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Hypotyreos

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Definition:
Ett tillstånd med nedsatt sekretion av tyroxin (T4) och trijodtyronin (T3) och nedsatt koncentration av hormonerna i blodet.
Förekomst:
Prevalensen för hypotyreos är cirka 4 % och risken att insjukna är 5–10 gånger vanligare bland kvinnor.
Symtom:
Symtomen är initialt diffusa men så småningom blir de mer karakteristiska med trötthet, frusenhet, tröghet, förstoppning och ökat sömnbehov.
Kliniska fynd:
Tidiga kliniska tecken är få, senare tillkommer psykomotorisk tröghet, torr hud, torrt hår, långsamma reflexer, långsam puls.
Diagnostik:
Man kan dela upp hypotyreos i overt hypothyreos där blodprover visar fritt T4 (FT4) under referensområdet och TSH över referensområdet. Subkliniskt hypotyreos  karakteriseras av förhöjt TSH men FT4 fortfarande inom normalområdet. Båda dessa former är primär hypotyreos – det vill säga rubbningen sitter i sköldkörteln. Om stimuleringen från hypofysen faller bort utvecklas sekundär hypotyreos – då ser man ofta ett normalt TSH (ibland lite förhöjt eller lite lågt) i kombination med FT4 under referensområdet.
Behandling:
Behandlingen är substitution med sköldkörtelhormon.
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  • Helena Filipsson Nyström, med dr och specialist i internmedicin, Institutionen för Medicin, Sahlgrenska akademin, Göteborgs universitet
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet