How do symptoms of hypothyroidism manifest in women or how to determine when it’s time to see a doctor

Mechanism of hormonal regulation

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The thyroid gland produces the hormones T4 (thyroxine, or tetraiodothyronine) and T3 (triiodothyronine), the synthesis of which requires the presence of a sufficient amount of iodine in the body. These hormones influence the regulation of metabolic processes, heart rate, blood pressure, psyche, body temperature, and reproductive processes.

Direct regulation of the function of the thyroid gland and the level of its secretion of T4 and T3 into the blood is carried out by the pituitary gland (part of the brain), which produces thyroid-stimulating hormone (TSH). In turn, the regulation of pituitary function is carried out by the hypothalamus through thyrotropin-releasing hormone. The hypothalamus is also a part of the brain and is connected to the pituitary gland by the portal circulatory system.

A signal for an increase or decrease in the secretion of TSH by the pituitary gland is a change in the content of thyroid hormones in the blood. Exceeding the normal concentration of T4 and T3 in the blood has an inhibitory effect on the pituitary gland, and a decrease has a stimulating effect.

Thus, the concentration of hormones in the blood is part of the universal feedback between the endocrine glands.

Table 1 - Normal levels of hormones in the blood

Symptoms and signs of hypothyroidism in women

In its manifest, clinically expressed form, hypothyroidism has the following symptoms.

Nonspecific symptoms of hypothyroidism are often found in other diseases and conditions. These include: severe muscle weakness, fatigue, drowsiness, decreased initiative and performance of a woman, inertia, decreased memory, absent-mindedness, weight gain, hair loss, constipation . For a long time, many women explain these symptoms of hypothyroidism by simple fatigue, overwork, everyday problems, the environment, overeating, lack of vitamins , stress and poor nutrition.

As it progresses, and in the absence of treatment, hypothyroidism acquires its main typical features. Muscle weakness, lethargy, apathy increase, the ability to remember and learn new things, and the ability to learn sharply decreases. Thought processes slow down, and patients struggle with simple arithmetic and logical tasks.

The weight continues to increase. The nature of excess body weight has its own peculiarities, since the cause of the latter is not “ obesity ” in its pure form, but a kind of mucous swelling of tissues and fluid retention. Tissue swelling in hypothyroidism is specific; this is the so-called hypothyroid obesity, which is associated with the accumulation of mucopolysaccharides in the tissues, which retain water. Tissue edema in severe hypothyroidism can become total, affecting the extremities, the anterior abdominal wall and the accumulation of fluid in the cavities (abdominal, pericardial).

The skin of a woman with hypothyroidism is characterized by severe dryness, peeling and thickening. Mucous tissue swelling and fluid retention create the specific appearance of a patient with hypothyroidism - pale yellow skin, swollen face, eyelids, lips. Swelling of the tissues of the extremities is aggravated by damage to the muscular system. Patients feel unmotivated progressive weakness and muscle stiffness.

Signs of hypothyroidism are manifested in impaired thermoregulation. The patient constantly experiences a feeling of cold and the need to warm up even in warm weather. When examining a woman's body temperature, it turns out to be significantly reduced.

The voice and speech changes. Due to mucous swelling of the tongue, the articulation and timbre of the voice changes, it becomes lower and rougher. With significant hypothyroidism, the patient struggles to find words and maintain a conversation.

Hypothyroidism causes pathological changes in the peripheral nerves; the patient may feel symptoms such as numbness, cramps and discomfort in the legs, and hearing loss.

Signs of hypothyroidism in a woman’s reproductive system have a significant impact on her health. Hormonal function sharply decreases, menstruation occurs irregularly or is absent, infertility or miscarriage occurs.

Deficiency of thyroid hormones (hypothyroidism) has a significant negative effect on the cardiovascular system. The heart rate tends to decrease (bradycardia, or slow pulse). Depending on the degree of hormone deficiency, the pulse may be 40 beats per minute or less. A rare pulse, interruptions and pain in the heart are the main symptoms of cardiac manifestations of hypothyroidism, which, if unfavorable, can be complicated by heart failure and myocardial dystrophy.

Symptoms of hypothyroidism affect the entire digestive tract. Changes in the digestive system, in the form of decreased appetite, motor function of the stomach and intestines (heaviness and fullness after eating, constipation, belching of air) often worry a patient with hypothyroidism. In severe cases, delayed evacuation of intestinal contents can lead to intestinal obstruction.

