Treatment of congenital hypothyroidism

A treatment plan for congenital hypothyroidism has been developed since the final diagnosis. Therapy depends on the form of the disease and its symptoms, the patient's age, the presence of comorbidities.

Treatment consists of the following main steps:

1. Etiotropic therapy - at this stage, all the causes and factors that cause the thyroid gland to malfunction are eliminated. Treatment of congenital hypothyroidism is aimed at stopping the inflammatory processes, elimination of the existing pathologies of the pituitary or hypothalamus. If the disease state is associated with iodine deficiency in the body, then the patient is prescribed special preparations based on iodine.
2. Replacement therapy is the intake of synthetic analogues of natural thyroid hormones. The duration of treatment with hormonal drugs depends on the type and stage of congenital pathology. In severe cases, drug therapy can be lifelong.
3. Symptomatic therapy is aimed at improving the patient's quality of life and minimizing the symptoms of endocrine disorders. Often, treatment consists of taking such medicines:
   • Cardioprotectors - normalize heart rhythm, blood pressure and the functioning of the cardiovascular system.
   • Neuroprotectors and nootropics - normalize metabolic processes in the central nervous system and brain.
   • Cardiac glycosides - shown with signs of heart failure.
   • Multivitamin complexes - improve the work of all organs, systems and general well-being.

All medicines are prescribed by the attending physician, selecting the dosage and duration of therapy, individually for each patient.

4. Diet is an essential part of treating hypothyroidism. The basic principle of nutrition is to ban foods that contain cholesterol and saturated fatty acids. It is necessary to minimize fast carbohydrates, as well as products that are hard to digest and increase secretion.

• Permitted products: meat and fish, cereals, dairy and vegetable products, dried fruits.
• Prohibited foods: fried, fatty, spicy, smoked meats, pickles and pickles, sauces, sweets and foods high in sugar, alcohol, pastries made from corn and wheat flour.

During the diet, special emphasis should be placed on fresh vegetables and fruits. It is also recommended to do at least one fasting day per week.

Medicines

Drug therapy is a mandatory component of the treatment of congenital hypothyroidism. Medicines are selected by an endocrinologist individually for each patient. The basis of treatment is hormone replacement therapy. For its implementation most often prescribed such drugs:

[1], [2], [3],

Levothyroxine sodium

Synthetic levorotatory hormone of the thyroid gland. It enhances protein synthesis, stimulates the growth and development of the body, increases the tissue's need for oxygen, stimulates metabolic reactions among proteins, fats and carbohydrates.

The drug increases the efficiency of the cardiovascular system and the central nervous system. Increased doses inhibit the production of thyrotropin releasing hormone hypothalamus and thyroid stimulating hormone of the pituitary gland. It is characterized by slow absorption, therefore the therapeutic effect develops within 7-12 days.

• Indications for use: primary and secondary hypothyroidism, complex therapy for diffuse enlargement of the thyroid gland and enhancement of its functions, euthyroid hyperplasia. Prevention of relapses of reducing the functions of the organ after surgical treatment of nodular and malignant tumors. A sharp decline in mental and physical abilities, cretinism. The drug can be used for differential diagnostic test for suppression of thyroid function.
• Method of application: the dosage is selected individually for each patient and depends on the evidence. Therapy begins with small doses of 12-15 mg per day. The average daily dosage of 25-200 mg, the multiplicity of reception - 1 time per day before meals. Maintenance dose of 25-200 mg per day. During treatment, it is not recommended to take antidepressants and anticoagulants, since Levothyroxine enhances their action.
• Side effects: worsening symptoms of the underlying disease, signs of coronary heart disease, diabetic disorders, adrenal insufficiency. Nausea, sleep disturbances, excessive sweating, weakness and palpitations are also possible.
• Contraindications: acute myocardial infarction, Addison's disease in the acute stage, cardiac arrhythmias, increased thyroid function. With extreme caution, the drug is prescribed for ischemic heart disease, atherosclerosis, hypertension, circulatory failure.

