1.General condition.
Patient presentation is varied and lacking in specificity, with hypometabolism and hyposympathetic excitation being the main manifestations. Early hypothyroid patients with mild disease can be completely asymptomatic. Typical patients often feel weak, cold, less sweaty, sluggish expression, unresponsive, slow movement, hoarse voice, pale face, puffy face and/or eyelids, broad nose, thick lips and large tongue, and hyperkeratosis of the skin cuticle. The skin appears pale yellow and hair growth is slowed. Peripheral vascular constriction, manifesting pale, cool, dry, thick, flaky, inelastic skin, keratinized hair follicles, sparse hair loss, loss of the outer 1/3 of the eyebrows, brittle and thickened finger (toe) nails.
2. Cardiovascular system.
When thyroid hormone is low, physical examination reveals that the patient has a slow and weak heartbeat, low heart sounds, enlarged heart, bradycardia, swelling of the lower limbs, elevated blood pressure, and reduced pulse pressure difference. Myocardial pseudohypertrophy, electrocardiogram shows low voltage, and sinus bradycardia. About 30% of patients have pericardial effusion and, in severe cases, pleural or abdominal effusion.
Professor Zhong Xueli of Shanghai Medical University proposed the following definition of hypothyroid heart disease.
(1) Hypothyroidism;
(2) heart enlargement (bradycardia, low voltage, low and/or inverted T waves) except for other causes;
(3) Cardiac changes improve or disappear after thyroid hormone replacement therapy.
The diagnosis of hypothyroid heart disease is more favorable if the patient has pericardial effusion or prolonged systolic time interval (STI) of the heart.
3. Respiratory system.
Pulmonary function is mostly normal when hypothyroid patients are quiet, a few patients have impaired ventilation, and serious cases can cause sleep apnea syndrome. Hypothyroidism combined with obesity often has alveolar hypoventilation disorder, and cerebral hypoxia is an important cause of coma in mucinous edema.
4. Gastrointestinal system.
Smooth muscle tone of esophagus, stomach, gallbladder, small intestine and colon is weakened, gastrointestinal peristalsis is slow, emptying time is prolonged, gastric acid secretion is reduced, and serum anti-gastric wall cell antibody is positive. Patients show loss of appetite, abdominal distension, nausea, little gastric acid, and difficulty in defecation.
5. Neuropsychiatric system.
Due to hypometabolism and reduced sympathetic excitability, patients show memory loss, especially significant forgetfulness of recent events, inability to concentrate, and reduced comprehension and calculation ability. Older patients with hypothyroidism often have depression, the lighter the expression is indifferent, depression does not speak; serious manifestations of mental disorders, delusions, hallucinations, disobedience, and even stiffness, dementia and epileptic-like seizures, should draw attention.
6, muscle and joint.
Hypothyroid patients show clinical weakness, muscle pain, tonicity, spasm, edema and hypertrophy, elevated serum CPK, LDH and AST, and isoenzymes mainly from the transverse muscle. Achilles tendon reflex relaxation period is significantly prolonged in hypothyroid patients, but not sensitive enough.
7. Hematological system.
Approximately 25% of hypothyroid patients exhibit anemia, mostly mild or moderate normochromic or hypochromic microcytic anemia and a few macrocytic anemia.
The causes of decreased erythropoiesis are: (1) decreased renal erythropoietin due to decreased metabolism and reduced oxygen consumption, (2) the effect of hypothyroidism on erythropoietic precursors, (3) hypothyroid patients are mostly women with increased menstruation, and (4) lack of gastric acid and impaired absorption in the gastrointestinal tract.
Some hypothyroid patients (about 12%) also exhibit macrocytic anemia, positive antibodies to gastric lining cells or internal factor antibodies, vitamin B12 or folic acid deficiency, and macrocytic anemia.
8. Growth and development.
Thyroid hormone has a permissive effect on growth hormone, and thyroid hormone deficiency will affect the growth-promoting effect of growth hormone. Children with hypothyroidism often show growth retardation, slow epiphyseal healing, and delayed bone age. Adolescents with hypothyroidism show delayed sexual development, and a few show true precocious puberty, the cause of which is unknown.
9. Other.
The lack of thyroid hormone will lead to accelerated transformation of E2→E3, female patients show heavy menstruation, prolonged menstruation, and less easy to conceive, and men show reduced libido; some female patients with hypothyroidism are triggered to lactate due to increased prolactin; thyroid hormone prompts the liver to produce sex hormone binding globulin (SHBG), and thyroid hormone The lack of thyroid hormone causes SHBG to decrease and free testosterone to increase, causing hirsutism.