Hypothyroidism: Symptoms, Causes, Treatment

What are the symptoms of hypothyroidism?

Hypothyroidism, or an underactive thyroid, can cause a variety of symptoms due to a slowed metabolism. Common symptoms include:

1. Fatigue: Persistent tiredness and lack of energy.
2. Weight Gain: Unexplained weight gain or difficulty losing weight.
3. Cold Intolerance: Increased sensitivity to cold temperatures.
4. Dry Skin and Hair: Dry, rough skin and hair that may also become thin and brittle.
5. Hair Loss: Thinning hair or hair loss.
6. Constipation: Frequent or severe constipation.
7. Muscle Weakness: Weakness, cramps, or aches in muscles and joints.
8. Depression: Feelings of sadness or depression.
9. Memory Problems: Difficulty concentrating or memory issues.
10. Slow Heart Rate: A slower than normal heart rate.
11. Elevated Blood Cholesterol: Increased levels of cholesterol in the blood.
12. Menstrual Irregularities: Heavier, irregular, or prolonged menstrual periods.
13. Hoarseness: A hoarse voice.
14. Swelling in the Neck: Enlargement or swelling of the thyroid gland, known as a goiter.
15. Puffy Face: Puffiness in the face, particularly around the eyes.
16. Carpal Tunnel Syndrome: Numbness, tingling, or pain in the hands and wrists.
17. Mood Changes: Irritability or mood swings.

It’s important to note that these symptoms can vary widely in severity and may develop slowly, making them easy to overlook. If you suspect you have hypothyroidism, it is essential to consult a healthcare provider for a proper diagnosis and treatment.

What are the causes of hypothyroidism?

Hypothyroidism, or an underactive thyroid, can be caused by various factors. The most common causes include:

1. Hashimoto’s Thyroiditis: An autoimmune disorder where the body’s immune system attacks the thyroid gland, leading to inflammation and reduced thyroid function.
2. Thyroid Surgery: Partial or total removal of the thyroid gland can result in hypothyroidism.
3. Radiation Therapy: Radiation treatment for cancers of the head and neck can damage the thyroid gland, leading to hypothyroidism.
4. Medications: Certain medications, such as lithium (used to treat psychiatric disorders) and amiodarone (used to treat heart rhythm problems), can interfere with thyroid function.
5. Congenital Hypothyroidism: Some babies are born with a defective or absent thyroid gland, leading to hypothyroidism from birth.
6. Pituitary Disorders: If the pituitary gland fails to produce enough thyroid-stimulating hormone (TSH), the thyroid gland does not receive the signal to produce thyroid hormones, resulting in hypothyroidism. This can be caused by a pituitary tumor or other pituitary disorders.
7. Iodine Deficiency: Iodine is essential for thyroid hormone production. A lack of iodine in the diet can lead to hypothyroidism. This is rare in countries where iodine is added to table salt and other foods.
8. Pregnancy: Some women develop hypothyroidism during or after pregnancy, known as postpartum thyroiditis. This can be temporary or permanent.
9. Radiation Exposure: Exposure to radiation from nuclear accidents or certain medical treatments can damage the thyroid gland.
10. Thyroiditis: Inflammation of the thyroid gland, often caused by an autoimmune response, can lead to hypothyroidism. This includes subacute thyroiditis and silent thyroiditis.
11. Genetic Factors: A family history of thyroid disease increases the risk of developing hypothyroidism.

Understanding the underlying cause of hypothyroidism is important for determining the appropriate treatment and management. If you suspect you have hypothyroidism, it is crucial to consult a healthcare provider for accurate diagnosis and treatment.

How is the diagnosis of hypothyroidism made?

The diagnosis of hypothyroidism is typically made through a combination of medical history, physical examination, and laboratory tests. Here are the steps involved in diagnosing hypothyroidism:

