1.What is hypothyroidism? Please popularize the knowledge about hypothyroidism? The full name of hypothyroidism is hypothyroidism, which means that the thyroid gland cannot produce enough thyroid hormone to meet the normal needs of the human body due to various reasons. The symptoms of hypothyroidism include fear of cold, decreased sweating, dry skin, impassive expression, slow heart rate, loss of appetite, dry stools and fatigue. The prevalence of clinical hypothyroidism is about 1%, and is more common in women than in men, with the prevalence increasing with age. Hypothyroidism that begins in the fetus or newborn is called cretinism; in prepubertal children, it is called juvenile hypothyroidism; and in adults, it is called adult-type hypothyroidism. In severe cases, it can cause mucous edema, and in more serious cases, it can cause mucous edema coma. 2.Will hypothyroidism be hereditary? Hypothyroidism is mostly an autoimmune disease, autoantibodies are formed in the acquired environment, the premise is antigen invasion. However, why some people produce antibodies after bacterial and viral infections, while others do not, suggesting that there is a certain genetic susceptibility, i.e., some people are particularly sensitive to certain antigens, and antibodies will be produced once they come into contact with them. This genetic susceptibility may be inherited. (Note that it is not a genetic disease, but a sensitivity to antigens). Taking this a step further, hypothyroidism is a polygenic disease where the genetic susceptibility, as well as the onset of the disease, is determined by a combination of multiple gene loci, which raises the issue of probability. For example, if 50 genes are associated with that susceptibility, as soon as 35 genes are passed down, the offspring develops the disease. Assuming the mother has the disease and carries 36 genes, and she passes on half of the genes to her offspring, 18 genes, and the father does not have the disease and is less than 35 genes, if he passes down 17 genes, the offspring will have 18 + 17 = 35 susceptibility genes, and will be susceptible to the disease. If the father passes down 16 relevant genes, the offspring will have 18+16=34 susceptibility genes and will not develop the disease. Therefore, it is difficult to say whether it is hereditary or not, and the probability of heredity has yet to be further studied. 3.How to treat hypothyroidism and what are the precautions for treatment during pregnancy? Treatment of hypothyroidism: The general principle is that hypothyroidism is treated with replacement therapy. The amount of replacement needs to be individualized according to the degree of hypothyroidism and the patient’s own condition. For mild hypothyroidism, no special treatment is needed, and dietary therapy can be used to supplement iodine, the raw material for thyroid hormone production, by eating some seafood (this applies to patients with low antibodies); while for moderate or severe hypothyroidism, thyroid hormone replacement therapy must be used. Of course, the specific dosage needs to vary from person to person, young patients should regularly review the thyroid function, according to the indicators, adjust the medication, generally recommended to control the sTSH at less than 2.5IU/ml, the optimal range of 1-2. Elderly patients do not require too much supplementation, as long as the sTSH is controlled to be within the normal level. Hypothyroidism is generally irreversible and requires lifelong replacement therapy. Precautions during pregnancy: patients with hypothyroidism who have not been treated with isotope therapy within six months can become pregnant after their thyroid function is normalized. Pregnant mothers need to monitor the thyroid function every month and adjust the drug dosage in time to ensure the safety of the fetus and the mother. The most important thyroid function is FT4, because only Ft4 can pass through the placenta and supply the needs of fetal development. Ft3 and TSH cannot pass through the placenta, so they are only corrective indicators. The requirement for maternal Ft4 in pregnancy is to adjust to the normal midline or above to ensure adequate Ft4 for fetal development, which requires a TSH below 2.5. Especially in the first 3 months of pregnancy, which is a critical period for fetal neurological development. Since Ft4 is 0.02% of total T4, the measurement error is large and is corrected by TSH. as soon as 1 of Ft4 and Ft3 is elevated, TSH is lowered; if TSH is high, it means that neither Ft3/Ft4 is high, although Ft4 measurements may be in the normal range. The thyroid hormone replaced during pregnancy must be pure T4 (e.g., Euthyrox – levothyroxine T4), and thyroid tablets are not recommended because they are dried and ground animal thyroid glands, which contain both T4 and T3. more T3 supplementation results in a drop in TSH, which masks the lack of Ft4. Also during pregnancy, total T3 total T4 is elevated because TBG (Thyroid Binding Globulin) is elevated in pregnancy. Total T4 is 1.5-2 times higher when pregnant than when not pregnant. After 6-7 months of pregnancy, as the fetus develops and grows, the amount of Ft4 needed gradually increases, and the amount of euglycemic (L-T4) supplementation must be gradually increased at this time to ensure that the TSH is below 2.5. Therefore, it is necessary to check the nail function every month. 