Clinical features

The complaints are general weakness, tiredness, somnolence, cold intolerance, poor hearing, disorders of mental abilities, dyspnea, constipation, weight gain, impairment of sexual function, headache and dizziness. Subjective muscle dysfunction is the myalgia, muscle cramps and stiffness. The complaints of muscle weakness and fatigability are common. Hypothyroid patients may complain of arthralgia and joint stiffness.

Objective examination: the condition of the patient is satisfactory. In case of prolonged hypothyroidism and accompanying changes of organs the conditions becomes grave and even extremely grave if the coma occurs. The patient with hypothyroidism as a rule is adynamic. Patient has specific features of face, so called myxoedematous face (facies myxoedemica): periorbital pufliness narrowing of the eye slit, poor mimic, purplish lips, the hair is thinned or absent on the outward portions of the eyebrows. The patient looks older his real age.

The skin of patient is pale with icterus tint. Pallor develops due to vasoconstriclion and anemia. Yellow color is explained by carotinemia resulted from delayed turnover of carotin to vitamin A. The skin becomes rough, scaly and thickened. Trophic disorders of the skin and its derivates are characterized by such signs: dryness. Fragility and loss of hairs, nails are thin, brittle with transvered lines, grow slowly, infiltration of the skin with specific substances which content mucopolysaccharides leads to edema which does not pit with pressure. The edema is most marked in the skin of the hands, feet. The periorbital edema is observed. As a rule edema is nonpitting. If the edema is pitting, especially in the legs, should suspect the presence of complication as heart failure as a result of myxoedematous heart.

The skin is cold due to the both thickening and decreased blood flow, poor peripheral circulations. The patients are usually overweight.

Signs of muscular affection are dystrophy, muscle stiffness, mainly at the proximal part of extremities, muscular weakness and painful spasms, myotonia. Chronic hypothyroid myopathy occurs due to increased muscle mass (pseudohyperthrophy). Movements may be slow and clumsy. Some patients have synovial thickening and synovial effusions, usually of the knees.

Respiratory system. The signs related to the upper airways and respiratory system include chronic nasal congection, shortness of breath and sleep apnea. Complaints referable to the airways are explained by mutinous edema of the nasal mucosa and larynx. Shortness of breath may inducate on the presence of pleural effusion. The patient has low-pitched hoarse voice due to the edema of vocal cords. Simultaneously with enlarged tongue and lips therefore speech become very slowly with lingering intervals. The course of hypothyroidism is characterized by frequent attacks vasomotor rhinitis, pneumonia.

Disorders of the cardiovascular system are characterized so-called, myxoedematous heart due to the interstitial myocardial edema, dystrophy of its fibers. The apex beat is displaced to the left, diffuse and weak. In percussion the borders of relative cardiac dullness are displaced outside. In auscultation decreased loudness of both sounds over in all listening points are revealed. In case of pericardial effusion the loudness of cardiac sounds extremely decreased or even disappears. Constant and stable bradycardia less than 60 beats per minute is typical sign of hypothyroidism. Appearance of premature beat is possible. Blood pressure mainly systolic is decreased, pulse pressure diminished. Hypothyroidism promotes and accelerates the development of atherosclerosis with affection different vessels. These patients as usually have clinical features of ischemic heart disease.

Changes from the digestive system occur due lo the edema of gastrointestinal tract, which associated with motor and secretory dysfunction. These alterations appear as persistent constipation, flatulence, paresis of intestine. Decreased intestinal motility may cause abdominal distension and constipation, produce paralytic ileus or megacolon with the clinical feature of intestinal obstruction. Sometimes is observed the propensity to parodontosis. The liver usually is unaffected. Ascitis is uncommon sign of hypothyroidism.

Renal blood flow is reduced according to the decrease in cardiac output. The glomerular filtration rate is usually reduced and mild proteinuria is revealed. Due to the hypotension develops oliguria till anuria.

Neurological dysfunction manifested by carpal tunnel syndrome due to the edema of the flexor of the wrist. Patient has slow deep tendon reflexes with prolonged contraction and relaxation phases.

Cerebellar dysfunction includes such signs as ataxia, intention tremor and nystagmus. Disorders thermoregulation may present in a form of cold intolerance.

Hypothyroid patients have the signs of mental dysfunction due to chronic insufficiency of cerebral circulation, hypoxia and brain edema. The main features are somnolence, and even lethargy. The patient may sleep longer at night or may go to asleep frequently during the day.

The patient becomes physically and mentally slow: the speech is slow, memory loss, significant limitation of activity, adynamia, and apathy. In some patients may observe depression, indifference to surrounding or severe anxiety and agitation, maniac state. Lingering hypothyroidism leads to cognitive impairment and overt dementia. Outcomes of hypothyroidism may be disorders of pituitary gland. In men observe decreased sexual potential till impotence, deranged spermatogenesis. In women appears amenorrhea or menorrhagia, infertility. In patients of both gender groups occur diminished libido, no pubic and armpit hair. One of the dangerous complications of disease may be hypothyroid coma. The patient's condition is grave, unconsciousness, passive posture, declining body temperature till 23°C, deep and slow breating sinus bradycardia till 30 beats per minute, hypotension. Accumulation of fluid in pericardial cavity may cause the compression of the heart with acute heart failure. Constant and severe constipation resemble ileus.