt: grief, various kinds of losses, fright, anger, fear have repeatedly been the cause of development, and sometimes extremely quickly, within a few hours of time , the most severe and characteristic symptoms of Graves' disease."

However, it is, of course, impossible to completely attribute the causes of hyperthyroidism to “nerves” alone. Apparently, a whole complex of reasons is important, which leads to disruption of the endocrine glands, primarily the thyroid gland.

Hereditary predisposition also matters. If one of the twins suffers from the disease, the risk of the other twin also increases. Women suffer from diffuse toxic goiter more often than men.

According to M.A. Zhukovsky (1995), among children suffering from diffuse toxic goiter, the predominant part are girls, and the disease most often develops at the age of 11-15 years.

Previously, it was believed that the cause of Graves' disease was disturbances in the hypothalamus-pituitary-thyroid system. It was believed that the pituitary gland produces too much large number thyroid-stimulating hormone, which ultimately leads to increased thyroid function. However, recent studies have proven that the level of thyroid-stimulating hormone in the blood of patients with diffuse toxic goiter can be not only elevated, but also normal, and sometimes even reduced. Therefore, views on the development of the disease were subsequently revised.

Today, the so-called “autoimmune theory” has become most widespread. “Autoimmune” means “developing immunity against itself.” In other words, the body produces antibodies to thyroid cells, resulting in increased thyroid function. These antibodies are called "thyroid-stimulating immunoglobulins." The most studied of them is the so-called LATS factor, a long-acting thyroid stimulant: it occurs in almost half of patients with diffuse toxic goiter. Increased function of the thyroid gland is accompanied by an increase in the level of its hormones - thyroxine and triiodothyronine, which causes the manifestations of the disease.

Diseases against which thyrotoxicosis most often develops: diffuse toxic goiter, nodular (multi-nodular) goiter, thyrotoxic phase of autoimmune thyroiditis.

Symptoms of diffuse toxic goiter

It is usually impossible to predict in advance what kind of disease course a given patient will have. It is believed that diffuse toxic goiter occurs more easily in children than in adults. Mild and moderate forms can often last for years without causing any particular inconvenience to the patient. However, sometimes they can suddenly become severe. With diffuse toxic goiter, many organs and systems are affected, therefore the manifestations of the disease are very diverse. Determining the boundary between mild, moderate and severe forms of the disease is not always easy. Sometimes they can turn into one another.

One of the main signs of diffuse toxic goiter is an enlargement of the thyroid gland. It can be of varying degrees. At the same time, there is no direct connection between the degree of enlargement of the thyroid gland and the severity of thyrotoxicosis, however, severe forms of the disease are usually accompanied by a large goiter.

Almost all patients have changes in the nervous system. These are irritability, nervousness, increased impressionability, moodiness, tearfulness. All this together does not necessarily occur in every patient. But almost all authors note that patients with diffuse toxic goiter are more excitable, irritable, and hot-tempered; Many people experience increased activity, and children experience a desire to constantly move and an inability to sit still. Some children have problems with perseverance at school: students cannot attend classes properly. In both adults and children there are frequent changes mood with a tendency to aggressiveness and tearfulness (medics call this “convulsive roar”). Many complain of sleep disturbances, memory disorders, and headaches.

A frequent sign of a deviation from the nervous system in diffuse toxic goiter is a slight trembling (tremor) of the fingers. Trembling becomes noticeable if the patient stretches his arms. The severity of this symptom is not directly related to the severity of the disease. However, when severe forms The disease, trembling of the fingers occurs almost always. Children may experience tics - violent movements of the arms, head, and facial muscles. In adults, such tics with diffuse toxic goiter are rare.

One of the signs of the disease is increased sweating. Not only the whole body sweats, but also the armpits, palms, and feet. Even with a mild form of thyrotoxicosis, more than half of patients complain of excessive sweating, and with a severe form - almost all. The skin of patients with thyrotoxicosis is usually thin, moist, pink, and red spots often appear on it; If you rub a blunt object over the skin, a red mark will remain on it for a long time.

The body temperature of patients is often elevated, although not greatly. Many people complain of itchy skin, weakness and fatigue. All these manifestations are more pronounced in severe forms of the disease than in moderate and mild ones. In severe cases of the disease, the muscles of the entire body are affected, including the muscles of the legs, hands, neck, and, less commonly, the masticatory muscles. In mild and moderate forms of the disease, mainly the muscles of the shoulder girdle and arms are affected: patients complain of their weakness and the inability to perform prolonged and heavy muscular work.

Another characteristic sign of the disease is changes in the cardiovascular system. To one degree or another, just like changes in the nervous system, they almost always occur.

The earliest sign of diffuse toxic goiter is a rapid heartbeat (tachycardia). A rapid heartbeat often appears earlier than all other signs of goiter, sometimes even earlier than an enlarged thyroid gland. A small proportion of patients may have no complaints of palpitations. In some cases, patients do not complain, but the doctor determines an increased pulse rate in patients. The pulse rate is usually more than 90 beats per minute (the heart rate of a healthy person is from 60 to 90, on average 70-75 beats per minute). With diffuse toxic goiter, the pulse in some patients can reach 180-200 beats per minute. It should be noted that the heart rate may accelerate for no apparent reason. The elevated heart rate in patients usually persists during sleep. Doctors listen to heart murmurs in many patients.

In some patients, especially with severe thyrotoxicosis, there is an enlargement of the left chambers of the heart. The more severe the disease, the more common cardiac arrhythmias occur. Many patients complain of shortness of breath, but usually it is not associated with the activity of the heart, but with the fact that patients constantly experience a feeling of heat. So, in a warm room they almost always cover themselves with only a sheet and even in winter they often sleep with the window open. Even with the window open, patients often complain of stuffiness. Doctors find changes in the electrocardiogram, indicating disturbances in metabolic processes and heart rhythm.

Most patients experience increased blood pressure. In the most typical cases, increased upper pressure, but the lower one remains normal, sometimes it can even be reduced.

One of the sure signs of diffuse toxic goiter is changes in the eyes, scientifically called “endocrine ophthalmopathy.” In total, about 40 eye symptoms, or signs, are known, which are almost always recorded in severe and, less often, in moderate forms of the disease. It is not necessary that one person will exhibit all the signs known to medicine. The most well-known of these symptoms are bulging eyes and wide opening of the palpebral fissures. Even people far from medicine know that patients with Graves' disease are characterized by “wide-open eyes” that attract attention. Some people think that patients with thyrotoxicosis have a special, “angry” look. Others pay attention to the pronounced, compared to healthy people, sparkle of eyes. Doctors associate the occurrence of most eye symptoms not with the direct effect of increased levels of thyroid hormones, but with the action of a special antibody - LATS factor, or thyroid-stimulating immunoglobulin. It is believed that as a result of this, the fiber located behind the eyes swells, and the eyes seem to “bulge out”. Doctors divide all eye symptoms into groups: there are characteristic signs that arise from the pupils, cornea and conjunctiva, fundus, eyelids, muscles responsible for eye movements, as well as from structures that are located behind the eyeballs and are not visible to patients. The latter are usually determined by a doctor during examination.

