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Levothyroxine hair loss: Diffuse scalp hair loss due to levothyroxine overdose

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Diffuse scalp hair loss due to levothyroxine overdose

Sir,

A 10-month-old, 7.4 kg, newly diagnosed hypothyroid infant (thyroid profile showed T3 0.25 ng/mL, T4 1.2 μg/dL, TSH 150 μIU/dL] [] was started on levothyroxine 100 μg/day (14 μg/kg/day). Sonography of the neck showed hypoplasia of thyroid gland. Antiperoxidase and antithyroglobulin antibodies were negative. Ten days after starting levothyroxine, the baby presented with sudden onset, diffuse of loss of scalp hair. The remaining hairs were thin and easily pluckable. On examination, infant had non-scarring alopecia involving 90% of the scalp area without the exclamation mark appearance [Figure and ]. Thyroxine overdose was suspected as the cause of anagen effluvium. At this stage the serum T4 level was very high (Serum T4 = 18.2 μg/dL, TSH = 0.72 μIU/dL), suggesting hyperthyroidism. Levothyroxine dose was reduced by 50% to 50 μg/day. A follow up after 15 days showed dramatic regrowth of hairs []. Six weeks later, T4 level was still slightly high and therefore the dose was decreased to 37. 5 μg/day (5 μg/kg/day). In the follow ups (T4 = 9 μg/dL) scalp hair growth was normal without further hair loss [Figure and ].

Sequence of events and action. (a) At the time of diagnosis as hypothyroidism, before starting thyroxine. (b) After 20 days of 100 μg/day levothyroxine, on thyroxine 100 μg/day. (c) After 20 days of 100 μg/day levothyroxine, on thyroxine 100 μg/day. (d) After 15 days of decreased levothyroxine dose to 50 μg/day. (e) After 50 days of levothyroxine 50 μg/day. (f) After 50 days of levothyroxine 37.5 μg/day

Normally, human hair growth and maintenance depends on three phases of their growth cycle: Anagen, catagen, and telogen. Most hair follicles would be in anagen at any given time, which is the mitotically active and growing stage.[1] Common causes of diffuse scalp hair loss are shown in . Medications can cause two types of hair loss, telogen effluvium and anagen effluvium. Telogen effluvium is the most common form and usually appears within two to four months after medication. Anagen effluvium occurs within a few days to weeks after medication, as in our patient. The severity of medication-induced hair loss depends on the type and dosage. When we diagnosed hypothyroidism in our child, scalp hair was absolutely normal in texture and distribution []. Our case developed diffuse hair loss, which was secondary to overdose of levothyroxine; hair loss occurred within a few days of starting treatment and also reversed after correcting the dose [Figure –]. Diffuse alopecia areata is another cause of rapid, diffuse hair loss without any clinical inflammatory signs. Well-circumscribed round to oval patches of hairless skin interspersed with normal hair will be seen. Exclamation point hairs is characteristic of alopecia areata, which was not present in our case.[2] Clinically both hyper- and hypothyroidism are associated with hair loss.[3] In hypothyroidism, hair becomes dry, coarse, brittle, increasingly thinner, and slow growing. The relative proportions of telogen compared with anagen hairs in the scalp increase in patients with hair loss. [4] Confusingly, hyperthyroidism can also lead to hair loss where the scalp hair is often fine, soft, greasy, reduced hair shafts tensile strength together with thinned hair shaft diameter despite an apparently increased hair matrix proliferation.[4,5] Ahsan et al. demonstrated thyroid receptors in human hair follicles and through these receptors, thyroid hormone can exert a direct effect on hair follicles.[4] It is very difficult to explain why both hypo- and hyperthyroid states are associated with substantial hair loss.[3] T3 at both lower and higher levels is not suitable to promote the proliferation and/or metabolism of hair follicles. Probably the magnitude of the effects of thyroid hormone on hair growth is variable, and its expression may be influenced by local factors and/or other hormones.[4] Our child developed diffuse hair loss within two weeks of starting levothyroxine, when the estimated T4 and T3 levels were high. After decreasing the levothyroxine dose, there was a dramatic improvement in the scalp hair growth, suggesting anagen effluvium. Scalp hair growth was absolutely normal in texture and distribution while on thyoxine maintenance dose. To conclude, hair follicles need adequate and correct levels of thyroxine to have appropriate hair growth and all children on levothyoxine should be monitored for serum levels of T3 and T4.

Table 1

Common causes of diffuse scalp hair loss

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Side Effects of Levoxyl (Levothyroxine Sodium), Warnings, Uses

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Thyroid Hair Loss vs. Male Pattern Baldness: What’s the Difference?

Hair loss caused by thyroid problems and male pattern baldness are two very different conditions. Learn how to distinguish between these two common causes of hair loss.

Hair health is like a barometer for the overall wellbeing of your body. Although hair falling out or thinning can be an indicator of illness, it can also happen due to lifestyle habits or genetics. Because multiple health conditions can lead to hair loss, it is essential to determine the underlying cause so doctors can prescribe the appropriate treatment.

Androgenetic alopecia, also known as male pattern baldness, and hair loss due to thyroid problems are common conditions. These two types of hair loss have very different causes and lead to distinct patterns of hair thinning or baldness.

Hair Loss and Your Thyroid

The thyroid produces a hormone responsible for regulating many bodily functions, including heart rate, metabolism, and energy. It also plays a role in how well your hair and nails grow.

Disruptions to thyroid function can tamper with the hair growth cycle, causing the hair’s resting phase to carry on for a longer amount of time. Because hair is suspended in rest mode, it stops regenerating and becomes thinner throughout the scalp. Both underactive thyroid (hypothyroidism) and overactive thyroid (hyperthyroidism) can cause hair loss.

“Thyroid hormone is essential to the development and maintenance of the hair follicle; thus, any disease-causing thyroid dysfunction can result in hair loss,” plastic surgeon and hair restoration specialist Gary Linkov, MD tells WebMD Connect to Care. “The hair loss associated with thyroid disease is typically diffuse and can affect not only scalp hair but also body hair. Thyroid-associated hair loss usually improves with treatment of the underlying thyroid disease, though it may take several months before hair regrowth occurs.”

What Is Male Pattern Baldness?

Androgenetic alopecia is the most common cause of hair loss in men. Approximately half of the male population will experience androgenetic alopecia in their lifetime, says the US National Library of Medicine. The condition can also affect women and has a strong link to genetics.

Patients with androgenetic alopecia have scalps with greater sensitivity to the hormone dihydrotestosterone (DHT), which affects hair follicle output and shortens the growth phase of the hair re-growth cycle. Over time, hairs become thinner and stop growing in localized areas like the top of the head.

How to Know the Difference

Androgenetic alopecia and hair loss caused by thyroid issues cause hair to fall out in distinct patterns. This allows doctors to easily distinguish between the two types of hair loss.

“Hair loss from hypothyroidism is more diffuse and does not have a pattern,” physician and medical communications writer Leann Poston, MD tells WebMD Connect to Care. “It involves the entire scalp. The ability to see the scalp through the overlying hair is typical.”

“Male pattern baldness or androgenic alopecia can occur in both men and women,” says Poston. “Men typically notice a thinning of hair on the top and front of the head above both temples. Women notice it more on the top and crown of the head. In women, the hairline does not recede as it does in men.”

If your doctor suspects that thyroid problems are causing your hair loss, they will run a blood test. “A diagnostic blood test can measure the Thyroid-Stimulating Hormone (TSH). Excess TSH usually indicates hypothyroidism, while abnormally low levels suggest hyperthyroidism,” hair loss specialist and hair restoration surgeon Abraham Armani, MD tells WebMD Connect to Care. “Your treating physician may prescribe a thyroid hormone medication to restore levels to normal.”

Get Help Now

Don’t wait. The sooner you address the symptoms of hair loss, the more likely you are to prevent irreversible damage. Speak to a medical professional today to begin your journey to a fuller head of hair.

Thyroid Conditions and Hair Loss: What You Need to Know

Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 9/23/2020

Is your hair starting to look thinner than usual? It’s common for men to experience some degree of hair loss at some point in our lives. In fact, one form of hair loss called androgenetic alopecia (or male pattern baldness) is thought to affect 50 million men in the United States alone. 

While androgenetic alopecia is the most common type of hair loss men experience, hair loss can also occur as a result of certain medical conditions. 

If you have a thyroid condition such as hypothyroidism or hyperthyroidism, it’s possible that this could contribute to hair loss. Thyroid conditions can also occur in conjunction with autoimmune diseases such as alopecia areata, which can affect the growth of your hair. 

Hair loss from thyroid conditions can vary in severity, from mild diffuse thinning to almost total loss of hair on your scalp. Below, we’ve explained why and how thyroid-related hair loss occurs, as well as what you can do to treat hair loss that’s caused by a thyroid condition. 

The Basics of Hair Loss

Hair loss can occur for a large variety of reasons. In men, the most common cause of hair loss is male pattern baldness — a form of hormonal hair loss that’s caused by a genetic sensitivity to the hormone dihydrotestosterone, or DHT.

This type of hair loss occurs when DHT gradually miniaturizes the hair follicles, stopping them from producing new hairs.

However, it’s also possible for your thyroid to contribute to hair loss by disrupting your body’s natural hair growth cycle.

As we’ve covered in our guide to the hair growth process, every single hair on your scalp goes through a four-stage growth process, with each stage corresponding to a different phase in the hair’s development:

  • During the anagen phase, the hair grows from the follicle
  • During the catagen phase, the follicle shrinks and the hair detaches from your scalp
  • During the telogen phase, a new hair starts to grow underneath the old hair
  • During the exogen phase, the old hair falls out and is replaced by the new hair

As part of this process, old hairs that have reached the end of their growth cycle are constantly falling out from your scalp, causing you to lose about 50 to 100 hairs every day. Since your hair follicles don’t all grow in sync, this daily loss doesn’t have any impact on your appearance. 

Understanding this simple process is key to understanding how thyroid disorders, as well as a range of other medical conditions, can affect your hair.

Hair Loss and Your Thyroid

Thyroid conditions such as hypothyroidism and hyperthyroidism can cause a diverse range of symptoms, from reduced or increased energy levels to changes in your body composition and weight. It’s also possible for these conditions to affect your hair. 

Because your thyroid plays a vital role in regulating so many bodily functions, any disruption to the production of thyroid hormones such as triiodothyronine (T3) and thyroxine (T4) can affect numerous important bodily processes. 

