Hyperandrogenic Disorders and Female Diseases: Differential Diagnosis and Treatment Approaches

Ilovaiskaya, I. A.

doi:10.31550/1727-2378-2018-150-6-49-55

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…У женщин с гипотиреозом может наблюдаться гиперандрогения, проявляющаяся легким или умеренным гирсутизмом и обусловленная снижением активности ароматазы, торможением синтеза эстрадиола из тестостерона и, как следствие, повышением его уровня [41].…”

Section: гинекологические «маски»unclassified

Hypothyroidism is an interdisciplinary problem

Verbovoy¹,

Dolgikh²,

Verbovaya³

2022

Russian Medical Inquiry

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Hypothyroidism is one of the most prevalent endocrine disorders, second only to diabetes. Hypothyroidism diagnosis can be difficult in view of its varied and non-specific symptoms. The reason is that thyroid hormones affect virtually every organ system in the body. At the same time, the severity of thyroid hormone deficiency may vary and does not always correlate with the changes in laboratory testing results. Clinical presentation of patients with hypothyroidism may include multiple symptoms and, as a result, it can be difficult to diagnose this disorder, especially in elderly and polymorbid individuals. In some patients, the prevailing symptoms indicate that only a particular system is affected. Thus, there are diseases known as the "masks" of hypothyroidism, and this review is focused on their clinical manifestations. Conditions that may be running under the "mask" of hypothyroidism include diastolic hypertension, dyslipidemia, hydropericardium, chronic constipation, biliary lithiasis, polyarthritis, alopecia, onycholysis, depression, dysfunctional uterine bleeding, infertility, anemia, etc. Due to a variety of clinical signs and symptoms, a patient with hypothyroidism may get an appointment with any medical specialist or receive a follow-up care provided in parallel by multiple specialists. Physicians should be aware of potential hypothyroidism and specific effects of the underactive thyroid on patient’s organs and systems. It is necessary to obtain a thorough medical history about comorbidities which would help to figure out that hypothyroidism is the cause of co-occurring conditions. KEYWORDS: autoimmune thyroiditis, hypothyroidism, subclinical hypothyroidism, euthyroidism, dyslipidemia, cardiovascular diseases, arterial hypertension FOR CITATION: Verbovoy A.F., Dolgikh Yu.A., Verbovaya N.I. Hypothyroidism is an interdisciplinary problem. Russian Medical Inquiry. 2022;6(9):509–515 (in Russ.). DOI: 10.32364/2587-6821-2022-6-9-509-515.

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Section: гинекологические «маски»unclassified

Hypothyroidism is an interdisciplinary problem

Verbovoy¹,

Dolgikh²,

Verbovaya³

2022

Russian Medical Inquiry

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Hypothyroidism in a physician’s practice: difficulties of diagnostics and treatment

Вербовой

Долгих

2020

Medicinskij sovet

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Hypothyroidism is the most common endocrine disease after diabetes mellitus. Its frequency depends on age, sex and iodine intake. The highest prevalence of hypothyroidism is observed in older women. Chronic autoimmune thyroiditis is the most common cause of this condition. The peculiarity of hypothyroidism is an erased clinical picture, diversity and nonspecific symptoms. This makes it difficult to diagnose the disease, leads to an erroneous diagnosis and later detection of thyroid insufficiency. This article discusses the various «masks» of hypothyroidism and peculiarities of clinical manifestations. The main «masks» are: cardiological, dermatological, urological, gastroenterological, endocrine and reproductive system disorders, neurological, psychiatric, hematological, rheumatological. Free thyroxine and thyroid-stimulating hormone are used to diagnose hypothyroidism, as well as antibody titer to thyroid peroxidase and thyroglobulin to detect chronic autoimmune thyroiditis. Levothyroxine preparations are used as a substitution therapy. The dose of the drug depends on the age of the patient and the presence of cardiovascular disease. Patients under 50 years of age without a severe concomitant cardiovascular disease are given 1.6 µg of levothyroxine per kg of body weight. In persons over 50 years of age with cardiovascular diseases, the drug dose is prescribed at the rate of 0.9 µg per kg of body weight. The therapy starts with small doses, slowly increasing it under the control of electrocardiography. At occurrence or strengthening of symptoms of angina a dose of levothyroxine is reduced to the previous one and the cardiovascular therapy is corrected. Evaluation of the effectiveness of the treatment is carried out on the level of thyroid hormone.

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Hypothyroidism: find and neutralize

et al. 2021

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Hypothyroidism is one of the most common diseases of the endocrine system. It is more often recorded in older women. This disease is characterized by nonspecific symptoms and a blurred clinical picture. Patients often have many symptoms from various organs and systems. Because of this, hypothyroidism often remains unrecognized, and patients are not prescribed the necessary therapy on time. Doctors of various specialties should pay attention to the symptoms that may manifest as hypothyroidism. This is especially true for elderly patients. As a screening, the definition of thyroid-stimulating hormone (TSH) is used. First of all, attention should be paid to the pathology of the cardiovascular system, the presence of arterial hypertension, often diastolic and poorly controlled, a decrease in stroke volume and heart rate. Also, in hypothyroidism, lipid metabolism disorders, an earlier onset of atherosclerosis, a connection with metabolic syndrome and type 2 diabetes mellitus were noted. Therefore, it is recommended to diagnose hypothyroidism in patients with these diseases. Screening should also be done in the presence of neurological disorders, depressive and anxiety disorders, gastrointestinal diseases, and hematological disorders (anemias). The determination of TSH is included in the examination plan for infertility, and may also be necessary for other disorders of the reproductive system: menstrual irregularities in women and androgen deficiency in men. Treatment of overt hypothyroidism consists in the appointment of replacement therapy with levothyroxine. If subclinical hypothyroidism is detected, the question of treatment is decided individually and depends on the level of TSH, the patient’s age, and the clinical manifestations of the disease.

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Hyperandrogenic Disorders and Female Diseases: Differential Diagnosis and Treatment Approaches

Cited by 3 publications

References 31 publications

Hypothyroidism is an interdisciplinary problem

Hypothyroidism is an interdisciplinary problem

Hypothyroidism in a physician’s practice: difficulties of diagnostics and treatment

Hypothyroidism: find and neutralize

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