The most important “eye symptoms” that occur with diffuse toxic goiter

Eye membranes - corneas conjunctiva	Enhanced eye shine “Mica shine” of the outer shell of the eye - the conjunctiva Red coloration of the conjunctiva (the eyes may resemble “rabbit eyes”)
Eyelids	Wide opening of the palpebral fissures is one of the most common and well-known signs or symptoms Periodic fleeting opening of the palpebral fissures when fixing (stopping) the gaze: when the patient stops his gaze on something, from the outside it may seem that he is surprised Angry look Lower eyelid lag when staring Palpebral fissure, which remains wide even when laughing: patients do not squint their eyes when laughing
Pupils	Jerky contraction (narrowing) of the pupil of one eye when the other eye is illuminated
fundus	Uneven dilation of the pupils Dilation and pulsation of retinal vessels (this symptom can only be assessed by ophthalmologists)
Eyeball movement	Paralysis of one or more external eye muscles (manifested by the inability to move the eyeball to the side) Disorder of concordant (corresponding to each other) movements of the eyes and facial muscles The absence of wrinkles when looking up is one of the most common symptoms of diffuse toxic goiter

Changes that occur in patients with the eyes often give the patient's face an expression of fear, surprise or anger. On average, bulging eyes are detected in more than half of patients with diffuse toxic goiter. It is believed that the more severe the disease, the more pronounced changes in the eyes occur, however, according to a number of authors, this is not entirely true. Even with severe forms of diffuse toxic goiter, changes in the eyes may sometimes be absent. Along with this, cases were described in which patients with a mild form of diffuse toxic goiter had many complaints about changes in the eyes. However, it often happens that changes in the eyes are noticed primarily by those around them, and not by the patients themselves. In children, bulging eyes are usually less pronounced than in adults, however, exceptions are possible here. Usually the bulging eyes are uniform, less often one eye (usually the right) seems larger than the other. On average, one in ten patients, or even less often, has uneven bulging eyes, when one eye appears much larger than the other. In most cases, scientists explain this by the pressure of an enlarged thyroid gland on the nerve of the sympathetic nervous system, which runs on the “sick” side. As a rule, such problems cause patients a lot of cosmetic inconvenience. Fortunately, they are less common in children than in adults.

In addition to all the listed eye problems, patients with diffuse toxic goiter are often bothered by the feeling of “sand” in the eyes, lacrimation, sometimes pain in the eyes and double vision. Some authors believe endocrine ophthalmopathy(a complex of changes in the eyes) is an independent disease, which is based on impaired immunity, resulting in the production of antibodies to eye muscles, fiber, etc. In this case, swelling of the fiber located behind the eyeball is noted. If left untreated, the swelling of the tissue turns into fibrosis, that is, it is replaced by connective tissue. Connective tissue does not dissolve. After this, the eye changes become irreversible. It is believed that predisposition to this disease is inherited. Usually it goes hand in hand with diffuse toxic goiter.

In addition to the nervous system, heart, blood vessels and eyes, with diffuse toxic goiter, changes in other organs and systems are also noted. This is due to the fact that the effect of thyroid hormones on the body is very diverse and multifaceted.

Adult patients often complain of disorders of the gastrointestinal tract. Most often this is diarrhea and vomiting. Patients, as a rule, eat a lot, but remain hungry because they do not digest food well, that is, they suffer from increased appetite. In children, diarrhea and vomiting are rare, but increased appetite occurs quite often.

All types of metabolism increase sharply in diffuse toxic goiter. Increased water metabolism leads to dehydration of the body of patients. Patients eat a lot, but do not gain weight. On the contrary, most of them experience weight loss, despite increased or normal appetite. Body temperature rises.

In some cases, liver function is impaired. The appearance of jaundice is a dangerous sign that occurs in severe cases of the disease. With milder variants of the disease, the liver may be enlarged and painful.

The activity of the adrenal cortex changes. There is a lack of hormones produced by the adrenal cortex, which is manifested by general weakness, fatigue, and decreased performance. Some patients may have increased pigment deposition in the skin (especially in the knees and elbows), which also indicates insufficient function of the adrenal cortex, enlarged lymph nodes, low "low" blood pressure, along with normal or increased "high".

Carbohydrate metabolism also changes. Some patients may experience an increase in blood sugar. Carrying out special tests (glucose tolerance test) allows you to determine that the body does not properly absorb and process sugar. It is believed, however, that these changes are largely associated with impaired liver function, which often occurs with this disease. The combination of diffuse toxic goiter and diabetes mellitus is observed in approximately 3% of patients, usually adults; in children, such a combination occurs only in a few cases.

Since all types of metabolism change, the structure of the skeletal system also changes. Many patients complain of increased fragility and fragility of bones—osteoporosis. In children, there is increased growth and an earlier appearance of ossification points. However, in the future, the growth process ends faster than in healthy children, so subsequently, on the contrary, growth retardation may be observed.

In children, premature physical development is often combined with delayed sexual development. The process of puberty maintains the same sequence as in healthy children, but slows down somewhat. Menstruation in teenage girls comes a little later, and if a girl gets sick after the monthly cycle has been established, it is disrupted or even stops. Adult women may also experience cycle irregularities. Subsequently, with the treatment of diffuse toxic goiter, the hormonal sphere is normalized, and the female cycle, as a rule, returns to normal.

Along with metabolic disorders, changes in the blood system can be observed: increased levels of lymphocytes, erythrocyte sedimentation rate, reduced level leukocytes.

Doctors distinguish three degrees of severity of thyrotoxicosis: mild, moderate and severe. This allows you to more specifically assess the patient’s health status and decide on his treatment.

A mild course is established on the basis of a laboratory hormonal study with a mild clinical picture (in this case, signs of the disease may be blurred or absent).

Flow moderate severity placed if there are pronounced manifestations of the disease.

Complicated (severe) is established in the presence of complications (atrial fibrillation, heart failure, changes and disruption of the functioning of many internal organs, mental disorders, sudden weight loss).

This classification is convenient for doctors, but not for patients. You can independently roughly assess the severity of your disease based on the following signs.

Mild: heart rate 80-120 per minute, no atrial fibrillation, sudden weight loss, slightly reduced performance, slight hand tremors.

Average: heart rate 100-120 per minute, increased pulse pressure (the difference between “upper” and “lower” blood pressure), no atrial fibrillation, weight loss up to 10 kg, reduced performance.

Severe: heart rate more than 120 per minute, atrial fibrillation, mental disorders, pronounced changes in parenchymal organs, body weight is sharply reduced, and ability to work is lost.

These data in no way mean that you can determine the severity of your illness independently of your doctor. They will simply help you better understand your condition or the condition of your relatives (if you or they have thyrotoxicosis). Do not forget that independent treatment of endocrine diseases is unacceptable: it can lead to the most dangerous consequences- a more severe course of the disease, disorders of the internal organs, and even such a dangerous condition as thyrotoxic crisis.

Thyrotoxic crisis

Thyrotoxic crisis - emergency life-threatening. It is caused by a sharp increase in the production of thyroid hormones: increased body temperature, extreme weakness, agitation and anxiety, abdominal pain, confusion and impaired consciousness (up to coma), mild jaundice. Increased cardiac activity in this condition can lead to abnormal heart rhythms and shock.

Thyrotoxic crisis occurs with inadequate treatment of thyrotoxicosis (diffuse toxic goiter) and can be provoked by the following conditions and situations:

• infection;
• injury;
• surgery;
• surgery on the thyroid gland (partial removal) in patients with unresolved thyrotoxicosis who have not undergone treatment with inorganic iodine;
• pregnancy and childbirth;
• mental stress;
• diagnosed severe thyrotoxicosis.