This includes the healthy growth of your hair. If your thyroid function is impaired, your hair might not grow as quickly as it normally would. This means that as old hairs reach the end of their hair growth cycle, they aren’t adequately replaced by new ones.  

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Symptoms of Thyroid-Related Hair Loss

Unlike male pattern baldness, which usually causes your hair to fall out in a clear, recognizable pattern, hair loss caused by a thyroid condition looks a little different. Instead of a balding crown or receding hairline, you’ll normally notice diffuse thinning across your entire scalp.

In simple terms, all of your hair might start to look a little thinner than usual, letting you see your scalp quite easily in bright light. 

Certain thyroid conditions can also change the texture of your hair. If you have hyperthyroidism (an overactive thyroid), your hair might feel overly fine and brittle. If you have hypothyroidism (an underactive thyroid), your hair might feel dry, harsh and more coarse than normal.

Diagnosing Thyroid-Related Hair Loss

Thyroid conditions such as hypothyroidism and hyperthyroidism don’t only affect the hair — they can also result in a range of other symptoms.

If you have hypothyroidism (an underactive thyroid), your symptoms may include:

  • Fatigue and tiredness
  • Weight gain
  • Dry skin
  • Slow heart rate
  • Increased sensitivity to cold
  • Discomfort, pain and/or swelling of the joints
  • Muscular weakness and muscle aches, stiffness and pain
  • Hoarse voice
  • Constipation
  • Impaired memory
  • Depression
  • High cholesterol levels

If you have hyperthyroidism (an overactive thyroid), your symptoms may include:

  • Rapid and/or irregular heartbeat or heart palpitations
  • Weight loss and difficulty maintaining a healthy weight
  • Increased appetite, often without an increase in body weight
  • Anxiety, irritability, nervousness and physical tremors
  • Increased sensitivity to heat
  • Sweating
  • Muscle weakness and/or fatigue
  • More frequent bowel movements
  • Insomnia or difficulty falling asleep

It’s also worth noting that in people over the age of 60, hyperthyroidism is sometimes mistaken for depression. Older adults may exhibit different symptoms — like loss of appetite or withdrawing from people. 

Thyroid conditions such as hypothyroidism and hyperthyroidism are quite easy to diagnose. If you display symptoms of a thyroid condition, your healthcare provider might request for you to take a blood test to measure your levels of thyroid-stimulating hormone (TSH) and thyroxine (T4).

If these levels are unusual, your healthcare provider may recommend additional testing to identify the root cause of your thyroid condition. 

If you’re worried that you might have thyroid-related hair loss, the best approach is to talk with your healthcare provider doctor about your symptoms. 

How to Treat Thyroid-Related Hair Loss

If your healthcare provider diagnoses you with a thyroid condition, you’ll likely be prescribed medication to treat your condition. 

For hypothyroidism, your healthcare provider may prescribe a synthetic thyroid hormone such as Levo-T® or Synthroid®. These medications work by bringing your thyroid hormones up to a normal level.

For hyperthyroidism, your healthcare provider may prescribe an anti-thyroid medication such as Tapazole® (methimazole) or propylthiouracil. These medications stop your thyroid gland from producing overly high levels of thyroid hormones. 

Depending on your symptoms, treatment for hyperthyroidism may include radioactive iodine and/or beta-blockers. Severe cases of hyperthyroidism are occasionally treated by removing some or all of the thyroid gland in a procedure known as thyroidectomy. 

Most of the time, thyroid-related hair loss resolves on its own after you successfully treat the underlying condition. After treating your thyroid condition, it can take several months for your hair to start growing again.

You might be able to speed up this growth using minoxidil, a topical medication that improves blood flow to the scalp. Because thyroid-related hair loss isn’t caused by DHT, finasteride isn’t effective at treating or preventing this form of hair loss.  

Thyroid Conditions and Alopecia Areata

Many people with thyroid conditions such as hypothyroidism and hyperthyroidism suffer from autoimmune thyroid disease. People affected by autoimmune thyroid disease have a greater risk of developing other autoimmune conditions, such as alopecia areata.Alopecia areata is a type of autoimmune hair loss in which the body’s immune system targets and damages the hair follicles. Hair follicles that are targeted by the immune system can stop producing new hairs, resulting in hair loss. 

Hair loss from alopecia areata usually occurs in small, often circular patches, rather than the receding hairline or crown hair loss of male pattern baldness or the diffuse thinning of thyroid hair loss. Some people with alopecia areata develop bands of bald skin, called ophiasis.

In severe cases, alopecia areata can also cause total hair loss on the scalp, as well as loss of hair in the eyebrows, eyelashes and beard area. Some  people with alopecia areata may notice that their nails become slightly red, with a weak, rough and brittle texture or may have pitting in their nails.  

If you have a thyroid condition and believe you’re suffering from alopecia areata, contact your healthcare provider.. Several effective treatments can help you to manage the symptoms of alopecia areata, including corticosteroids. 

Medications that stimulate hair growth, such as minoxidil, may also help to promote hair growth in people with alopecia areata.  

In Conclusion

If you have a thyroid condition, it’s possible that it could cause some degree of hair loss. Unlike male pattern baldness, thyroid-related hair loss usually doesn’t result in a receding hairline or a bald spot at the crown — instead, it usually leads to diffuse hair loss across the entire scalp. 

Most cases of thyroid-related hair loss get better on their own after treating the specific thyroid condition responsible for the hair loss. Medications such as minoxidil may  help to promote the growth of new, healthy hair. 

If you’re concerned about thyroid-related hair loss, contact your healthcare provider. With the right treatment for your thyroid condition, you can manage your symptoms and regrow any lost hair.

Learn More About Treating Hair Loss

Worried you’re starting to lose your hair? You’re not alone. Hair loss is a common issue that affects men of all ages and backgrounds. Our guide to hair growth products covers how the latest, most popular hair loss treatment options work, with real, scientific data on their effectiveness. 

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

What can you do about hair loss?

At Thyroid UK we hear from a lot of members who have problems with hair loss and it can be a very distressing condition especially for women.

What could be the cause?

Hair loss is a common symptom of thyroid disease but it can also be caused by various other conditions including vitamin and mineral deficiencies and certain medical conditions.

Let’s look at thyroid disease first.  Hair loss may be associated with hyperthyroidism and hypothyroidism1.  In hypothyroidism

Hypothyroidism
“a term used to describe an under-active thyroid gland”

, hair loss is also found in other areas of the body such as the eyebrows (usually the outer third), under the arms and the pubic area.

We have seen reports that hair loss can be a side effect of levothyroxine.2  However, it may be that the hair loss is actually a symptom of hypothyroidism that only showed as a symptom after the start of treatment with levothyroxine

Levothyroxine
“a synthetic thyroid hormone commonly given to treat an under-active thyroid. It is also known as L-thyroxine”

.  This may be because it can take months for hair loss to start due to the long hair growth cycle.

It may also be a sign that you are on too much levothyroxine, making you a little overactive and this may therefore be causing the hair loss.

We have read reports from patients, though, that they moved over to natural desiccated thyroid and their hair loss improved.

If your hair loss is due to thyroid disease once you have been treated with the correct thyroid medication for you and your levels are stable, the hair loss should improve.

Are there other causes?

Nutritional deficiencies are definitely something that you should look into if you have hair loss.

Iron deficiency anaemia can cause hair loss so always check your iron levels.  Dr Philip Kingsley, Trichologist, states that ferritin (iron store) levels also need to be checked and that, “Even if the ferritin is within the ‘normal’ range, the level may still not be adequate for optimum hair growth.

He states, “Hair loss due to low ferritin is one of the most common types of hair loss we see in women.” 3 Be careful when supplementing with iron as it can be toxic

Toxic
“something poisonous, very harmful or bad”

.

B12 deficiency may cause hair loss although evidence is sparse.4

Biotin deficiency has also been reported as a cause of hair loss and some people found that it improved after taking supplements. You need to be aware, though, that taking biotin

Biotin
“a vitamin found in small amounts in many foods such as eggs, milk, or bananas.  Commonly used for hair loss, brittle nails, nerve damage, and many other conditions”

can show skewed levels in your test results. 5,6

Other vitamin deficiencies that may play a role in hair loss are vitamin C, vitamin D and vitamin E.4  The mineral, zinc, also plays a part in hair loss.4,5

Taking vitamin supplements may not always be helpful, though.  Too much Vitamin A has been reported as causing hair loss so be careful with this vitamin.4

Once you have looked into your nutritional status and found that you have optimum levels, it could be a medical condition that is causing your hair loss.

Medical conditions

Telogen Effluvium is a form of diffuse

Diffuse
“spread out over a large area”

hair loss that occurs when the anagen (growth) phase of the hair growth cycle is cut short by an internal disturbance. This causes many more hairs than usual to move from anagen into the telogen (shedding) phase all at once, resulting in excessive daily hair fall.7

Anogen Effluvium refers to the shedding that arises during the anagen (growth) stage of the hair cycle. The main causes of anagen effluvium are radiation, chemotherapy

Chemotherapy
“the treatment of disease by the use of chemical substances, especially the treatment of cancer by cytotoxic and other drugs”

, infection, drugs and toxins.8

Alopecia Areata is a more localised loss, and can be temporary, semi-permanent (recurring) or permanent and can affect eyebrows, eyelashes and body hair; as well as beard hair in men. 9

Androgenetic Alopecia is probably caused by a variety of genetic

Genetic
“relating to genes or heredity”

and environmental factors although the exact cause is not known.  It is often referred to as ‘Male Pattern Hair Loss’ or ‘Female Pattern Hair Loss’. It is the most common type of hair loss affecting approximately 50% of men over the age of 50 and around 50% of women over the age of 65.10

Alopecia Fungal Infections are due to certain infections which may cause patchy and localised loss and are generally treated by systemic anti-fungal treatment.11

So, if you are suffering from hair loss, you first need to check your thyroid levels, then make sure your nutritional status is optimal and if these are not the cause, there are medical causes you should look into.

There are various treatments on the market for hair loss but be aware that some of them will probably not help

It’s best to visit a specialist to help you deal with hair loss if it isn’t due to thyroid disease or nutritional deficiencies.

