It has long been noted that the clinical manifestations and course of hypothyroidism vary significantly in individuals of different ages.
In young and middle-aged patients, hypothyroidism usually occurs in a classical form with characteristic subjective and objective manifestations.
In the elderly, hypothyroidism clinic may be erased. The clinical picture comes to the forefront with signs of damage to the cardiovascular system: cardialgia, rhythm disturbances: sinus bradycardia or tachycardia (for anemia and heart failure), extrasystole .
The frequent presence of concomitant diseases of the heart, kidneys and other organs, as well as the wear and tear of clinical manifestations are the causes of hypothyroidism in hypothyroidism in old age.
In childhood, hypothyroidism clinic also depends on the time of occurrence of the disease.
Symptoms of hypothyroidism in newborns and infants. Congenital hypothyroidism in newborns is manifested by the following symptoms:
• high birth weight (more than 3500 g);
• swollen face, eyelids, half-open mouth with a wide “sprawled” tongue;
• localized edema in the form of dense “pads” in the supraclavicular fossa, the back surfaces of the hands, feet;
• low, rough voice when crying, screaming;
• prolonged jaundice;
• signs of immaturity at full-term gestation.
Further (in 3-4 months of life) other clinical symptoms appear:
• decreased appetite, difficulty swallowing;
• poor weight gain;
• flatulence, constipation;
• dryness, pallor, peeling of the skin;
• hypothermia (cold hands, feet);
• brittle, dry, dull hair;
• muscle hypotonia.
Symptomatology of late congenital or acquired hypothyroidism in children. In older children (after 5-6 months), the clinical manifestations of hypothyroidism approach those in adults. However, in the absence of treatment, the growing delay in psychomotor, physical, and then sexual development comes to the fore. The proportions of the body are close to chondrodystrophic, the development of the facial skeleton is lagging, the eruption and the change of teeth are lagging. Typically a sharp backlog of bone age from the passport (sometimes 5-7 years or more), while the bone age is delayed even to a greater degree than growth. Distinctive, characteristic only for hypothyroidism, is a violation of the usual sequence of the appearance of ossification centers (epiphyseal dysgenesis).
In areas with severe iodine deficiency, congenital hypothyroidism may be a manifestation of endemic cretinism .
The classic symptoms of this disease are:
• mental retardation;
• c hearing loss (due to a cochlear defect), up to deaf;
• neuromuscular disorders of spastic or rigid type;
• gait disturbances, coordination of movements;
• strabismus, miosis, impaired reaction of pupils to light;
• goiter or other forms of developmental disorders of the thyroid gland and reduction of its function.
Since the description of R. McCarrison (1908) distinguish between two forms of endemic cretinism.
The most common neurological endemic cretinism, in the clinic whose neurological (pyramidal and extrapyramidal) and intellectual disorders come to the fore. A pronounced hypothyroidism clinic is found in this case only in 10% of patients, more often they have laboratory manifestations of thyroid hypofunction (an increase in the level of TSH and its response to TRH). There is evidence that the formation of neurological cretinism begins in the second trimester of pregnancy, probably under the influence of hypothyroidism in the mother and the delay in the onset of the thyroid gland functioning in the fetus. The development of this form of the disease can be prevented provided iodine prophylaxis begins before the onset of pregnancy and it is impossible – when prophylaxis starts after 2-3 months of gestation. Therapy with thyroid hormones after birth also does not lead to the elimination of manifestations of neurological cretinism.
With another form of the disease – myxedema endemic cretinism – the symptoms of hypothyroidism are the most demonstrative. This form of the disease is typical only for certain areas with a high intensity of endemia. The clinic is characterized by congenital hypothyroidism with myxedema, delayed skeletal formation, growth and psychomotor development. Typical atrophy of the thyroid gland. Deaf-mute is rare. The cause of the disease, apparently, is the failure of the thyroid gland of the fetus in the third trimester of gestation.
It should be noted that two forms of endemic cretinism can occur in the same lesions, and the symptoms of both forms can be detected in one child.