Description of Hypothyreosis:
Alternative names: Myxedema; Adult hypothyroidism
A condition in which the thyroid gland does not produce enough thyroid hormone is Hypothyreosis. It is the most common thyroid disorder, far more common than hyperthyroidism (an overactive thyroid).
In about 95 percent of cases, hypothyreosis is due to a problem in the thyroid gland itself and is called primary hypothyroidism. Certain medications and diseases can decrease thyroid function, and, ironically, hypothyreosis can also follow medical treatments for hypothyreosis, such as thyroidectomy (surgical removal of the thyroid) or radioactive iodine treatment (to destroy thyroid tissue). In some cases, hypothyreosis is a result of decreased production of thyroid-stimulating hormone (TSH) by the pituitary gland.
Thyroid problems and the presence of antibodies against the thyroid (which predict hypothyreosis) are more common in women, increase with age.
Hypothyreosis usually develops gradually. When the disease results from surgery or other treatment for hyperthyroidism, symptoms may appear suddenly and include severe muscle cramps in the arms, legs, neck, shoulders, and back.
It's important to see a doctor if any of these symptoms appear unexpectedly. People whose hypothyreosis remains undiagnosed and untreated may eventually develop myxedema. Symptoms of this rare but potentially deadly complication include enlarged tongue, swollen facial features, hoarseness, and physical and mental sluggishness
Thyroid dysfunctions like hypothyroidism or hyperthyroidism don't become noticeable over night, they just modify step by step a lot of functions in the organism, inducing the sufferer a lot of signs and symptoms that are hard to be classified at once as they are given by many organs and body regions, and all due to an unbalance of the level of thyroid hormones.
A lot of the symptoms given by hypothyreosis might seem quite common for other affections too, but when put up together they can easily draw attention towards the thyroid gland. A lot of doctors tend to ignore thyroid as a possible source of problems and seem focus more on other organs and body regions when analyzing patient complains. Here are most of the signs and symptoms hypothyroidism gives and I hope they will guide you towards an endocrinologist's office first that towards any other doctor who might say your thyroid is just fine without even performing any hormonal tests.
1. Fatigue. Consider this as an extreme tiredness. Even though you might get 10 hours of sleep at night you still can't handle being focused and fresh during the whole day at work. Fatigue gets you to avoiding social events as you know you won't be able to stay awake.
2. The word `slow' is ideal for defining the way you seem to be moving, thinking and speaking lately. Also, forgetting a lot of things is another symptom of hypothyreosis.
3. Constipation. Besides the fact that you seem to be getting slower in everything, even the intestines seem to work slower, causing constipation no matter how much water and healthy food is consumed.
4. During the winter the body can't get warm enough and the thyroid sufferer always has to wear a lot of clothes on and stay close to a space heater.
5. Weight gaining might become a problem. For a person that does not eat a lot and did not seem to be having problems with the body weight before, gaining weight in a short period of time is quite suspicious and should point towards a thyroid dysfunction. Also, cholesterol levels get elevated.
6. Irritability. People around you might complain about the fact they you have lost your patience with them and always seem to be moody. Being angry and depressed is quite often encountered in hypothyroidism.
7. Beauty also is affected by thyroid problems. If you observe that your skin looks puffy, your hair is falling and is loosing its healthy aspect, your nails are brittle and the external part of your eyebrows seems to be disappearing then you are facing a thyroid dysfunction almost for sure.
8. Slow heart rate, below 60 beats per minute, low body temperature and muscle weakness are all symptoms of thyroid affections too.
Hypothyreosis does not necessarily require all these symptoms to be present at once. Also having some of these signs present does not mean that it is for sure that your thyroid gland is causing them. This is why blood tests taken by an endocrinologist should be performed, so that you can see exactly at what levels your thyroid hormones are, and if they are elevated, what treatment and in what dosage you can receive so that you can get back to normal.
Hypothyreosis can be easily treated using thyroid hormone medicine. The most effective and reliable thyroid replacement hormone is man-made (synthetic). After starting treatment, you will have regular visits with your doctor to make sure you have the right dose of medicine.
In most cases, symptoms of hypothyroidism start to improve within the first week after you start treatment. All symptoms usually disappear within a few months. Infants and children with hypothyroidism should always be treated. Older adults and people who are in poor health may take longer to respond to the medicine.
