Hypothyroidism, also known as underactive thyroid, occurs when the thyroid gland is insufficiently active, meaning it can no longer produce enough thyroid hormones. Approximately 2 out of every 100 people are affected by hypothyroidism, with milder forms being more common. If left untreated, hypothyroidism can worsen over time, leading to increased complaints. In some cases, life-threatening complications such as heart failure and coma may occur. Fortunately, hypothyroidism can be easily identified through blood tests and is readily treatable.
Why does the thyroid become underactive?
The most common cause of thyroid insufficiency (hypothyroidism) is autoimmune inflammation of the thyroid gland, a condition known as Hashimoto’s disease. Typically, our immune system only responds to external threats like bacteria and viruses, but in autoimmune thyroiditis, the immune system mistakenly attacks the thyroid gland itself, causing damage. As a result, the capacity to produce hormones decreases. While autoimmune diseases do not discriminate based on gender, women are more susceptible to these conditions.
Another type of thyroid inflammation occurs after childbirth, affecting approximately 5-11% of women shortly after giving birth. This condition is usually temporary.
Another common cause of thyroid insufficiency is treatment for hyperthyroidism. When radioiodine therapy or surgery is used to control an overactive thyroid, the thyroid may become underactive months to years later.
NOTE: Iodine deficiency is also a significant factor. Approximately 100 million people worldwide do not receive sufficient iodine, a chemical element essential for thyroid hormone production.
Hypothyroidism symptoms
The symptoms of hypothyroidism (underactive thyroid) are quite the opposite of hyperthyroidism (overactive thyroid). In hypothyroidism, all bodily reactions slow down due to insufficient secretion of thyroid hormones.
Patients with hypothyroidism may experience reduced appetite, intolerance to cold, sluggish movements, dry and coarse skin, brittle hair, weakness, fatigue, hoarse voice, constipation, and muscle stiffness. Additionally, they might complain of the following:
- Memory decline
- Daytime drowsiness
- Difficulty concentrating
- Numbness in hands and feet
- Mild weight gain
- Swollen face, especially around the eyes
- Severe and irregular menstrual bleeding
- Breast milk secretion
- Infertility
- Goiter (abnormal swelling in the front of the neck due to thyroid gland enlargement)
It’s important to note that some individuals with hypothyroidism may not exhibit any noticeable symptoms. If you experience the above signs and your doctor informs you that there is no thyroid issue after conducting tests, don’t be surprised. Many of these symptoms are nonspecific and have various underlying causes.
How does a doctor diagnose hypothyroidism?
Like any other disease, it’s important to be vigilant about the initial warning signs of hypothyroidism. However, your doctor can confidently diagnose whether you are ill or not only after conducting blood tests. Before performing these tests, your doctor will take your medical history and then examine you. Ultimately, if there is suspicion of hypothyroidism, they will request blood tests, including TSH (and if necessary, T4 and …).
How is hypothyroidism treated?
The standard treatment involves hormone-containing tablets because the thyroid gland cannot produce hormones adequately in this condition. These tablets supply the necessary hormones to the body. In most cases, levothyroxine is used.
Usually, 2-3 months after starting treatment, blood tests are repeated to measure hormone levels and adjust the dose of levothyroxine accordingly. This process may be repeated several times until the thyroid hormone levels in the blood reach the normal range. Once the appropriate medication dosage is determined for each individual, your doctor may request annual hormonal tests.
Levothyroxine is taken once daily on an empty stomach, preferably in the morning. The patient must receive the correct dose. Sometimes, patients may take more than the necessary amount of this medication to accelerate recovery or attempt weight loss. However, excessive use can lead to symptoms of hyperthyroidism, where there is an excess of thyroid hormone in the blood. Over time, this can cause issues such as osteoporosis or heart disease.
How long should a patient with hypothyroidism take medication?
Most patients with hypothyroidism need to continue taking medication for their entire lives, but the dosage may require adjustments in subsequent years.
In which situations might the need for medication increase?
- If the patient gains weight.
- In the case of pregnant women with hypothyroidism.
- Certain gastrointestinal diseases that lead to impaired levothyroxine absorption.
- A high-fiber diet or use of cholestyramine (a cholesterol-lowering drug).
- Antacids containing calcium or aluminum.
- Iron supplements. In these situations, the levothyroxine dosage may need to be increased. Alternatively, adjusting the timing of levothyroxine administration during the day can also be considered. Additionally, anticonvulsant medications and rifampin, which accelerate levothyroxine excretion, may increase the need for dosage adjustment.
In which situations might the need for medication decrease?
- With advancing age.
- After infancy.
- If the patient experiences weight loss.
Hypothyroidism During Pregnancy
Taking levothyroxine during pregnancy is safe, and pregnant women with hypothyroidism should never discontinue their medication. Higher doses of the medication may be needed during pregnancy. Typically, more frequent monitoring is necessary. After becoming pregnant, initial assessments may occur every 4 weeks. Once the appropriate levothyroxine dosage is established during pregnancy, follow-up evaluations can occur approximately every three months. Women with well-regulated thyroid hormone levels during pregnancy can have natural childbirth. After delivery, the medication dosage should be re-evaluated.
Keep in mind:
- Only take the exact dosage of medication prescribed by your doctor, and never adjust it on your own.
- If you experience any signs suggestive of hypothyroidism or hyperthyroidism, contact your healthcare provider.
- For reassurance that your hypothyroidism remains well-controlled, adhere to the scheduled follow-up visits with your physician.
- Be reassured that your condition, although significant, is easily manageable. Consistent medication use and timely visits will make little difference compared to a healthy individual.
Reference:
- Hypothyroidism: Diagnosis and Treatment | AAFP
- Best Diet for Hypothyroidism: Foods to Eat, Foods to Avoid (healthline.com)
- Articles about Hypothyroidism | NIH MedlinePlus Magazine