4.What are the symptoms of hypothyroidism and can I check myself? Hypothyroidism can be self-tested. When the following ten symptoms occur, consider the possibility of hypothyroidism, and recommend to go to the hospital for medical treatment: easy to be sleepy, low physical strength and energy; slow thinking, hard to concentrate, memory loss; weight gain; dry skin; nails become brittle, gray, easy to break; often feel cold; easy to be depressed; easy to have bowel movements; feel stiff and painful muscles and bones, numbness in the hands, higher blood pressure or slower heartbeat; higher cholesterol levels; and more frequent and more frequent use of the Internet for medical treatment. Slowed down; increased cholesterol level; etc. 5. How to prevent hypothyroidism, e.g. from diet, medicine, etc.? Causes of cretinism: In endemic cretinism, iodine deficiency in pregnant women during the embryonic period leads to insufficient production of thyroid hormones in the mother, and the fetus does not get sufficient supply of these hormones is the key to the development of cretinism. Pregnant women who are not positive for other antibodies and who are simply iodine deficient can be treated with iodine supplementation (eating more iodine-containing foods) – for mild cases – or with a finished product (eugenol, L-T4) – for both mild and moderate cases. Sporadic cretinism, most often caused by certain autoimmune thyroid disorders in pregnant women, identify the cause for prevention. Hyperthyroid mothers taking antithyroid medications during pregnancy try to avoid overdosing to prevent hypothyroidism from developing, consider adding euglycemic if necessary, and keep the TSH below 2.5, preferably between 1 and 2. And avoid other goiter-causing drugs. Hypothyroid mothers must be supplemented with eugenol during pregnancy to keep the TSH below 2.5, especially during the first trimester. The need for dietary iodine supplementation depends on the cause of the hypothyroidism. In the case of hypothyroidism after treatment of hyperthyroidism with isotope therapy, pregnant women who remain TRAb positive during pregnancy should avoid an iodine diet. After all, what the fetus needs is mainly the mother’s finished thyroxine (FT4) rather than iodine. Otherwise, it is easy to cause the recurrence of hyperthyroidism, or the fluctuation of the need for eugenol, which is not suitable for control. Iodine is not contraindicated if the hypothyroidism is caused by other reasons and TRAb is negative. Prevention of adult hypothyroidism: timely treatment of thyroid diseases that easily cause hypothyroidism, such as Hashimoto’s thyroiditis, even if the thyroid function is normal at that time, due to the antibody is still positive, it will continue to destroy the thyroid gland, and ultimately lead to hypothyroidism, so it is necessary to adjust the immune system, lower the antibody, and eliminate the factor that destroys the thyroid gland at an early date. For example, in sub-thyroiditis, viral destruction leads to rupture of a large number of thyroid follicles, which can be painful, while some patients eventually lead to hypothyroidism. Therefore, in the course of treatment, in addition to symptomatic pain relief, early use of hormones, stabilize the thyroid cell membrane, reduce rupture, to prevent future hypothyroidism. It is also necessary to treat the root cause, anti-inflammatory and anti-viral, get rid of the antigen, and reduce the immune response from the source. For hypothyroidism caused by surgical treatment of thyroid disease or radioactive 131 iodine treatment of hyperthyroidism, due to surgical removal or isotope destruction of part of the thyroid follicles (like a factory for producing thyroid hormone), the remaining thyroid gland is not enough to produce enough hormones for the normal use of the body, and exogenous thyroid hormone (eugenol, L-T4) is needed to make up for it. All moderate or higher hypothyroidism requires lifelong eugenol replacement. 