scholarly journals Hypothyroidism: current state of the problem

2020 ◽  
pp. 96-107
Author(s):  
E. V. Biryukova ◽  
D. V. Kileynikov ◽  
I. V. Solovyeva
Keyword(s):  
Kinase Inhibitors ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Pathological Process ◽  
Primary Hypothyroidism ◽  
The Body ◽  
Hormone Deficiency ◽  
Side Reactions ◽  
Secondary Hypothyroidism

The article presents the issues of epidemiology, classification, and clinic of hypothyroidism. The frequency of hypothyroidism increases significantly with age. The most common form is primary hypothyroidism, caused by a pathological process in the thyroid gland itself. Secondary hypothyroidism or tertiary hypothyroidism is caused by insufficient secretion of thyroid- stimulating hormone (TSH), or thyrotropin-releasing hormone. The article deals with the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both separately and simultaneously with other autoimmune diseases, as part of polyglandular syndrome. Special attention should be paid to the change of thyroid status as a result of adverse side reactions when using a range of drugs. The questions about the mechanisms of thyroid insufficiency development as a result of unfavorable side reactions when using a number of drugs (lithium preparations, iodine-containing compounds, tyrosine kinase inhibitors, etc.) have been raised. Undiagnosed hypothyroidism is a risk factor for the progression of already existing cardiovascular diseases. The severity of clinical manifestations is determined by the severity of thyroid hormone deficiency. There are no significant clinical differences between the pronounced forms of primary and secondary hypothyroidism. Depending on the degree of lesion, secondary hypothyroidism may be complicated by other manifestations of hypothalamic-pituitary disorders, as well as the latter may include a decrease in the secretion of antidiuretic hormone at a certain stage of their development. Diagnostic difficulties are discussed, as hypothyroidism disrupts the functioning of most organs and systems of the body (musculoskeletal, cardiovascular, urinary, gastrointestinal, central and peripheral nervous systems) and can be masked by various diseases. The final diagnosis of hypothyroidism is clarified by a number of laboratory and instrumental studies. Substitution therapy with levothyroxine is used to treat hypothyroidism of any etiology.

scholarly journals SECONDARY HYPOTHYROIDISM: CURRENT APPROACHES TO DIAGNOSIS AND TREATMENT

2017 ◽  
pp. 64-67
Author(s):  
T. A. Gavrilova ◽  
T. B. Morgunova ◽  
V. V. Fadeev
Keyword(s):  
Thyroid Hormone ◽  
Replacement Therapy ◽  
Thyroid Function ◽  
Clinical Manifestations ◽  
Primary Hypothyroidism ◽  
Free Thyroxine ◽  
Diagnosis And Treatment ◽  
Hormone Deficiency ◽  
Secondary Hypothyroidism ◽  
Peripheral Markers

Secondary hypothyroidism is a very rare cause of hypothyroidism in adults. Clinical manifestations of secondary as well as primary hypothyroidism are nonspecific; in addition, thyroid hormone deficiency often clinically simulates other tropic hormone deficiencies, thus complicating timely diagnosis of the disease. Certain difficulties are also caused by replacement therapy in secondary hypothyroidism, since the level of free thyroxine in the blood is used as the criterion for evaluating levothyroxine dosage, and questions about the use of peripheral markers of thyroid function to assess the adequacy of therapy remain understudied.

scholarly journals MANAGEMENT OF CASE OF PRIMARY HYPOTHYROIDISM ON THE PRINCIPLES OF DHATWAGNIMANDYA - A CASE REPORT

2021 ◽  
Vol p6 (1) ◽  
pp. 3258-3261
Author(s):  
Neetu Sharma ◽  
Shalini Rai ◽  
Sisir Kumar Mandal ◽  
Anand More
Keyword(s):  
Case Report ◽  
Symptomatic Relief ◽  
Clinical Manifestations ◽  
Biochemical Parameter ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Management Approach ◽  
Endocrine Disorders ◽  
Dietary Regimen