Another complication of thyrotoxicosis is dystrophic changes in the myocardium, which is accompanied by the development of atrial fibrillation and heart failure.

A more rare complication is periodic paralysis.

Toxic multinodular goiter

Toxic multinodular goiter is the second most common cause of thyrotoxicosis. With this disease, the thyroid gland does not enlarge evenly, as with diffuse goiter, but in patches, which leads to the formation of one or several nodes. Multinodular toxic goiter usually develops in older women with long-existing multinodular non-toxic (without increasing hormone levels) goiter.

The cause of nodular goiter may be a restriction or, conversely, excessive intake of iodine into the body, for example, with certain medications. Most often, with iodine-induced thyrotoxicosis (caused by excess iodine), symptoms of cardiac dysfunction (arrhythmia, heart failure), depression, and muscle weakness appear.

Diagnosis of hyperthyroidism

If diffuse toxic goiter is suspected, the level of thyroid hormones in the blood is first determined. The concentration of thyroxine (T 4) and triiodothyronine (T 3) is increased; the concentration of thyroid-stimulating hormone (TSH) is usually reduced.

Blood tests may detect antibodies to thyroid tissue.

Other tests are also prescribed: scanning (with radioactive iodine or technetium), ultrasound, thyroid biopsy. The uptake of I 131 is increased in the first hours of the test, then decreases.

Interestingly, the uptake of I 131 by the thyroid gland may be increased during neurosis, in which case increased iodine accumulation was noted throughout the study.

Treatment of hyperthyroidism

It takes several years to bring the endocrine system to a normal state with increased thyroid function. There are three main treatments for hyperthyroidism: medication, surgical removal of part or all of the thyroid gland, and "bloodless surgery" - treatment with radioactive iodine, which destroys the thyroid tissue.

Drug treatment begins with the patient being prescribed thyreostatic drugs that suppress the activity of the thyroid gland.

The synthesis of thyroid hormones is also inhibited by lithium preparations, although less weakly than Mercazolil.

Lithium salts cause adverse reactions such as increased urination, loss of appetite, nausea, severe tremor, and unsteadiness of gait.

Contraindications to the use of lithium salts are parkinsonism and atrioventricular block of varying degrees.

Iodine preparations suppress the release of T 3 and T 4 from the thyroid gland, their synthesis, the uptake of iodine by the thyroid gland, the conversion is low active form hormone T4 into the more active T3 (which occurs in the liver and other organs).

For exophthalmos, diuretics are prescribed, and in severe cases, prednisolone. Radiation therapy to this area is also used. Surgical treatment is also possible.

Propylthiouracil, Propycyl

Available in tablets of 0.05 g (50 mg).

Indications. Thyrotoxicosis.

Therapeutic effect. It has a pronounced thyreostatic effect, reduces the formation of the active form of iodine in the thyroid gland, and inhibits the conversion of T4 to T3.

Directions for use and doses. Take 50-100 mg orally 3 times a day.

During treatment, it is necessary to monitor the level of thyroid hormones, blood picture, level of activity of liver enzymes (transaminases), concentration of bilirubin, alkaline phosphatase.

Duration of treatment is 1-1.5 years.

Side effects

Possible:

• skin itching;
• paresthesia (feelings like crawling);
• hair loss;
• loss of appetite;
• nausea, vomiting.

Occasionally noted:

• increased body temperature;
• periarteritis;
• development of goiter.

Contraindications

• Hypothyroidism, marked decrease in leukocytes in the blood, active hepatitis, cirrhosis of the liver; hypersensitivity to the drug.
• Prescribed with caution for chronic hepatitis, fatty liver, nodular goiter.
• The drug is contraindicated during pregnancy and lactation.

Interaction with other medications. It is not recommended to use simultaneously with drugs that inhibit the formation of leukocytes.

Thiamazol, Mercazolil, Tyrosol

Available in tablets of 0.005 g (5 mg).

Indications. Diffuse toxic goiter (mild, moderate and severe forms).

Therapeutic effect. Causes a decrease in the synthesis of thyroxine in the thyroid gland, due to which it has a specific therapeutic effect in case of its hyperfunction. Like other antithyroid substances, it reduces basal metabolism.

Methods of administration and doses. Take orally, after meals: for mild and moderate forms of thyrotoxicosis - 5 mg, for severe forms - 10 mg 3-4 times a day. After the onset of remission (after 3-6 weeks), the daily dose is reduced every 5-10 days by 5-10 mg and the minimum maintenance doses are gradually selected (5 mg once a day, every other day or once every 3 days) until stable therapeutic effect.

If treatment is stopped too early, a relapse of the disease is possible.

Maximum doses for adults: single - 10 mg, daily - 40 mg.

Side effects

The drug in therapeutic doses is usually well tolerated. However, in some cases, leukopenia (a decrease in the number of white blood cells in the blood) may develop, so a clinical blood test must be done once a week.

Also possible:

• nausea, vomiting;
• liver dysfunction;
• goitrogenic effect;
• drug-induced hypothyroidism;
• skin rash;
• joint pain.

If side effects occur, reduce the dose or stop taking the drug.

In patients receiving Mercazolil in preparation for surgery, the risk of bleeding during surgery increases, therefore, as soon as remission or significant improvement in the patient's condition is achieved, Mercazolil is discontinued and iodine preparations are prescribed; The operation is performed after 2-3 weeks.

Contraindications

• Hypothyroidism, a marked decrease in the number of leukocytes and granulocytes in the blood, nodular forms of goiter (except for cases of severe progressive disease, in which the possibility of surgery is temporarily excluded).
• The drug cannot be used during pregnancy and lactation.

Interaction with other medications. You should not combine Mercazolil with drugs that can cause a decrease in the number of leukocytes in the blood (sulfonamides, etc.).

Treatment with radioactive iodine

Treatment with radioactive iodine for diffuse toxic goiter is indicated for patients over 40 years of age (past childbearing age). It is difficult to select the dose of radioactive iodine, and it is impossible to predict the reaction of the thyroid gland. Nevertheless, it is known that if an amount of I 131 is administered sufficient to normalize the function of the thyroid gland, then in approximately 25% of cases hypothyroidism develops after a few months. Then, over the course of 20 years or more, this frequency increases every year. However, if a smaller dose is administered, there is a high probability of relapse of hyperthyroidism.

Nutrition for hyperthyroidism

The basal metabolism in thyrotoxicosis is significantly increased, which means there is an increased energy expenditure, which can lead to weight loss. Therefore, thyrotoxicosis requires a high-calorie diet. The content of proteins, fats and carbohydrates must be balanced.

The diet of men should contain an average of 100 g of protein, with 55% from animal sources; fat - 100-110 g (25% vegetable), carbohydrates - 400-450 g (of which 100 g sugar). Calorie content - 3000-3200 kcal.

A woman’s diet should contain: proteins - 85-90 g, fats - 90-100 g, carbohydrates - 360-400 g. Calorie content - 2700-3000 kcal.

Proteins should be easily digestible, their main source should be dairy products. Dairy products are also a supplier of highly digestible fats and calcium, the need for which is increased in patients with thyrotoxicosis.

The content of vitamins in the diet is very important for thyrotoxicosis. In addition to foods rich in vitamins (liver, vegetables, fruits), it is also necessary to take vitamin supplements. The same can be said about mineral salts. The diet includes foods rich in iodine: sea fish, seaweed and other seafood.