6.What do I need to pay attention to in terms of diet after having hypothyroidism? The occurrence of hypothyroidism has a great relationship with diet and nutrition. (1) Supplement the right amount of iodine (kelp, nori, iodized salt, iodized soy sauce, iodized eggs and bread with iodine), avoid using goiter-generating substances (such as cabbage, cabbage, oilseed rape, cassava, walnuts, etc.). It should be noted that, for hyperthyroidism isotope treatment of hypothyroidism, TRAb is still positive, it is necessary to avoid iodine; Hashimoto’s thyroiditis patients will have an increase in antibodies after taking high iodine foods, so do not avoid iodine, but also not encouraged to eat more. (2) Supply sufficient protein (eggs, dairy, various meats, fish; plant proteins can be complementary, such as various soy products, soybeans, etc.). (3) Limit fat and cholesterol-rich diets (cream, animal brains and offal). (4) Supply rich vitamins. 7. Can I get pregnant if I have hypothyroidism? If you have hypothyroidism, you can get pregnant as long as you take enough supplements (normal thyroid function), and you have to take enough thyroid hormone supplements all the time during pregnancy, and you need to monitor your thyroid function every month because as the fetus grows up, the amount of Ft4 you need increases every month, and your thyroid function changes every month, so you need to make adjustments in time. In hypothyroidism, the synthesis of thyroxine is insufficient, and the body is not easy to conceive. Even if you are pregnant, because thyroid hormone is necessary for growth and development, insufficient early pregnancy will cause fetal neurological development disorders, resulting in cretinism; hypothyroidism in the second trimester of pregnancy, the growth and development of the fetus is delayed. So hypothyroidism to get pregnant, the premise is to make up enough thyroid hormone. If you make up enough, you will be the same as normal people. 8.Can hypothyroidism be completely self-healing? Thyroid follicular cells is the production and storage of thyroid hormone factory shop, a variety of reasons for the destruction of the thyroid gland, such as post-surgery hypothyroidism (surgery to remove part of the thyroid tissue), isotope hypothyroidism (radioactive destruction of part of the thyroid tissue, surgery without surgery), Hashimoto’s thyroiditis (antibody damage to part of the thyroid tissue), sub-thyroiditis (viral damage to part of the thyroid tissue), have led to the production of Thyroid hormone in fewer factory floors. Destroyed thyroid follicles are irreversible and can only be replaced by what is left. If there is little destruction, the remaining thyroid cells can compensate and the thyroid function will still be normal. Destroyed more, even if the compensation, the remaining thyroid gland desperately production, but also not enough to replace, thyroid function will show hypothyroidism, will need to external aid of thyroid hormone life-long replacement. Hyperthyroidism antithyroid medication overdose leads to medicated hypothyroidism, which is restored when the medication is reduced. Because the drug did not destroy the thyroid cells (factory floor), just inhibit the synthesis of thyroid hormones (so that the machine to turn slower, less production), the drug to reduce the amount of production will be restored, so the drug hypothyroidism is reversible. 9, the main difference between hypothyroidism and hyperthyroidism? Hyperthyroidism is a clinical syndrome caused by a variety of etiologic factors that increase thyroid function and secrete too much thyroid hormone. Hypothyroidism is a systemic endocrine disease caused by a variety of causes of thyroid hormone synthesis, secretion or physiological effects of insufficient. 10.Can patients with hypothyroidism breastfeed? Patients with hypothyroidism can breastfeed and it has little effect on the baby. The amount of thyroid hormone passing through breast milk is very small, and Eugenol replacement is only to replace the normal level of thyroid function, after delivery can be normal breastfeeding. Generally, hypothyroid patients take eugenol replacement when pregnant. During pregnancy, Ft4 requirements gradually increase as the fetus grows, peaking just before delivery. Once delivery occurs and the fetus that was sharing Ft4 in the body has left, maternal thyroid hormones may increase or even become excessive. Therefore, it is recommended to review the thyroid function once after 48-72 hours after delivery (when the mother reaches equilibrium) and adjust the dose of eugenol in time. While hyperthyroidism occurs during breastfeeding in patients with hypothyroidism, regardless of the overdose of Eugenol or the recurrence of true hyperthyroidism, the amount of T4 contained in the breast milk will increase, and the development of the newborn’s own thyroid will be affected, and it is necessary to wait until the thyroid function is normalized before breastfeeding.