Hypothyroidism is a condition caused by thyroid hormone deficiency. It occurs due to hormonal imbalance & decreased metabolism. Clinical manifestations range from no signs or symptoms to life-threatening conditions. In Ayurveda, it corresponds to Dhatvagni Mandya. In this case report the patient presented with puffiness of the face, swelling in both the limbs, muscle (back) pain, loss of appetite, constipation and abnormal weight gain. According to symptomatic presentations, the case was diagnosed as Dhatvagni mandya. Clinical presentation and biochemical parameter i.e., Thyroid Stimulating Hormone (TSH) was 12.07uIU/ml which confirmed the case as Hypothyroidism in modern medicine. The multimodal Ayurvedic management approach incorporating ahara, vihara and aushadha was adopted. The case was treated on the line of principles of Agnimandya. Shaman Chikitsa (pacifying therapy) including internal administration of herbo-mineral formulations such as Arogyavardhini vati, Kanchnaar guggul, Punarnava mandur, Avipattikar churna, Swarna vanga along with a dietary regimen was prescribed to the patient. After 3 months’ treatment, significant symptomatic relief along with reduction of serum TSH level (3.05uIU/ml) without any adverse effects was observed in the patients. It can be inferred from the case that Ayurvedic intervention has enough potential to be employed and utilized in such endocrine disorders. Keywords- Ayurveda, Dhatawagni, Agni, Hypothyroidism, Kanchnar Guggul, Arogyavardhini vati.

The Thyroid Gland: Physiology and Pathophysiology

2000 ◽  
Vol 19 (8) ◽  
pp. 11-26 ◽  
Author(s):  
Denise Kirsten
Keyword(s):  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Laboratory Tests ◽  
Clinical Manifestations ◽  
Thyroid Stimulating Hormone ◽  
The Body ◽  
Premature Delivery ◽  
Follicular Cells ◽  
Metabolic Hormones ◽  
Radiologic Findings

The thyroid gland contains many follicular cells that store the thyroid hormones within the thyroglobulin molecule until they are needed by the body. The thyroid hormones, often referred to as the major metabolic hormones, affect virtually every cell in the body. Synthesis and secretion of the thyroid hormones depend on the presence of iodine and tyrosine as well as maturation of the hypothalamic-pituitary-thyroid system. Interruption of this development, as occurs with premature delivery, results in inadequate production of thyroid-stimulating hormone and thyroxine, leading to a variety of physiologic conditions. Pathologic conditions occur in the presence of insufficient thyroid production or a defect in the thyroid gland. Laboratory tests are important in diagnosing conditions of the thyroid gland. A thorough history in combination with clinical manifestations and radiologic findings are also useful in diagnosing specific thyroid conditions. Nurses play an important role in identifying and managing thyroid disorders and in providing supportive care to infants and their families.

Manifestation of Graves’ disease, resulting from radiosurgical treatment of acromegaly, in a patient with panhypopituitarism

2019 ◽  
Vol 65 (2) ◽  
pp. 101-106
Author(s):  
Ludmila I. Astafyeva ◽  
Pavel L. Kalinin ◽  
Tatyana A. Kienia ◽  
Valentin V. Fadeyev
Keyword(s):  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Graves Disease ◽  
Free T4 ◽  
Disease Manifestation ◽  
Secondary Hypothyroidism ◽  
Residual Tissue ◽  
High Level

Cases of thyrotoxicosis associated with a previous case of secondary hypothyroidism are extremely rare. This article presents a rare clinical case of Graves disease manifestation in a patient with secondary hypothyroidism after radiosurgical treatment of acromegaly. A 38-year old woman presented with acromegaly and endo-supra-laterosellar pituitary adenoma. After non-radical removal of the pituitary adenoma, radiosurgical treatment of the of the residual tissue of the pituitary tumor in the cavernous sinus area was performed. After 14 months of radiation therapy, the acromegaly was in remission; after 24 months of radiation therapy, panhypopituitarism developed (secondary hypothyroidism, adrenal insufficiency, hypogonadism, and growth hormone deficiency). Furthermore, 1.5 years after the panhypopituitarism was diagnosed, the manifestation of Graves disease was also noted, requiring thyrostatic and radioactive iodine treatments. Diagnostic criteria for secondary hypothyroidism are low levels of the thyroid hormones free T4 and free T3, with a reduced, normal or slightly elevated level of thyroid stimulating hormone (TSH). The criterion for the development of thyrotoxicosis in the context of the secondary hypothyroidism was the persistent increase in the level of free T4 despite adequate drug therapy with levothyroxine. In the case report, the patients diagnosis of Graves disease was confirmed by the presence of a high level of antibodies to the TSH receptor.

scholarly journals A study of serum thyroid stimulating hormone levels, and its correlation with clinical features and delayed diagnosis of hypothyroidism in central India

2019 ◽  
Vol 7 (1) ◽  
pp. 176
Author(s):  
Dharmendra Jhavar ◽  
Umesh Kumar Chandra ◽  
Shivshankar Badole ◽  
Anurag Rahekar ◽  
Sumit Vishwakarma
Keyword(s):  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Central India ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Delay In Diagnosis ◽  
High Level ◽  
High Index Of Suspicion

Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order to appreciate the clinical manifestation of the disorder to reach a diagnosis. Purpose of this study was to correlate serum TSH level with severity of clinical manifestations and evaluate possible cause of delay in the diagnosis.Methods: A cross section observational and descriptive study for the assessment of severity of primary hypothyroidism at presentation and evaluation of the causes of delay in diagnosis in 86 patients was done from December 2012 to November 2013 in the Department of Medicine, MGM Medical College, Indore, MP, India.Results: Illiterate patients had significantly (p value 0.002) higher TSH values at presentation. 34.8% of patients presented as severe hypothyroidism with TSH value >100 mIU/L. Delay of as much as 7 years was noted. Majority of patients had a delay of around 1 to 3 years in diagnosis. Only 4.6% patients were diagnosed without any delay due to high level of suspicion at presentation.Conclusions: Due to non-specific symptomatology of hypothyroidism diagnosis is often delayed. Therefore, high index of suspicion is required at the physician’s level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.

Update of hypothyroidism and its management in Unani medicine

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Md. Anzar Alam ◽  
Mohd Aleemuddin Quamri ◽  
Ghulamuddin Sofi ◽  
Shabnam Ansari
Keyword(s):  
Thyroid Hormone ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Developed Countries ◽  
Modern Medicine ◽  
Thyroid Stimulating Hormone ◽  
Clinical Syndrome ◽  
Hormone Deficiency ◽  
Unani Medicine

AbstractHypothyroidism is a clinical syndrome caused by thyroid hormone deficiency due to reduced production, deranged distribution, or lack of effects of thyroid hormone. The prevalence of hypothyroidism in developed countries is around 4–5%, whereas it is about 11% in India, only 2% in the UK, and 4·6% in the USA. It is more common in women than in men. Hypothyroidism has multiple etiologies and manifestations. The most common clinical manifestations are weight gain, loss of hair, cold intolerance, lethargy, constipation, dry skin, and change in voice. The signs and symptoms of hypothyroidism differ with age, gender, severity of condition, and some other factors. The diagnosis is based on clinical history, physical examination and serum level of FT3, FT4, and thyroid-stimulating hormone, imaging studies, procedures, and histological findings. The treatment of choice for hypothyroidism is levothyroxine, however; in this review article, we have discussed the epidemiology, etiology, clinical sign and symptoms, diagnosis, complications, and management of hypothyroidism in modern medicine and a comparative treatment by the Unani system of medicine (USM). In the USM, the main emphasis of the principle of treatment (Usool-e-Ilaj) is to correct the abnormal constitution (Su-e-Mizaj) and alter the six prerequisites for existence (Asbab-e-Sitta Zarooriya) to restore normal health. It is a packaged treatment, that is, different components of treatment are given as a package form which includes different drugs, dosages form, and regimens.

scholarly journals Severe primary hypothyroidism in an apparently asymptomatic 19-year-old woman: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Rania Dannan ◽  
Sulaiman Hajji ◽  
Khaled Aljenaee
Keyword(s):  
Incidental Finding ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Conflicting Evidence ◽  
Thyroid Function Testing ◽  
History Of ◽  
Asymptomatic Individuals ◽  
High Index Of Suspicion

Abstract Background Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. Case presentation We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient’s insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. Conclusion There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.

scholarly journals ETIOTROPIC THERAPY OF INFECTIOUS DIARRHEA

2018 ◽  
Vol 23 (6) ◽  
pp. 301-307
Author(s):  
Murad Z. Shakhmardanov ◽  
V. V. Nikiforov
Keyword(s):  
Small Intestine ◽  
Intestinal Microflora ◽  
Clinical Manifestations ◽  
Subsequent Development ◽  
Pathological Process ◽  
The Body ◽  
Cell Renewal ◽  
Infectious Diarrhea ◽  
Microbial Antagonism ◽  
Infectious Gastroenteritis

