Hypothyroidism (hypothyroidism) is a disease in which the body’s metabolism is reduced due to a decrease in the synthesis and secretion of thyroid hormones or a lack of their physiological effects. According to its etiology, it is divided into three categories: primary hypothyroidism, secondary hypothyroidism and peripheral hypothyroidism. Hashimoto’s thyroiditis is the main cause of primary hypothyroidism, while surgery or isotope therapy is also a common cause of hypothyroidism.
Clinical manifestations
1, pale face, eyelids and cheek swelling, indifferent expression, dry, thickened, rough and flaky skin, non-sunken edema, hair loss, atrophic yellow palms, weight gain, thick and brittle nails in a few patients.
2, memory loss, mental retardation, drowsiness, unresponsiveness, worry, dizziness, headache, tinnitus, deafness, nystagmus, ataxia, blunted tendon reflex, prolonged relaxation period of Achilles tendon reflex, dementia, wood stiffness, and even lethargy in severe cases.
3.Bradycardia, reduced cardiac output, low blood pressure, low heart sound, enlarged heart, may be complicated by coronary artery disease, sometimes accompanied by pericardial effusion and pleural effusion.
4.Anorexia, abdominal distension, constipation. In severe cases, paralytic intestinal obstruction may occur. It leads to pernicious anemia and iron deficiency anemia.
5, muscle weakness, pain, ankylosis, may be accompanied by joint lesions such as chronic arthritis.
6.Female excessive menstruation, long-standing amenorrhea, infertility; male impotence, loss of libido.
In severe cases, mucus edema coma or “hypothyroidism crisis” can be induced by cold, infection, surgery, anesthesia or improper application of sedatives and other stress.
8. Dull expression, muffled pronunciation, periorbital puffiness, widening of the distance between the eyes, collapse of the nasal bridge, thick lips and salivation, large tongue and outstretched limbs, duck walk, mental retardation and delayed sexual development.
Diagnosis
Diagnosis can be made based on the etiology, clinical manifestations and laboratory tests.
1.Thyroid function test
Serum TT4, TT3, FT4, FT3 are lower than normal values.
2.Serum TSH value
(1) In primary hypothyroidism, TSH is significantly elevated and free T4 is decreased at the same time. In subclinical hypothyroidism, serum TT4 and TT3 values can be normal, while serum TSH is mildly elevated.
(2) In pituitary hypothyroidism, serum TSH levels are low or normal or higher than normal and do not respond to TRH excitation tests. Serum TT4 levels are elevated after TSH application.
(3) Hypothalamic hypothyroidism with low or normal serum TSH level and good response to TRH excitation test.
(4) Thyroid hormone resistance syndrome has elevated TSH in central resistance, low TSH in peripheral tissue resistance, and different manifestations of TSH in systemic resistance.
(3) Thyroid ultrasound: In case of Hashimoto’s thyroiditis, the thyroid gland shows diffuse enlargement with uneven echogenic grid-like changes.
Treatment
Thyroid hormone replacement therapy is usually given, mainly oral levothyroxine. Thyroid function is tested regularly to maintain TSH in the normal range. Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disease.
I. Clinical features
1. It is common in young and middle-aged women, with no obvious symptoms in the early stage, and may show symptoms of hypothyroidism in the late stage.
2. Moderate diffuse enlargement of the thyroid gland, usually without pain and pressure.
3, increased blood sedimentation, elevated serum gammaglobulin, positive turbidity, flocculence test.
4. The thyroid gland iodine uptake rate of 131 is normal or may be reduced.
5. Elevated serum immune complexes, positive thyroid autoantibodies (TgAb, TPOAb), and markedly elevated titers.
6. Fine needle aspiration cytology of the thyroid gland shows abundant lymphocytes and also plasma cells.
The disease may coexist with other autoimmune diseases, such as pernicious anemia, systemic lupus erythematosus, rheumatoid arthritis, atrophic gastritis, etc. It may also coexist with hyperthyroidism (Hashimoto-hyperthyroidism), nodular goiter, and thyroid cancer, and thyroid biopsy or surgical exploration may be performed to determine the diagnosis if necessary.
8. This disease needs to be differentiated from thyroid cancer, which is antibody negative. The incidence of thyroid cancer in this disease is reported to be 5%-17% in the literature.
Diagnostic points
1. Middle-aged women with diffuse enlargement of the thyroid gland and tough texture should be considered for this disease regardless of thyroid function.
2, serum TgAb and TPOAb titers are significantly elevated, which can basically confirm the diagnosis.
3. Ultrasound of the thyroid gland shows a diffusely enlarged thyroid gland with uneven echogenicity and grid-like changes.
The stages of Hashimoto’s thyroiditis
Normal thyroid function
In the development of Hashimoto’s thyroiditis, the early stage is not without special sensation and thus is not taken seriously by the patient and is not seen by the doctor. It is often detected during a physical examination. Or, they may seek medical attention for an enlarged thyroid gland.
Hyperthyroidism
In mild cases, patients only have mild symptoms of hyperthyroidism, such as good appetite, easy fatigue, mild insomnia, and irritability. In severe cases, there are obvious symptoms of hyperthyroidism, such as panic, fear of heat and sweating, and hand trembling. Good results can be obtained with treatment, but drug-induced hypothyroidism is also likely to occur. In some cases, the inflammation is reduced and the patient “heals” on its own without treatment. Although some patients with Hashimoto’s thyroiditis have indicators and symptoms of hyperthyroidism in the early or mid-early stages, they should never be treated with surgery or isotope therapy, as this will cause them to become more severely hypothyroid very quickly.
Hypothyroidism
After repeated destruction of the thyroid tissue, the number of cells with normal function gradually decreases, and hypothyroidism symptoms appear at a certain level. In patients with Hashimoto’s thyroiditis, after thyroxine supplementation, although the laboratory indicators are normal, many people feel uncomfortable at times. It is important to pay attention to the characteristics of Hashimoto’s thyroiditis disease in treatment so that misdiagnosis can be avoided.
IV. Treatment
1. Thyroid hormone preparations: When the thyroid function is normal or low, thyroid preparations are available with good results. L-thyroxine can be taken daily, and the specific dose should be based on thyroid function, the degree of goiter, the patient’s age and the cardiovascular system. Generally, the symptoms can be improved after 2 to 4 weeks of medication, at which time the dose can be reduced appropriately to maintain treatment.
2. Anti-thyroid drugs: If there is hyperthyroidism, anti-thyroid drugs can be applied appropriately, but the dose should not be too high, and thyroid function should be monitored to adjust the dose or discontinue the drug in time.
The first thing you need to do is to take a look at the following
If you have a high iodine diet, eating foods like kelp and seaweed with high iodine content will not help your condition, but will also aggravate your thyroid autoimmunity and make your symptoms worse, leading to hypothyroidism. In addition, patients should pay attention not to stay up too late during the illness, avoid too much exertion, etc., but also to maintain a relaxed mood.