HYPOTHYROIDISM.we all happened to come across a patient with hoarse, scratchy, obese, preferably female, a clumsy person who feels cold, that pasty skin, his face ipoespressiva, or massive swelling of the throat and short stature, growing evil, which is tired. If these signs we have seen, we think of a ipotiroidismoCon this term we refer to paintings in which there is deficiency of thyroid hormone production. Hypothyroidism may be primitive, in 90-95% of cases, or secondary, in other cases, which resulted from inadequate stimulation by the pituitary and / or hypothalamus.

Tireoprivo hypothyroidism. This can be caused in whole or agenesis of t. parzile for development embrinale deficit (cretinism) eg. in areas with endemic iodine deficiency, can result also from thyroid ablation for inflammatory processes (suppurative thyroid, Hashimoto's thyroiditis, Riedel's thyroiditis). In the adult, in our regions, appears hypothyroidism idiopathic adult or disease Gull (MDGs).

The MDGs are characterized by the presence of autoimmune thyroid antibodies (frequent association with autoimmune frameworks (m autoimmune) of pernicious anemia, lupus erythematosus, chronic hepatitis, Sjogren S., rheumatoid arthritis) and the association with pictures of endocrine insufficiency Primary (hypoadrenalism, hypogonadism, hypoparathyroidism). In such cases it is frequently reflected dell'aplotipo HLA-B8. The disease is slow and Isis.

Clinical picture. The subjects, female, after 40-60 Others become listless, apathetic, apathetic and indifferent, have marked weakness, particularly sensitive to cold, psychoneurosis events, mood instability, mental lethargy, tendency to depression, to 'insomnia, depression. The voice becomes hoarse and deep, and slurred speech is monotonous, the facies is myxedematous, mimicry is slow, dry skin, the subcutaneous fat, infiltrated a hydrophilic substance, acid condroitinsolforico.

hair become brittle, dry and dull, his eyes taking on a mushroom, because the eyeballs are sunken, the language becomes edematous (macroglossia). The axillary pubic hair does not grow, the muscles hypotonic fano; appears anemia portmanteau of red blood cells, abnormal gastrointestinal tract with dyspeptic phenomena, for achlorhydria appears constipation (constipation), and abnormal motility of the tube ge. Compare commitment heart because even infiltrates the heart of mucopolysaccharides, with decrease of pulse rate and peripheral you have high cholesterol and angina crisis, abnormal T wave and low voltage QRS complexes.

Laboratory. The diagnosis relies on the determination of basal metabolism is lowered by 10-20%, the detection of T3 and T4 levels are reduced, which results in an increase in TSH and a hyper-response to TRH.

Therapy. Should be given as soon as l-thyroxine (100-200 micrograms / day) replacement treatment should be started at doses of 25-50 micrograms / day and gradually increased. If hypothyroidism is replacement therapy from birth and the intervention did not happen in time, we have a framework of disharmonic dwarfism with extreme cephalic developed and changes in facial appearance (broad nose, eyeballs widened with narrow palpebral fissure, open mouth, macroglossia, and skeletal dysgenesis with abnormal epiphyseal ossification centers and anserine gait)

Hypothyroidism and endemic goiter. Sometimes the lack of thyroid hormone is endemic (en demos, ie the people), which is evident in some regions of the Umbria highlighting cases of endemic goiter with hypothyroidism in iodine deficiency, which is fondamantale, as we said in the synthesis of hormones T3 and T4. The gland, in these cases, given the chronic lack of iodine in order to overcome this situation, and subjected to continuous stimulation by TSH, undergoes hypertrophy, a goiter can be associated with the intake of substances activities thyrostatic (cruciferous and Brassicaceae, which are rich in thiocyanate and natural gozzigeni).

The simple goiter. The crop is simple if the increased volume of t entails neither a hyper, nor to hypothyroidism. There are:

Shape-endemic areas of iodine deficiency where the TSH stimulation leads to hypertrophy of t.

-The sporadic form of adolescence and pregnancy, overstimulation due to defective synthesis of iodothyronines for momentary
.

>>>see first page

>>>see also RICERCA