Levothyroxine sodium is available in the form of tablets for oral administration.

[4], [5], [6], [7]

L-thyroxine

Drug with active ingredient - levothyroxine. Its action is similar to the activity of human endogenous thyroid hormones. Regulates the processes of growth and development of the organism, affects the metabolism and oxidative reactions. Stimulates the central nervous system.

The therapeutic effect on hypothyroidism is noted on the 3-5th day of therapy. With continuous treatment for 3-6 months, diffuse goiter significantly decreases or disappears completely, hormone production is normalized.

• Indications for use: replacement therapy for hypothyroidism of different etiology, after thyroid surgery and a course of treatment with radioactive iodine. Appointed with myxedema, cretinism, overweight with signs of disruption of the gland, as well as with cerebral-pituitary diseases. Prevents the recurrence of nodular goiter after resection. It is also used in the treatment of autoimmune thyroiditis Hashimoto and Graves disease. Effective in the treatment of hormone-dependent highly differentiated malignant tumors of the gland, follicular and papillary carcinomas.
• Method of application: the drug is taken once a day, in the morning 30 minutes before meals. The daily dosage is calculated by the attending physician, individually for each patient. In the first days of treatment, 25-100 mg are applied, and then the dose is increased every 2-3 weeks by 25-50 mg to achieve the desired therapeutic effect of maintenance therapy.
• Side effects: change in appetite and weight gain, hair loss, renal impairment. Visual acuity, tachycardia, arrhythmia, sleep and wakefulness disorders, limb tremor. In rare cases, there is allergic dermatitis, diarrhea, vomiting. Symptomatic treatment with mandatory dosage adjustment.
• Contraindications: individual intolerance to the components of the drug, thyrotoxicosis of any etiology, cardiac arrhythmias, ischemia, circulatory disorders, severe forms of hypertension and heart failure. Patients over 65 years old, Addison's disease, adrenal insufficiency. The drug is allowed during pregnancy and lactation.
• Overdose: signs of thyrotoxicosis, and in severe cases of thyrotoxic crisis. Violations of the cardiovascular system, tremor of the limbs, irritability. Treatment consists in the abolition of the drug.

L-thyroxin is available in the form of tablets of 25, 50 and 100 mg in blisters of 50 capsules each.

[8], [9]

Eutirox

Synthetic analogue of the hormone - thyroxine. Contains the active ingredient - sodium salt of levorotatory isomer of thyroxin. The pharmacological effect of the drug depends on its dosage:

• Low doses stimulate protein and lipid metabolism.
• Mediums enhance the synthesis of proteins and nucleic acids, regulate growth processes, improve tissue respiration. Increase the functional activity of the cardiovascular and central nervous system.
• High doses reduce the synthesis of the releasing factor in the hypothalamus, which helps to reduce the concentration of thyroid stimulating hormone pituitary.

A pronounced therapeutic effect develops within 1-2 weeks after the start of treatment. With a pathological decrease in the level of thyroid hormones, the effect of the drug develops faster.

• Indications for use: primary and secondary hypothyroidism, euthyroid goiter, replacement therapy after thyroid surgery. Prevention of disease recurrence after complete or partial removal of the gland. Combined therapy of diffuse toxic goiter. Diagnostic tool for thyroid suppression test.
• Method of application: the dosage and duration of treatment are determined by the attending physician, individually for each patient. When hypothyroidism in patients under 55 years of age and with normal function of the cardiovascular system, 75-150 mg per day is prescribed. For patients older than 55 years with impaired function of the cardiovascular system, the initial dose is 25 mg, then the dose is increased by 25 mg every 2 months until the normal level of TSH is reached.
• Side effects: allergic reactions with intolerance to the components of the drug.
• Contraindications: hypersensitivity to active substances, acute myocardial infarction and myocarditis, adrenal insufficiency. It is prescribed with caution for patients with diabetes mellitus, impaired function of the cardiovascular system and malabsorption syndrome. Use of the drug during pregnancy and lactation is allowed.
• Overdose: signs of thyrotoxicosis, tachycardia, pain in the heart, tremor of the extremities, disturbance of sleep and wakefulness, irritability and anxiety. It is also possible loss of appetite, sweating, impaired stool. There is no specific antidote, symptomatic treatment with mandatory dosage adjustment.

