Hypothyroidism : what treatment ?

Paris Match. What are the clinical signs of hypothyroidism ?
Pr Philippe Touraine. Today, they are very rarely those of hypothyroidism, profound fatigue, or apathy, chilliness, strong constipation, psychomotor retardation) linked to a hormone deficiency severe. The thyroid hormones whose role is to regulate the most of our metabolism (body temperature, intestinal transit time, heart rate…), a variety of signs is possible. With the screening current, widely prescribed, the discovery of biological abnormalities alert, often before the onset of clinical signs, which may be absent or isolated, happy non-specific (fatigue, for example) and discrete : these are mild forms of hypothyroidism that are prevalent currently.

Also read:Annick Geille – “I saved my thyroid”

Is this a common disease ?
Yes. It is estimated that 4 to 5 % of the general population is concerned, especially women (8 of 10 cases), with peaks of onset between 20 and 30 years and 50 and 60 years. A birth can sometimes induce an underactive thyroid. Deficiency in iodine (necessary for thyroid hormone synthesis), before any food has not disappeared from our country. Conversely, some treatments iodine can saturate the thyroid gland and by the reaction to make it active.

In two thirds of cases the cause is an autoimmune disease, called Hashimoto’s

What are the possible causes ?
1. In two thirds of cases the cause is an autoimmune disease, called Hashimoto’s : antibodies of the person would turn against her thyroid gland. 2. It can be an inflammation of viral origin, thyroiditis de Quervain, who has the distinction of being painful, but heal quickly on anti-inflammatory (aspirin).3. Sometimes a drug (for example the treatment of a disorder of the heart rhythm by amiodarone, a product rich in iodine). 4. It can be managed with surgery, after total removal, subtotal, or partial, of the thyroid (in the case of cancer, or for some hyperthyroïdies). Other causes are more rare.

What report confirms and clarifies the diagnosis ?
It is necessary to measure in the blood, thyroid hormones, mostly T4 (thyroxine), TSH (thyroid-stimulating hormone, a pituitary hormone that stimulates the thyroid gland) and antibodies of Hashimoto’s thyroiditis (anti-thyroglobulin, anti-thyroperoxidase). An ultrasound may be useful for characterizing thyroid tissue (density, size, etc.).

What is the support ?
First, to assess whether a replacement therapy with levothyroxine (T4 synthesis) is justified or not. When the thyroid is not functioning at all, or very badly, it can not be discussed. Front of hypothyroidism, mild, in which only the TSH is disrupted – the hormones of the thyroid is still normal and the signs a priori missing – include a symptom discreet but persistent to nuance the approach. Depending on the case, you can opt for a simple clinical and laboratory monitoring, treatment or test with the assessment of well-being or not of the subject after two or three months. Similarly, an elevation in isolated antibodies, indicative of an autoimmune disease, will be only monitored, except in special cases (pregnancy is desired). The treatment of hypothyroidism, dose adjustment included, must be personalized, take into account the clinical signs and not just the biology. If levothyroxine should be prescribed, we may use a form other than that which has been the subject of complaints since the summer of 2017, because there are several. Or the new form if it is well tolerated, as in 99% of cases. Figure is confirmed by two surveys of the national security Agency of medicines and health products (MSNA) in 2017, more than 17 000 patients, and three analyses have validated the compliance of its composition. n

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