You should not consume large quantities of foods and dishes that stimulate the cardiovascular and central nervous systems - strong tea, coffee, spices, chocolate, as well as strong meat and fish broths. It is advisable to first boil meat and fish, and then stew or fry.

Meals should be 4-5 times a day. Water regime is not limited.

Among the drinks, preference is given to tea, rosehip infusions and wheat bran. Juices are allowed in diluted form, all except grape, plum, apricot.

Butter is limited to 10-15 g per day, vegetable oils - no more than 5 g per dish. Other fats are not recommended.

With severe exacerbation chronic enteritis with severe diarrhea, use liquid, semi-liquid, mashed, boiled in water or steam. Limit the content of fats and carbohydrates in the diet. The protein content should be within the physiological norm.

Approximate one-day menu for thyrotoxicosis 2955 kcal

First breakfast Cottage cheese with milk - 50 g Crumbled buckwheat porridge - 150 g Tea - 180 ml Lunch Fresh apples - 100 g Dinner Vegetarian rice soup - 400 g Boiled meat - 55 g Apple compote - 180 g Afternoon snack Rosehip decoction - 180 ml White crackers - 50 g Dinner Fish dumplings - 60 g Carrot puree - 200 g Milk semolina porridge - 200 g For the night Kefir – 180 ml All day White bread - 200 g Bread with bran - 150 g Sugar - 50 g Butter - 20 g

Sample menu for thyrotoxicosis with intestinal syndrome

First breakfast Soft-boiled eggs Oatmeal milk porridge Tea Lunch Fresh apples or other fruits Dinner Peasant soup with meat broth Boiled meat pilaf Kisel Afternoon snack Rose hip decoction Cookies Dinner Boiled fish Mashed potatoes Baked curd pudding Tea For the night Fermented milk drink(kefir, etc.) Not a rich bun

Thyroid nodules

Approximately half of the adult population has nodules in the thyroid gland, and in approximately 30% of cases the diameter of the nodules is 2 cm or more. In some cases there is a single node, in others there are several nodes.

A single node is most often benign. Sometimes it appears as a cyst. A benign nodule is not life-threatening, but sometimes quite serious problems can arise. One of them is the development of hyperthyroidism, which requires appropriate treatment; the other is pressure on the throat and difficulty breathing if the nodule is large. Occasionally, the node begins to bleed and a hematoma forms - an accumulation of blood under the skin.

Enlargement of the thyroid gland due to many small nodes is called multinodular goiter. Thyroid function most often remains normal; if it increases, then toxic multinodular goiter develops.

Inflammatory diseases of the thyroid gland - thyroiditis

Hashimoto's thyroiditis

One of the very common inflammatory diseases of the thyroid gland - autoimmune thyroiditis, or Hashimoto's thyroiditis - is caused by an autoimmune reaction, that is, an “attack” of the immune system on the body’s own cells, in this case, on the cells of the thyroid gland. As a result, inflammation develops.

Typically, the first symptom of Hashimoto's thyroiditis is a painless enlargement of the thyroid gland or a feeling of fullness in the neck, a "lump in the throat." Most often, the enlargement of the thyroid gland in this disease is very slight, but in some cases the goiter develops quite large and can put pressure on the vocal cords and larynx, pharynx, etc. Then symptoms such as difficulty swallowing, cough, and hoarseness appear. There may also be pain in the neck.

Most patients are forced to receive lifelong hormone replacement therapy to compensate for progressive hypothyroidism. Most often used synthetic analogue thyroxine - levothyroxine, or L-thyroxine.

Subacute thyroiditis (de Quervain's thyroiditis)

This disease is a viral infection that affects the thyroid gland. Mostly people aged 30–50 years old are affected; women are approximately 5 times more likely than men. Often the disease develops several weeks after past influenza or ARVI.

The symptoms of subacute thyroiditis are very vague: weakness and fatigue, neck pain radiating to the ear, lower jaw, and back of the head. They develop gradually, although sometimes the disease can begin acutely.

In the first stages, de Quervain's thyroiditis is accompanied by mild hyperthyroidism, which is later replaced by hypothyroidism, which is also mild.

Treatment of subacute thyroiditis is reduced to taking aspirin, sometimes prednisolone is used. In most patients, the disease is cured fairly quickly, and thyroid function is restored.

Postpartum thyroiditis

Postpartum, or asymptomatic lymphocytic thyroiditis, is a condition that occurs in approximately every tenth woman giving birth. The thyroid gland enlarges; it is painless when palpated. Its function is elevated for several weeks or months, then hypothyroidism usually sets in.

Symptoms often go unnoticed.

In most cases, thyroiditis goes away within a few months without treatment, but 5-7% of women develop chronic hypothyroidism 1-3 years after childbirth. In such cases, hormonal drugs are usually prescribed.

Thyroid cancer

In recent decades, medicine and, especially, pharmacology have achieved such success that often, especially with early detection of a tumor, a person can be completely cured.

What are the means offered? scientific medicine for cancer treatment?

First of all, this is a surgical operation - the oldest and most proven remedy. Its success largely depends on the type and stage of the malignant tumor.

The second method of treating malignant tumors is radiation therapy. Its action is based on the fact that radioactive radiation primarily destroys those cells that quickly divide. And in this regard cancer cells have no equal.

The third treatment method is chemotherapy. Currently, the following groups of drugs are used: alkylating agents, antimetabolites, plant alkaloids, antitumor antibiotics, enzymes, hormones, biological response modifiers.

Combination therapy is often used in the treatment of malignant tumors.

Types of thyroid cancer

The only sign of thyroid cancer may be a slight swelling in the neck. In this case, it is necessary to do a thyroid scan. This is especially true for those who have risk factors for thyroid cancer.

Thyroid cancer can be of four types:

• papillary;
• follicular;
• medullary (solid, with amyloid struma);
• anaplastic.

Mixed papillary-follicular cancer is common; the rarest form is anaplastic cancer.

Papillary cancer

This type includes 60-70% of all malignant neoplasms of the thyroid gland. It is diagnosed 2-3 times more often in women than in men, and more often in young people than in older people (but in older people it is more malignant). It is often associated with a history of radiation exposure for some other reason.

If the tumor is small (less than 1.5 cm), then treatment consists of surgical removal of the affected lobe of the gland and the isthmus. In almost all cases, surgical treatment gives good effect; relapses are extremely rare.

If the tumor is large (more than 1.5 cm) and spreads to large areas of the gland (both lobes), then the entire gland is removed. In the future, lifelong hormonal therapy with L-thyroxine is necessary. The average daily dose is 100-150 mcg.

Follicular cancer

This form accounts for about 15% of all cases of thyroid cancer. It is more often found in older people, and in women more often than in men. Follicular cancer is more malignant than papillary cancer and can metastasize.

Regardless of the size of the tumor, radical surgery is required: removal of almost the entire thyroid gland. After this, radioactive iodine is prescribed. Such patients also receive lifelong hormonal therapy.

Anaplastic cancer

This form accounts for no more than 10% of all cases of thyroid cancer and occurs mainly in older people, slightly more often in women than in men. The tumor grows very quickly and is usually clearly visible. Anaplastic cancer progresses rapidly and has a poor prognosis. Although chemotherapy and radiation therapy before and after surgery are sometimes successful.

Medullary cancer

In this form of cancer, the thyroid gland produces too much calcitonin because the medullary tumor cells are hormonally active. They can also produce other hormones, so medullary cancer often presents with very unusual symptoms. In addition, it may be accompanied by other types of malignant tumors of the endocrine system. This is called multiple endocrine neoplasm syndrome.

Medullary cancer metastasizes through the lymphatic system to the lymph nodes, and through the blood to the liver, lungs, and bones. The only treatment for this form of cancer is total removal of the thyroid gland.

Multiple endocrine neoplasia syndrome

It's rare hereditary disease, characterized by the formation of benign or malignant tumors in several endocrine glands. Moreover, tumors can appear in the first year of life, or after 70 years. All manifestations of this disease are caused by an excess of certain hormones produced by tumors.

Multiple endocrine neoplasia is conventionally divided into three types - I, IIA and II B. Mixed or cross types are sometimes observed.

Neoppasia type 1

In this type of multiple endocrine neoplasia, tumors of the parathyroid glands, pancreas and pituitary gland develop. This can happen simultaneously or in isolation.

In almost all cases, there are tumors of the parathyroid glands that produce excess parathyroid hormone. This condition is called hyperparathyroidism and usually leads to elevated levels of calcium in the blood, which in turn can contribute to the formation of kidney stones.

Typically, type I neoplasia also develops pancreatic islet cell tumors called insulinomas, and in almost half of the cases these tumors produce insulin. This leads to an increase in the level of insulin in the blood - hyperinsulinemia - and, as a consequence, to hypoglycemia - a decrease in blood sugar levels.

Hypoglycemia

Hypoglycemia is a common complication of insulin therapy for type 1 diabetes mellitus (insulin-dependent) - a condition in which the blood glucose level sharply decreases (less than 2.5 mmol/l). In this case, symptoms such as hunger, sweating, severe trembling, heartbeat; the skin is moist to the touch, cold, pale. Behavioral disorders and visual impairment are very common. To cope with this condition, it is enough to eat 5-6 pieces of sugar or drink a few sips of sweet juice, tea with sugar, or lemonade.

More than half of insulomas produce gastrin, a substance that increases the acidity of gastric juice and is normally synthesized in the stomach. Therefore, such patients develop ulcers, corresponding to the clinical picture of gastric ulcers and pancreatic lesions.

Insulomas in approximately 2/3 of cases are benign. Malignant insulinomas progress more slowly than other types of pancreatic cancer, but just like any malignant tumors, they can metastasize to other organs.

Pituitary tumors in type I neoplasia develop in approximately 2/3 of cases, and in every fourth case such a tumor produces the hormone prolactin. This leads to menstrual irregularities in women and impotence in men. Very rarely, pituitary tumors produce adrenocorticotropic hormone, resulting in Cushing's syndrome. And about a quarter of tumors do not produce any hormones.

Sometimes, with type I neoplasia, tumors of the adrenal glands and thyroid gland also develop, but in the vast majority of cases they are non-cancerous.

Neoplasia type IIA

With this type of multiple endocrine neoplasia, medullary thyroid cancer and pheochromocytoma (a tumor of the adrenal gland, often benign) develop. Thyroid cancer occurs in almost all cases of type IIA neoplasia, and pheochromocytoma occurs in approximately half of patients. Pheochromocytoma usually manifests itself in increased blood pressure. The pressure can increase quite significantly, but not constantly, but periodically.

In approximately 25% of cases of type IIA neoplasia, parathyroid function is increased. Excess parathyroid hormone leads to an increase in calcium levels in the blood, and this, in turn, leads to the formation of kidney stones and sometimes kidney failure.

Neoplasia PB type

This type of multiple endocrine neoplasia is characterized by medullary thyroid cancer, pheochromocytoma, and neuromas, which are tumors of the tissue around nerves.

Medullary thyroid cancer can develop in early childhood. It progresses and metastasizes faster than with type IIA neoplasia.

Neuromas develop in almost all cases, are usually located on the mucous membranes and look like shiny nodules. Neuromas in the intestinal mucosa are thought to cause enlargement and lengthening of the colon, as well as gastrointestinal dysfunction.

Patients with neoplasia of the BE type often have spinal diseases (in particular scoliosis), deformities of the bones of the feet and hips, and joint weakness. Many patients have a characteristic appearance: long arms and legs.

Treatment of multiple endocrine neoplasia comes down to treatment of specific tumors and correction of hormonal balance.

Surgical operations on the thyroid gland

So, surgical removal of the thyroid gland may be necessary the following reasons:

• malignant tumor of the thyroid gland;
• inefficiency drug therapy with hyperthyroidism;
• a very large goiter that makes swallowing and breathing difficult;
• internal bleeding from the thyroid gland.

For hyperthyroidism, surgery is mainly indicated for young people, as well as for very large goiters or allergic reactions to medications.

Scope of surgery

The scope of surgical intervention may vary, depending on the indications for surgery:

• removal of the entire gland - total thyroidectomy;
• removal of approximately 2/3 of the gland - subtotal resection;
• removal of a single node or one lobe (half) of the thyroid gland.

Total thyroidectomy is most often done for cancer, sometimes for a very large multinodular goiter.

In case of diffuse toxic goiter, as a rule, subtotal resection of the thyroid gland is limited.

Lifelong hormonal therapy with thyroxine is required in all cases where more than two-thirds of the thyroid gland has been removed.

Possible complications of the operation

Any surgical procedure involves some risks. On the one hand, these are complications common to all operations, on the other hand, there are specific complications characteristic of this type of surgical intervention.

Common complications include local bleeding, infection in the wound, as well as the formation of blood clots in the veins of the legs and postoperative pneumonia. In addition, there is a risk associated with general anesthesia, but it is very small.

Specific complications of thyroid surgery include the following:

• headache;
• difficulty swallowing; neck stiffness;
• voice change;
• damage to the parathyroid glands.

This is important!

A person suffering from any disease of the thyroid gland must definitely warn the doctor about this when contacting him for any other disease! This is especially true in cases where surgery is to be performed (for any reason). Before surgery, it is absolutely necessary to normalize the function of the thyroid gland.

During pregnancy

Thyroid dysfunction is common during pregnancy. High content thyroid hormone deficiency during pregnancy is usually caused by Graves' disease (thyrotoxicosis, or thyroiditis). With Graves' disease, antibodies are formed that stimulate the thyroid gland, and it begins to produce too many hormones. These antibodies can cross the placenta and increase the activity of the fetus's thyroid gland, causing the fetus to have an increased heart rate and slower growth. Sometimes Graves' disease produces antibodies that block the production of thyroid hormone. These antibodies can cross the placenta and suppress the synthesis of thyroid hormones in the fetus (hypothyroidism), causing mental retardation (cretinism).

Several methods are used to treat thyrotoxicosis. Typically, a pregnant woman is prescribed the lowest possible dose of propylthiouracil. Often in the last 3 months of pregnancy, thyrotoxicosis manifests itself less strongly, so the use of propylthiouracil can be reduced or even discontinued. The surgeon can remove the thyroid gland in the second trimester (at 4-6 months of pregnancy) if there is intolerance to antithyroid drugs and significant enlargement of the gland, accompanied by compression of the trachea. A woman should start taking thyroid hormone medications 24 hours after surgery and continue for the rest of her life. These drugs do not cause any harm to the fetus.