If you have had radiation therapy and have hypothyroidism, or if your thyroid gland has been removed, you will most likely need treatment for the rest of your life. If your hypothyroidism is caused by Hashimoto's thyroiditis, you might also need treatment for the rest of your life. Occasionally, thyroid gland function returns on its own in Hashimoto's thyroiditis.
If a serious illness or infection triggered your hypothyroidism, your thyroid function most likely will return to normal when you recover.
Some medicines may cause hypothyroidism. Your thyroid function will return to normal when you stop the medicines. If you have mild (subclinical) hypothyroidism, you may not need treatment but should be watched for signs of hypothyroidism getting worse. Current research does not provide clear evidence to support treatment, and many health professionals disagree about whether mild hypothyroidism should be treated. When making the decision to treat mild hypothyroidism, you and your doctor will talk about the possible benefits of improved symptoms compared to potential risks and the costs of medicine and monitoring symptoms. The dose of thyroid medicine must be monitored carefully in people with heart disease because too much medicine increases the risk of chest pain (angina) and irregular heartbeats (atrial fibrillation).
Initial treatment: Your doctor will treat your hypothyroidism with the thyroid medicine levothyroxine sodium (for example, Synthroid, Levoxyl, or Levothroid). Take your medicine as directed. Your doctor will want to see you 6 to 8 weeks later to make sure the dose is right for you.
If you take too little medicine, you may have symptoms of hypothyroidism, such as constipation, feeling cold or sluggish, and gaining weight. Too much medicine can cause nervousness, difficulty sleeping, and shaking (tremors). If you have heart disease, too much medicine can cause irregular heartbeats and chest pain. People with heart disease often start on a low dose of levothyroxine, which is increased gradually.
If you have severe hypothyroidism by the time you are diagnosed, you will need immediate treatment. Severe, untreated hypothyroidism can cause myxedema coma, a rare, life-threatening condition. Treatment for myxedema coma involves care in an intensive care unit (ICU). Thyroid hormone is given intravenously (IV). If you have trouble breathing, a ventilator may be used. You will also be monitored for heart problems, including heart attack, and treated if necessary.
Treatment during pregnancy is especially important because hypothyroidism can harm the developing fetus.
If you develop hypothyroidism during pregnancy, treatment should be started immediately. If you have hypothyroidism before you become pregnant, your thyroid hormone levels need to be monitored to determine whether the dosage of thyroid medicine is correct. During pregnancy, your dose of medicine may need to be increased by 25% to 50%.3
You also may need treatment if you develop hypothyroidism after pregnancy (postpartum hypothyroidism). You will be retested for hypothyroidism if you become pregnant again. In some cases, hypothyroidism will go away on its own; in other cases, it is permanent and requires lifelong treatment.
Ongoing treatment: You are likely to need treatment for hypothyroidism for the rest of your life. As a result, you need to take your medicine as directed. For some people, hypothyroidism is a progressive disease and the dosage of thyroid medicine may have to be increased gradually as the thyroid continues to slow down.
Most people treated with thyroid hormone develop symptoms again if their medicine is stopped. If this occurs, medicine needs to be restarted.
If a serious illness or infection triggers your hypothyroidism, your thyroid function most likely will return to normal when you recover. To determine whether thyroid function has returned to normal, thyroid hormone medicine may be stopped for a short time. In most people, a brief period of hypothyroidism occurs after thyroid medicine is stopped; there is often a delay in the body's signals that tell the thyroid to start working again. If the thyroid can produce enough hormone on its own, treatment is no longer needed. But if hormone levels remain too low, you need to restart thyroid medicine.
While taking thyroid hormone medicine, you need to see your doctor once a year for checkups. You will have a blood test (thyroid-stimulating hormone [TSH] assay) to make sure you have a normal hormone level.
Treatment if the condition gets worse: Sometimes symptoms of hypothyroidism continue, such as sluggishness, constipation, confusion, and feeling cold. This may occur if you are not taking enough thyroid hormone or if your medicine is not absorbed from your gastrointestinal tract. Having a bowel disease or taking certain other medicines may block thyroid hormone. Your doctor may increase your dose of thyroid medicine if you are taking estrogen or phenytoin (Dilantin).3 Take calcium supplements at least 4 hours before or after taking thyroid hormone.9
Your doctor may suggest you try the combination therapy of T3/T4 medicine if T4 medicine is not controlling your symptoms.
