Thyroid disease is defined as a condition of malfunction of thyroid.
Hyperthyroidism is a condition in which the thyroid gland is over active
and produces too much thyroid hormones. Hypothyroidism is a condition
in which the thyroid gland is under active and produces very little
thyroid hormones.
A. Symptoms
Symptoms of the Hypothyroidism is depended to the severe stage of the
disease. as it progresses slowly over years. Most common symptoms
include
1. Weight gain and fatigue
In a prospective observational research design where 198 consecutive
breast cancer patients receiving adjuvant chemotherapy were monitored
from start to end and 6 months post-therapy on changes in
anthropometics, fatigue, nutritional intake, physical activity, thyroid
and steroid hormones, found that a weight gain over >5 lb in 22.2% of
this patient population with a significant and progressive gain of 6.7
lb (P < 0.0001) at 6 months. Ninety four percent of all patients
reported fatigue and 56% of patients reported lowered physical activity.
A significant reduction in serum free and total estradiol (P <
0.0001) was observed indicative of reduction in ovarian function with
86% amenorrehic at the end of treatment. A significant reduction in mean
serum triiodothyronine uptake levels (P < 0.05), in addition to a
significant increase in TBG (P < 0.0001) from baseline to end of
chemotherapy, was observed. In addition 20-25% of this patient group was
already diagnosed with clinical hypothyroidism at diagnosis and
treated. Changes in fatigue frequency and serum sex-hormone-binding
globulin (SHBG) were variables significantly predictive of weight gain
(P < 0.0001)(1).
2. Vitiligo and alopecia areata
There is a report of the parents of an 18-year-old woman had noticed
white hair while combing their daughter's hair 12 years ago. They found
tiny white spots on her scalp, but she was asymptomatic. The spots have
since progressed. Examination of the affected skin on the scalp was
marked by the presence of a chalky/ivory white macule, 8 to 10 cm in
diameter, conforming to that of segmental (zosteriformis) vitiligo
(Figure 1). The lesions were located on the temporoparietal region of
the scalp. The hair over the macules was white (leukotrichia) and dry,
coarse, and brittle. The patient's nails were thin and dull. Her thyroid
profile revealed the following: triiodothyronine, 1.12 nmol/L (0.95-2.5
nmol/L); thyroxine, 69.21 nmol/L (60.0-120.0 nmol/L); and
thyroid-stimulating hormone, 6.26 microIU/mL (0.25-5.00 microIU/mL),
indicative of primary hypothyroidism(2).
3. Chronic constipation
Geriatric patient educational material and a general practice review
suggest insufficient dietary fiber intake, inadequate fluid intake,
decrease physical activity, side effects of drugs, hypothyroidism, sex
hormones and colorectal cancer obstruction may play a role in the
pathogenesis of constipation, according to the study by the University
of California at Los Angele(3).
4. Urticaria and puffiness of hands and feet, yellow ivory skin,
coarse rough dry skin, alopecia periorbital edema, amenorrhe,
dysparunia, PCO, PMS and Breast tenderness, menstrual irregularities and
infertility
In the study to study is to highlight the presenting dermatologic and
gynecologic manifestations of firstly-diagnosed hypothyroid females,
showed that Compared to euthyroid cases, hypothyroid ones were
presenting mostly with amenorrhea (OR=7.76). Other gynecologic
manifestations that were prominent in hypothyroid cases were dysparunia,
PCO, PMS and Breast tenderness. On the other hand, rate of menstrual
irregularities and infertility were non-significantly different in both
groups.hypothyroid women showed also significantly higher frequency of
urticaria and puffiness of hands and feet (both were present in 16.7% in
hypothyroid vs. 3.3% of euthyroid cases, p =0.007, OR=5.8). Hypothyroid
cases showed also significantly higher frequency of yellow ivory skin
(OR=5.4) and coarse rough dry skin (OR=3.8). On the other hand, alopecia
and periorbital edema were observed only among cases of hypothyroidsm
and none of euthyroid cases(4).
5. Depression
In the study to investigate the depression-like behavior performances of
subclinical hypothyroidism (SCH) rat. SCH rat model induced by
hemi-thyroid electrocauterization, and the behavior performances were
measured by sucrose preference test, force swimming test (FST), and tail
suspension test (TST). SCH rat model was established successfully by
hemi-thyroid electrocauterization, found that SCH could result in
depression-like behavior, accompanied with subtle hyperactivity of HPA
axis. The reduced hippocampal T3 prior to the reduction of thyroid
hormone in serum might be taken as an early sign of hippocampus
impairment in the progression from SCH to CH(5).
6. Mood, declarative memory, motor learning and working memory
In a double-blinded, randomized, cross-over study of usual dose l-T(4)
(euthyroid arm) vs. higher dose l-T(4) (subclinical thyrotoxicosis arm)
in hypothyroid subjects, showed that The Profile of Mood States (POMS)
confusion, depression, and tension subscales were improved during the
subclinical thyrotoxicosis arm. Motor learning was better during the
subclinical thyrotoxicosis arm, whereas declarative and working memory
measures did not change. This improvement was related to changes in the
SF-36 physical component summary and POMS tension subscales and free
T(3) levels(6).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/17933284
(1) http://www.ncbi.nlm.nih.gov/pubmed/14997046
(2) http://www.ncbi.nlm.nih.gov/pubmed/21675503
(3) http://www.ncbi.nlm.nih.gov/pubmed/17219073
(4) http://www.ncbi.nlm.nih.gov/pubmed/21475555
(5) http://www.ncbi.nlm.nih.gov/pubmed/23794115
(6) http://www.ncbi.nlm.nih.gov/pubmed/18285414
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