Read more information about hair loss

Check out what people are saying on our online community: http://www.healthunlocked.com/thyroiduk

References

1. A Descriptive Study of Alopecia Patterns and their Relation to Thyroid Dysfunction

Dysfunction
“a problem or fault in a part of the body”

Maya Vincent and Krishnan Yogiraj
Int J Trichology. 2013 Jan-Mar; 5(1): 57-60
https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3746235/

2. RXList – Levoxyl
https://www.rxlist.com/levoxyl-side-effects-drug-center.htm#overview

3. Ferritin and Hair Health
https://www.philipkingsley.co.uk/clinics/from-the-clinic/ferritin-and-hair-health

4. The Role of Vitamins and Minerals in Hair Loss: A Review
Hind M. Almohanna, Azhar A. Ahmed, John P. Tsatalis, and Antonella Tosti
Dermatol Ther (Heidelb).
2019 Mar; 9(1): 51–70
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380979/

5. Diet and hair loss: effects of nutrient deficiency

Deficiency
“a lack of, or shortage of something”

and supplement use
Emily L. Guo and Rajani Katta
Dermatol Pract Concept. 2017 Jan; 7(1): 1–10
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315033

6. Nutrition of women with hair loss problem during the period of menopause
Zuzanna Sabina Goluch-Koniuszy
Prz Menopauzalny. 2016 Mar; 15(1): 56–61
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828511/

7. Telogen Effluvium
https://www.philipkingsley.co.uk/hair-guide/hair-loss/telogen-effluvium

8. Telogen & Anagen Effluvium
https://www.alopecia.org.uk/faqs/telogen-anagen-effluvium

9. Alopecia-areata
https://www.philipkingsley.co.uk/hair-guide/hair-loss/alopecia-areata

10. Types of Alopecia
https://www.alopecia.org.uk/Pages/FAQs/Category/types-of-alopecia

11. Trichomycoses
G Sentamilselvi, C Janaki, and Sundaram Murugusundram
Int J Trichology. 2009 Jul-Dec; 1(2): 100–107
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938571/

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Thyroid Problems: Fluctuating Weight, Hair Loss and More

A small, butterfly-shaped gland tucked right underneath your Adam’s apple can have a huge impact on your health.

Your thyroid produces hormones that control everything from digestion and heart function to muscle control and metabolism. When the thyroid produces too many or too few hormones, you can experience a wide range of health issues.

If you suspect you may have thyroid trouble – especially if someone in your family has been diagnosed – your primary care physician can use a simple blood test to assess your thyroid function. Depending on your diagnosis, you have many treatment options. The experts at the USC Caruso Department of Otolaryngology-Head and Neck Surgery are continually researching new treatments and therapies for thyroid conditions.

There are many types of thyroid conditions, but the two most common are hypothyroidism and hyperthyroidism. Women are more likely to develop thyroid trouble, particularly after pregnancy and menopause.

 

Hypothyroidism

Hypothyroidism, or underactive thyroid, can slow your metabolism and cause many problems, including:

Hair loss – When your metabolism slows, your body may invest more energy trying to keep vital functions going rather than maintaining healthy hair. You may experience hair loss, or your hair may become brittle or coarse. Frequently feeling cold – Low metabolism can make you feel sluggish and you may struggle to stay warm.

Weight gain – If you haven’t been eating more or exercising less, yet find yourself gaining weight, an underactive thyroid may be suppressing your metabolism.

Muscle or joint pain– When the thyroid isn’t working properly, you may experience swelling and inflammation in the joints and muscles, which can cause aches and pains, plus plantar fasciitis in the feet or carpal tunnel in the wrists.

Constant fatigue or depression – A malfunctioning thyroid can decrease the amount of serotonin produced by your brain, potentially causing fatigue, sadness or depression.

 

Hyperthyroidism

When the thyroid is overactive and produces too many hormones, your metabolism will speed up, causing different symptoms:

Constant hunger and/or weight loss – Hyperthyroidism can make you lose weight and be constantly hungry, even if you’re eating as you always have. You may also have more frequent diarrhea or bowel movements.

Rapid or irregular heartbeat – Your heart may feel like it’s pounding, and you may have trembling in your hands and fingers. You may also sweat more. Anxiety or irritability – A fast metabolism may make you feel nervous, anxious or irritable. Fewer or lighter periods – Women with hyperthyroidism may have fewer or lighter menstrual periods, potentially affecting ovulation and leading to infertility. Thyroid trouble may also lead to low sex drive or miscarriage.

Is your thyroid working properly?

A simple blood test through your primary care physician can check your thyroid function, and many thyroid conditions can be managed with medication. If you think you may have thyroid trouble, request an appointment with a Keck Medicine of USC physician through the online form, or by calling (800) USC-CARE.

The American Thyroid Association Office on Women’s Health, U.S. Department of Health and Human Services Thyroid Foundation of Canada

(PDF) Diffuse scalp hair loss due to levothyroxine overdose

Letters to the Editor

S60 Indian Dermatology Online Journal –

2015 – Volume 6 – Supplement Issue 1

absolutely normal in texture and distribution while on thyoxine

maintenance dose. To conclude, hair follicles need adequate

and correct levels of thyroxine to have appropriate hair growth

and all children on levothyoxine should be monitored for serum

levels of T3 and T4.

Declaration of patient consent

The authors certify that they have obtained all appropriate

patient consent forms. In the form the patient(s) has/have

given his/her/their consent for his/her/their images and other

clinical information to be reported in the journal. The patients

understand that their names and initials will not be published

and due efforts will be made to conceal their identity, but

anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conicts of interest.

K. Jagadish Kumar, Malebennur Santhosh Kumar,

Tummala Sujith Kumar, Abhishek Chavan

Department of Pediatrics, JSS Medical College, JSS University,

Mysore, Karnataka, India

Address for correspondence:

Dr. K. Jagadish Kumar,

Department of Pediatrics, JSS Medical College, JSS University,

Mysore, Karnataka, India.

E‑mail: [email protected]

REFERENCES

1. KanwarAJ,NarangT.Anagenefuvium.IndianJDermatolVenereol

Leprol 2013;79:604‑12.

2. Seetharam KA. Alopecia areata: An update. Indian J Dermatol Venerol

Leprol 2013;79:563‑75.

3. Paus R. Exploring the “thyroid‑skin connection”: Concepts, questions,

and clinical relevance. J Invest Dermatol 2010;130:7‑10.

4. Ahsan MK, Urano Y, Kato S, Oura H, Arase S. Immunohistochemical

localizationofthyroidhormonenuclearreceptorsinhumanhairfollicles

and in vitro effectofL‑triiodothyronineonculturedcellsofhairfollicles

and skin. J Med Invest 1998;44:179‑84.

5. van Beek N, Bodó E, Kromminga A, Gáspár E, Meyer K, Zmijewski MA,

et al.Thyroidhormonesdirectlyalterhumanhairfolliclefunctions:Anagen

prolongationandstimulationofbothhairmatrixkeratinocyteproliferation

andhairpigmentation.JClinEndocrinolMetab2008;93:4381‑8.

Cite this article as: Kumar KJ, Kumar MS, Kumar TS, Chavan A. Diffuse

scalp hair loss due to levothyroxine overdose. Indian Dermatol Online J

2015;6:58‑60.

This is an open access article distributed under the terms of the Creative

Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows

others to remix, tweak, and build upon the work non‑commercially, as long as the

author is credited and the new creations are licensed under the identical terms.

Access this article online

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Website: www.idoj.in

DOI:

10.4103/2229-5178.171054

Dermatophyte infection

encircling vitiligo

Sir,

Tinea corporis is a supercial fungal infection of glabrous skin

caused by various species of dermatophytes; epidermophyton,

trichophyton, and microsporon. Vitiligo is an autoimmune

disease. The occurrence of tinea bordering vitiligo patch is

unique and literature search could yield only one case report.

A 30‑year‑old woman presented with annular itchy, scaly patch

on right lower back of one week duration. She was a known case

of vitiligo on combination therapy (PUVA and tacrolimus 0.1%)

for the last two months and was responding satisfactorily. There

was no history of diabetes mellitus or hypertension and she

was not on any other medication including immnosuppressives.

Family history was negative for similar skin ailments. Cutaneous

examination revealed multiple depigmented patches distributed

on upper and lower limbs and trunk varying between 2 and 5 cm

in size, most of them showing follicular pigmentation. An oval

depigmented patch on the right lower back measuring 5 × 3 cm,

was encircled by papules, pustules, and scaling [Figure 1],

suggestive of dermatophyte infection. Other vitiligo patches

did not show any clinical evidence of dermatophyte infection.

Hair, nails, and mucous membranes were normal. There was

no clinical evidence of dermatophyte infection over other parts

of the body. A clinical diagnosis of tinea encircling vitiligo was

offered. Her routine blood chemistry including renal function

test (RFT) and liver function test (LFT) was unremarkable

and serology for human immune deciency virus (HIV) and

VDRL was nonreactive. Scrapings from the margin of the

plaque revealed fungal elements on potassium hydroxide

10% mount [Figure 2] and culture on Sabouraud’s dextrose

agar showed raised creamish‑white downy colonies and

reverse showed yellow‑brown pigmentation, characteristic of

Trichophyton rubrum species, thus conrming the diagnosis

of tinea corporis [Figure 3]. Biopsy from the depigmented

patch with Fontana–Masson stain revealed absence of

[Downloaded free from http://www.idoj.in on Wednesday, September 28, 2016, IP: 82.176.89.42]

90,000 Is there a link between levothyroxine and hair loss?

A condition known as hypothyroidism is caused by insufficient thyroid levels and a lack of adequate thyroid hormone in the body. This can lead to effects such as hair loss, weight gain, muscle cramps, and fatigue. Levothyroxine is a medication that treats this condition, and it serves as an artificial version of a thyroid hormone designed to have the same effect on the body.

As with any medication, there are certain side effects associated with levothyroxine. In many cases, these side effects are similar to those of a condition called hyperthyroidism, which is caused by an overproduction of thyroid hormone. One of the most common side effects is hair loss.

Levothyroxine and hair loss are not completely related. For many people, the link between taking levothyroxine and hair loss occurs only for a short period of time, during the first few months of using the drug.Any hair lost by these people grows back quite quickly. As of early 2011, there were no comprehensive studies that recorded the incidence of hair loss on a large scale, and this does not appear to be a widespread problem.

In other people, an association between levothyroxine and hair loss may indicate medication dosing problems. Hair loss can also be a potential symptom of hyperthyroidism.This means that doses of this drug that are too high for the patient’s needs, which can mimic the symptoms of hyperthyroidism, can often lead to the same problem.

