Symptoms
- Constant fatigue, drowsiness, decreased performance
- Chilliness, poor cold tolerance
- Weight gain with the same diet, swelling of the face and eyelids
- Dry skin, brittle and hair loss, brittle nails
- Constipation
- Slow heart rate, lower blood pressure
- Depression, loss of memory and concentration
- In women - cycle disorders and difficulty conceiving
- Hoarseness, swelling of the tongue, sensation of a lump in the throat
Прибавка веса при гипотиреозе обычно умеренная — несколько килограммов, во многом за счёт задержки жидкости. Списывать выраженное ожирение только на щитовидную железу не следует, но проверить ТТГ при необъяснимом наборе веса нужно обязательно.
Diagnostics: what and how to test
- Blood is donated in the morning, on an empty stomach
- If you are already taking levothyroxine, take it BEFORE taking the pill.
- Biotin in vitamins distorts the result: it is canceled within 2–3 days
- Monitoring after changing the dose - no earlier than 6-8 weeks: earlier the indicator simply does not have time to stabilize
- ТТГ — main и достаточный скрининговый показатель. При гипотиреозе он повышен.
- Свободный Т4 — уточняет степень: при манифестном гипотиреозе он снижен, при субклиническом остаётся нормальным.
- Антитела к тиреопероксидазе (ТПО) — подтверждают аутоиммунную природу, самую частую причину.
- УЗИ щитовидной железы — оценка структуры и узлов; для диагноза гипотиреоза не требуется, но часто выполняется.
Reasons
- Autoimmune thyroiditis (Hashimoto's disease) is the most common cause
- Consequences of thyroid surgery or treatment with radioactive iodine
- Iodine deficiency - relevant for regions with insufficient iodine consumption
- Taking certain medications, including amiodarone and lithium
- Congenital hypothyroidism - detected during newborn screening
- Less commonly, diseases of the pituitary gland with insufficient production of TSH
Treatment
Treatment consists of replacement therapy with levothyroxine, a synthetic analogue of the T4 hormone. This is not “hormone therapy” in the scary sense: the drug simply replenishes what the gland has stopped producing.
- Take strictly on an empty stomach, 30–60 minutes before breakfast, with water
- Calcium, iron, magnesium, antacids and soy preparations interfere with absorption - they are taken after at least 4 hours
- Coffee immediately after the tablet also reduces absorption - it is better to wait half an hour
- The dose is selected by weight and adjusted by TSH every 6–8 weeks until the goal is achieved, then monitored 1–2 times a year
- Therapy is usually lifelong; self-cancellation when feeling better leads to a return of symptoms
- During pregnancy, the need for a dose increases already in the first trimester - TSH is checked immediately upon confirmation of pregnancy
Субклинический гипотиреоз (повышенный ТТГ при нормальном Т4) лечат не всегда. Решение зависит от уровня ТТГ, симптомов, наличия антител, возраста и планов на беременность — его принимает врач.
Hypothyroidism and pregnancy
Thyroid hormones are necessary for the formation of the fetal nervous system, especially in the first trimester, when the child’s own gland is not yet working. Uncompensated hypothyroidism increases the risk of miscarriage and affects the development of the child.
- Those planning pregnancy - check TSH in advance and achieve target values before conception
- If pregnancy occurs, the dose is usually increased and TSH is monitored every 4–6 weeks
- Levothyroxine during pregnancy is safe and mandatory - it cannot be canceled