1. Medical History: The doctor will ask about symptoms such as fatigue, weight gain, dry skin, hair loss, cold intolerance, constipation, and depression or anxiety. They will also ask about any family history of thyroid problems or previous thyroid surgery or radiation therapy.
2. Physical Examination: The doctor will perform a physical examination to look for signs of hypothyroidism such as:
   • Dry skin
   • Hair loss or brittle nails
   • Fatigue
   • Weight gain
   • Cold intolerance
   • Enlarged thyroid gland (goiter)
3. Thyroid Function Tests (TFTs): The doctor will order one or more of the following laboratory tests to measure thyroid hormone levels:
   • Thyroid-Stimulating Hormone (TSH): TSH is produced by the pituitary gland and stimulates the thyroid gland to produce thyroid hormones. Elevated TSH levels indicate hypothyroidism.
   • Free Thyroxine (FT4): FT4 is the active form of thyroid hormone produced by the thyroid gland. Low levels of FT4 indicate hypothyroidism.
   • Free Triiodothyronine (FT3): FT3 is another active form of thyroid hormone produced by the thyroid gland. Low levels of FT3 also indicate hypothyroidism.
4. Antithyroglobulin Antibodies (TgAb): Some people with hypothyroidism may have elevated levels of antithyroglobulin antibodies, which can indicate autoimmune thyroiditis, a common cause of hypothyroidism.
5. Thyroid Autoantibody Test: This test measures the levels of antithyroid peroxidase (TPO) antibodies, which can also indicate autoimmune thyroiditis.
6. Ultrasound: An ultrasound examination may be performed to evaluate the size and structure of the thyroid gland and detect any nodules or cysts.
7. Biopsy: In some cases, a biopsy may be performed to diagnose nodules or cancerous growths on the thyroid gland.

The diagnosis of hypothyroidism is usually confirmed if:

• TSH levels are elevated
• Free thyroxine (FT4) levels are low
• Free triiodothyronine (FT3) levels are low
• Thyroid function tests (TFTs) show a consistent pattern of hypothyroidism

Once diagnosed, further testing may be necessary to determine the underlying cause of hypothyroidism, such as autoimmune thyroiditis or radiation exposure.

What is the treatment for hypothyroidism?

The treatment for hypothyroidism is typically thyroid hormone replacement therapy, which involves taking synthetic thyroid hormones to replace the hormones that are missing or not being produced properly by the thyroid gland. The goal of treatment is to restore normal thyroid hormone levels and alleviate symptoms.

Thyroid Hormone Replacement Therapy:

1. Synthetic Thyroxine (T4): The most common medication used to treat hypothyroidism is levothyroxine (T4), which is a synthetic version of the hormone thyroxine. T4 is converted to triiodothyronine (T3) in the body, which is the active form of thyroid hormone.
2. Triiodothyronine (T3): Some people may be prescribed triiodothyronine (T3) medication, which is a synthetic version of the hormone triiodothyronine. However, T3 medication is less commonly used due to its shorter half-life and potential side effects.
3. Combination Therapy: In some cases, combination therapy with both T4 and T3 may be prescribed, especially for people who do not respond well to T4 alone.

Dosing and Monitoring:

1. Initial Dosing: The initial dose of thyroid hormone replacement therapy is typically started at a low dose and gradually increased until the patient’s symptoms improve and thyroid hormone levels return to normal.
2. Monitoring: Blood tests are used to monitor thyroid hormone levels every 6-12 months to ensure that the medication is effective and to adjust the dose as needed.
3. Dose Adjustments: The dose of thyroid hormone replacement therapy may need to be adjusted over time as the patient’s needs change.

Lifestyle Changes:

1. Dietary Changes: A balanced diet that includes foods rich in iodine, zinc, and selenium can help support thyroid function.
2. Exercise: Regular exercise can help improve energy levels and overall health.
3. Stress Management: Stress can exacerbate hypothyroidism symptoms; practicing stress-reducing techniques such as meditation or yoga can help manage stress.

Surgery:

In rare cases, surgery may be necessary to remove a portion of the thyroid gland if it is enlarged or cancerous.

Radioactive Iodine (I-131) Treatment:

Radioactive iodine (I-131) treatment is used to treat hyperthyroidism (an overactive thyroid gland), but it can also be used to treat some cases of hypothyroidism.

Alternative Therapies:

While there are no alternative therapies that have been proven to be effective for treating hypothyroidism, some alternative practitioners may recommend supplements such as thyroid extract or ashwagandha. However, these therapies have not been scientifically proven and may interact with conventional medications or worsen symptoms. It’s essential to consult with a healthcare provider before trying any alternative therapies.

It’s essential to work closely with a healthcare provider to find the right treatment plan for hypothyroidism and to monitor its effectiveness and any potential side effects.