Hypothyroidism

What is hypothyroidism?

Your thyroid is a gland in the front region of your neck over your windpipe.  It functions to secrete thyroid hormones or chemicals into your body which are important to maintain normal body metabolism or use of energy.

Hypothyroidism is caused by abnormally low amounts of thyroid hormone. Many elderly people have hypothyroidism. It affects 6-10% of women and 2-3% of men over the age of 65. The presence of autoimmune disease such as  diabetes, rheumatoid arthritis, lupus, pernicious anemia, underactive adrenal or parathyroid glands can also make you more prone to hypothyroidism.

Low levels of thyroid hormone can change the way your body uses your energy and cause a variety of different symptoms.

What are the symptoms ?

These symptoms can include: sluggishness or fatigue, dry coarse skin, slow speech, swelling of the eyelids, decreased sweating, coarse hair, brittle nails, constipation, depression, memory problems, hypersensitivity to cold, and heavy and irregular menses or periods. You can also have swelling of the arms and legs, carpal tunnel syndrome, weight gain, and  sometimes muscle aches.

What else can happen with low levels of thyroid hormone?

Some serious complications of hypothyroidism include:

• High cholesterol and triglyceride levels in your blood
• Anemia
• Growth retardation, behavioral problems, and mental retardation in babies and children
• Confusion
• Coma
• Psychosis
• Fluid around the heart (pericardial effusion)
• Heart failure
• Heart attack and stroke (from high cholesterol/triglycerides)

What are the causes of hypothyroidism?

There are many causes of hypothyroidism. Some causes are:
1. Idiopathic hypothyroidism—this exists when the exact cause of hypothyroidism is unknown.
2. Hashimotos thyroiditis,, or chronic lymphocytic thyroiditis, is the most common inflammatory thyroid disorder and the most frequent cause of goiter in the United States.
3. Previous treatment for hyperthyroidism, or hyperactive thyroid, with radioactive iodine, surgery or pills like PTU. These treatments can sometimes lead to hypothyroidism.
4. Iodine deficiency (this is rare in the U.S. but is sometimes seen in developing countries)
5. Certain medications (such as lithium, interferon alpha.
6. Previous treatment for hyperthyroidism with radioactive iodine or surgery, and sometimes pills like PTU, which can lead to hypothyroidism.
7. History of thyroid cancer, pituitary tumors, or being born with an underactive pituitary gland. The pituitary gland is a small gland in your brain that is responsible for the release of certain hormones, some of which also control the thyroid gland.
8. Pregnancy – 5 to 8% of women develop thyroiditis after delivery of the baby. This condition is characterized by hyperthyroidism (or hyperactive thyroid) that is followed by hypothyroidism
9. Radiation treatment to the head, neck, chest, and tonsil area.


How can I be tested for hypothyroidism?

Your doctor will be able to determine if you have hypothyroidism by examining you and performing blood tests, such as your TSH and free T4, to see if they are abnormal. Less often, other tests such as an antithyroid antibody blood test, thyroid ultrasound, thyroid scan, and other tests or imaging studies may be ordered.

There is a condition called subclinical hypothyroidism in which the TSH is high, but other thyroid levels are normal. Haivng this condition may increase your chances of having hypothyroidism down the road and may also be associated with higher LDL cholesterol levels, but treatment of this condition may or may not be given by your doctor. 

What are the treatments for hypothyroidism?

Medication can be given to replace the deficient levels of thyroid hormone. This medication is called levothyroxine (Levoxyl, Synthroid). Calcium and iron supplements may decrease absorption of thyroid hormone, and should be taken four hrs before or after thyroid hormone. Always consult your doctor for any questions you may have about your medications. Your doctor will check your blood periodically (usually every 4-6 wks)  to make sure you are on the right dose of this medication. Once your levels have stabilized, blood tests may be performed every 6 months to1 year.

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