Hypothyroidism
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Hypothyroidism is a chronic syndrome of symptoms resulting from insufficient production of thyroid hormones - thyroxine (T4) and triiodothyronine (T3) - or from impaired action of these hormones at the tissue level. Thyroid hormones play a key role in regulating cellular metabolism, thermogenesis, cardiovascular and nervous system function, as well as maintaining the normal structure of the skin, hair, and nails. Their deficiency leads to a slowdown of metabolic processes throughout the body. The disease can be primary (directly related to the thyroid), secondary, or tertiary (resulting from disorders of the hypothalamus-pituitary-thyroid axis) and often develops gradually, which means it can remain undiagnosed for a long time.
Hypothyroidism - symptoms
The symptoms of hypothyroidism are varied and often nonspecific, which can lead to them being overlooked or attributed to other conditions. Their severity depends on the degree of hormone deficiency, the duration of the disease, and the patient's age.
The most common systemic symptoms include:
- Chronic fatigue and sleepiness that are disproportionate to lifestyle,
- Feeling cold with an intolerance to low temperatures,
- Weight gain, usually moderate, resulting from a reduced metabolic rate,
- Psychomotor slowing, decreased concentration and memory,
- Low mood and depressive symptoms,
- Constipation due to slowed intestinal peristalsis,
- Bradycardia and decreased cardiac output.
In women, the following are often observed:
- Menstrual irregularities,
- Fertility problems,
- Increased risk of miscarriage.
In older individuals, symptoms may be sparse or masked by other chronic diseases, while in children and adolescents, hypothyroidism can lead to growth and physical development disorders and delayed sexual maturation.
Hypothyroidism – effects on the skin
The skin is one of the organs particularly sensitive to a deficiency in thyroid hormones, as they regulate the proliferation of keratinocytes, epidermal lipid synthesis, and the functioning of skin glands.
Typical skin changes include:
- dry skin (xerosis cutis) – the skin becomes rough, dull, and prone to cracking,
- paleness or a yellowish skin tone, resulting from the accumulation of carotenoids,
- myxedema – characteristic, non-pitting edema of the face, eyelids, and limbs, caused by the deposition of glycosaminoglycans in the dermis,
- cooling of the skin and decreased peripheral blood flow,
- increased tendency to irritation and hypersensitivity.
Changes also affect skin appendages:
- hair becomes thin, dry, brittle, and may fall out excessively (especially the outer parts of the eyebrows),
- nails are brittle, grow slowly, with a tendency to split.
Long-term, untreated hypothyroidism leads to a deterioration of the skin's regenerative abilities, slower wound healing, and an increase in the symptoms of skin aging, such as loss of elasticity and sagging.
Hypothyroidism – Treatment
The treatment of hypothyroidism involves supplementing the deficiency of thyroid hormones and is long-term, often lifelong. The goal of therapy is to restore the normal concentration of hormones in the blood and normalize the body's metabolic functions.
The basic principles of treatment include:
- individualized dosage selection of the hormonal preparation,
- regular monitoring of laboratory parameters,
- assessment of the patient's clinical response to treatment.
Therapy monitoring is primarily based on measurements of:
- TSH concentration,
- free fractions of thyroid hormones,
- in selected cases – anti-thyroid antibodies.
In the initial phase of treatment, doses are usually smaller and gradually increased, especially in older individuals and patients with cardiovascular diseases. Properly conducted therapy leads to the gradual resolution of general symptoms and improvement in organ function, although skin changes and hair structure disorders may require a longer time to regenerate.
An important element of management also includes:
- patient education on the regularity of treatment,
- avoiding factors that disrupt hormone absorption (e.g., certain supplements and medications),
- periodic assessment of hormone requirements in special situations such as pregnancy, weight changes, or comorbid diseases.
It should be clearly emphasized that untreated or improperly treated hypothyroidism leads to progressive metabolic and systemic disorders. However, rational, consistent treatment allows for full control of the disease and maintaining a good quality of life.
