Acquired hypothyroidism is one of the most common endocrine diseases . The main cause of persistent primary hypothyroidism is chronic autoimmune thyroiditis , followed by the prevalence of iatrogenic hypothyroidism should be developing in the outcome of surgery on the thyroid gland or treatment with radioactive 131I.

One of the causes of primary hypothyroidism can be severe iodine deficiency. Light and moderate iodine deficiency hypothyroidism in adults under normal conditions can not lead. In newborns due moderate and sometimes even mild iodine deficiency , due to a combination of low iodine in the thyroid gland and a high level exchange of thyroid hormones may develop transient neonatal gipertirotropinemiya . Pregnant women in iodine deficiency may develop gestational relative hypothyroxinemia . Nevertheless, the phenomenon of the last two should not be confused with the syndrome of hypothyroidism in full.

Relatively rare cause of secondary hypothyroidism usually are various destructive processes in the hypothalamic- pituitary region . Most often it is a pituitary macroadenomas and suprasellar structures , as well as surgery for these diseases.

Diagnosis of hypothyroidism , that is proof of the fact decrease thyroid function, is simple enough. It involves determination of TSH and T4 , with the discovery of an isolated increase of TSH indicates subclinical hypothyroidism , and the simultaneous increase in serum TSH and T4 levels decrease - on the explicit or the manifest hypothyroidism . Much greater problem is the definition of the indications for this study because nonspecific clinical picture of hypothyroidism , determines the fact that even the " obvious symptoms " can not find confirmation with hormonal study , along with it, in some cases, hypothyroidism, even accompanied by significant increases in TSH and T4 decrease , sometimes asymptomatic. If we talk about subclinical hypothyroidism , it is in most cases has no manifestations , which would allow him to suspect . When comparing these facts, the question arises about the feasibility of screening determine thyroid function to diagnose hypothyroidism , which supports many of the recommendations .

Cardiac " mask " subclinical hypothyroidism :

resistant hypercholesterolemia, atherogenic dyslipidemia ;

atherosclerosis;

CHD ;

arrhythmias ( sinus bradycardia or tachycardia, polytopic extrasystoles, paroxysmal fibrillation and atrial flutter , sick sinus syndrome );

cerebrovascular disease ;

hypertension ;

Mitral valve prolapse (MVP ) ( and / or other valves) hydropericardium

Thank you Olga Shnaybel for your answer and I have read about supportive recommendations. But you can suggest me some molecular surrogate bio-markers of hypothyroid and atherosclerosis which can enhance diagnosis efficiency or methodology.

At the moment there is no evidence-based clinical guidelines for effective and safe method of drug prevention of autoimmune gireoidiga (AIT ), which is the main cause of hypothyroidism , except replacement therapy has already developed hypothyroidism Effective drug prevention hypothyroidism should be aimed at reducing the tiger autoantibodies rapid suppression of inflammatory activity , decrease in the activity of apoptotic processes , emerging already underway SG debatable about the need to designate patients with SG levothyroxine still open is the problem of pharmacological correction of immune disorders in this group of patients appointment of levothyroxine in patients with MG is not questioned , however, the activity of autoimmune processes in microgravity remains high , despite the appointment of levothyroxine Until now, there is no objective assessment of the impact of levothyroxine on the molecular links underlying autoimmune process in hypothyroidism , followed by the identification of new targets for promising drugs becomes evident that the problem of evidence pharmacotherapy SG and MG possible on the basis of new bioanalytical high-tech methods and mathematical solutions that form the basis of a technological platform to optimize treatment of hypothyroidism relevance of the topic relates to the need to improve the protocol of patients with hypothyroidism on evidence-based research to the provision of objective

tion of information about the effectiveness and safety of treatment regimens SG and MG

Patients observed a general practitioner ( district physician ), if necessary consult an endocrinologist used . During decompensation when matched adequate doses of thyroid drugs , the patient is examined at least 1 time in 10 days.

Treatment is carried out under the supervision of clinical indicators for indications defined T3, T4 , TSH. Upon reaching medical examinations compensation multiplicity reduced to 4 times a year. Adequate replacement therapy is conducted under the supervision of clinic data , according to testimony determined T3, T4 , TSH , cholesterol, ECG recorded . Criterion of effectiveness of rehabilitation therapy is resistance euthyroid state .

thank you, but we can use some interleukins status, inflammatory markers and immunological markers for efficient methodology.

Please give your opinion about this concepts.

Measures of circulatory proprotein convertase subtilisin/kexin type 9 (PCSK9) in older individuals may help determine those who are at increased risk for CV events, new research suggests[1].

Leander K, Mälarstig A, van't Hooft FM, et al. Circulatory PCSK9 predicts risk of cardiovascular events independently of established risk factors.Circulation 2016; DOI:10.1161/CIRCULATIONAHA.115.018531. Abstract