Thyreopathy in primary care

Summary

Thyroid gland disorders, as the core of all endocrinopathies, affect 5–7% of the population of the Czech Republic, with women being affected 6–8 times more often than men. Clinically, thyreopathies are divided into hormonal production disorders and morphology disorders. Thyroid hormones fT₃, fT₄ and TSH serum levels determine the diagnosis of a thyroid gland disorder. Primary hypothyreosis is characterized by reduced fT₄ and increased TSH. Low T₃ syndrome is a protective reaction of the organism and is associated with conversion of T₄ into hormonally inactive triiodothyronine (rT₃). Primary hyperthyreosis is characterized by higher fT₄ and low TSH levels. Acute thyreoiditis: Inflammatory signs and normal thyroid function, anti-TPO as well as anti-TG are not elevated. Subacute thyreoiditis is manifested as an inflammation, normal anti-TPO and anti-TG, sometimes also hyperthyreosis. Chronic thyreoiditis, Hashimoto‘s struma is among the most frequent causes of hypothyreosis in the Czech Republic and it is diagnosed through high anti-TPO and anti-TG levels and higher TSH. Thyreoidal adenomas and carcinomas are clinically usually euthyroid. Determination of tumour markers – thyreoglobulines in papillary and follicular carcinomas and calcitonin in medullar carcinoma that requires genetic assessment (determination of germinal mutations, usually with PCR) – is essential.

Key words:
thyroid gland – hypothyreosis – hyperthyreosis – thyroxin – TSH – fT₄ – inflammation – tumours