Eutirox has a tablet release form of 25, 50, 75, 100, 125 tons of 150 mg of the active substance. In one blister are 25 capsules.

[10], [11]

Tiro-4

Drug that compensates for the deficiency of thyroid hormones. Shows pharmacological thyroid action.

• Indications for use: hypothyroidism, autoimmune thyroiditis, euthyroid hyperplasia of the gland. Prevention of disease recurrence after surgical treatment of nodular and malignant tumors. The dosage is selected by the attending physician for each patient individually.
• Contraindications: ischemic heart disease, myocarditis, myocardial infarction, adrenal insufficiency, hyperthyroidism, severe arrhythmia, marked atherosclerosis, arterial hypertension, heart failure, cardiopathy.
• Side effects: hyperthyroidism, insomnia, excessive sweating and weakness, rapid heartbeat, arrhythmia, angina. It is also possible violation of the chair, bouts of vomiting, weight change, hyperglycemia, exacerbation of Addison's disease. Symptomatic treatment with dose adjustment or drug withdrawal.

Tyro-4 is available in the form of tablets for oral use.

Teatroit

Hormonal drug from dried defatted thyroid gland of cattle. It has the biological activity of organ hormones, contains from 0.17 to 0.23% iodine. Small doses of medication enhance protein synthesis and pituitary activity. Increased dosage slows down the thyrotropic activity of the pituitary gland and the synthesis of hormones.

• Indications for use: primary hypothyroidism, myxedema, cretinism, cerebral-pituitary diseases, obesity with reduced organ functions, endemic and sporadic goiter, cancer of the gland.
• Method of application: patients of adult age are prescribed at 50-200 mg per day with constant dosage adjustment to achieve normalization of heart rhythm, metabolic processes and blood cholesterol levels. The dosage for children is calculated by the attending physician, individually for each baby. The therapeutic effect manifests itself in 2-3 days after the start of the drug. A lasting therapeutic effect is noted in 3-4 weeks.
• Side effects: in case of overdose, signs of thyrotoxicosis, angina pectoris, allergic reactions, worsening of diabetes mellitus appear.
• Contraindications: thyrotoxicosis, diabetes mellitus, general exhaustion of the body, acute coronary insufficiency, Addison's disease.

Thyroidine has two forms of release: powder and enteric-coated tablets.

Violations of the thyroid gland adversely affect the functionality of the brain and its cognitive activity. Because of this, drugs for improving metabolism in the brain are part of drug therapy.

Piracetam

Enhances dopamine synthesis in the brain and increases the content of norepinephrine. Positive effect on metabolic processes and blood circulation. Stimulates redox reactions, increases energy potential.

• Indications: atherosclerosis of the brain, vascular parkinsonism, chronic cerebrovascular insufficiency, impaired memory, attention and speech. Dizziness, cerebrovascular accident, brain injury and intoxication. Diseases of the central nervous system, pathology with a decrease in intellectual-mnestic functions.
• Method of application: with parenteral intravenous administration, the initial dose of 10g, in severe conditions - up to 2 g per day with a gradual decrease in dosage after improving the condition. When administered orally, the initial dose of 800 mg, divided into three doses. The course of treatment from 3 weeks to 6 months.
• Side effects: increased irritability, mental agitation, decreased concentration. Increased anxiety, sleep disturbances, dizziness and headaches, nausea, vomiting and stool disorders. Also possible convulsions, tremor of the limbs, increased libido. Adverse reactions develop at dosages above 5 g per day.
• Contraindications: acute renal failure, diabetes, allergic reactions to the components of drugs, patients under 1 year.
• Overdose: irritability, sleep disturbances, tremor of the limbs, exacerbation of heart failure.