Doses of levothyroxine that are not low enough to adequately treat the patient can also cause hair loss. There is strong medical evidence that hypothyroidism can cause alopecia or hair loss. In this case, the doctor may need to evaluate the condition of the patient taking the medication to ensure that the dosage is at the appropriate level.Patients should not try to change the dosage of this medication on their own to stop hair loss.

Compared to some of the other potential side effects, such as chest pain and heart problems, the association between levothyroxine and hair loss is not so strong. However, if it persists for more than a month after starting this medication, most healthcare professionals recommend that you see your prescribing doctor. They may perform tests to determine if this is a normal side effect or if it indicates a potential dosage change is necessary.

OTHER LANGUAGES

Hormonal preparations BERLIN-CHEMIE L -THYROXIN – “Means for hair loss forever!”

My big and very sad hello to everyone! This is my first review. Do not judge strictly and if you have questions, then ask. I will definitely answer. I want to tell you about the use of the drug l-thyroxine and the harm it caused to my health.
I’ll make a reservation right away. I am not campaigning against this drug. If endocrinologists have prescribed it for you, you are absolutely confident in your doctor, or you have already started the course of treatment, then in no case do not quit the course yourself, continue to be treated as prescribed.
And here’s my story, think for yourself.
I was prescribed l-thyroxine at the end of January 2015 due to the diagnosis of subclinical hypothyroidism. Analyzes for ttg and t4 were slightly outside the normal range. With such indicators, hormonal treatment is not prescribed. But! The symptoms of hypothyroidism have manifested too much for me for several years, namely: edema (in the morning you cannot recognize your face, and by the evening your legs became twice as thick as usual), fatigue (I simply did not recognize myself, there was no strength), and the worst thing is persistent constipation (persistent, this is when you cannot on your own at all, only with a laxative, whoever went through this will understand).By the way, I will say that the entire esophagus and other body systems were in order. In addition to tests for thyroid hormones, other indicators were normal. So you yourself understand whether or not to take this drug, I didn’t have to think for a long time. I really wanted to return to a full life, and I really hoped for l-thyroxine. In vain.
From the beginning of February I began my course of taking l-thyroxine. Control analysis of TTG was prescribed after 3 months. During this period, I had to increase the dose from 25 μg to 50 μg.
This is what happened to me while taking l-thyroxine. From the first pill (25mkg, in the morning on a lean), I realized that my thermo-regulation was recovering, those, when I went to work in the morning, in public transport, I sweated a little or felt a fever, I don’t know. But before taking l-thyroxine, for a long time my thermoregulation was disturbed. I didn’t sweat even in the gym with heavy loads. After a week of taking it, by that time the dose had already become 50 μg, I felt that I felt more cheerful in the morning (before l-thyroxine, I was generally a vegetable).I can’t say anything about edema. It seems that they were getting smaller. Normal stool, oh woe !, did not recover. I decided to go to my endocrinologist again about the changes in my health.
The endocrinologist decided to increase my dose to 75mcg without repeated tests. The doctor initially characterized the drug as safe for me, because I drink thyroxine in small doses, and I believed. And I didn’t even know what awaited me next.
I took a dose of l-thyroxine 75mkg for the next 3 months. It turned out to be very big for me, which was shown by new analyzes.Tm from 4.75 in winter slipped down to 0.2 after six months. True, I did not feel any symptoms of an overdose such as tachycardia or the like. But a terrible thing happened to the hair. Perhaps the most terrible thing that any person, both a woman and a man, at any age can imagine for himself. I must say right away that I have always looked after my hair very much, looked after, and despite the thrill that is happening now, I continue to look after. I have not dyed or toned them for more than three years now, take multivitamin complexes, make homemade and buy professional masks.So in February 2015 the hair was excellent, of good thickness, despite my hypothyroidism manifested. Unfortunately, at the beginning of taking l-thyroxine (about three weeks after the first pill), my hair began to fall out. Very little. Those, if before there was no loss, then in February it was necessary to clean the comb much more often. Further more. Of course, I myself am a fool, that I trusted the doctor from the clinic, a stupid endocrinologist. But you know, the oud really wanted to get well. In general, at the time when the tests showed an overdose, I began to take off my hair in shreds.I didn’t even need to comb my hair. I run my hand through my hair and a plump lock of hair remains in my hand. Once again I will spend one more. The most annoying thing is you know what? That when I with these symptoms turned to the endocrinologist of the polyclinic, where I was treated for hypothyroidism, the doctors with fright refused to send me a referral for repeated tests and said that I combed out this hair myself !!! So worried about jobs.
Then I decided to get off l-thyroxine while at least something remained on my head. I must say right away that I ruled out other causes of loss for myself, as my hair only became thicker every year after I stopped dyeing it and I did not experience any dermatitis / seborrhea / stress / shock.I climbed into the Internet. I sat on the forums of patients with hypothyroidism and was horrified. How many people start to lose hair intensively while taking l-thyroxine! Such people are dark! People are starting to think seriously about wigs. Even on my favorite airrecommendation, I met a couple of unfortunate girls like me.
And now some facts. The fact is that l-thyroxine increases the activity of 5-alpha reductase. This is such an enzyme. It’s in your hair. Or rather, in the base of the hair, hair follicles. When this enzyme is very active, its sensitivity to dihydrotestosterone is great.This is a hormone, the increased sensitivity of the follicles to which leads to hair loss. Up to complete baldness, by the way. When you take l-thyroxine, 5-alpha reductase becomes very active in the follicles and, then, the sensitivity of these hair follicles to dihydrotestosterone increases. Dihydrotestosterone deforms the hair follicle. Hair falls out. Next time, very thin and weak hair will grow from this follicle. and again nothing will grow out. The instructions for thyroxine also contain information about baldness.Only you need to look for it very carefully. Overdose symptoms. But in fact, people who have a high sensitivity to dihydrotestosterone (their genes are to blame) do not need an overdose. Even with small doses of l-thyroxine, they will get an excellent stable bald spot. It’s a question of time. Who doubts my words, everything is for you !!! this information is available on the internet. There are in the comments of patients with hypothyroidism, in the instructions where they write about the side effects of l-thyroxine (try it, find it), there are on medical sites, where they talk in detail about the causes of androgenic vlopecia (baldness).
And the final part of this Marlezon ballet. Try to “extinguish” the activity of 5-alpha reductase and restore hair follicles (after all, dihydrotestosterone deforms them greatly and such plump healthy hair will no longer grow in place of the fallen out). You will be able to do it with great difficulty. For three months I have been like a tear from l-thyroxine. Hair falls out with the same intensity as three months ago on l-thyroxine. Only constant intake of inhibitors of this enzyme will help.This is money, effort and time. If you stop inhibiting alpha reducer, your hair will begin to fall out again. And it doesn’t matter if you are taking l-thyroxine at this moment or not.
And the interchange. I am sure that a question has ripened in your head now. Why don’t doctors warn patients about such a side effect? Here’s my answer. Kids, this is just business. And nothing personal. L-thyroxine (aka eutirox) is a drug that you will go and definitely buy if you are sick with hypothyroidism. Do you understand that the thyroid gland cannot not be treated? And you will choose between the same l-thyroxine and etirox (and the essence of these two poisons is one – the artificial hormone m4).And the doctor who prescribed l-thyroxine for you will receive a separate money for prescribing l-thyroxine for you. And the doctor who prescribed eutirox to you will receive a salary increase for prescribing eutirox to everyone. And this is only your problem, that neither one nor the other drug may simply not suit you. Yes, these drugs remove nodes well. Just how much health will it cost your body?!? And whoever does not have a nodular goiter, there is generally how lucky. For someone, these drugs remove unpleasant symptoms for a while, for someone they do not work at all.But while you are taking them, the function of your thyroid gland, they will reduce for sure. And then you will take the same drugs for life. The thyroid gland has already stopped working completely. There is no other choice. Those who live in Our Rush. In more civilized countries (in all of Europe for sure), l-thyroxine is not prescribed to everyone in a row. There are options for the combined treatment of hypothyroidism with T3 and T4 hormones. The fact is that the thyroid gland produces not only T4 (thyroxine), but also more active hormones – T3, T2, T1.And your thyroid gland may initially have decreased production of some of these hormones. And you are literally poisoned with thyroxine. It is the same as that all “heart” would be treated with one medicine for all. You lose hair, plant your heart, the nervous system is shattered as a bonus (every third patient with hypothyroidism suffers from neuroses). Swelling and fatigue do not go away. And you still drink l-thyroxine, go to the doctors, look for the reasons for your not health. And pay for l-thyroxine to pharmaceutical companies, doctors earn on prescriptions by prescribing new doses of l-thyroxine for you.Vicious circle. If my story reminds you of yours, I advise you to get out of it as soon as possible. While taking l-thyroxine, I lost half of my hair, I don’t go to the toilet without laxatives, my metabolism is zero. Zero and I will appreciate this “medicine”. It’s a pity you can’t put a minus mark. Perhaps even minus 100 points would be malr. I give the same assessment to the endocrinologist who prescribed l-thyroxine to me and brought me to androgenic alopecia in six months. The photo shows the hair that I lost over the past two months. And that’s not all.I do not store everything that I collect from the floor and furniture. these are only those that I take off from the comb or by hand. draw conclusions milking yourself. All health and good luck!

Institute of Endocrinology and Metabolism. Komissarenko, Kiev

TRUTH AND MYTHS ABOUT THE THYROID

(At the request of patients and colleagues)

Fear makes people think. (Aristotle).

In the daily work of a doctor, patients, and more often patients, with thyroid diseases are regularly encountered.
What symptoms bother them? Very different. At the same time, not all complaints that are associated with the thyroid gland in everyday life are really related to it.

Rapid change in body weight, heart rhythm disturbances, edema, shortness of breath, eye pain, changes in skin moisture, reproductive disorders, irregular bowel movements, hair loss, mood changes – all this gives grounds to conduct a study of thyroid function (namely, the function, and not structures).

The sensation of a “lump in the throat”, a feeling of suffocation, impaired swallowing are usually not associated with the thyroid gland and can be a manifestation of psychosomatic disorders, respiratory diseases, esophageal pathology, signs of spinal diseases.