Types of hypothyroidism

Hypothyroidism is divided into four types (depending on the cause): primary, secondary, tertiary and tissue.

Primary , or thyroidogenic hypothyroidism accounts for 95% and develops with:

• lack of iodine in the body in people living in areas where this disease is endemic with a lack of iodine in drinking water and food;
• long-term use of high doses of iodine-containing drugs;
• congenital deficiency of fully functioning tissue as a result of its underdevelopment or absence of gland lobes (developmental anomalies);
• congenital disorder of T4 and T3 synthesis;
• partial or complete surgical removal of the gland;
• malignant tumors or metastases of tumors in the thyroid gland, tuberculosis, syphilis;
• chronic thyroiditis of autoimmune etiology, postpartum, subacute, asymptomatic and fibrous variants of thyroiditis;
• toxic effects of lithium, perchlorate, administration of dopamine, interleukin-2 and interferon-alpha, as well as drugs containing dopamine;
• radioactive irradiation of the thyroid gland;
• treatment with drugs that suppress thyroid function, in particular radioactive iodine.

Secondary , or pituitary hypothyroidism develops with the destruction or lack of cells of the anterior pituitary gland that produce TSH. The reason for this may be:

• congenital incomplete development of the pituitary gland;
• radiation therapy, brain injury or surgical interventions with damage to the pituitary gland, hemorrhages and circulatory disorders in the portal system hypothalamus - pituitary gland;
• brain tumors and pituitary adenoma, tuberculosis, abscesses, histiocytosis (active proliferation of unknown nature of immune cells histiocytes and eosinophils);
• autoimmune chronic inflammation of the pituitary gland (lymphocytic hypophysitis):
• developing necrosis in the area of ​​the anterior pituitary gland as a result of acute massive blood loss (Schien's syndrome);
• long-term use of significant doses of glucocorticoids.

Tertiary , or hypothalamic hypothyroidism is explained by a decrease in the production of thyrotropin-releasing hormone. The causes of secondary and tertiary types are the same.

Tissue or peripheral hypothyroidism is caused by the insusceptibility of the receptor apparatus of target tissues to the influence of thyroid hormones with a normally functioning hypothalamic-pituitary system and thyroid gland. The causes and mechanism of development of the disease have not been established. It is assumed that the basis of widespread resistance in the body is genetic defects (gene mutations) of specific T4 and T3 tissue receptors or a violation of the transformation of T4 into a biologically active form (triiodothyronine). The disease, as a rule, is familial in nature and is accompanied by abnormal development of internal organs and the musculoskeletal system.

Classification of hypothyroidism

Thyroid hormones (T3 and T4), formed in follicular tissue, undergo a rather complex synthesis process. It is controlled by the hypothalamus and pituitary gland, which secrete tropic substances, and also depends on the presence of trace elements (iodine, selenium, zinc). Depending on the stage at which thyroid hormones ceased to be formed, the classification of hypothyroidism is based:

• primary hypothyroidism , if as a result of hereditary (congenital) or acquired causes (loss or inhibition of thyrocyte function as a result of removal of part of an organ, tumor process, exposure to radiation or irradiation), the amount of thyroid hormones has decreased. Hypothyroidism of primary origin occurs many times more often than other forms of thyroid insufficiency;
• secondary hypothyroidism , in which there is pituitary insufficiency (trauma, tumor, congenital condition);
• tertiary hypothyroidism , lack of thyroid hormone-releasing hormone due to a violation of its synthesis in the hypothalamus (tumor, injury);
• peripheral - tissue insensitivity when thyroid hormones do not find the place of application.

Thus, hypothyroidism is a disease, a secondary condition that developed due to some reason. Hypothyroidism affects both men and women.

A separate problem is hypothyroidism in women, which occurs relatively often among the fairer sex. Each age period of a woman is characterized by its own characteristics of the course of this endocrine pathology and brings dangers and problems to its owners. Hypothyroidism can occur in childhood (congenital), in young and reproductive years, during pregnancy, in the elderly and senile periods.

Hypothyroidism is a disease that sequentially passes through a number of stages. Starting with subclinical hypothyroidism , when the patient does not have any symptoms, and hypothyroidism can only be detected by laboratory tests, it gradually moves into the stage of obvious manifestations - when the signs of hypothyroidism are quite typical. Hypothyroidism affects all organs and systems of the female body, disrupts all types of metabolism in a woman.