The issues of etiotropic therapy of infectious diarrhea require a differentiated approach not only depending on the etiological factor, but also on the type of diarrhea caused by the location of the pathological process. Infectious diarrhea occur in the form of three main types: secretory, osmotic, inflammatory (invasive). Secretory and osmotic type of diarrhea are found in infectious gastroenteritis. In the mechanisms of elimination of infectious gastroenteritis pathogens, the following factors play a leading role: the destructive effect on pathogens in the lumen of the small intestine of trypsin, chemotrypsin and acid duodenal content entering the small intestine; the «killer» action of interepithelial large granular lymphocytes (M-cells) on pathogens; the increase in resistance of the small intestine epithelium under the influence of M-cell cytokines; the difficulty of intercellular distribution of pathogens due to faster than in the gut, small intestine epithelial cell renewal; microbial antagonism of representatives of normal intestinal microflora. The appointment of etiotropic agents in cases of infectious gastroenteritis, at least, suppresses the manifestations of microbial antagonism on the part of representatives of the normal intestinal microflora, creating prerequisites for the delay of the pathogen in the body. The inflammatory type of diarrhoea occurs when invasion of pathogens to the mucosal lining of the colon, with subsequent development of the destructive changes and the possibility of further translocation. Obstacles to adhesion, penetration and intercellular spread of invasive pathogens in the colon mucosa is much less than in the small intestine. Pathogens of the same genera, species and serological variants (e.g. Salmonella, Campylobacter) can cause both secretory and invasive types of diarrhea. However, the appointment of antibacterial therapy will depend on the location of the pathological process. When gastroenteritis etiotropic therapy in most cases is impractical. In the presence of clinical manifestations of colitis, involving the implementation of invasive properties of the causative agent, the appointment of etiotropic treatment is justified.

scholarly journals Thyroid dysfunction in Human immunodeficiency virus infected patients and their correlation with CD4 count

2021 ◽  
Vol 9 (3) ◽  
pp. 745
Author(s):  
Vipin Porwal ◽  
Rajesh Deshpande ◽  
Aadish Kumar Jain
Keyword(s):  
Human Immunodeficiency Virus ◽  
Thyroid Dysfunction ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Cd4 Count ◽  
Thyroid Disorder ◽  
Cross Sectional ◽  
Secondary Hypothyroidism ◽  
Immunodeficiency Virus ◽  
Stimulating Hormone

Background: The aim of this study was to evaluate the prevalence of thyroid abnormalities in a subset of human immunodeficiency virus positive patients.Methods: This was a cross-sectional prevalence study conducted on adult HIV positive patients. The patients presenting with hypertension, diabetes mellitus, coronary artery disease or thyroid disorder were excluded from the study. An exhaustive medical history and investigation using biochemical, microbiological and radiological tests were performed to confirm the diagnosis. Additionally, tests were done to determine the free T3, T4, thyroid stimulating hormone and CD4 cell count in all the patients.Results: The prevalence of thyroid dysfunction in our study was 45.7%. Various types of thyroid dysfunctions obtained were euthyroid sick syndrome in 18.6%, subclinical hypothyroidism in 11.4%, secondary hypothyroidism in 10% and primary hypothyroidism and hyperthyroidism each in 2.9% cases. As the stage of HIV advanced, there is alteration in the level of thyroid stimulating hormone, FT3 and FT4. A direct correlation was found between FT3 and CD4 counts but no correlation was found between thyroid stimulating hormone and FT4 levels and CD4 counts.Conclusions: A higher prevalence of thyroid dysfunction that was largely asymptomatic was observed in HIV infected patients with significant change in the hormonal levels in patients with low CD4 count. A direct correlation was observed between FT3 hormone level and CD4 count.

scholarly journals Secondary hypothyroidism in adults: diagnosis and treatment

2019 ◽  
Vol 15 (2) ◽  
pp. 64-72
Author(s):  
Tatiana A. Kienia ◽  
Tatiana B. Morgunova ◽  
Valentin V. Fadeyev
Keyword(s):  
Replacement Therapy ◽  
Biochemical Markers ◽  
Laboratory Tests ◽  
Radiation Effects ◽  
Clinical Manifestations ◽  
Primary Hypothyroidism ◽  
Diagnosis And Management ◽  
Secondary Hypothyroidism ◽  
Pituitary Macroadenomas

Secondary hypothyroidism is a rare disease. There is a number of questions and difficulties in diagnosis and management of this condition. There are two forms of secondary hypothyroidism: congenital (casuistic seldom) and acquired. The main causes of secondary hypothyroidism in adults are tumors of the hypothalamic-pituitary region and the state after surgical and radiation effects on this area. Hormonally active and inactive pituitary macroadenomas cause the development of acquired secondary hypothyroidism in more than 50% of cases. The development of secondary hypothyroidism is possible years after the radiotherapy of brain tumors. As well as in case of primary hypothyroidism, the clinical manifestations of secondary hypothyroidism are non-specific. Diagnosis and management of this pathology is often complicated by its combination with the deficiency of other tropic hormones. The diagnosis of secondary hypothyroidism is based on anamnestic data and laboratory tests - the simultaneous determination of the levels of fT4 and TSH. The level of fT4 today is also used as the main marker of the adequacy of the dose of L-T4 in the treatment of secondary hypothyroidism. The results of recent studies help us to optimize replacement therapy in secondary hypothyroidism. However, the use of additional biochemical markers to assess the adequacy of replacement therapy remains unexplored.

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