FUNCTION of the thyroid gland is determined by the level of TSH (thyroid stimulating hormone of the pituitary gland). Normal TSH values ​​are 0.4–4.0 μIU / ml. If TSH is less than the specified parameters, thyrotoxicosis (excess of thyroid hormones) is assumed, if more, hypothyroidism (lack of thyroid hormones). Thyrotoxicosis is treated with thyrostatics (drugs that block the thyroid gland), radioiodine, and surgery. Hypothyroidism is treated with levothyroxine, a medication that replaces a lack of thyroid hormones.

STRUCTURE of the thyroid gland is determined by examination, palpation and, if necessary, ultrasound. But the ultrasound will not show how the gland works.

Over the years as an endocrinologist, I have heard from patients many myths associated with various diseases and their treatment.

Let’s debunk together some popular myths about the thyroid gland.

1. MYTH. “They say that all thyroid diseases will go away with more iodine and seafood.”
This is not true.The use of iodine-containing products (primarily iodized salt) is the prevention of iodine deficiency, which ensures the normal functioning of a healthy thyroid gland.
2. MYTH. “With diseases of the thyroid gland, it is harmful to be in the sun, you can not go to the sauna, receive physiotherapy and massage.”
There is not a single study that would confirm the validity of this statement.
3. MYTH. “Do I need to add a drop of iodine to milk to combat iodine deficiency?”
This is a dangerous idea: the thyroid gland may be disrupted.One drop of an alcohol solution contains a monthly rate of iodine.
4. MYTH. “If you cure AT to TPO, then thyrotoxicosis will be cured.”
This is not the case. Treating antibodies to TPO is a senseless undertaking, they are only markers (“witnesses”) of autoimmune damage to the gland.
5. MYTH. “Levothyroxine drugs damage the stomach and liver. It is best to take them after meals. ”
Levothyroxine tablets do not damage organs and systems. If you take levothyroxine after a meal, then its absorption will be disrupted.
6. MYTH. “Levothyroxine causes obesity because it is a hormonal drug.»
Treatment with the correct dose of levothyroxine does not lead to weight gain. Conversely, an overdose of levothyroxine sometimes leads to a decrease in body weight. (In no case should this property of levothyroxine be used to combat obesity! Thyrotoxicosis is dangerous for the heart.)
7. MYTH. “If, during the treatment of hypothyroidism, TSH has returned to normal, then the dose of levothyroxine can be reduced or canceled.”
Imagine a legless disabled person, he got the perfect prosthesis. Now shorten this prosthesis for him or take it away altogether.Will a person be able to walk normally? This is the case with substitution therapy – the correctly selected dose cannot be reduced or subtracted.
8. MYTH. “Women taking levothyroxine should not take hormonal contraceptives.”
Wrong. Women receiving levothyroxine may take other medications, including hormonal contraceptives. The only remark is not overnight: levothyroxine must be taken separately from other drugs.
9. MYTH. “When operating on the thyroid gland, it is imperative that a part of the gland be left.»
In most cases, if an operation on the thyroid gland is required, it must be removed completely (for example, in case of Graves’ disease, in case of cancer). After surgery, it is not difficult to choose replacement therapy with levothyroxine.
10. MYTH. “A man with a removed thyroid gland is disabled.”
Disabled people are people with disabilities. A person who takes one pill in the morning, who is no different in capabilities from healthy people, is not considered a disabled person.
11.MYTH. “Do not take levothyroxine during pregnancy or breastfeeding.”
Absolutely wrong! If a pregnant or nursing mother has hypothyroidism, then taking levothyroxine is not only possible, but also necessary. Moreover, its dose during pregnancy should be increased by one and a half times to ensure the normal development of the fetus.
12. MYTH. “If there is a suspicion of a malfunction of the thyroid gland, an ultrasound scan should be done.”
Wrong. Ultrasound examines the structure of the gland, but does not show how the gland is functioning.
13. MYTH. “Taking thyroid hormones is addictive.”
This is not the case. Thyroid hormone drugs, like our own hormones, are non-addictive.
14. MYTH. “If a mother has a thyroid disease, it will certainly be passed on to her children.”
Fortunately, this is not the case. A child born to a mother with an autoimmune thyroid disease has an increased hereditary risk of autoimmune disease, but it does not mean that he or she will develop a thyroid disease.
15. MYTH. “If a student is given 200 micrograms of iodide every day, he will grow wiser and will study better.”
Will not grow wiser. Intelligence is laid during intrauterine development. 200 mcg of iodide per day should have been taken by his mother during pregnancy and lactation.
16. MYTH. “It is dangerous to puncture the nodes of the thyroid gland.”
Fine needle aspiration biopsy (TAB) is a completely safe diagnostic procedure.
17. MYTH. “In summer, the dose of levothyroxine should be reduced, and in winter, increased, because in hot weather the need for levothyroxine decreases.
This statement would be true if we were newts and not humans. Our levothyroxine (T4 hormone) is converted in cells, under the action of the enzyme deiodinase, into triiodothyronine (T3 hormone). From T4 can be formed T3 active and T3 reversible (inactive). The cell itself regulates its amount, depending on the needs of the body, including seasonal ones. But newts do not have such a regulation mechanism.
18. MYTH. “We need to take a break from taking levothyroxine for 1-2 days a week.”
No way.Our thyroid gland works seven days a week, every day, and this should be the case for taking levothyroxine.
19. MYTH. “Some thyroid diseases are successfully treated by homeopaths.”
There is not a single study that confirms the effectiveness of homeopathic medicines. Thyroid disease is no exception.

We have considered only a few typical questions, myths and fears that accompany our patients. Of course, “fear has big eyes.”
The best cure for fear is reliable information.Do not hesitate to ask your doctor questions. It is your right to know the truth about your disease. Well, if an endocrinologist is not around, read the book “What’s with me, doctor? The whole truth about the thyroid gland “from the popular series” Dr. Rodionov’s Academy “. In it you will find answers to your questions.
The book was included in the educational project for the citizens of Russia “The program of the nation’s health improvement.
IT’S TIME TO TREAT RIGHT”.

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90,000 Thyroid diseases and their effect on hair loss

The immune system is the main defender of the body.It destroys disease-causing bacteria, fungi, viruses and the body’s own cells that are out of control (including cancers). In order to perform its functions correctly, immunity has a rather complex system of recognizing “friend or foe”. It works exactly like a good Swiss watch, but, unfortunately, even such perfect mechanisms sometimes fail. When the immune system begins to recognize normal cells as “outsiders” and attack them, autoimmune diseases develop.

This is a fairly large group of diseases – there are more than 80 of them.Some of them are widespread and constantly on everyone’s lips – for example, type I diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis. Others are rare, and it is not always possible to immediately recognize them even from specialist doctors: it may take several years before the doctor understands what it is, and the patient is finally diagnosed correctly.

Causes of

No doctor will tell you about the exact reasons for the development of autoimmune diseases.Immunity is very complex, so it is impossible to say unequivocally why it starts to work incorrectly in each specific case. However, some factors are known that increase the likelihood of developing these diseases:

  • Floor. Most often, women of childbearing age get sick.

  • Family history. Many autoimmune diseases often affect members of the same family.

  • Genetics.Some pathologies can be inherited, for example, multiple sclerosis, lupus. Certain genes increase the predisposition to a particular disease, provoke its onset.

  • Excess weight. It is known that overweight and obese people are at increased risk of developing rheumatoid arthritis, psoriatic arthritis. This can be due to the fact that extra pounds increase the load on the joints, and adipose tissue produces biologically active substances that cause inflammation.

  • Smoking. Some scientific studies have shown that this bad habit increases the risk of developing lupus, rheumatoid arthritis, hyperthyroidism, and multiple sclerosis.

  • Exposure to the body of certain chemical compounds and physical factors, for example, ultraviolet radiation, solvents.

  • Viral and bacterial infections.They are able to “confuse” the immune system, as a result of which it begins to attack its own tissues.

  • Medicines. Certain antibiotics and blood pressure medications can lead to lupus. And drugs to lower blood cholesterol, according to some sources, are ways to cause myositis – a rare disease that manifests itself in the form of muscle weakness.

  • Race and ethnicity.For example, in the United States, type I diabetes is more common among whites, and systemic lupus erythematosus is more common among African Americans and Hispanics.

Some examples

We will not talk about all eighty possible diagnoses here – we will dwell briefly on only a few.

In rheumatoid arthritis, the immune system attacks primarily the joints, namely the cartilage that lines them from the inside.The result is inflammation, pain, and swelling. Over time, the lesion becomes persistent, and 70% of patients become disabled. Also, the disease affects other organs, for example, patients die most often from kidney failure.

Systemic lupus erythematosus (abbreviated SLE) got its name from its characteristic manifestation – a red rash on the face: in the Middle Ages it was believed that it resembles the marks of wolf bites. Another analogy gave rise to the term lupus butterfly.In general, SLE affects not only the skin, but also other organs, most often joints, lungs, kidneys, nervous system, blood cells, heart.

Multiple sclerosis is a disease in which the immune system destroys the myelin sheath that covers nerve fibers in the brain and spinal cord. Because of this, the conduction of nerve impulses is disrupted, and serious neurological disorders occur, including weakness, deterioration and loss of vision, pain, impaired coordination of movements, muscle spasms.

Graves’ disease, or diffuse toxic goiter, is characterized by increased production of thyroid hormones. In the body, antibodies appear against the receptor proteins of the cells of this organ. Normally, thyroid-stimulating hormone, which is produced by the pituitary gland, is attached to these receptors, and it activates the production of thyroid hormones. Antibodies work in a similar way – they do not destroy the thyroid gland, but make it work more actively.

Hashimoto’s disease also affects the thyroid gland, but causes inflammation in it and impairs hormone production.In 70% of patients, inflammation is mild and thyroid hormone levels are normal. In 20% of cases, mild hypothyroidism develops, in 10% – pronounced.

In type I diabetes, antibodies are produced against the cells in the pancreas that produce insulin. It is the only human hormone that helps cells absorb sugar and reduces its concentration in the blood.

Inflammatory bowel disease manifests itself as a chronic inflammatory process in the digestive tract.The most common manifestations: diarrhea, rectal bleeding, painful urge to defecate, abdominal pain, fever. Most often, there are two pathologies: Crohn’s disease and ulcerative colitis. They increase the risk of developing malignant tumors.