Piracetam increases the action of thyroid hormones, neuroleptics, psychostimulants and indirect anticoagulants. Available in the form of capsules of 400 mg of the active ingredient in each, in the form of enteric-coated tablets, as well as in the form of a solution in ampoules.

[12]

Aminallo

Gamma-aminobutyric acid (GABA) is a biogenic amine that is found in the central nervous system and is involved in the metabolic and neurotransmitter processes of the brain. Restores metabolic processes, improves glucose utilization, activates energy processes, improves blood circulation. Displays toxic metabolic products and has a psychostimulant effect, restoring speech and movement after serious violations of cerebral circulation.

• Indications for use: disorders of cerebral circulation, craniocerebral and birth injuries, atherosclerosis of cerebral arteries, vascular diseases, cerebral palsy. Mental retardation with reduced mental activity, motion sickness complex, alcoholic encephalopathy and polyneuritis.

• Method of application: the dosage and duration of treatment are determined by the attending physician, individually for each patient. As a rule, patients are prescribed 500 mg 2 times a day with a gradual increase in dose. Therapy lasts from 2 weeks to 4 months.

• Side effects: dyspeptic symptoms, sleep and wakefulness disorders, blood pressure jumps, sensation of heat. The drug is contraindicated in case of intolerance to its components.

Aminalon is available in tablet form of release for 6 and 12 tablets in blisters.

Pyriditol

It affects the metabolic processes in the central nervous system, accelerates the penetration of glucose through the blood-brain barrier. It reduces the level of lactic acid and improves the supply of amino acids to the brain tissue. Increases resistance of brain tissue to inadequate supply of oxygen.

• Indications for use: increased weakness, neurosis-like and adynamic conditions, traumatic and vascular diseases of the brain. Residual effects after neuroinfections, injuries and disorders of cerebral circulation. Combined therapy of depression. Delayed mental and mental development, cretinism, mental retardation. Alcohol withdrawal, asthenic conditions.
• Method of application: orally 2-3 times a day after meals. The daily dose for adults is 100-300 mg, for children 50-100 mg. The duration of treatment is from 1 to 8 months, repeated courses are conducted in 1-6 months.
• Side effects: headaches and dizziness, insomnia, nausea, irritability. The drug is contraindicated in case of hypersensitivity to its components, expressed psychomotor agitation, epilepsy, increased seizure activity.

Pyriditol has two forms of release: tablets with an enteric coating of 50 and 100 mg, pills of 100 mg, and syrup in bottles (every 5 ml of the drug is 100 mg of the active ingredient).

Mexidol

Inhibitor of free radical processes, increases the resistance of tissues to oxygen deficiency. It has a wide range of biological activity, is effective in hypoxia of various etiologies. Mexidol increases the body's resistance to oxygen-dependent states, improves memory, reduces the toxic and damaging effects of alcohol.

• Indications for use: acute disorders of cerebral circulation, dyscirculatory encephalopathy, dystonia, atherosclerotic disorders. Withdrawal syndrome in alcoholism, drug addiction and other conditions with severe tissue hypoxia.
• Method of application: intramuscularly or intravenously, the dosage is determined by the attending physician for each patient separately.
• Side effects: nausea and dryness in the mouth. The drug is contraindicated in case of intolerance to its components, with marked impaired renal function and liver, allergic reactions to pyridoxine.

Mexidol is produced in the form of a 5% solution in 2 ml ampoules.

Cerebrolysin

Hydrolyzed brain substance released from protein. The preparation contains 85% amino acids and 15% low molecular weight peptides. Improves metabolic processes in the brain tissue. Cerebrolysin penetrates the blood-brain barrier, regulates intracellular metabolism and improves the transmission of nervous excitement. Increases the survival of brain cells with insufficient supply of oxygen to the tissues and the action of other damaging factors.

