Diseases of the thyroid gland. Reflections

I continue to celebrate World Thyroid Day.

I would like to share some thoughts that were formed in the process of working with patients. No one will deny that the number of people with thyroid diseases is growing. Moreover, there is a “decline”, then a “new wave”, almost the same as in the incidence of type 1 diabetes mellitus.

This suggests the participation of viral infections in this process – herpes viruses (so common in St. Petersburg), the spread of Coxsackie viruses (last year, many children were ill at the resorts of Turkey and Crimea), etc.

I also think that an important role belongs to the so-called endocrine disruptors – toxic substances of any genesis that pollute the environment and our body (products of gasoline combustion, plastic, etc.).

Poor quality food – deficient in vitamins and minerals. Decreased protein in the diet – meat, poultry and fish – not many people eat them daily. Well, for St. Petersburg – the lack of a sufficient amount of solar activity, so necessary for the synthesis of vitamin D.

Lack of sleep and disturbed sleep phases – the lack of a daily regimen also disrupts the circadian rhythm of hormone synthesis! Including thyroid hormones. Stress is generally the main reason for the development of DTG (diffuse toxic goiter), one of the most serious thyroid diseases.

But today I would like to reflect on the subclinical forms of hypothyroidism in more detail. That is, those forms when TSH is still low 4.0-10.0 mIU / ml, T4 sv. and T3 St. are still normal and you think for a long time – to treat the patient with hormones at once or to observe, and in each specific case you are very interested in whether such an increase in TSH is a consequence of AIT (autoimmune thyroiditis) and primary hypothyroidism, or is it a consequence of other concomitant diseases.

At the same time, the patient continues to actively complain and look for symptoms of hypothyroidism. And even tenths and hundredths of an increase in TSH make him absolutely sure that it is precisely this thyroid disease that “makes him feel so bad.” But this is often not the case, just not everyone has enough time and imagination to get to the bottom of the reasons for the slight increase in TSH.

Often you try to prescribe combined vitamin therapy with hormones, you look at the normalization of the TSH level and again try to draw conclusions about the primacy of the increase in TSH. And I come to the conclusion that in most cases the reason for the increase in TSH (especially with negative antibodies to TPO and TG) is not AIT, but other pathologies. Here are some examples:

A 48-year-old woman first came up with TSH = 5.7 mIU / ml, TPO and TG antibodies are not present, complains of all the symptoms of hypothyroidism, insists on therapy with Triiodothyronine, with more active history taking, it turns out that she has not been examined for a long time Chr. Glomerulonephritis is a formidable kidney disease leading to renal failure, as shown by her creatinine level of more than 150 mmol / L. Conclusion – TSH rose a second time, the body “tried” to compensate for glomerulonephritis by creating subclinical hypothyroidism, so that the exchange of vitamins slowed down and the death of the kidney glomeruli did not progress!

This means that kidney disease in the stage of renal failure is the cause of hypothyroidism and the underlying disease must be treated! And therapy with Triiodothyronine has nothing to do with it! The second conclusion: when you visit a doctor, you need to roll out in more detail about your chronic pathologies.

Further, according to my observations hr. long-term untreated iron deficiency or mixed (with B12 deficiency) anemia, is also the cause of an increase in TSH within subclinical numbers, the conclusion is that you always treat anemia, you have to imagine what severe O2 deficiency your body is experiencing, and the clinical picture of anemia almost completely repeats the clinical picture of Hypothyroidism !

Already in many studies, it has been repeatedly written that all centenarians who have lived for more than 90 years have subclinical hypothyroidism !!! Subtly slowed down metabolism allows them to create a “model of economical energy consumption” and better adapt to changing environmental conditions, the conclusion remains controversial – is it always necessary to treat subclinical hypothyroidism? Maybe this will allow you to live up to 90 years?: D

For example: a young woman, 32 years old, complains of symptoms of hypothyroidism: weight gain, weakness, memory loss, edema, TSH – ideal! 1.5 mIU / ml with normal T4w and T3w, but according to the sublingual temperature test – the body temperature does not rise above 36.3C – an obvious clinical picture of hypothyroidism, but she was diagnosed with adrenal dysfunction by the type of “adrenal fatigue” (decrease in cortisol sharply by 13:00 – 17:00 and 23:00 with a normal morning release) – a conclusion, whether it is necessary for her to “spur the adrenal glands” by prescribing L Thyroxine preparations according to complaints, this will not improve her condition and aggravate weakness and weakness, and in this case – it is necessary to deal with the adrenal glands, and not the clinical picture of hypothyroidism and its treatment, at least not in the first place, but in the second.

It is always important to compensate for the deficiency of selenium, B vitamins, vitamin D – and this is enough to normalize TSH levels. Tested many times!

A young woman, 28 years old, ARVI temperature is elevated, for some reason 2 times passes against the background of TSH disease (she never had thyroid pathology before) and it is sharply increased = 9.6 mIU / ml, but after a month the increase in TSH “does not remain and trace “- is kept constantly below 2.0. Conclusion – there is no need to rush to appointments. Especially in the absence of a clinic of hypothyroidism, as in this case. TSH has the ability to normalize spontaneously.

In babies, even adults 🙂 due to a protein deficiency in the diet, TSH may increase, check if you are eating enough protein? This is a fundamental question!

Another important fact is that now a lot of young women and men are taking antidepressants, many of them increase the level of Prolactin, this hormone is often “paired” with TSH, therefore, TSH can rise again here too! Conclusion – tell your doctor about all the drugs you are taking!

If we talk about AIT, then this is also a rather mysterious disease. During AIT there can be several “waves” of both hyperthyroidism and hypothyroidism, and they can alternate, they do not need to be treated – they only require observation (the exception is pregnancy).

What I wanted to say is that thyroid https://en.wikipedia.org/wiki/Thyroid pathology is very multifaceted. And one should not neglect the attempt to “get to the bottom”. In this search, a lot of interesting things can come to light. And it will allow you to avoid unnecessary unnecessary appointments.