A decrease or increase in thyroid hormone levels after pregnancy is usually temporary but may require treatment.

ATTENTION! Radioactive iodine taken by a pregnant woman to treat an overactive thyroid gland (hyperthyroidism) can cross the placenta and affect the fetal thyroid gland or cause severely decreased thyroid function (hypothyroidism). Propylthiouracil and methylmazole, medications also used to treat hyperthyroidism, may cause the fetus to enlarge the thyroid gland; when necessary, propylthiouracil is usually used because it is better tolerated by both the woman and the fetus.

Almost all cases of thyrotoxicosis in pregnant women are associated with diffuse toxic goiter.

Detection of diffuse toxic goiter in a pregnant woman is not an indication for termination of pregnancy. Safe methods of conservative treatment of this disease have been developed.

All thyreostatics cross the placenta and can have a suppressive effect on the fetal thyroid gland. Propicil penetrates less well through the placental barrier, as well as from the blood into mother's milk. In this regard, propicil is the drug of choice for the treatment of thyrotoxicosis in pregnant women.

In case of intolerance to thyreostatic therapy - the development of severe leukopenia, allergic reactions - surgical treatment of diffuse toxic goiter during pregnancy is possible. The optimal time is the second half of pregnancy. After removal of the thyroid gland, thyroxine is prescribed at a dose of 2.3 mcg per 1 kg of body weight.

Hypothyrsosis, a condition caused by a long-term, persistent lack of thyroid hormones, occurs in 19 out of 1,000 women and 1 in 1,000 men. This is a disease associated with decreased thyroid function. As a result, an insufficient amount of hormones (thyroxine and triiodothyronine) enters the blood, and many organs and tissues suffer.

In 99% of cases, the cause of hypothyroidism is damage to the thyroid gland itself (primary hypothyroidism), in 1% - damage to the pituitary gland or hypothalamus (secondary hypothyroidism).

Diseases of the thyroid gland against which hypothyroidism may be detected: endemic goiter, thyroiditis (inflammation of the thyroid gland), nodular goiter, multinodular goiter. Hypothyroidism can also be caused by: removal of the thyroid gland, irradiation of the thyroid gland, treatment with thyreostatics. The manifestations of the disease may not differ significantly.

This is one of the most common metabolic diseases: according to statistics, every tenth woman over 65 years old has signs of the initial stage of this disease.

The disease can be caused by malformations of the thyroid gland, it can develop as a result of insufficient iodine intake in the body (see “Endemic goiter”), as well as as a result of hereditary disorders (the thyroid gland cannot produce the normal amount of hormones or produces hormones whose structure is disturbed and which do not have the desired effect on the body). Sometimes children with a congenital form of hypothyroidism are born from mothers who suffered from diffuse toxic goiter and received iodine preparations or other drugs during pregnancy that cause a decrease in thyroid function.

In children, hypothyroidism is more often congenital, in adults it is acquired. For the child’s body, an important role is played by how the mother’s pregnancy proceeded: occupational hazards, diseases of the woman, infections, malnutrition, air polluted by emissions from industrial enterprises - all this can affect the condition of the baby’s thyroid gland.

Patients with an overactive or underactive thyroid gland experience many various symptoms and signs. However, in many cases, these disorders are diagnosed during routine examinations for completely unrelated medical problems.

Symptoms of an overactive thyroid gland

An overactive thyroid gland, also known as thyrotoxicosis, is quite common. It affects approximately 0.5% of the world's population. Thyrotoxicosis occurs three times more often in women than in men.

Three main options for increasing thyroid activity:

• Graves' disease (in Russian terminology the concept of Graves' disease is more common);
• isolated toxic node;
• multinodular toxic goiter.

Graves' disease is the most common form of thyrotoxicosis. It is the result of complex autoimmune processes in which the body produces specific antibodies that stimulate the production of excess thyroid hormone.

An isolated toxic node is a rare form of thyrotoxicosis. The nodule is a benign group of cells that produces excess thyroxine and can be detected by scanning using radioisotope tracers.

Multinodular goiter is observed mainly in menopausal women. Characterized by chronic enlargement of the thyroid gland, in which part of the goiter degenerates, degenerating into fibrous and colloidal connective tissue. The nodes produce excess thyroxine, which gives clinical manifestations of thyrotoxicosis, which is why the nodes are called toxic.

In all forms of an overactive thyroid, excess thyroxine production can cause feelings of heat, excessive sweating, increased heart rate, tremors, irritability, or mood swings. Sometimes there are changes in the frequency of bowel movements and menstrual irregularities.

Physical symptoms

Patients with Graves' disease (Graves' disease) often experience exophthalmos (bulging eyes) and swelling of the eyelids in addition to the symptoms mentioned above. This can cause double vision and, very rarely, blurred vision as a result of increased pressure on the optic nerve. Such changes are characteristic only of Graves' disease.

In elderly patients, thyrotoxicosis causes tachycardia and heart rhythm disturbances, which may be accompanied by respiratory failure (a consequence of heart failure). Children with this condition may experience accelerated growth or behavioral problems such as hyperactivity.

Diagnosis and treatment of overactive thyroid gland

Diagnosis of an overactive thyroid gland is usually based on the described combination of clinical manifestations. It is confirmed by a blood test for thyroid hormone levels. In some cases, ultrasound and/or radioisotope scanning of the thyroid gland may be necessary during the initial examination.

There are three treatment options used for gland hyperfunction:

• antithyroid drugs;
• radioactive iodine preparations;
• surgery.

Choice specific method Treatment depends on the clinic's capabilities and patient preference.

The patient's age and other medical conditions should also be taken into account.

For patients with Graves' disease, treatment with radioactive iodine is the best option. It is safe, effective and can quickly correct excess thyroxine production. Previously, it was prescribed only to women who already had the desired number of children, or to men. However, at present, treatment with radioactive iodine can be safely used for younger patients who are planning a pregnancy no earlier than a year after treatment.

Antithyroid drugs include carbimazole and propylthiouracil. Both can cause skin irritation or, less commonly, reversible bone marrow suppression. Treatment is usually carried out for 12 months. In approximately 40% of cases, repeat therapy is required.

Surgery for Graves' disease is now rarely resorted to and only in cases where the gland is too large and disfigures the appearance or causes breathing problems.

In patients with extensive multinodular goiter or an isolated toxic nodule, antithyroid drugs are rarely effective. In such cases, radioactive iodine or, in some cases, surgery is usually recommended.

Underactive thyroid gland

Decreased thyroxine production causes the patient to gain weight, feel cold, tired, lethargic and depressed.

Lethargy and general fatigue are very common clinical signs of many diseases, but in some cases a specific cause of fatigue can be called a decrease in the activity of the thyroid gland. It is also known as hypothyroidism (hypo means decreased or insufficient). The syndrome caused by a lack of thyroid hormones in this pathology is called hypothyroidism. It affects about 2% of women and only 0.1% of men. Globally, the most common cause of hypothyroidism is a lack of iodine in the diet. IN developed countries this condition usually results from previous treatment for thyrotoxicosis or autoimmune diseases. Hypothyroidism most often affects women over 50 years of age.

In younger women, this may be a consequence of autoimmune diseases, in which antibodies are present in the blood that attack the thyroid gland, which suppresses the normal production of thyroxine.

