Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can’t make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood. Common causes are autoimmune disease, such as Hashimoto’s thyroiditis, surgical removal of the thyroid, and radiation treatment.
The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.
When thyroid hormone levels are too low, the body’s cells can’t get enough thyroid hormone and the body’s processes start slowing down. As the body slows, you may notice that you feel colder, you tire more easily, your skin is getting drier, you’re becoming forgetful and depressed, and you’ve started getting constipated. Because the symptoms are so variable and nonspecific, the only way to know for sure whether you have hypothyroidism is with a simple blood test for TSH.
Tell your family members. Because thyroid disease runs in families, you should explain your hypothyroidism to your relatives and encourage them to get periodic TSH tests. Tell your other doctors and your pharmacist about your hypothyroidism and the drug and dose with which it is being treated. If you start seeing a new doctor, tell the doctor that you have hypothyroidism and you need your TSH tested every year. If you are seeing an endocrinologist, ask that copies of your reports be sent to your primary care doctor.
There is no cure for hypothyroidism, and most patients have it for life. There are exceptions: many patients with viral thyroiditis have their thyroid function return to normal, as do some patients with thyroiditis after pregnancy.
Hypothyroidism may become more or less severe, and your dose of thyroxine may need to change over time. You have to make a lifetime commitment to treatment. But if you take your pills every day and work with your doctor to get and keep your thyroxine dose right, you should be able to keep your hypothyroidism well controlled throughout your life. Your symptoms should disappear and the serious effects of low thyroid hormone should improve.
If you keep your hypothyroidism well-controlled, it will not shorten your life span.
There can be many reasons why the cells in the thyroid gland can’t make enough thyroid hormone. Here are the major causes, from the most to the least common.
- Surgical removal of part or all of the thyroid gland. Some people with thyroid nodules, thyroid cancer, or Graves’ disease need to have part or all of their thyroid removed. If the whole thyroid is removed, people will definitely become hypothyroid. If part of the gland is left, it may be able to make enough thyroid hormone to keep blood levels normal.
- Congenital hypothyroidism (hypothyroidism that a baby is born with). A few babies are born without a thyroid or with only a partly formed one. A few have part or all of their thyroid in the wrong place (ectopic thyroid). In some babies, the thyroid cells or their enzymes don’t work right.
- Medicines. Medicines such as amiodarone, lithium, interferon alpha, and interleukin-2 can prevent the thyroid gland from being able to make hormone normally. These drugs are most likely to trigger hypothyroidism in patients who have a genetic tendency to autoimmune thyroid disease.
- Damage to the pituitary gland.The pituitary, the “master gland,” tells the thyroid how much hormone to make. When the pituitary is damaged by a tumor, radiation, or surgery, it may no longer be able to give the thyroid instructions, and the thyroid may stop making enough hormone.
The correct diagnosis of hypothyroidism depends on the following:
- Symptoms. Hypothyroidism doesn’t have any characteristic symptoms. There are no symptoms that people with hypothyroidism always have and many symptoms of hypothyroidism can occur in people with other diseases. One way to help figure out whether your symptoms are due to hypothyroidism is to think about whether you’ve always had the symptom (hypothyroidism is less likely) or whether the symptom is a change from the way you used to feel (hypothyroidism is more likely).
- Physical exam. The doctor will check your thyroid gland and look for changes such as dry skin, swelling, slower reflexes, and a slower heart rate.
- Blood tests. There are two blood tests that are used in the diagnosis of hypothyroidism.
- TSH (thyroid-stimulating hormone) test. This is the most important and sensitive test for hypothyroidism. It measures how much of the thyroid hormone thyroxine (T4) the thyroid gland is being asked to make. An abnormally high TSH means hypothyroidism: the thyroid gland is being asked to make more T4 because there isn’t enough T4 in the blood.
THYROXINE (T4) REPLACEMENT.Hypothyroidism can’t be cured. But in almost every patient, hypothyroidism can be completely controlled. It is treated by replacing the amount of hormone that your own thyroid can no longer make, to bring your T4 and TSH levels back to normal levels.
So even if your thyroid gland can’t work right, T4 replacement can restore your body’s thyroid hormone levels and your body’s function. Synthetic thyroxine pills contain hormone exactly like the T4 that the thyroid gland itself makes. All hypothyroid patients except those with severe myxedema (life-threatening hypothyroidism) can be treated as outpatients, not having to be admitted to the hospital.
For the few patients who do not feel completely normal taking a synthetic preparation of T4 alone, the addition of T3 (Cytomel®) may be of benefit.
The only dangers of thyroxine are caused by taking too little or too much. If you take too little, your hypothyroidism will continue. If you take too much, you’ll develop the symptoms of hyperthyroidism—an overactive thyroid gland.
The most common symptoms of too much thyroid hormone are fatigue but inability to sleep, greater appetite, nervousness, shakiness, feeling hot when other people are cold, and trouble exercising because of weak muscles, shortness of breath, and a racing, skipping heart.
Patients who have hyperthyroid symptoms at any time during thyroxine replacement therapy should have their TSH tested. If it is low, indicating too much thyroid hormone, their dose needs to be lowered.
You’ll need to have your TSH checked 6 to 10 weeks after a thyroxine dose change. You may need tests more often if you’re pregnant or you’re taking a medicine that interferes with your body’s ability to use thyroxine. The goal of treatment is to get and keep your TSH in the normal range.
Babies with hypothyroidism must get all their daily treatments and have their TSH levels checked as they grow, to prevent mental retardation and stunted growth. Once you’ve settled into a thyroxine dose, you can return for TSH tests about once a year.
- Your symptoms return or get worse.
- You want to change your thyroxine dose or brand, or change taking your pills with or without food
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- You gain or lose a lot of weight (as little as a 10-pound difference for those who weren’t overweight to begin with).
- You start or stop taking a drug that can interfere with absorbing thyroxine (such as certain antacids, calcium supplements and iron tablets), or you change your dose of such a drug. Medications containing estrogen also impact thyroxine doses, so any change in such a medication should prompt a re-evaluation of your thyroxine dose.
- You want to try stopping thyroxine treatment. If ever you think you’re doing well enough not to need thyroxine treatment any longer, try it only under your doctor’s close supervision. Rather than stopping your pills completely, you might ask your doctor to try lowering your dose. If your TSH goes up, you’ll know that you need to continue treatment.