Ipotiroidismo
Table of Contents
Introduzione
L’ ipotiroidismo è una sindrome clinica dovuta a un’insufficiente azione degli ormoni tiroidei a livello tissutale, che determina un rallentamento di tutti i processi metabolici. L’ipotiroidismo che si sviluppa durante la vita fetale e neonatale determina una riduzione importante e spesso permanenza dei processi accrescitivi dello sviluppo intellettivo fino al ritardo mentale grave, (cretinismo); quello che si determina in epoca giovanile è causa di ritardi accrescitivi, mente l’ ipotiroidismo dell’adulto determina un rallentamento generalizzato dei processi metabolici. L’ipotiroidismo dell’adulto ha una prevalenza elevata con maggiore frequenza nel sesso femminile) con un rapporto da 2/1 a 8/1), nell’età avanzata e nelle aree con carenza iodica. Esso si manifesta in maniera subdola e insidiosa ed equivocabile con altre affezioni, sia perché, accanto alle forme conclamate, esistono quadri a sintomatologia più sfumata o addirittura asintomatiche (ipotiroidismo subclinico o lieve).
Si possono identificare tre forme principali di ipotiroidismo:
1. Ipotiroidismo primitivo che può essere congenito acquisito, è sostenuto da una ridotta massa e/o funzione del tessuto tiroideo e rappresenta più del 90% dei casi di ipotiroidismo,
2. Ipotiroidismo centrale sostenuto da una ridotta stimolazione ipotalamo ipofisaria .
3. Ipotiroidismo da resistenza generalizzata all’azione degli ormoni tiroidei (GRTH) una rarissima forma familiare dovuta ad alterazione del recettori per La T3
1. Ipotiroidismo primitivo che può essere congenito acquisito, è sostenuto da una ridotta massa e/o funzione del tessuto tiroideo e rappresenta più del 90% dei casi di ipotiroidismo,
2. Ipotiroidismo centrale sostenuto da una ridotta stimolazione ipotalamo ipofisaria .
3. Ipotiroidismo da resistenza generalizzata all’azione degli ormoni tiroidei (GRTH) una rarissima forma familiare dovuta ad alterazione del recettori per La T3
IPOTIROIDISMO DELL’ADULTO
Il quadro clinico è essenzialmente determinato dalla durata e dall’entità della carenza di ormoni tiroidei.
Sintomi più caratteristici sono presenti nelle forme più gravi e di maggiore durata meno frequentemente la sintomatologia è di modesta entità o addirittura assente (ipotiroidismo subclinico).
I sintomi sono:
Sintomi più caratteristici sono presenti nelle forme più gravi e di maggiore durata meno frequentemente la sintomatologia è di modesta entità o addirittura assente (ipotiroidismo subclinico).
I sintomi sono:
- adinamia
- sonnolenza
- intolleranza al freddo
- irregolarità mestruali (queste irregolarità possono rendere difficile il concepimento; le donne con ipotiroidismo in gravidanza soffrono di aumento del rischio di aborto nelle prime settimane di gravidanza. Il trattamento riduce questo rischio)
- crampi muscolari
I segni includono
- cute secca, ruvida e fredda
- edema al volto e alle palpebre
- voce rauca
- macroglossia
- secchezza e fragilità dei capelli
- sopracciglia rade
Sistema nervoso
- letargia
- difficoltà memoria
- scarsa attenzione
- cambiamento di personalità
- alterazione dei riflessi e sensoriali
- atassia
Muscolo scheletrici
- debolezza
- crampi
- dolori articolari
- S.tunnel del carpale
Grasrointestinali
- nausea
- stipsi
Riproduzione
- libido
- fertilità
- alterazioni mestruali
QUAL E’ LA CAUSA DELL’IPOTIROIDISMO
Nella persona adulta la causa più comune di ipotiroidismo è la tiroide di Hashimoto : una condizione in cui il sistema immunitario del paziente attacca la tiroide e la danneggia in modo che non può più produrre quantità adeguate di ormoni. L’ipotiroidismo può anche insorgere come conseguenza del trattamento con iodio radioattivo ( usato per trattare altre forme di malattie della tiroide) o della rimozione chirurgica della tiroide per il trattamento dell’ipertiroidismo. Più raramente l’ipotiroidismo è risultato della riduzione di produzione di TSH da parte dell’ipofisi per un problema della ghiandola ipofisaria. L’ipotiroidismo può anche essere presente dalla nascita se la tiroide non si sviluppa normalmente.
DIAGNOSI
La diagnosi può essere effettuata con un semplice esame del sangue e può permettere di riconoscere precocemente la malattia. L’esame del sangue può essere effettuato nel sospetto di ipotiroidismo in presenza di alcuni dei sintomi sopradescritti o come test di screening nel neonato, prima di una gravidanza.
L’esame del sangue può confermare la diagnosi ma anche indirizzare verso la causa della malattia. Il test più importante da effettuare è la determinazione di TSH: questo è il test più sensibile perché il TSH aumenta anche in presenza di piccoli difetti della funzione tiroidea. Viene effettuata anche il dosaggio di tiroxina T4, che è il principale ormone prodotto dalla tiroide. Il paziente affetto da ipotiroidismo avrà alti livelli di TSH e bassi livelli di T4 nel sangue. Nelle prime fasi dell’ipotiroidismo il livello di TSH nel sangue aumenterà sopra la norma prima che la T4 scenda al di sotto dei limiti di norma. Quando la causa di ipotiroidismo è la tiroide Hashimoto nel sangue saranno presenti anche anticorpi antitiroidei. Lo screening in Italia come in altri paesi del mondo viene fortemente consigliato nelle donne in gravidanza.
Una volta raggiunto il livello ottimale di tiroxina il controllo ormonale può essere effettuata una volta all’anno o se necessario più frequentemente La maggior parte dei pazienti richiede un trattamento per tutta la vita e la dose di farmaco può richiedere adeguamenti nel corso del tempo. Non è opportuno aumentare o ridurre la dose di tiroxina senza aver consultato il medico; l’eccesso di terapia sostitutiva può causare ipertiroidismo, con il rischio di fibrillazione atriale, riduzione della mineralizzazione scheletrica (osteoporosi).
TERAPIA
La terapia dell’ipotiroidismo si basa sulla somministrazione di
L-tiroxina (L-T4) a dosi adeguate e a tempo indefinito. La
L-T4 è un farmaco di scelta in quanto, come avviene per la T4 nativa, essa viene convertita nel ormone attivo T3 a seconda della necessità dell’organismo. Inoltre essa ha una lunga emivita (circa 7 giorni) che consente un’unica somministrazione giornaliera.
Le dosi usuali sono comprese tra 1,4 e 1,8 mg/ kg peso corporeo.
È sempre opportuno iniziare con dosi molto basse (25/50 µg/die) da aumentare progressivamente, particolarmente in caso di ipotiroidismo di grave entità, nei pazienti anziani e con disturbi cardiovascolari. Nei bambini le dosi di (L-T4 necessari sono di (8-14 µg/kg / die da 1 a 5-6 ann).
Nelle donne in stato di gravidanza le dosi di L-T4 vanno aumentate
del 30-35% per compensare l’aumento delle proteine di trasporto indotto dagli alti livelli di estrogeni circolanti e la maggior richiesta ormonale tipica di tale condizione fisiologica.
| | Le informazioni riportate non sostituiscono il parere del medico e il rapporto medico-paziente. |
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