Psoriasis is a condition in which T-lymphocytes accumulate in the skin. Inflammation develops, cell proliferation is accelerated, and red-pink plaques with peeling appear on the skin. Itching may bother you.Some patients suffer from joints, most often fingers and toes – psoriatic arthritis develops. There is inflammation, pain, and over time, a chronic inflammatory process leads to joint deformation and a strong deterioration in mobility.

Inflammatory myopathies are a group of pathologies in which inflammation develops in the muscles and muscle weakness occurs. This group includes diseases such as polymyositis, dermatomyositis.

Vasculitis develops when the vascular wall is damaged.Manifestations depend on which blood vessels are involved in the process.

Alopecia areata is not particularly dangerous and does not cause complications, but many women tolerate it very hard. In this disease, the immune system attacks the hair follicles, and because of this, hair falls out in certain areas.

Common symptoms

Many autoimmune diseases present with the same symptoms, making it difficult to diagnose correctly.Doctors have to take into account all the features of the clinical picture, laboratory test data, and be guided by special criteria.

The following are the most common manifestations of diseases associated with impaired immunity:

  • feeling of tiredness, increased fatigue;

  • pain, swelling, redness in the joints, stiffness of movements;

  • changes in the skin: plaques, spots, thickening, roughness;

  • recurring episodes of an increase in body temperature of more than 38 ° C;

  • enlarged tonsils.

If these manifestations persist for a long time, you need to consult a doctor, first you can see a therapist. If you suspect a disease associated with excessive immunity activity, he will refer you to a specialized specialist. You may need to consult a rheumatologist, immunologist, neurologist, endocrinologist, hematologist, cardiologist, nephrologist, dermatologist, pulmonologist. Laboratory tests will be ordered to confirm or rule out the autoimmune nature of the disease.

How is it treated?

In most cases, autoimmune diseases are chronic and cannot be completely cured. But timely treatment will help take the disease under control, eliminate symptoms and prevent more severe damage, dangerous complications. There are many drugs available to combat these diseases, as well as some special treatments such as plasmapheresis. The doctor draws up a therapy regimen depending on the diagnosis, characteristics of the course of the disease, symptoms, age, general health of the patient.

The main directions of treatment:

  1. Symptomatic therapy. For example, to cope with inflammation, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are used – aspirin, ibuprofen. The doctor may prescribe medications that help fight swelling, pain, chronic fatigue, skin rashes, anxiety, depression, and sleep disturbances.

  2. Hormone replacement therapy is used when the production of hormones is disrupted due to a disease.In type I diabetes mellitus, insulin must be injected continuously. For Hashimoto’s disease, levothyroxine, an analogue of the thyroid hormone, is prescribed.

  3. Suppression of immunity is required when it is necessary to cope with very severe manifestations and to prevent damage to internal organs, to preserve their function. Adrenal hormone preparations (glucocorticosteroids), immunosuppressants are used.

  4. Removal of antibodies from the blood.In some cases, plasmapheresis is required – a procedure during which blood is passed through a special apparatus and antibodies that cause an immune reaction are removed from it.

  5. Surgical interventions are usually required when the disease severely destroys the joint, because of this, it is deformed, and movement in it becomes impossible.

  6. Rehabilitation is aimed at restoring the patient’s functional capabilities, maintaining the ability to work, the ability to self-service, and improve the psycho-emotional state.

Can you prevent it?

Since the exact causes of these diseases are unknown, there are no effective methods of prevention. But there are measures that help reduce the risk to some extent:

  1. Anti-inflammatory diet. It is recommended to limit trans fats and sugar in the diet as much as possible, increase the consumption of fruits, vegetables, foods rich in protein and omega-3 polyunsaturated fatty acids.

  2. Maintain a healthy weight. This will help with proper nutrition and regular exercise. You can consult a dietitian to help you find the best diet.

  3. Take care of your gut health. According to some reports, a violation of the composition of the intestinal microflora is associated with an increased risk of developing type I diabetes mellitus, rheumatoid arthritis, lupus, and multiple sclerosis.Here the recommendations are the same as in the first paragraph: include in your diet more fruits and vegetables, foods rich in fiber.

  4. Stop smoking. Compounds from tobacco smoke cause inflammation, affect immune function and damage DNA. As a result, the risk of developing multiple sclerosis is doubled, according to one study. Also, smokers are more likely to suffer from lupus, rheumatoid arthritis and thyroid lesions.

  5. Get enough sleep and stick to your routine. Lack of sleep, restless sleep and irregularities in the schedule have a bad effect on the state of the immune system.

What are the risks during pregnancy?

In most cases, women with autoimmune diseases may well become pregnant and have a baby. Some risks, of course, are present, but usually doctors can minimize them and take the necessary measures to prevent exacerbations and complications.

First of all, you need to consult a doctor. Perhaps he will advise planning a pregnancy when the disease enters the stage of remission (symptoms subsided), or change the therapy regimen, since some medications can be dangerous to the fetus.

I am severely falling out of my hair: what to do? Reasons for hair loss and how to stop it

“Every time I wash my hair, I collect hair that has fallen out of the bathroom. But this is not so bad. I comb my hair very carefully: I start from the ends of the hair, gradually rising to the head, carefully and patiently detangling them.But the lost hair still remains in the hands. I am afraid to touch them again – while adjusting my hair, I can notice that a few more hairs have fallen out. I am worried that I will lose all my hair at this rate. ”

“I began to notice that my hair began to fall out. I am very worried that at a young age I will lose all my hair. I find it unattractive and I’m afraid it can be a problem when meeting girls. ”

These are the most frequent fears of visitors to a pharmacy with a problem of hair loss.Let’s see if they are justified.

Hair loss – when does it become a problem?

In reality, hair loss is a normal process. Hair follicles have a life cycle. It consists of three phases:

  • Anagen – the phase of active hair growth.
  • Catagen – transition phase.
  • Telogen – resting phase: the old hair moves to the surface of the skin, and a new one begins to grow.

The phases of the hair life cycle exist in a certain ratio: anagen prevails over telogen.Under this condition, experts consider it normal to lose 50-150 hairs per day. It is worth sounding the alarm if this number has increased and you begin to notice a receding hairline.

Causes of hair loss

Professionals working to solve the problem of baldness believe that, regardless of the cause, hair loss occurs due to a disruption in the hair growth cycle. Normally, the ratio of the phases of the cycle is dominated by the phase of hair growth. Under certain conditions and the action of unfavorable factors, this ratio changes, and the resting phase becomes dominant.

Common hair loss conditions for men and women are:

  • Changes in hormonal levels: excess in the blood of male sex hormones in both men and women inhibits hair growth in the anagen phase.
  • Some medications may cause hair loss as a side effect. For example, this side effect is possessed by: diclofenac, amitriptyline, levothyroxine.
  • Stress produces the hormone cortisol. It changes the ratio of the phases of the hair’s life cycle.As a result, hair loss prevails over hair growth.
  • Unbalanced diet: deficiency of vitamins, minerals, proteins and fats leads to thinning, dullness and brittle hair. These processes make it easier to lose them.
  • Prolonged exposure to the sun contributes to the loss of moisture and the destruction of the lipid layer of the hair. They become dry and brittle, causing them to fall out.

Coloring, styling with hot appliances and chemicals has a significant impact on the quality and quantity of hair.

How to stop hair loss at home?

Hair health, like the health of the entire body, depends on a balanced diet. Normalize your diet: enrich it with vegetables and fruits, herbs, proteins and healthy fats. Many micro and macro elements contained in them are involved in the formation, growth and strengthening of hair.

Hair is composed of the protein keratin. For its synthesis, amino acids are required. Some of them are synthesized in the body, and some we can get only from food.The outside of the hair is covered with a protective lipid sheath. To build it, you need to eat healthy fats.

Normalize sleep. Lack of sleep hygiene is stressful. It leads to an increase in cortisol levels and, as a result, hair loss. Interestingly, its level increases with both sleep deprivation and excess. Feeling tired and fatigued in the morning means that the concentration of cortisol in the blood is increased.

Get rid of bad habits: alcohol and smoking.They degrade the quality of the hair and adversely affect its life cycle. Due to alcohol, the body loses water, and the quality of sleep deteriorates. Cigarette smoke contains heavy metal ions. They are found in hair, accelerating hair loss.

How to Stop Hair Loss Using Pharmacy Products?

Experts believe that the development of baldness is based on the mechanisms of disruption of the synthesis of substances responsible for the active growth of hair. This is associated with a decrease in the amount of special proteins, peptidoglycans.They are involved in the regulation of the compounds that promote active hair growth.

Researchers have isolated the rich peptidoglycan complex Marileks from cartilaginous fish material. On its basis, they have developed dietary supplements Nurkrin for women and Nurkrin for men. Marileks as part of Nurkrin replenishes the deficiency of proteins and promotes the synthesis of substances that trigger the active phase of hair growth. This product is intended for replacement therapy, replenishing the lack of proteins and normalizing the duration of the phases of the hair cycle.

During the tests, it was found that the normalization of the ratio of the phases of the cycle occurs within 4-6 months. During this period, the resting phase, when the hair does not grow, is shortened, and the phase of active hair growth is lengthened. Thus, the amount of hair loss is reduced and new hair growth occurs. In addition, the existing hair is strengthened and improved due to biotin and ascorbic acid in Nurkrin.

Thanks to Nurkrin:

  • the percentage of loss of existing hair is reduced
  • the hair is strengthened
  • the process of new hair growth is started due to the activation of the hair growth phase
  • the duration of the growth phase is increased

Nurkrin has undergone numerous tests, thanks to which it has been confirmed its effectiveness and safety.More than 65% of respondents noticed the result after six months of continuous use of Nurkrin, and more than 80% noted an improvement in their condition and hair growth after a year of treatment.

According to the research results, side effects have not been identified, but the manufacturer does not recommend using Nurkrin for people with individual intolerance to the components and hypersensitivity to fish and seafood. If it becomes necessary to use Nurkrin during pregnancy, be sure to consult your doctor.It is important to note that Nurkrin does not cause dandruff and unpleasant side effects such as dry scalp, burning and itching.

Taking care of your hair is good. But do not worry about the appearance of the hair that has fallen out on the comb. With Nurkrin, their number will not exceed the norm.

BAA. It is not a drug.
Consult a specialist before use.

Hypothyroidism – “the great pretender” | ALM Medicine

“Diseases are endless.»
Pliny the Elder

Hypothyroidism is a clinical syndrome, the development of which is caused by a persistent deficiency of thyroid hormones and a decrease in their effect on target organs in the body.