Undiagnosed and untreated congenital hypothyroidism leads to irreversible consequences (dementia, cretinism), since thyroid hormones, among other things, take part in the formation of the child’s nervous system. Hypothyroidism in a young woman can lead to infertility, menstrual dysfunction, and memory loss. Hypothyroidism in a pregnant woman is a common cause of miscarriages, premature termination of pregnancy, and congenital anomalies of the fetus.

Unfortunately, the diagnosis of hypothyroidism cannot always be made in a timely manner. The reason for late diagnosis, especially in the early stages, is that hypothyroidism in women can have many nonspecific symptoms that occur in various internal diseases and mask many pathological conditions.

More than a third of cases of clinically significant hypothyroidism in women occur postoperatively (after removal of part of the thyroid gland). A tenth of all cases are subclinical (latent) hypothyroidism. With age, the incidence of hypothyroidism in women increases.

It is important to diagnose hypothyroidism and begin treatment precisely at the subclinical, or early latent stage, before the disease leads to serious consequences and does not entail complications.

Clinical manifestations

When the function of the thyroid gland decreases, disturbances of all types of metabolic processes occur:

• protein - reducing the degree of protein breakdown and synthesis;
• carbohydrate - increased resistance to carbohydrates and a tendency to low blood glucose (hypoglycemia);
• fatty - an increase in the blood content of cholesterol, alpha and beta lipoprotein fractions;
• water-salt metabolism - retention of sodium chloride and water in tissues.

Due to a violation of the contractility of the walls of the lymphatic vessels, their permeability increases and the lymph flow slows down, as a result of which albumin (protein) is released into the surrounding tissues and cavities (pleural, pericardial). This leads to an increase in oncotic pressure, attraction of water and the formation of edema in tissues and cavities.

The clinical picture depends on the severity of these processes, according to which hypothyroidism is defined as:

1. Mild, or subclinical, in which symptoms are absent or very minor. Blood tests show an increase in TSH levels with normal T3 and T4 levels.
2. Manifest, manifested by multiple manifestations, an increase in TSH levels and a decrease in T3 and T4 levels.
3. Heavy, existing for a long time. It is characterized by severe symptoms and the possibility of developing a coma.

The most characteristic symptoms:

1. Paleness, dryness and swelling of the skin, puffiness of the face; striations, brittleness and dullness of nails.
2. Hair loss, brittleness and dryness.
3. General weakness, lethargy and drowsiness, physical inactivity, slowness of movements, muscle pain.
4. Decreased intelligence, memory impairment, depressive states, mental disorders.
5. Chilliness, hoarseness or roughness of voice, decreased hearing and difficulty breathing through the nose.
6. Slowing heart rate (up to 60 and below), lowering blood pressure and body temperature.
7. Lack of appetite, constipation.

Disturbances in the reproductive system manifest themselves:

1. Decreased sexual desire.
2. Premature or, conversely, delayed ejaculation.
3. Decreased erectile function.
4. Normal sperm content in the ejaculate in the initial stages of the disease with reduced sperm motility.
5. A decrease in the number of sperm and their motility in later stages.

Symptoms

Despite the large number of forms of hypothyroidism, the symptoms are fundamentally different only in two types: childhood (cretinism), adult (myxedema). This is due to the action of thyroid hormones. Their main function is to enhance the breakdown of glucose in the body and stimulate energy production. Not a single active human process can do without thyroxine and triiodothyronine. They are necessary for normal thinking, muscle function, physical activity, even nutrition and immunity.

Signs in children

During childhood, a huge amount of the body's energy is spent on growth and thought processes. Therefore, the main symptoms of hypothyroidism in children are:

• Delayed physical development, which is accompanied by failure of internal organs (most often the heart, liver, kidneys);
• Severe mental retardation - not only the emotional sphere is disrupted in the child, but also other functions of the cerebral cortex (reading, counting, writing, awareness of oneself in space, remembering the names of objects). In the absence of adequate treatment for hypothyroidism, this leads to idiocy;
• Goiter - since the usual number of cells does not produce enough hormones, the body tries to correct this and enlarges the thyroid gland in size. This is achieved through the production of hypothalamic (thyroid-stimulating) hormones. Unfortunately, organ growth rarely leads to the disappearance of symptoms.

Signs in adults

In adults, energy distribution occurs somewhat differently. Since the body, including the brain, is already formed, the main reserves of glucose are used to maintain normal life functions: physical and mental activity, adaptation to stress, adequate functioning of internal organs. With hypothyroidism, all these processes are disrupted. There are symptoms associated with damage to the following body systems:

• Nervous - it is the nerves and cerebral cortex that consume the most glucose, which is why they begin to suffer first. Insufficiency of the functions of the nervous system is manifested by: drowsiness, lethargy, forgetfulness, frequent depression, apathy, and instability to stress. At later stages, sensory disturbances may occur (usually on the arms or legs), paresthesia (feelings of “crawling goosebumps”, “tingling”), slow speech, as if “tongue-tied” are possible;
• Cardiovascular - manifested by a slow heartbeat (pulse less than 60 beats/min), decreased blood pressure (average 100/60 mmHg), pain to the left of the sternum (acute; moderate intensity; decreases at rest, but not passes to the end; nitroglycerin has no effect), anemia, headache;
• Digestive - characterized by decreased appetite, stool retention (more than 3 days), possible nausea, diarrhea (as absorption and intestinal motility are impaired), flatulence, enlarged liver, biliary dyskinesia;
• Muscular - severe weakness, muscle pain (due to a decrease in the amount of glucose, lactic acid accumulates and irritates pain receptors), in the later stages - hypo-/atrophy;
• Integumentary – dry skin, decreased skin elasticity, and peeling are noted. Splitting nails, hair loss.
• Reproductive - against the background of hypothyroidism, women experience menstrual irregularities (uterine bleeding, absence of menstruation), mastopathy. With a pronounced deficiency of thyroid hormones, a woman suffers from infertility; with a mild deficiency, pregnancy occurs, but the risks of spontaneous miscarriage or the appearance of a baby with neurological disorders increase. A decrease in libido occurs in women and men.
• Appearance - with a long course of the disease, the patient’s face becomes puffy, with a yellowish tint, swelling of the legs, arms, and eyelids appears.
• Change in voice - the voice becomes hoarse and low.
• Hearing decreases due to swelling of the tongue, middle ear, and larynx (in later stages due to neurological disorders).

Treatment of hypothyroidism in women

It is possible to treat hypothyroidism in women only by replacing the missing thyroid hormones. For treatment, L-thyroxine is used in an individually selected dose. Replacement therapy for hypothyroidism is carried out for life under the supervision of an endocrinologist .

If hypothyroidism is not treated, the disease can develop into an extremely serious complication – hypothyroid coma. In this condition, all previously existing symptoms intensify, and the patient gradually falls into a coma (loss of consciousness, a sharp decrease in temperature, blood pressure and pulse).

Useful tips

To prevent hypothyroidism in men, it is recommended:

• Do not drink unfiltered tap water. Fluorine and chlorine, which are present in it, stop the absorption of iodine.
• Drink water from glass or stainless steel containers. Do not use plastic bottles containing bisphenol A (BPA) for liquids.
• Eat foods rich in selenium (salmon, sunflower seeds, beef, onions).
• Do not place fillings with amalgam.
• Reduce carbohydrate intake and increase protein in your diet. Replace sugar, flour products, caffeine with healthy fats, which are found in avocados, flaxseeds, and coconut oil. Thanks to proteins, thyroid hormones are transported faster to tissues. It is advisable to increase the consumption of protein foods such as nuts and legumes.
• You can take glutathione supplements to boost your immune system.
• Protect yourself as much as possible from all kinds of radiation. During the X-ray, ask for thyroid protection.

Learn more about the first signs, symptoms and treatment features of hypothyroidism in men from the following video:

Diagnostics

If you suspect hormonal disorders in the body, you should contact an endocrinologist. The main method for diagnosing hypothyroidism is a blood test for hormones. The concentration of thyroxine and triiodothyronine and the level of TSH are determined. In primary hypothyroidism, TSH levels will be elevated and T3 and T4 levels will be decreased. If the TSH concentration is significantly reduced, then this is evidence of secondary or tertiary hypothyroidism.

To confirm the diagnosis and determine the cause of decreased thyroid function, additional studies are prescribed:

• blood for autoantibodies to thyroid cells;
• blood biochemistry (cholesterol and lipid levels are important);
• Ultrasound of the thyroid gland;
• scintigraphy;
• fine-needle biopsy (if a malignant process in the gland is suspected).