• Indications for use: pathological conditions with dysfunction of the central nervous system, cerebrovascular accident, brain surgery, mental retardation, psychiatric diseases.
• Method of administration and dosage depend on the indications for use of the drug, therefore, are determined and regulated by the attending physician.
• Side effects: sensation of heat, change in body temperature. Symptomatic treatment.
• Contraindications: intolerance to the components of the drug, pregnancy and lactation, allergic rashes, severe renal dysfunction. The drug is not used with a solution of amino acids.

Cerebrolysin is available in 1 and 5 ml ampoules of 5% solution.

Disorders in the thyroid gland entail a number of complications, including violations of the synthesis of red blood cells and absorption of iron in the stomach. For the treatment and prevention of anemia, anti-anemic drugs are used: Ferrum Lek, Ferropleks, Aktiferrin, Totem, as well as folic acid and B vitamins.

Another common symptom-complication of hypothyroidism is constipation. To eliminate them, patients are advised to take laxatives: Bisacodil, Senade, Lactulose, Regulax.

Vitamins

Decreased thyroid function arises due to a variety of factors, including a deficiency of vitamins and minerals in the body. Consider the basic substances that the body needs in hypothyroidism:

• Iodine

It is necessary for the normal operation of the thyroid and the production of its hormones. Takes part in metabolic and metabolic processes of the body, affects the rate of biochemical reactions. Iodine deficiency leads to hypothyroidism and is manifested by the following symptoms: increased drowsiness, weight gain, decreased performance, deterioration of general well-being.

An elevated trace element in the body causes thyrotoxicosis or hyperthyroidism. The recommended daily intake of iodine should be within 2-5 g. The substance is contained in seafood, beef liver, eggs. To compensate for iodine deficiency, it is enough to consume iodized salt daily.

• Vitamin A

Retinol is not produced independently in the human body. The substance is formed from beta-carotene, which comes from food. With thyroid abnormalities, the rate of retinol formation decreases, which leads to impaired metabolic reactions, eye problems and a decrease in the protective properties of the immune system.

During normal synthesis, vitamin A fights infectious pathogens, supports normal functioning and integrity of internal organs. Retinol is found in raw potatoes, carrots, persimmons, sea buckthorn and other products with a high content of beta-carotene.

• Vitamins of group B

Favorably affect the endocrine system, increase the functionality of the cardiovascular system and improve metabolic processes. Vitamin B deficiency is manifested by disorders of the digestive system, swelling of soft tissues and joints, and dermatological diseases. Secretory disturbances and sleep problems are also noted. The daily rate of the trace element - 2.6 mg. Contained in nuts and cereals, vegetables and dairy products. Particular attention should be paid to magnesium, that is, vitamin B6.

• Vitamin C

Vitamin C increases the protective properties of the immune system, improves the functioning of the thyroid and pancreas. Warns atherosclerosis. The deficiency of this vitamin is manifested by a worsening of general well-being, loss of appetite, bleeding gums and a bleeding disorder. Ascorbic acid is found in citrus fruits, hips, bell peppers, black currants. Vitamin quickly destroyed by high temperatures and does not tolerate direct sunlight.

• Vitamin D

Accumulates in cells and tissues, belongs to fat-soluble microelements. Responsible for normal bone growth and calcium absorption. Vitamin deficiency is manifested by increased fragility and deformation of the bones. To obtain a daily dose of a substance, it is necessary to be in the sun for 1-2 hours a day. Calciferol is found in fatty fish, eggs, sour cream and cream.

• Vitamin E

Responsible for the physical condition of the thyroid gland. Deficiency of tocopherol leads to the gradual destruction of tissues of the organ and even to the formation of diffuse goiter. Vitamin is not synthesized in the body, so it must come from food. It improves the functioning of the endocrine system, thyroid, pituitary and adrenal glands. Contained in cereals, nuts and eggs.

It is possible to provide the body with essential vitamins and minerals with the help of multivitamin medicines, dietary supplements and dietary supplements. For pathologies on the side of the thyroid gland, the following complexes are recommended:

• Iodomarin, iodine balance - restore and maintain the level of iodine in the body.
• Aevit - a vitamin complex with a high content of retinol, suitable for maintaining the endocrine system.
• Vitrum, Alphabet, Complevit are multivitamin preparations that contain the most essential substances for the body.