Hypothyroidism is one of the most common endocrine pathologies, the frequency of overt hypothyroidism in the population reaches 2%. However, women are more often affected, and the prevalence of hypothyroidism in them reaches 7.5-21%. In older people, hypothyroidism occurs in 6-12% of cases. From what has been said, it is clear that this disease is relevant not only for endocrinologists, but also for doctors of other specialties: therapists, cardiologists, gastroenterologists, etc.

Classifications of hypothyroidism

By the level of lesion distinguish

  1. Primary hypothyroidism: develops as a result of congenital (agenesis or dysgenesis of the thyroid gland) or acquired dysfunction of the thyroid gland – as a result of autoimmune thyroiditis (which is most common), as well as surgical removal glands, radioactive iodine therapy; infiltrative and inflammatory diseases, in the outcome of subacute, postpartum and painless thyroiditis; disorders of the synthesis of thyroid hormones due to congenital defects, severe deficiency or excess of iodine, while taking thyrostatics, lithium preparations, etc.
  2. Secondary hypothyroidism – develops as a result of dysfunction of the adenohypophysis;
  3. Tertiary hypothyroidism – develops due to a violation of the hypothalamic structures;
  4. Peripheral hypothyroidism is a rare form of hypothyroidism that occurs due to tissue resistance to thyroid hormones, impaired conversion of thyroxine (T4) to triiodothyronine (T3).

According to the severity of clinical manifestations :

  1. Manifest – there is an increase in the level of thyroid-stimulating hormone (TSH) with reduced values ​​of free thyroxine (T4), while the level of triiodothyronine (T3) can be normal or reduced, most often there are
  2. Complicated – an increased level of TSH and a reduced level of free T4 is accompanied by a detailed clinical picture of hypothyroidism and various complications: heart failure, polyserositis, cretinism, hypothyroid coma.
  3. Subclinical – there is an increase in the level of TSH in the blood with normal values ​​of T4 and T3, there are no clinical manifestations of hypothyroidism, nonspecific symptoms may occur.

The duration of the course distinguishes:

  1. Transient hypothyroidism is a short episode of decreased thyroid function, it can be induced by taking amiodarone (cordarone), it can also develop as a result of subacute, painless, postpartum thyroiditis, arising in hypothyroiditis, in hypothyroidism patients with severe chronic inflammatory diseases, in cancer patients.
  2. Permanent hypothyroidism.

Why does thyroid hormone deficiency lead to disease?

The normal level of TSH is within the range of 0.4-4mu / l. In recent years, the scientific literature has discussed the issue of how to lower the upper limit of the norm, since the overwhelming majority of people without thyroid pathology have a TSH level in the range of 0.5-2.0 mU / l. However, no recommendations for changing the reference values ​​have been accepted so far.

Prolonged and pronounced deficiency of thyroid hormones leads to the fact that the intensity of anabolic and catabolic processes in the body decreases, the production of a number of cellular enzymes is sharply reduced.The result is a decrease in basal metabolism and oxygen demand. Disruption of the metabolism of glucoseaminoglycans, protein breakdown products with increased hydrophilicity, leads to the fact that the mucous membranes, subcutaneous tissue, muscles, myocardium are infiltrated with fluid and the so-called. mucinous, “cold” edema. Violation of water-salt metabolism is aggravated by an excess of vasopressin and a lack of atrial natriuretic hormone, which causes the accumulation of extravascular fluid and sodium.

Thyroid hormones play a key role in the formation phase of the fetal brain in the 1st trimester of pregnancy, they contribute to the differentiation and migration of neurocytes, the formation of those parts of the fetal brain that are responsible for human intellectual development. Since the fetus’s own thyroid gland does not function at the early stages of embryogenesis, the huge role of the sufficiency of the mother’s thyroid hormones at this stage is understandable. In addition, thyroid hormones make a great contribution to the formation of surfactant, and when it is lacking, respiratory distress and severe asphyxia are observed, which again affects the state of the brain.In childhood, a deficiency of thyroid hormones inhibits physical and mental development, in the most severe cases with the development of hypothyroid dwarfism and cretinism.

How hypothyroidism manifests itself clinically.

In hypothyroidism, almost all organs and systems are affected, clinical manifestations are very diverse, therefore, a careful and targeted questioning of the patient is necessary.

In the classic case of overt hypothyroidism, the patient complains of dryness and yellowness of the skin, hyperkeratosis, more on the knee and elbow joints, hair loss on the head and lateral parts of the eyebrows, mucinous edema of the face and extremities, constipation, overweight, fatigue, fatigue , inadequate exercise, drowsiness, sleep apnea.memory impairment, decreased interest in work, the world around, up to depression. In women, menstrual irregularities are possible, in men – a decrease in libido and potency. Laboratory and instrumental examination reveals hypochromic iron deficiency anemia, increased cholesterol, creatine phosphokinase, decreased glomerular filtration of the kidneys, possibly polyserositis, effusion pericarditis, and the development of polyneuropathy.

But! Hypothyroidism is a great “pretender”, and even with manifest hypothyroidism, patient complaints are often scarce and nonspecific, and subjective sensations do not correspond to the severity of the condition (often underestimated).Quite often, the intellect and memory of patients are reduced, patients inaccurately analyze the events that are taking place, it is difficult for them to consistently state all the changes in their state. “Unreasonable fatigue portends illness” – Hippocrates noted. The development of the clinical picture is influenced by the duration and severity of thyroid hormone deficiency, age and the presence of concomitant diseases. Therefore, if the doctor does not conduct a detailed examination and questioning of the patient, the diagnosis may remain unclear for a long time.

In practice, they often meet and often make it difficult to make a correct diagnosis, i.e.n. “Hypothyroidism masks”:

  1. Therapeutic: polyserositis, ischemic heart disease, arterial hypertension, polyarthritis, hepatitis, biliary tract hypokinesia, atrophic gastritis and, of course, vegetative-vascular dystonia.
  2. Psychiatric – depression, there may be paroxysms of panic attacks with recurrent attacks of tachycardia, hypersomnia, agripnia, asthenia.
  3. Neurological – myopathies, polyneuropathies.
  4. Hematological – iron deficiency normo-, hypochromic, pernicious, folate-deficient anemia.
  5. Gynecological: polycystic ovaries, amenorrhea, opsomenorrhea, galactorrhea-amenorrhea, infertility, hirsutism.
  6. Endocrinological – obesity, prolactinoma, delayed puberty, pseudopubertal and even acromegaly, since the coarsening of facial features can be very pronounced
  7. Surgical: cholelithiasis.
  8. Dermatological: alopecia (both diffuse and nested).

With subclinical hypothyroidism, by definition, there are no manifestations of thyroid hormone deficiency, this condition is diagnosed only by laboratory methods.Therefore, screening is based on anamnestic data (previously suffered subacute thyroiditis, surgery on the thyroid gland or neck organs, taking drugs that can worsen the function of the thyroid gland – cordarone, lithium preparations, thyreostatics, radioactive iodine therapy, etc.). Features of the gynecological history in women (infertility, menstrual irregularities, miscarriage) or family history – for example, the presence of any thyroid disease in close relatives, the presence of autoimmune diseases in relatives or the patient himself.Since, according to various sources, hypothyroidism is detected in patients with depression in 7.4-8-9% (and in some studies up to 40%!), Then in this group of patients it is also advisable to screen for hypothyroidism, especially since depression may be the first and only clinical manifestation of thyroid hormone deficiency.

However, in the presence of complaints and a seemingly characteristic appearance of the patient, the blood test may contain absolutely normal indicators of the level of thyroid hormones, which often causes bewilderment of both the doctor and the patient.

How to make a differential diagnosis?

The leading diagnostic method is the determination of the level of thyroid-stimulating hormone (TSH) and free T4 in the venous blood by highly sensitive methods. This is quite enough, the determination of total T4 has no diagnostic value, since its level is affected by any fluctuation in the content of transporter proteins in the blood. Determination of free T3 is also impractical, because in hypothyroidism due to a compensatory increase in the peripheral conversion of T4 to T3.there may be a normal increase in T3.

Primary manifest hypothyroidism is characterized by an increase in TSH levels and a decrease in free T4. In subclinical hypothyroidism, TSH is elevated, but the level of free T4 is normal. To clarify the cause of primary hypothyroidism, ultrasound examination of the thyroid gland, determination of antibodies to thyroid peroxidase in the blood (the presence of autoimmune thyroiditis), sometimes thyroid scintigraphy or puncture biopsy of the thyroid gland may be indicated.

Secondary and tertiary hypothyroidism is characterized by a decrease in the levels of both TSH and free T4, since the central link of regulation suffers. Very rarely, normal TSH levels can be determined with low free T4, which is associated with the secretion of the biologically inactive hormone TSH. In doubtful cases, a test is carried out with thyreoliberin. To clarify the genesis of secondary hypothyroidism, CT or MRI of the brain and the sella turcica is necessary, and the determination of other tropic hormones of the pituitary gland, i.e.because hypothyroidism can be an integral part of the hypopituitarism syndrome. It is very important and essential to exclude the combination of hypothyroidism with adrenal insufficiency of primary (Schmidt’s syndrome) or secondary genesis, because in these cases, the tactics of treatment requires first-priority compensation for adrenal insufficiency, and only then – compensation for hypothyroidism.

A rare phenomenon is peripheral hypothyroidism associated with insufficient sensitivity of peripheral tissues to the action of thyroid hormones, in which increased levels of TSH and free T4 are combined with clinical signs of hypothyroidism.

The diagnosis was made. How to treat?

Substitution therapy is required for laboratory-confirmed hypothyroidism. The goal of treatment is to completely normalize the condition with the disappearance of the clinical symptoms of hypothyroidism and the normalization of the TSH level (0.4-4.0 m U / L).

Levothyroxine is one of the drugs most commonly used by patients around the world. It was first received in 1915 by Kendall, and in 1927. Harrington and Barger synthesized it. However, for more than 100 years in practice, drugs obtained from dried thyroid glands of cattle have been used.They consisted of thyroglobulin containing T3 and T4 and iodine; their disadvantages were difficulties in standardization, high iodine content, and the danger of cow rabies virus. After the discovery in 1970 by Braverman and Sterling of the peripheral transformation of thyroxine into the active form – triiodothyronine, synthetic L-thyroxine was used instead of preparations of animal origin. At the moment, treatment with L-thyroxine is the “gold” standard of hormone therapy.

After taking on an empty stomach, approximately 80% of the thyroxine dose is absorbed, and the maximum concentration of the drug in the blood is observed 3-4 hours after administration, the half-life is about 7 days.The action of thyroxine begins in 2-3 days (since peripheral conversion to triiodothyronine must take place), and then, with constant intake of thyroxine, the concentration of T3 remains at the same level. If triiodothyronine is used directly, then its action begins after 6-12 hours, therefore it is precisely it that is administered for hypothyroid coma.

Approaches to the dosage of the drug L thyroxine have essential features .

In case of manifest hypothyroidism, L-thyroxine is prescribed at a dose of 1.6-1.8 μg / kg of body weight (in obese patients, it is calculated on the ideal body weight).For young patients under 55 years of age, without any cardiovascular pathology, this entire dose can, in principle, be prescribed immediately, in a single dose in the morning on an empty stomach. This is exactly what is done when hypothyroidism is detected during pregnancy, when one cannot hesitate, since a deficiency of thyroid hormones can lead to irreversible changes in the formation of the central nervous system of the fetus. It must be taken into account that during pregnancy, the need for thyroid hormones increases by 40-50% compared to non-pregnant women (up to 2.3 μg / kg of weight).Immediately after childbirth, the dose of the drug is reduced. The need for hormones in newborns is very high – 10-15 μg / kg of weight, and replacement therapy for congenital hypothyroidism should begin immediately, from the first days of a child’s life. Now in our country, a system of screening for hypothyroidism in newborns has been introduced, which is carried out in maternity hospitals on the 4th day after birth. If the initiation of treatment for newborns is delayed, the consequences of hormone deficiency can be extremely severe (up to irreversible cretinism).Children with diagnosed hypothyroidism are also immediately prescribed the full age dose of L-thyroxine, but the need for an older age is less than in newborns.

In people over 55 years old, in patients with cardiac pathology, the tactics of compensating for hypothyroidism is more restrained. It is necessary to be especially careful when prescribing treatment for patients over 65 years of age who may have a previously undetected heart disease.The initial dose of L thyroxine should be 6.5-12.5-25 μg / day, in the morning, on an empty stomach, i.e.that is, very small doses. An increase in the dose by 12.5-25 mcg is recommended once every 1.5-2 months, with the control of TSH blood and a mandatory assessment of the tolerance of the drug. Sometimes correction and revision of cardiac therapy is required, which requires an individual approach to each patient. The target dose is calculated as 0.9 μg / kg of body weight. Since long titration of the hormone dose with a “small step” is required, it is very convenient to have drugs with various dosages on the pharmaceutical market (Eutirox Nicomed 25.50, 75, 100, 125 μg, L-thyroxin Berlin-Chemi 25.50,100 μg).This allows for more flexibility in changing the dosage of drugs, achieving good tolerability of treatment and, ultimately, compensation for hypothyroidism.

Although previously used in the treatment regimens combined preparations of L-thyroxine and triiodothyronine, however, in the future, randomized trials have not shown the benefits of such therapy, therefore, currently, monotherapy with L-thyroxine is mainly used.

However, it is not possible and advisable to achieve ideal compensation in all patients.This applies primarily to the elderly and patients with severe cardiac pathology, with cardiac arrhythmias. In such cases, increasing the dose of L-thyroxine can be much more problematic and lead to undesirable complications. Therefore, it is considered acceptable to prescribe a dose of L-thyroxine, which softens the manifestations of hypothyroidism without worsening the state of the cardiovascular system, although it does not completely restore the level of TSH and free T4 to normal values. The TSH level is not more than 10 μU / L and the dose selection period of up to 6 months is considered possible for this particular cohort of patients.

If a patient has untreated hypothyroidism concurrently with severe coronary insufficiency, angiography and coronary artery bypass grafting (if indicated) should be performed before starting thyroid hormone treatment to reduce the risk of severe intraoperative tachycardia. Uncompensated hypothyroidism insignificantly increases the risk of surgical intervention, urgent operations should not be postponed. In the absence of severe cardiac pathology before a planned operation, it is advisable to achieve compensation for hypothyroidism.

Treatment of central (secondary and tertiary) hypothyroidism is carried out according to the same rules, but the control of treatment is based on the level of free thyroxine in the blood (T4). If adrenal insufficiency is detected simultaneously with hypothyroidism, then the first and foremost full compensation of adrenal insufficiency is mandatory and paramount, and only then – compensation for hypothyroidism. Otherwise, the patient’s prognosis worsens significantly.

Subclinical hypothyroidism – to treat or not to intervene?

Subclinical hypothyroidism occurs much more often than manifest hypothyroidism – in 1.2-15% of the population, in women more often than in men, and its frequency increases with age.The diagnostic criterion is a moderate increase in TSH – not higher than 10mU / l, while maintaining normal free T4 values.

As already mentioned, subclinical hypothyroidism, by definition, has no clinical manifestations, is asymptomatic, however, upon careful analysis, in about 25-50% of patients, retrospectively, moderate signs of hypothyroidism can be found. The most frequently affected function of the central nervous system, namely emotional: depressed mood, unexplained melancholy, depression, decreased adaptation to stressful influences.An atherogenic shift in the lipid spectrum of the blood can be detected. And a natural question arises – is it necessary for a doctor to intervene in this situation, or is treatment necessary only at the stage of manifest hypothyroidism? This issue is being actively discussed and researched, and no full consensus has yet been reached.

However, there are decreed groups where the need for treatment of subclinical hypothyroidism is recognized as mandatory.

First of all, these are pregnant women in whom subclinical hypothyroidism was detected at the time of pregnancy.According to the existing rules, such patients are immediately prescribed a full dose of substitution therapy with thyroxine drugs (L-thyroxine, Eutirox), because the “price issue” is very high. Further treatment is under the control of a hormonal blood test. After childbirth, the question of the need for treatment of a woman is decided individually, because hypothyroidism can be transient.

For children of any age, when subclinical hypothyroidism is detected, treatment in age-related dosages is indicated, since it is believed that this condition can significantly affect the adaptive capabilities of the child and the maturation of the central nervous system and the immune system.

In other cases, the question of patient treatment is decided individually. It is mandatory to control TSH 3-6 months after the first detection of its increased values. Treatment is considered indicated with a persistent increase in TSH of more than 10 μU / L or a double presence of TSH in the range from 5 to 10 IU / L, the goal is to achieve normal blood TSH values. Treatment of subclinical hypothyroidism is justified in case of concomitant depression, disturbances in the lipid spectrum of the blood. In women with elevated TSH blood levels and a significant titer of antibodies to peroxidase, the risk of developing overt hypothyroidism is significantly increased.Therefore, some authors in such cases recommend the appointment of thyroxin preparations, regardless of the degree of increase in TSH.

Quality of life of patients with hypothyroidism

The study of changes in the quality of life in many chronic diseases is of great practical interest. This allows you to assess the impact of the disease itself and treatment on all components of human health – physical, psychological and social. General and specific questionnaires are standard research methods.General questionnaires are used to assess the impact of a disease on various components of the quality of life, to compare the quality of life of large groups of patients with a specific disease with population parameters. The most popular are the General Health Questionnaire (MOS SF-36), the European Quality of Life Group’s Quality of Life Questionnaire (EuroQol EQ-5D) and the Nottingham Health Profile (NHP). Special questionnaires are designed to compare different treatment programs or when assessing the effectiveness of the use of different drugs.

According to the results of many studies, not only uncompensated hypothyroidism reduces the quality of life of patients in almost all parameters (except pain), but also subclinical hypothyroidism worsens the mental and physical components of the quality of life of patients. After prescribing treatment and achieving compensation, in most cases, an increase in the quality of life is noted, as a result of an improvement in well-being.

However, according to a study conducted in Denmark, indicators of vitality and psychological health in patients even with compensated hypothyroidism were statistically lower compared to normal values ​​in the population.As has been shown in a number of studies, in a significant part of patients with hypothyroidism well compensated according to blood control data, complaints of a decrease in general well-being, weakness, bad mood, and memory loss may persist. Interestingly, the classic symptoms of hypothyroidism are detected in about only 30% of patients with a true deficiency of thyroid hormones, while similar manifestations were found in 17% of those examined without dysfunction of the thyroid gland! It is possible that a decrease in general well-being is associated with the very awareness of a person being sick and with the need for long-term, often lifelong therapy of this disease.Therefore, the basis for changing the dose of the drug L thyroxine should be the level of hormones in the blood, and not only complaints, which are rather nonspecific. Symptoms and complaints may be due to other diseases, emotional and personal reasons, and not decompensated hypothyroidism.

How effective are we in treating hypothyroidism?

The regimen of treatment with L-thyroxine preparations (L-thyroxin, Berlin-Chemi, Eutirox, Nycomed) seems to be very simple, since the synthesis of thyroid hormones occurs essentially without circadian rhythms. A single dose of the drug, in the morning, 30-40 minutes before meals.allows to achieve stable normalization of TSH levels, and free T4. And, despite the simple treatment regimen, the availability and relative cheapness of drugs, in many cases, hypothyroidism remains decompensated for a long time. According to the results of various studies, from 14.1 to 48% of patients with already established hypothyroidism who are prescribed substitution treatment, the state of decompensation remains. Moreover, it does not depend on gender, etiology of hypothyroidism and duration of the disease. This situation may be associated with low patient compliance, especially for depressed patients who are less likely to take drugs regularly and correctly during this period.How many times have I heard at the reception: “Doctor, I do not want to” get hooked “on pills, so I decided not to take them anymore!” And only long-term and painstaking work of a doctor with a patient, tuned in to cooperation, can help to change the position. In a study at Wellington Hospital, it was shown that the nature and characteristics of specialist recommendations significantly affect the level of achievement of compensation for the disease. Negative changes in blood tests and a deterioration in the patient’s well-being after discontinuation of therapy can also change the patient’s attitude.At the moment, there are outpatient “Tire schools” for teaching patients, there are sites Medobraz.ru, Thyronet.ru on the Internet, where you can get information in an accessible way.

Patient compliance is significantly influenced by the availability and convenience of drug dosages. At the moment, endocrinologists have a whole line of L-thyroxine preparations in various dosages – 25,50,75, 100, 125, 150 mcg in 1 tablet, which greatly simplifies the treatment and makes the dosage more accurate.