Clinical hypothyroidism variants (classification)
In the Dr. A.V. Ushakov "Clinic of the thyroid gland" they identified 15 major clinical variants of hypothyroidism. Some of them are more common, others - less. All of these options are determined by the blood picture and represent combinations: 1) TSH values and 2) thyroid hormone levels.
There are not two, but several dozen variations of hypothyroidism. The main - 15 clinical options.
The increase in TSH is more than normal, but up to 10-13 mU / l - corresponds to a small excessive stimulation of the thyroid gland. This is a small hypothyroidism. Increase in TSH more than 10-12 mU / l to 20-30 mU / l - moderate hypothyroidism. With an increase in TSH of more than 30 mU / L - significant stimulation of the thyroid gland, i.e. significant hypothyroidism. These and other classification features are important for the selection of adequate treatment and care.
The classification allows you to conveniently and clearly distribute all known variants and nuances of painful changes. This condition is important for simple orientation and understanding of pathological processes (in the thyroid gland). Patients call this understanding the “decoding” of a blood test.
Classification of hypothyroidism
(Clinic of Dr. A.V. Ushakov, Moscow, 2015)
1. Thyrotropic (stimulation)
1.1. Small
1.2. Moderate
1.3. Significant
2. Thyroid
2.1. Compensated
2.2. Subcompensated
2.3. Decompensated
2.4. With overcompensation
2.5. With gain (compensation)
Thyroid variants of hypothyroidism depend on the magnitude and ratio of thyroid hormones. First of all, from two indicators of the blood test: T4fr. and T3fr.
If both indicators are within the optimum norm (at an average of 50%), then this is compensated for hypothyroidism (i.e. full sufficiency of thyroid hormones). With the location of these hormonal parameters or their relationship T3fr./T4fr. in less than 25% of the norm, subcompensated hypothyroidism (i.e., initial hormone deficiency) is judged. With the location of these hormonal parameters or their relationship T3fr./T4fr. less than normal, decompensated hypothyroidism (i.e., pronounced deficiency) is defined. The location of the hormonal parameters or their relationship T3fr./T4fr. in the largest 25% of the norm, and T3fr. even higher than the norm (this happens) is called overcompensation (i.e., excess compensatory response). Great value relationship T3fr./T4fr. is associated with more intensive consumption of thyroid hormones and is called increased compensation.
All these clinical variants of thyroid hormones can be combined in different ways with the magnitude of TSH (i.e., different force of stimulation of the pituitary gland). This variety creates a wide range of clinical hypothyroidism options.
Specify - what is your clinical version of hypothyroidism!
There are two obsolete and defective hypothyroidism options. These are “subclinical” and “manifest” (manifest) hypothyroidism. Despite the fact that these concepts are still used in endocrinology, they are increasingly subjected to sound scientific criticism. The “subclinical and manifest” variants of hypothyroidism are of little use, they have become obsolete, but they persist due to the very significant spread in the medical environment and the reluctance of authoritative specialists to abandon their old dogmas. A critical description of these terms can be found in the book of Dr. A.V. Ushakov "Blood test for diseases of the thyroid gland" (2016) and the article by Professor W.M. Wiersinga, who heads the department of endocrinology and metabolism at the University of Amsterdam.