If your dose of thyroid hormone is too high, you may develop complications such as irregular heartbeats and, over time, osteoporosis. If you have heart disease, too much medicine can cause pain (angina) and irregular heartbeats. Your doctor will monitor your thyroid levels using a thyroid-stimulating hormone (TSH) assay. If necessary, your doctor will lower your dose.
Causes and Risk factors:
Hypothyroidism is most often the result of Hashimoto's disease, also known as chronic thyroiditis (inflammation of the thyroid gland). In this disease, the immune system fails to recognize that the thyroid gland is part of the body's own tissue and attacks it as if it were a foreign body. The attack by the immune system impairs thyroid function and sometimes destroys the gland. Other causes of hypothyroidism include:
Radiation: Radioactive iodine used to treat hyperthyroidism (overactive thyroid) or radiation treatments for head or neck cancers can destroy the thyroid gland.
Surgery: Removal of the thyroid gland because of cancer or other thyroid disorders can result in hypothyroidism.
Viruses and bacteria: Infections that depress thyroid hormone production usually cause permanent hypothyroidism.
Medication: Nitroprusside, lithium, or iodides can induce hypothyroidism. Because patients who use these medications are closely monitored by their doctors, this side effect is very rare.
Pituitary gland malfunction: This is a rare condition in which the pituitary gland fails to produce enough TSH to activate the thyroid's production of T4.
Congenital defect: One of every 4,000 babies is born without a properly functioning thyroid gland.
Diet: Because the thyroid makes T4 from iodine drawn from food, an iodine-deficient diet can cause hypothyroidism. Adding iodine to table salt and other common foods has eliminated iodine deficiency in the United States. Certain foods (cabbage, rutabagas, peanuts, peaches, soybeans, spinach) can interfere with thyroid hormone production.
Environmental contaminants: Certain man-made chemicals-such as PCBs-found in the local environment at high levels may also cause hypothyroidism.
Hypothyroidism is sometimes referred to as a "silent" disease because early symptoms may be so mild that no one realizes anything is wrong. Untreated symptoms become more noticeable and severe, and can lead to confusion and mental disorders, breathing difficulties, heart problems, fluctuations in body temperature, and death.
A diagnosis of hypothyroidism can be suspected in patients with fatigue, cold intolerance, constipation, and dry, flaky skin. A blood test is needed to confirm the diagnosis.
When hypothyroidism is present, the blood levels of thyroid hormones can be measured directly and are usually decreased. However, in early hypothyroidism, the level of thyroid hormones (T3 and T4) may be normal. Therefore, the main tool for the detection of hyperthyroidism is the measurement of the TSH, the thyroid stimulating hormone. As mentioned earlier, TSH is secreted by the pituitary gland. If a decrease of thyroid hormone occurs, the pituitary gland reacts by producing more TSH and the blood TSH level increases in an attempt to encourage thyroid hormone production. This increase in TSH can actually precede the fall in thyroid hormones by months or years (see the section on Subclinical Hypothyroidism below). Thus, the measurement of TSH should be elevated in cases of hypothyroidism.
However, there is one exception. If the decrease in thyroid hormone is actually due to a defect of the pituitary or hypothalamus, then the levels of TSH are abnormally low. As noted above, this kind of thyroid disease
is known as "secondary" or "tertiary" hypothyroidism. A special test, known as the TRH test, can help distinguish if the disease is caused by a defect in the pituitary or the hypothalamus. This test requires an injection of the TRH hormone and is performed by an endocrinologist (hormone specialist).
The blood work mentioned above confirms the diagnosis of hypothyroidism, but does not point to an underlying cause. A combination of the patient's clinical history, antibody screening (as mentioned above), and a thyroid scan can help diagnose the precise underlying thyroid problem more clearly. If a pituitary or hypothalamic cause is suspected, an MRI of the brain and other studies may be warranted. These investigations should be made on a case by case basis
Medicine and medications:
Thyroid hormone medicine is the only effective way to treat hypothyroidism. In most cases, thyroid hormone medicine: Reduces or eliminates symptoms of hypothyroidism. Symptoms usually improve within the first week after you begin therapy. All symptoms usually disappear within a few months.
May reduce the risk of slowed physical growth, mental retardation, and behavioral problems in infants and children.
Thyroid hormone medicine does not cause side effects if you take the correct dose.
Medication Choices: Thyroid hormone medicine, such as levothyroxine sodium (for example, Synthroid, Levoxyl, or Levothroid)
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.