6. Endocrinology

1. Syndrome of hypothyroidism:

REASONS: The disease is caused by a decrease or complete loss of thyroid function. Severe

hypothyroidism is called myxedema. There are primary hypothyroidism caused by direct damage

to the thyroid gland and secondary, developing as a result of insufficient production of

thyrotropin or thyroliberin. The most common causes of hypothyroidism are autoimmune

thyroiditis (autoimmune destruction of the thyroid gland) and thyroidectomy (postoperative

hypothyroidism). Iodine deficiency in our country exists in most regions, but it is never the cause

of hypothyroidism.

SYMPTOMS:

1. Damage to the nervous system: lethargy, drowsiness, lethargy, memory loss, speech slowdown, adynamia.

2. Cardiovascular system: bradycardia, dull heart sounds, decreased voltage of ECG teeth, decreased blood pressure, sometimes increased blood pressure (mainly diastolic), myocardial damage (myocardial dystrophy).

3. Damage to the skin and mucous membranes: the skin is dry, cold, dense (not folded), peeling off; hyperkeratosis of the palms, brittle nails, hair loss. The face is swimming, mask-like, the eye slits are narrow. Swelling of the lips, eyelids, cheeks, neck. When pressed on the edematous tissue, there is no fossa. Speech becomes slow, voice is low (due to the thickening of the vocal cords). The tongue is edematous. Violation of the gastrointestinal tract, constipation, belching, etc.

3. Edema in serous cavities (usually hydropericardium, hydrothorax) Hertog’s symptom is hair loss on the eyebrows, especially on the lateral side.

1. Laboratory data: hypercholesterolemia, normochromic anemia, decreased basal metabolism,

hypoglycemia, decreased levels of thyroid hormones (T3 and T4). With primary hypothyroidism, TSH increases (negative feedback principle), with secondary TSH decreases.

Pic 6.1 Hypothyroidism, before and after treatment.

2. Thyrotoxicosis syndrome (hyperthyroidism):

Thyrotoxicosis is an increase in the level of T3 and T4 in the blood and their toxic effect on the body. The term hyperthyroidism is often used as a synonym for thyrotoxicosis. However, it should be remembered that thyrotoxicosis (i.e., an excess of thyroid hormones) is not always associated with an increase in the functional activity of the thyroid gland.

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REASONS for thyrotoxicosis: 1. Thyrotoxicosis associated with increase in the functional activity of the thyroid gland occurs with diffuse toxic goiter (Graves-Bazedov disease) or nodular toxic goiter;

2. Thyrotoxicosis, not associated with increase in the functional activity of the thyroid gland occurs with destruction of the thyroid gland. The destruction of the thyroid gland leads to the release of accumulated hormones (destructive thyrotoxicosis). At the same time, the functional activity of the gland is not increased. This is observed with thyroiditis (subacute thyroiditis, autoimmune thyroiditis); destructive thyrotoxicosis is always short-term and is not treated with thyreostatics. Also, thyrotoxicosis without hyperthyroidism is observed with an overdose of L-thyroxine (in this case, on the contrary, there is hypothyroidism that is treated with L-thyroxine).

SYMPTOMS:

1. Damage to the nervous system: nervousness, irritability, fussiness, tearfulness, sleep disturbance, memory loss, tremor of fingers and the whole body.

Symptom Marie - a small symmetrical tremor of the fingers of extended arms, as well as a "symptom of a telegraph pole" - a pronounced trembling of the patient, which is felt by the doctor upon palpation of the patient's chest.

2. Eye symptoms:

Gref's symptom: when the vision fixes an object that slowly falls down, a section of the sclera is exposed between the upper eyelid and the edge of the iris.

Kocher's symptom is the same when moving an item from bottom to top.

The symptom of Dalrymple is the same when fixing the object with vision in a horizontal plane, another interpretation of this symptom is wide open eye slits Rosenbach's symptom is tremor of the eyelids with closed eyes.

Symptom of Geoffrey - inability to form folds on the forehead, when looking up; Shtelvag symptom - a rare blink.

The symptom of Moebius is the eyeball moving outward when the gaze fixes an object brought to the nose bridge; indicates weak convergence due to changes in t. rectos internus.

The symptom of Stasinsky or the "red cross" - manifests itself in the form of an injection of vascular sclera. The departure of the injected vessels up, down, to the right, to the left of the iris gives the impression of a red cross in the center of which the pupil is located. Symptom Elineka - pigmentation of the eyelids.

Symptom Kraus - increased eye gloss.

Lagophthalmus - the inability to close your eyes for centuries, which in severe cases causes

ulceration of the cornea and sclera with subsequent infection.

3. Cardiovascular system: tachycardia, cardiac arrhythmias (extrasystole, atrial fibrillation), systolic hypertension, development of heart failure.

3. Gastrointestinal tract lesion: increased appetite, increased motility and gastric secretion, diarrhea, weight loss, toxic hepatitis.

3. Catabolic disorders: symptoms associated with increased metabolism: fever, sweating, feeling hot.

3. The defeat of other endocrine glands (hypogonadism, adrenal insufficiency, impaired carbohydrate metabolism).

3. Laboratory data: hypocholesterolemia, increase in basal metabolic rate. T3 and T4 increase, TSH decreases according to the principle of negative feedback.

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Pic 6.2 Thyrotoxicosis, before and after treatment.