2023-05-03 13:57:00
Thyroid dysfunctionsalso called dysthyroidism, would affect about 2% of the French population according to the High Authority for Health (HAS). “We distinguish hypothyroidismlinked to a decrease or absence of thyroid hormone production, and hyperthyroidisma consequence of an excess of thyroid hormones.
Occurring mainly in women, with an incidence that increases between 35 and 60 years of age, it is estimated that there are approximately 3.1 new cases of hypothyroidism per year per 1,000 women. Conversely, experts consider less than 0.2 new cases per year for men.
This disease is characterized by decreased production of thyroid hormones. However, they play a major metabolic role by increasing the amount of energy and oxygen consumed by the cells of the body. As a result, when there is a lack of these hormones, the metabolism drops, which alters the functioning of all the organs.
Of varying intensities, “the symptoms of hypothyroidism are non-specific and are varied. Generally, “the first symptoms are hair loss, fatigue and weight gain“, explains Doctor Alain Scheimann, endocrinologist and author of the book What if it was the thyroid? (InPress Editions) from Medisite. La nervousness, depressive symptoms or menstrual cycle disorders are also warning signs.
So, “an isolated symptom cannot, on its own, predict hypothyroidism”, say the experts. And yet, “in case of proven hypothyroidism, the standard treatment is medicationwith levothyroxine, which is currently prescribed to around 3 million people in France.”
Treatment adapted to the patient’s profile
To ensure better care of a person with hyperthyroidismthe French National Authority for Health published comprehensive recommendations on March 14, 2023.
Now, the patient who has several symptoms that raise suspicion of the disease should carry out biological analyzes in sequence, according to a process called “cascade”. In other words, the doctor draws up a single prescription in which he lists the different useful dosagesstarting with that of thyroid stimulating hormone (TSH).
“Only one blood sample is taken and the biologist initiates additional assays only if the TSH result is abnormal from the outset (or confirmed abnormal after a few weeks), “explains the HAS. “This method of prescription makes it possible to avoid repeated and unnecessary blood tests for the patient.”
And if hypothyroidism is proven…
In cases where the disease is recognized, “initiation of treatment with levothyroxine is indicated.” In this research, the HAS recalls that the management of hypothyroidism can be carried out by the general practitioner. “Nevertheless, a consultation with an endocrinologist may be recommended in cases where the patient is unbalanced, has a history of ischemic heart disease, is found to have a nodule, goiter, pregnancy or a desire to become pregnant.”
Hypothyroidism after 65: follow-up must be different
As the years pass, it is normal for our anatomy to change. And the thyroid is no exception. “Ageing is accompanied by progressive anatomical and functional changes in the thyroid”, recalls in its report the High Authority for Health. “It is therefore important for health professionals to distinguish what is part of the thyroid pathology that can lead to hypothyroidism.”
In effect, “The mere fact of being over 65 should not justify the performance of a TSH assay to detect hypothyroidism”, say the experts. This is recommended in certain situations:
- If clinical signs suggestive of hypothyroidism;
- And recent cognitive decline is discovered;
- And known neurocognitive disorders worsen in an unexplained way;
- In case of treatment with amiodarone. Prescribed in case of heart rhythm disorders, this drug may be linked to the appearance of hypothyroidism. This cause is therefore more common in the elderly.
Therefore, the HAS recommends to adapt care when patients are over 60 years old. “Furthermore, if initiation of treatment with levothyroxine is necessary, it should start at a low dosage.”
Pregnancy: specific cases for pregnant women
“Pregnancy causes significant physiological changes in thyroid function. It is estimated that the activity of the thyroid increases by around 50% to maintain the thyroid balance and compensate for the needs”, explains in its report the HAS. “The doses of levothyroxine must then be increased by 20% to 30% at the start of pregnancy. To do this, she will have to take 2 more daily doses per week, i.e. 9 tablets per week instead of 7.
Or, “there may be consequences for the mother and the fetus (miscarriage, premature birth, low birth weight, learning disabilities…).”
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