Treatment

Drug treatment of patients with hypothyroidism involves lifelong administration of synthetic thyroxine. The use of this hormone helps return the metabolism to its normal state. The patient has an annual blood test to monitor his condition and determine the need for dose changes. In elderly people with heart disease, the dose of thyroxine is increased gradually to avoid heart problems.

Symptoms and diagnosis

Typical symptoms of an underactive thyroid include:

• weight gain;
• tissue swelling - water retention in tissues, most noticeable on the skin of the eyelids and hands;
• hair loss;
• change in voice, which becomes hoarse, slow and monotonous;
• eyebrow loss;
• muscle weakness;
• lethargy;
• hypertension - high blood pressure;
• cold intolerance;
• constipation

Due to increasing attention to this disease, patients with a profound decrease in the level of activity of the gland (myxedema) are now quite rare. The diagnosis of thyroid deficiency is confirmed by a simple blood test.

The concentration of both thyroid hormones and thyrotropin, a hormone secreted by the pituitary gland in response to a decrease in thyroxine concentration, is measured. If the thyroid gland is underactive, the concentration of thyroid hormones will be low, while the concentration of thyrotropin will be high.

Human body. Outside and inside. №16 2008

A large number of conditions in which a person pays attention to the thyroid gland are diseases. But the borderline state also requires due attention so as not to lead to advanced pathology.

The thyroid gland, which is located in the neck and is shaped like a butterfly, can have a dramatic effect on huge number functions of the body, and if you are a woman over 35, then you have a high risk of thyroid disease - according to some estimates, more than 30%. Women have thyroid problems 10 times more often than men.

Thyroid gland

Located above the Adam's apple, this gland produces a specific hormone - thyroid hormone (TH), which regulates, among other things, your body temperature, metabolism and heart rate.

Problems can start when your the thyroid gland is overactive or, conversely, underactive. If the thyroid gland is weak, then it produces too little TN, but if it is overactive, then it produces too much.

What can cause the thyroid gland to fail? These could be genetic causes, autoimmune attacks, pregnancy, stress, poor nutrition or environmental toxins, but experts are not so sure. Since the body is full of thyroid hormones - from the brain to the intestines - diagnosing the disease can be a difficult task.

Signs that your thyroid is not working well.

1. Your strength is depleted

Feeling tired and lacking energy has many causes, but they all have to do with hypothyroidism - a disease in which insufficient thyroid hormones are produced. If you still feel tired in the morning or throughout the day after a night's sleep, this may indicate that your thyroid may be underactive. If there is too little thyroid hormone circulating in your bloodstream and cells, it means your muscles are not getting the signals to start working. “The first signal I see is fatigue,” says Dr. Miller.

2. You're depressed

Unusual feeling depressed or sad can also be a symptom of hypothyroidism. Why? Because by producing too little hormone, the thyroid can affect levels of the “feel good” neurotransmitter, serotonin, in the brain. If the thyroid gland is not active enough, then other systems of the body also “slide”, and therefore it is not surprising that our mood also drops.

3. Nervousness and anxiety

Feelings of anxiety are associated with hyperthyroidism, when the thyroid gland produces too much thyroid hormone. Overflowing with constant signals " all systems- forward!", your metabolism and entire body may become overstimulated. If you feel as if you can't relax, your thyroid may be overactive.

4. Appetite and taste preferences have changed

An increased appetite may indicate hyperthyroidism, where too much hormone production can cause you to experience hunger constantly. The only difference and, one might say, “plus” of this is that in this case, problems with the thyroid gland due to its hyperactivity compensate for the use of excess calories due to increased appetite, so the person ultimately does not gain weight. On the other hand, an underactive thyroid gland can create confusion in your perception of tastes and smells.

5. Fuzzy thinking

Of course, unclear thinking can be a consequence of lack of sleep or aging, but cognitive abilities can also take a significant hit as a result of problems with the thyroid gland. Too high levels of thyroid hormones (hyperthyroidism) can make it difficult to concentrate, while too low (hypothyroidism) can lead to to forgetfulness and “foggy thinking.”“When we treat patients for hypothyroidism, they are often surprised at how quickly their brain fog goes away and how much more alert their senses become,” says Dr. Miller. “Many women think it’s something that comes with menopause, when in fact it’s a thyroid problem.”

6. Loss of interest in sex

Weak or lack of interest in sex may be a side effect of thyroid disease. Low hormone levels can cause low libido, but overall impact Other hypothyroid symptoms - lack of energy, body pain - may also play a role in this issue.

7. Everything is shaking before my eyes

This "shaking" may occur due to increased heart rate. You may feel like your heart is fluttering or skipping a beat, or beating too hard or too fast. You can also notice these sensations on your wrist or at the pulse points on your throat or neck. Heart palpitations or palpitations may be a sign that your system is flooded with hormones (hyperthyroidism).

8. Dry skin

Dry skin, if it also itches, may be a sign of hypothyroidism. Changes in skin texture and appearance are most likely due to a slower metabolism (caused by low hormone levels), which can reduce sweating. Without enough fluid, skin can quickly become dry and flaky.. Besides, nails become brittle and voluminous longitudinal stripes appear on them.

9. The intestines began to work unpredictably

People with hypothyroidism sometimes complain of constipation. Insufficient functioning of the thyroid gland causes a slowdown in digestion processes. "There's no movement in your bowels," says Dr. Miller. “This is one of the three main symptoms of hypothyroidism that I see.” On the other hand, too much activity of the thyroid gland can cause diarrhea or more frequent bowel movements. All of these can be signs of hyperthyroidism.

10. The frequency of menstruation has changed

Longer menstrual periods with more bleeding and pain can be a sign of hypothyroidism, where not enough hormones are produced. The periods between menstruation may become shorter. In hyperthyroidism, high levels of TH cause various types of Irregularity of menstruation. Periods are shorter or longer, menstruation may occur in very small quantities. “I always ask my patients about their cycles and their regularity,” says Dr. Miller. She discovered a close relationship between irregular cycles and problems with the thyroid gland. And if your periods are very difficult, then she also checks for anemia.

11. Pain in limbs and muscles

Sometimes such pain is explained by increased work of muscles and limbs. However, if you feel causeless and unexpected tingling, numbness or just pain - in the hands, feet, legs or arms- this may be a sign of hypothyroidism. Over time, insufficient levels of thyroid hormones can destroy the nerves that send signals from your brain and spinal cord all over the body. This is expressed in such “inexplicable” tingling and pain.

12. High blood pressure

Increased blood pressure may be a symptom of thyroid disease. This may be due to either hypothyroidism or hyperthyroidism. According to some estimates, people with hypothyroidism have 2-3 times higher risk of developing hypertension. One theory is that low amounts of thyroid hormone can slow the heartbeat, which can affect the force of blood pumping and the flexibility of blood vessel walls. Both can cause high blood pressure.

13. Temperature at zero

Feeling cold or chills may have roots in hypothyroidism. Inactivity of the body's systems due to low hormone levels means there is less energy in the body to be burned by the cells. Less energy equals less heat. On the other hand, an overactive thyroid gland causes cells to burn too much energy. This is why people with hyperthyroidism sometimes feel fever and sweat profusely.

