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Thyroid stimulating hormone (TSH, TSH) in circulation by the pituitary gland stimulates the thyroid gland to synthesize and release thyroid hormone, including triiodothyronine (T3) and thyroxine (T4). TSH is controlled by the development of the hypothalamic thyrotropin releasing hormone (TRH), which stimulates the release of TSH dose-dependent manner. T3 and T4 negative comments gene negatively regulates the expression of TRH and keeps the pituitary to respond to hormone replacement therapy. hormones T3-most active forms in circulation or in the tissues targeted by T4 deiodination by enzymes containing selenium.
Current Psychiatry Illustration by Rich LaroccoThe degree of deterioration may depend on the normal function of the patient level. For example, a patient mine well educated thyroiditis, hypothyroidism is linked to the difficulty in finding the words. Instead of asking her husband to take a bottle of wine from the rack, she asked him to take a bottle of wine from the ‘what’.It ‘also frequent loss of vitality, fatigue, lethargy, hypersomnia (especially if sleep apnea is present), and depressed mood observed.
Depressive symptoms. hypothyroid patients are usually several important criteria, such as depression, such as difficulty concentrating, fatigue, decreased libido, and sometimes pessimism or sadness and relief of symptoms suffered after thyroid hormone alternative treatment meet. 3 women with mild hypothyroidism negative screening for psychiatric syndrome show a statistically significant improvement in mood and a better fluidity after 6 months of levothyroxine replacement treatment.4
In some patients, no clear evidence of a biochemical or clinical mood symptoms of thyroid disorders, however, respond to the increasing thyroid hormone antidepressants.5
symptoms of anxiety. Sometimes a thyroid dysfunction in patients with anxiety disorders, including panic disorder, agoraphobia, social phobia, post-traumatic stress disorder performance anxiety and generalized anxiety disorder 0.6
It may seem a paradox, but hypothyroidism is probably as common as hyperthyroidism in very anxious patients. Both hypoand Hyperthyroidism is more frequent in patients with anxiety panic in the general population.
In a sample of 144 consecutive female patients with a psychiatric disorder and / or panic agoraphobia history of life:
27 had a history of thyroid disorders
17 had hypothyroidism
8 had hyperthyroidism.7
The symptoms of hypothyroidism. Symptoms of hypothyroidism (Table 2) may include cold intolerance, the absence or decreased sweating, dry skin, constipation, lethargy, psychomotor slowness and subjective paresthesias and muscle aches. Edema is often present. The face is usually inflated or ‘inflated’ in the morning, but the legs at night (not the face) are edematous.
tendon reflexes are usually slowly relax after initial stimulation. vascular resistance increases, but hypertension is not usual. noradrenergic systems become more active against the establishment of a form of compensation; However, bradycardia, when present, is in deep times. Weight gain may occur, but is often absent.
severe hypothyroidism has a huge paradoxical agitation, paranoia and aggression. The skin is tanned and facies are usually rough. Myxedema is quite common, even in patients with high-functioning. I have seen a case of what is called ‘myxedema madness; Hyperactivation of the patient, shouting insults subtle cognitive abilities, paranoid delusions and vaguely conceived are unforgettable.
Galactorrhoea (hyperprolactinemia related) can be a symptom of severe hypothyroidism probably increased hypothalamic thyrotropin releasing hormone player (TRH). TRH is the major secretagogue known secretion of prolactin. Infertility, oligomenorrhea or amenorrhea may be part of clinical hypothyroidism.
Other symptoms. Macroglossia and hypertrophy of the uvula are possible; In a recent report, dysarthria following the changes orally was the only symptom of hypothyroidism man.8 dysarthria corrected immediately after the replacement of levothyroxine.
Hypothyroidism is one of the main causes of central sleep apnea caused by a malfunction of the control and / or reduction of the airways have aperture.Hypothyroidism when hiding or subclinical, may cause subtle changes in energy or Frank, mood, anxiety level, or cognition. Some emotional symptoms of patients recover with thyroid hormone replacement or antidepressants only after a euthyroid state is established.
To help the recognition of hypothyroidism in patients with psychiatric illnesses and provide effective treatment, this article provides the following:
The signs and symptoms of hypothyroidism
primary subclinical hypothyroidism and thyroiditis, central hypothyroidism, and thyroid hormone resistance
the laboratory screening for thyroid dysfunction in patients with psychiatric symptoms.
Clinical signs overlap
The thyroid hormone is necessary for the metabolic activity of each cell of the body. When patients have linked axis abnormal function of the hypothalamic-pituitary-thyroid (Figure), psychiatric symptoms are often the first professionals to consult.
The diagnosis of thyroid disorders is based on biochemical and clinical data (Table 1), one that may not be consistent. The clinical symptoms of hypothyroidism, for example, are notoriously variable. severe biochemical hypothyroidism may be associated with mild clinical symptoms, while mild biochemical hypothyroidism can be associated with serious symptoms.2
Patients with thyroid disorders and psychiatric symptoms are often misdiagnosed with a spectrum of depressive syndrome. The most common are:atypical depression (which may present as dysthymia)
Bipolar spectrum syndrome (including manic depression, mixed mania, bipolar depression, rapid cycling disorder, cyclothymia, and premenstrual syndrome)
Borderline Personality Disorder
or a psychotic disorder (paranoid psychosis in general).
psychiatric symptoms of hypothyroidism (Table 1) often leads or even primary. Patients usually present:
Warning reduced concentration, learning and memory
and / or mental dullness.