The dosage of vitamins is selected by the doctor, individually for each patient. Trace elements are best taken in the morning after meals. This will contribute to maintaining good health throughout the day. Vitamins can not be taken on an ongoing basis, treatment consists of several courses, between which there should be a temporary break.

Physiotherapy

Comprehensive treatment of hypothyroidism includes physiotherapy. Physiotherapy has such an effect on the body:

• Increase the effectiveness of drugs used.
• Normalize the functioning of the secretion organs.
• Stimulate the thyroid gland and other endocrine organs.
• Improve the redox and metabolic processes in the body.
• Favorably affect the cardiovascular and nervous system, digestion.
• Restore the production of hormones.
• Improve overall well-being.

In diseases of the thyroid, climatotherapy and heat therapy are used in combination with medicines, as well as massages and electrophoresis. The most effective physiotherapeutic procedures for the correction of thyroid insufficiency include:

1. Thyroid stimulating methods:

• Iodine-bromine baths.
• Low-intensity SMW-therapy of the thyroid.

2. Enzyme-stimulating methods:

• Oxygen baths.
• Ozone baths.
• Vibrovacuum therapy.
• Contrast and air baths.
• Thalassotherapy.

3. Hormonal correcting methods:

• Tangenial electroalgesia.
• Carbonated baths.
• Radon baths.
• Transcerebral UHF Therapy.
• Transcerebral low-frequency electrotherapy.

To enhance the functions of the body, DMB-therapy is used, that is, the exposure of the UH microwaves to the front surface of the neck and the adrenal glands. Microwaves increase glucocorticoid activity, the level of free forms of hydrocortisone and cortisol, immunological tolerance.

Iodine electrophoresis and UHF therapy in the area of the affected organ is used to stimulate the thyroid gland. Also recommended ultraviolet radiation, exercise therapy and massages. If hypothyroidism is accompanied by impaired motor function of the gastrointestinal tract, then mineralized mineral water and thermal procedures are prescribed. Arthropathy shows mud therapy, which increases motor activity and reduces pain in the joints. In severe forms of the disease, sanatorium treatment is carried out.

[13], [14], [15],

Alternative treatment

To speed up the healing process, many patients resort to using unconventional methods. Alternative treatment of congenital hypothyroidism is carried out using the following recipes:

1. Pour a glass of boiling water a tablespoon of crushed lemon peel and 30 g of flax seeds. Boil the mixture over medium heat for 5-10 minutes. After cooling, strain and take as tea for ½ cup 2-3 times a day.
2. 300 g of wild apple fruits, clean from seeds and finely chop. Pour apples 1 liter of boiling water and boil for 10-15 minutes. Cool and drink in small portions throughout the day.
3. Take a tablespoon of crushed inner walls of the walnut and its shoots. Fill the raw material with 250 ml of vodka and put it in a sealed container for 3-4 weeks. Ready tincture take 1 teaspoon per glass of water in the morning and evening.
4. Take fresh potatoes, carrots and beets. Do not grate the vegetables and squeeze the juice or make a drink in a juicer. Juice can be drunk in a mixture or separately from each vegetable and ½ cup 3 times a day.
5. When iodine deficiency in the body, dissolve in a glass of water 1 drop of iodine and a teaspoon of vinegar. Take a drink 2 times a day with meals.

Before applying the above methods, you should consult with your doctor.

[16], [17]

Herbal medicine

Today, medicine knows many medicinal plants that positively affect the functioning of the thyroid gland.

Medicinal herbal recipes:

1. Chop 50 grams of aniseed fruit with 300 grams of walnuts. Add to the mixture 100 g of boiled and chopped garlic until smooth. Combine all ingredients and mix thoroughly. Take 1 tablespoon 2-3 times a day for 20 minutes before meals.
2. Take 100 grams of common cocklebur and pour 500 ml of water. Boil on low heat for 5-10 minutes, cool, strain. Take 1 glass 3 times a day. More effective is the juice of the plant, diluted with 25% alcohol. It is taken on 10-15 drops with a spoon of honey. Durnikov contains a large amount of iodine, so it acts no worse than pharmaceutical preparations.
3. Chop 15 g of dried May lily of the valley and pour 100 ml of vodka / alcohol. The tool should be insisted 1-2 weeks in heat. The medicine is taken in 15-30 drops per glass of water 2-3 times a day.
4. Take three parts of the leaves of nettle, one part of the crushed root of Eleutherococcus, the same amount of dying grass, dandelion and carrot seeds. Add to the vegetable mixture two parts of the grass of a cocklebur and mix thoroughly. 1.5 tablespoons of the dry mixture pour 500 ml of warm water, boil for 5-10 minutes. Strain and add to the broth 80 drops of alcohol infusion of walnut partitions. Take a drink 100 ml before meals 1-2 times a day.

Herbal treatment for congenital hypothyroidism is prescribed by a phytotherapist.

[18], [19]

Homeopathy

Another alternative treatment for hypothyroidism is homeopathy. Homeopathic therapy normalizes the production of hormones, providing a positive effect on the entire body. Promotes the restoration of physical and mental health, normalizes weight.

With a decrease in thyroid function, these drugs are used:

1. Arnica - traumatic injuries and operations on the thyroid gland, muscle aches and cramps. The appearance of hematomas, coagulation disorders, increased levels of liver enzymes.
2. Sepia - depression, inhibition of reactions and speech, swelling of the upper eyelids, flaky skin with dark pigmentation in the cheek area. Violations of the chair, gynecological pathology.
3. Thyroidin (calf thyroid tissue) - disproportionate body structure, edematous neck, elevated liver enzymes.
4. Kolhikum - increased weakness and swelling, swelling around the eyes, sensitivity to odors, and stool disorders.
5. Graphite - swelling and compaction of the skin, folliculitis in the shoulder area. Increased loss and breakage of hair, nails. Overweight, depression, melancholicity, gastrointestinal disorders, constipation.

All homeopathic remedies are used only for medical purposes, with the selection of individual dosage and duration of therapy.

[20]

Surgery

Surgery for hypothyroidism is extremely rare. Surgery is prescribed for a nodular form of the disease or a significant increase in the organ. The operation is also possible if it is necessary to achieve radically positive results in a short time.

The main indications for surgical treatment of congenital thyroid disease:

• The large size of the body, impeding the process of breathing and swallowing.
• Suspicions of oncological processes.
• Adverse reactions, contraindications or failure of other treatments.
• Use of radioactive therapy to reduce goiter.
• Nodules that are not sensitive to radioactive iodine.

Today, both open surgery and surgery using an endoscope are used, that is, minimally invasive techniques. The minimum amount of tissue removed is one lobe, the maximum is all of the gland. Removal of individual nodal neoplasms is not carried out, since almost always relapses occur, and the powerful fibrous membrane of the gland does not allow for a second operation.

As for the surgical treatment of other organs in patients with congenital and other forms of hypothyroidism, there is a high risk of complications. The most likely consequences of surgery:

• Respiratory failure.
• Intestinal obstruction.
• Violation of blood coagulation and increased bleeding of tissues.
• Cardiac arrest and coma.
• Hypothermia.
• Gyptonia.
• Adrenal insufficiency.

Patients with disorders of the thyroid before surgery are treated with hormonal drugs to minimize the development of the above complications.

There is also such a thing as postoperative hypothyroidism. A painful condition develops after surgery in the thyroid area. The prevalence of this complication is 20% among women and 16% in men. The risk group includes elderly patients, patients with anemia, diabetes, renal failure. In this case, a violation of the synthesis of organ hormones is the result of inhibition of its functional capabilities, iodine deficiency or destructive processes in the hypothalamic-pituitary region.

[21], [22], [23], [24]