14. Hoarseness and strange sensations in the neck

Changes in voice or feeling of a “lump in the throat” may be a sign of problems with the thyroid gland. One way to check is to take a good look at your neck for any signs of an enlarged thyroid. You can check your thyroid gland yourself by following these recommendations: Take a mirror in your hand and, looking at your throat, drink water. Your job is to watch for any lumps or protrusions in the thyroid area, which is located below the Adam's apple and above the collarbone. You may have to do this several times to understand where the thyroid gland really is. If you notice any bumps or anything suspicious, consult a doctor.

15. Problems with sleep mode

Do you want to sleep all the time? This may be due to hypothyroidism. An underactive thyroid can slow down your body's functions to the point that sleeping (even during the daytime) may seem like a brilliant idea. Can't sleep? This may be due to hyperthyroidism. High level hormones can result in anxiety and increased heart rate, which can make it difficult to go to sleep or even cause waking up in the middle of the night.

16. Weight gain

Plus two clothing sizes - there are so many reasons for this circumstance that it is unlikely that your doctor will consider weight gain as a symptom of a potential thyroid disease. However, weight gain is one of the main signals for the need to check the thyroid gland for Dr. Miller. “Patients report that they are not eating more than usual, but they are still gaining weight,” she says. “They do the exercises, but nothing changes. They can't reset it." Almost always the cause is the thyroid, says Miller. On the other hand, unexpected weight loss may signal hyperthyroidism.

17. Hair is thinning or falling out

Dry, brittle hair or even hair loss can be a sign of hypothyroidism. Low hormone levels disrupt the hair growth cycle and put many follicles into “rest” mode, resulting in hair loss.“Sometimes even all over the body, including the eyebrows.” “A lot of patients talk about hair loss,” Miller says. They say, “My hairdresser says I’m losing hair and I need to ask the doctor about the condition of my thyroid." Hair salons are more knowledgeable about thyroid problems than some doctors!“ Excess thyroid hormones can also affect the amount of your hair. Symptoms of hyperthyroidism, which are reflected in the hair, are usually expressed as in thinning hair only on the head.

18. Problems with pregnancy

If you have been trying to get pregnant for a long time without success, this may be due to an excess or deficiency of thyroid hormones. Difficulty conceiving are associated with a high risk of undiagnosed thyroid problems. Both hypothyroidism and hyperthyroidism can interfere with the ovulation process, which affects your ability to conceive. Thyroid diseases also lead to problems that arise during pregnancy.

19. High cholesterol

High levels of low-density lipoprotein (LDL) that are unaffected by diet, exercise, or medications may be related to hypothyroidism. Increased levels of “bad” cholesterol" may be caused by a “malfunction” of the thyroid gland and be a cause of concern. If hypothyroidism is left untreated, it can lead to heart problems, including heart failure.

Who should have their thyroid checked regularly?

Starting from the age of 35, every person should undergo a thyroid examination every 5 years. People with increased risk thyroid diseases, as well as those who have symptoms of thyroid diseases, should be examined more often. Thyroid problems most often occur in women aged 60 years.

Thyroid self-examination

Stand in front of a mirror, take some water into your mouth, tilt your head back, and when you take a sip, pay attention to your neck below the Adam's apple and above the collarbone. There should be no bulges or swelling. Repeat this procedure several times if you notice something, you need to see a doctor!

Diagnosis of thyroid diseases

If you have one or more of these symptoms and suspect a thyroid problem, contact your doctor and ask for tests for:

• thyroid stimulating hormone (TSH),
• free triiodothyronine (fT3),
• free thyroxine (fT4),
• do an ultrasound of the thyroid gland

Blood test will measure the level of thyroid-stimulating hormone (TSH), which regulates the functioning of the thyroid gland.

If TSH high- thyroid function is too low (hypothyroidism).

If TSH is low, this means an overactive thyroid gland (hyperthyroidism).

Based on the test results, symptoms and examination, you may be prescribed synthetic hormones. Testing and prescribing treatment for thyroid disease can involve some trial and error, so be prepared to visit your doctor several times to get your treatment. correct dosage. In some cases, the doctor may prescribe and thyroid biopsy.

The thyroid gland is an important organ of the human body that controls many organs. Thyroid activity should be normal. Deviations from the norm in the functioning of the thyroid gland, both in the direction of increasing and decreasing activity, are dangerous for a person. Under unfavorable conditions and certain diseases, the load on the thyroid gland increases. To cope with the increased load, the body increases the activity of the gland, because he needs more hormones that participate in the body’s metabolic processes and also provide a person with energy.

Thyroid hormones

There are several thyroid hormones that, once produced, enter the bloodstream. These include the following hormones:

• thyroxine is the main hormone of the thyroid gland, which regulates energy metabolism in the body, synthesizes proteins, and is also responsible for growth and development;
• triiodothyronine - this hormone is formed in the thyroid gland itself, as well as in the liver and kidneys under its influence; it also carries out energy metabolism (oxygen absorption by tissues);
• calcitonin is a thyroid hormone that regulates the amount of calcium and phosphorus in the body, which must be balanced; calcium is responsible for the normal structure of bones, and phosphorus is responsible for conducting impulses through tissues.

Possible thyroid conditions

There are three possible conditions of the thyroid gland according to the degree of activity of its work.

• Euthyroidism is a condition in which the thyroid gland produces a normal amount of hormones.
• Hyperthyroidism is a pathology of the thyroid gland in which the organ produces an excessive amount of hormones.
• Hypothyroidism is pathological condition, in which the thyroid gland produces insufficient amounts of hormones.

All these conditions are caused by the influence of the autonomic nerve centers. Most often, thyroid diseases are associated with hypothyroidism and hyperthyroidism.

Decreased gland activity

Reduced activity of the thyroid gland can be caused by various diseases, removal of part of the thyroid gland. The most common cause of the development of hypothyroidism (lack of hormones as a result of decreased thyroid activity) is thyroiditis, which can be congenital or acquired as a result of autoimmune disorders in the patient’s body. The second common cause of hypothyroidism is endemic goiter. Lack of iodine in the body provokes various diseases and, as a result, a decrease in the production of thyroid hormones.

Hypothyroidism is accompanied by symptoms such as fatigue, drowsiness, disruption of the gastrointestinal tract, memory loss, and attention. Possible depressive, apathetic state, accompanied by tearfulness and emotional instability. Most manifestations are associated with a decrease in metabolism in the body. Gradually, the functioning of many organs (for example, the organs of the reproductive system) is disrupted. An overactive thyroid gland leads to serious diseases that require long-term treatment.

Increased gland activity

An overactive thyroid gland or hyperthyroidism may be associated with diffuse toxic goiter, the formation of multiple nodules in the thyroid gland, or other thyroid diseases. Most often, the pathology is associated with an excess of iodine in the body, which provokes various diseases and increased thyroid activity. Usually this is a diffuse or nodular toxic goiter.

The functioning of the thyroid gland is controlled by the pituitary gland and hypothalamus, as a result of dysfunction of which there is an increase in the activity of the gland and excessive production of hormones. Hyperthyroidism can be a reaction to stress, mental overload, and also a consequence of exacerbation of diseases of other organs.

The clinical picture is as follows: weight loss, increased sweating and body temperature, rapid heartbeat, tearfulness, irritability, etc. Excessive activity of the thyroid gland can, like an inactive state of the gland, lead to dangerous diseases. This is especially true for children whose bodies have not fully developed.

Both hyperactivity and decreased thyroid function require mandatory treatment, which is most often carried out in the form of drug hormonal therapy. Further progression of the pathology leads to the need for surgical intervention.