Hypothyroidism in men

Hypothyroidism is an endocrine disease caused by a persistent deficiency of thyroid hormones or a decrease in their biological effect on the organs and peripheral tissues of the body. In latent form, the disease is registered in 10 - in 20% of the total population, in a form that proceeds with a complex of clinical symptoms - in 0.2% of men of reproductive age and 2.5% in elderly( after 60 years).

Mechanism of hormonal regulation

Thyroid hormones T4( thyroxine, or tetraiodothyronine) and T3( triiodothyronine) are produced by the thyroid gland, the synthesis of which requires the presence of sufficient iodine in the body. These hormones affect the regulation of metabolic processes, the frequency of cardiac contractions, blood pressure, psyche, body temperature, reproductive processes.

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

The signal for increasing or decreasing the secretion of TSH by the pituitary is the change in the content of thyroid hormones in the blood. Excess of normal concentration in the blood of T4 and T3 has a retarding effect on the pituitary gland, and a decrease is stimulating.

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

Table 1 - Norms for the maintenance of hormones in the blood

Types of hypothyroidism

Hypothyroidism is subdivided into fourIda( depending on the cause): primary, secondary, tertiary and tissue.

Primary , or thyreigenic hypothyroidism, is 95% and develops with:

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

Secondary , or pituitary hypothyroidism, develops with the destruction or deficiency of the anterior pituitary cells producing TSH.The reason for this may be:

• congenital incomplete development of the pituitary gland;
• Radiation therapy, brain trauma or surgical interventions with pituitary damage, hemorrhage and impaired circulation in the portal system of the hypothalamus - pituitary;
• brain tumors and pituitary adenoma, tuberculosis, abscesses, histiocytosis( active reproduction of the unclear nature of immune cells of histiocytes and eosinophils);
• autoimmune chronic inflammation of the pituitary gland( lymphocytic hypophysitis):
• developing necrosis in the anterior pituitary region as a result of severe massive blood loss( Shien syndrome);
• prolonged intake of significant doses of glucocorticoids.

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

Tissue , or peripheral hypothyroidism, is caused by the immunity of the receptor apparatus of target tissues to the effect of thyroid hormones in the normally functioning hypothalamic-pituitary system and the thyroid gland. Causes and mechanism of the disease are not established. It is assumed that genetic defects( gene mutations) of specific T4 and T3 receptors of tissues or a violation of the transformation of T4 into a biologically active form( triiodothyronine) are based on the widespread resistance in the body. The disease, as a rule, is of a family nature and is accompanied by an abnormal development of internal organs and the musculoskeletal system.

Clinical manifestations of

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

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

Because of the disruption of the contractility of the walls of the lymph vessels, their permeability and lymph flow retard increase, resulting in albumin( protein) reaching the surrounding tissues and cavities( pleural, pericardial).This leads to an increase in oncotic pressure, the 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. Light, or subclinical, in which the symptomatology is absent or very insignificant. In blood tests there is an increase in TSH levels with normal T3 and T4.
2. Manifest, manifested by multiple manifestations, an increase in the content of TSH and a decrease in T3 and T4 levels.
3. Heavy, existing for a long time. It is characterized by the severity of the symptoms and the possibility of developing a coma.

The most common symptoms:

1. Pale, dry and swollen skin, puffiness of face;Stria, brittleness and dullness of the nails.
2. Hair loss, brittle and dry.
3. General weakness, lethargy and drowsiness, inactivity, slowness of movement, pain in muscles.
4. Decreased intelligence, memory impairment, depressive states, mental disorders.
5. Chilliness, hoarseness or rudeness of the voice, decreased hearing and difficulty with nasal breathing.
6. Slowing heart rhythm( up to 60 and below), lowering blood pressure and body temperature.
7. Lack of appetite, constipation.

Violations in the reproductive system are manifested:

1. Decreased sex drive.
2. Premature or, conversely, slow ejaculation.
3. Decreased erectile function.
4. Normal contents of spermatozoa in the ejaculate at the initial stages of the disease with reduced mobility.
5. Decreased number of spermatozoa and their mobility in later stages.

Treatment of hypothyroidism

Treatment of the disease is carried out with drugs of levothyroxine. The most effective of them with long-lasting activity of the active ingredient is "L-thyroxine Berlin-Chemie".It is a synthetic sodium salt of thyroxin and for the convenience of dosing is available in tablets from 50 to 150 mg( intervals between doses - 25 mg each).Dosage is carried out strictly individually according to laboratory analyzes.

The remaining medications are symptomatic and are prescribed depending on various systemic disorders.

Recommended for viewing: