What is hypothyroidism? What causes it? How is it diagnosed and treated? Find the answers to these questions and more in our in-depth article on this common thyroid condition.

Understanding Hypothyroidism: The Basics

Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowdown in the body’s metabolism. The thyroid gland, located in the front of the neck, plays a crucial role in regulating various bodily functions, including heart rate, muscle and bone health, and energy levels.

Symptoms of Hypothyroidism: Recognizing the Signs

The symptoms of hypothyroidism can often be mistaken for other health issues, making it important to be aware of the common signs. These include fatigue, unintended weight gain, muscle weakness, sensitivity to cold, constipation, dry skin, and changes in menstrual patterns. In infants and children, hypothyroidism can also lead to delayed growth and development.

Causes of Hypothyroidism: Uncovering the Underlying Factors

The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto’s disease, where the body’s immune system attacks the thyroid gland. Other causes include certain medications, radiation therapy, thyroid surgery, and iodine deficiency. Congenital defects and pituitary disorders can also contribute to the development of hypothyroidism.

Diagnosing Hypothyroidism: The Role of Blood Tests

Diagnosing hypothyroidism typically involves a simple blood test to measure the levels of thyroid hormones and thyroid-stimulating hormone (TSH) in the body. Your doctor may recommend screening for hypothyroidism, especially if you have a family history of thyroid disease or are pregnant or planning to become pregnant.

Treating Hypothyroidism: Restoring Thyroid Balance

The primary treatment for hypothyroidism is the daily intake of thyroid hormone replacement medication. This helps to regulate the body’s hormone levels and alleviate the symptoms of the condition. The correct dosage may require some adjustments to find the right balance for each individual patient.

Preventing Hypothyroidism: Strategies for Maintaining Thyroid Health

While there is no known way to completely prevent hypothyroidism, certain risk factors can be managed. These include maintaining a healthy weight, avoiding exposure to radiation, and ensuring adequate iodine intake through a balanced diet or supplementation.

Living with Hypothyroidism: Coping and Management Strategies

Managing hypothyroidism requires ongoing monitoring and communication with your healthcare team. It’s important to adhere to your medication regimen, maintain regular check-ups, and be mindful of any changes in your symptoms. With proper treatment and lifestyle adjustments, individuals with hypothyroidism can lead healthy and fulfilling lives.

What is the most common cause of hypothyroidism?
The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto’s disease, where the body’s immune system attacks the thyroid gland and impairs its ability to produce sufficient thyroid hormones.

How is hypothyroidism diagnosed?
Hypothyroidism is typically diagnosed through a simple blood test that measures the levels of thyroid hormones and thyroid-stimulating hormone (TSH) in the body. This test helps confirm the diagnosis and determine the appropriate treatment plan.

Can hypothyroidism be prevented?
While there is no known way to completely prevent hypothyroidism, certain risk factors can be managed. These include maintaining a healthy weight, avoiding exposure to radiation, and ensuring adequate iodine intake through a balanced diet or supplementation.

How is hypothyroidism treated?
The primary treatment for hypothyroidism is the daily intake of thyroid hormone replacement medication. This helps to regulate the body’s hormone levels and alleviate the symptoms of the condition. The correct dosage may require some adjustments to find the right balance for each individual patient.

What are the symptoms of hypothyroidism in infants and children?
In infants and children, hypothyroidism can lead to delayed growth and development, slow mental development, delayed permanent teeth, and delayed puberty. Symptoms may also include yellowing of the skin and whites of the eyes, a puffy face, and poor muscle tone.

Can hypothyroidism cause infertility?
Yes, low levels of thyroid hormones can play a role in infertility. This is why healthcare providers often recommend screening for hypothyroidism in women who are pregnant or trying to become pregnant.

How can hypothyroidism be managed long-term?
Managing hypothyroidism requires ongoing monitoring and communication with your healthcare team. It’s important to adhere to your medication regimen, maintain regular check-ups, and be mindful of any changes in your symptoms. With proper treatment and lifestyle adjustments, individuals with hypothyroidism can lead healthy and fulfilling lives.

Hypothyroidism – familydoctor.org

What is hypothyroidism?

Hypothyroidism is known as underactive thyroid. It occurs when your thyroid gland does not make enough thyroid hormone. It means you have low thyroid activity. The thyroid gland is shaped like a butterfly. It is located in the front of your neck, below your Adam’s apple. The thyroid controls your metabolism. It makes hormones that control how well you burn calories, your heart rate, your muscles, bones, and other organs.

Symptoms of hypothyroidism

Hypothyroidism often begins slowly. Symptoms can be mistaken for stress, depression, or other health problems. Common symptoms include:

• Fatigue.
• Unplanned weight gain.
• Muscle weakness.
• Muscle aches, cramps, tenderness, or stiffness.
• Increased sensitivity to cold.
• Constipation.
• Pale, dry skin.
• Puffy face.
• Hoarse voice.
• Joint pain, stiffness, or swelling.
• Changes in menstrual patterns, such as heavier flow.
• An enlarged thyroid gland (called a goiter), which can appear as swelling at the base of the neck.
• Brittle hair and fingernails.
• Forgetfulness or confusion.

Anyone can have an underactive thyroid. This includes infants and teenagers. Babies who are born without a thyroid gland or with a thyroid that doesn’t work may not have many symptoms at first. They may have yellowing of the skin and yellowing of the whites of their eyes (jaundice). Their face could be puffy and their tongue may be enlarged causing choking. As the disease progresses, infants can have trouble feeding and may not grow and develop normally. They also may be constipated, sleepy, and have poor muscle tone. If it is not treated, hypothyroidism in infants can lead to physical and an intellectual disability. In the United States, newborn infants are screened for hypothyroidism before leaving the hospital.

Kids and teens who have hypothyroidism have the same symptoms as adults. In addition, they could have:

• Slow growth.
• Slow mental development.
• Delayed permanent teeth.
• Delayed puberty.

What causes hypothyroidism?

The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto’s disease. Normally, the immune system helps protect the body against viruses, bacteria, and other substances. An autoimmune disease causes it to attack your body’s tissues and/or organs. With Hashimoto’s, the immune system attacks the thyroid and keeps it from producing enough hormones.

Other common causes of hypothyroidism include:

• Certain medicines.
• Radiation therapy.
• Thyroid surgery.
• Treatment for hyperthyroidism (overactive thyroid).

Some less common causes of hypothyroidism include:

• Congenital disease. About 1 in 3,000 infants in the United States are born with a defective thyroid or no thyroid at all.
• Pituitary disorder. The pituitary gland produces a thyroid-stimulating hormone (TSH). This tells the thyroid gland how much thyroid hormone to produce. A pituitary disorder may keep the pituitary gland from producing the right amount of TSH to manage thyroid hormones.
• Some women have hypothyroidism during or after pregnancy. This is because their bodies produce antibodies that attack the thyroid gland. If not treated, hypothyroidism can be harmful to both mother and baby.
• Iodine deficiency. Iodine is a mineral used by the body to make thyroid hormones. A lack of iodine can keep your thyroid from producing enough hormones. In the United States, table salt has iodine added to it to make sure everyone gets enough.

How is hypothyroidism diagnosed?

Contact your doctor if you have symptoms of an underactive thyroid. He or she will do a blood test to measure the amount of thyroid hormone and TSH in your blood. This confirms the diagnosis.

Some doctors recommend screening older women for hypothyroidism during routine physical exams. Some also recommend screening women who are pregnant or trying to become pregnant. This is because low amounts of the thyroid hormone can play a role in infertility.

Can hypothyroidism be prevented or avoided?

There is no known way to prevent hypothyroidism. It is more common in women than men, especially those older than 60 years of age. You also are at greater risk if you:

• Have a family history of thyroid disease.
• Have been treated with radioactive iodine or anti-thyroid medicines.
• Have received radiation therapy to your neck or upper chest.
• Have had thyroid surgery.

Hypothyroidism treatment

Treatment for hypothyroidism is a replacement thyroid hormone. You take the supplement daily in pill form. This medicine regulates your hormone levels and helps relieve symptoms. Over time, your metabolism goes back to normal. The medicine helps to lower your LDL cholesterol and may reverse some weight gain.

The correct medicine dose varies for each person. It may take a few tries to get the right dose. If you don’t take enough, you may continue to have symptoms of hypothyroidism. If you take too much, you may have symptoms similar to those of hyperthyroidism. Your doctor can tell how much to give based on your symptoms, blood test results, and the cause.

Some medicines and foods affect your body’s ability to absorb the replacement thyroid hormone. Examples of medicine are iron supplements, calcium supplements, cholestyramine, and aluminum hydroxide (found in some antacids). Tell your doctor if you eat large amounts of soy products or are on a high-fiber diet.

Living with hypothyroidism

If it is not treated, hypothyroidism can lead to other health problems. These include:

• A goiter. It is common to have an enlarged thyroid. This can cause a swollen lump on your neck called a goiter. A goiter can affect your appearance and can even make it hard for you to swallow or eat.
• Obesity. Weight gain is common in people who have underactive thyroid. This is because your hormone levels affect your metabolism. Diet and exercise can help manage your weight.
• Heart disease. An underactive thyroid causes high levels of “bad” (LDL) cholesterol.
• Mental health issues. Depression that occurs with hypothyroidism can worsen over time.
• Myxedema. This is a rare, life-threatening condition. Symptoms are intense sensitivity to cold and drowsiness or severe lethargy. This can lead to unconsciousness and a coma. See a doctor right away if you notice these warning signs.
• Birth defects. Babies who are born to women who have untreated hypothyroidism can have birth defects.
• Infertility. Not enough thyroid hormone can make it hard for some women to get pregnant. An underactive thyroid also can be harmful to the mother and baby during pregnancy. Most doctors test women’s thyroid hormone levels at this stage.

Questions to ask your doctor

• What is the cause of my hypothyroidism?
• Do I have Hashimoto’s disease?
• What are the results of my blood test and what do the results mean?
• How long will I need to take medicine? What are the side effects?
• Are there any lifestyle changes I can make to relieve my symptoms?
• Am I at risk for related health problems?

Resources

American Thyroid Association: Hypothyroidism

National Institute of Diabetes and Digestive and Kidney Diseases: Hypothyroidism (Underactive Thyroid)

National Institutes of Health, MedlinePlus: Hypothyroidism

Hypothyroidism: Causes, Symptoms, and Treatment | Doctor

For congenital hypothyroidism see the separate Childhood and Congenital Hypothyroidism article. There are also separate articles on Subclinical Hypothyroidism, Thyroid Disease in Pregnancy and Myxoedema Coma.

Hypothyroidism often has an insidious onset but has a significant morbidity. The clinical features are often subtle and nonspecific and may be wrongly attributed to other illnesses, especially in postpartum women and in the elderly.

The earliest biochemical abnormality is an increase in serum thyroid‐stimulating hormone (TSH) concentration with normal serum fT4 and fT3 concentrations (subclinical hypothyroidism), followed by a decrease in serum fT4, at which stage most patients have symptoms and require treatment (overt hypothyroidism).

Hypothyroidism epidemiology

^[1]

The prevalence of hypothyroidism varies according to the definition used, the population characteristics, and the geographical area studied. The prevalence increases in women and with increasing age.

• One European meta-analysis found the total prevalence (diagnosed and undiagnosed) of hypothyroidism to be 3%. The prevalence of undiagnosed hypothyroidism was 4.9% (6.4% in females and 3. 4% in males). Of these, the prevalence of overt hypothyroidism was 0.8% in females and 0.3% in males, and the prevalence of subclinical hypothyroidism was 5.9% in females and 3.4% in males.
• A retrospective analysis of General Practice data in the North East of England found the overall prevalence of treated hypothyroidism to be 4.5% in 2016. The prevalence increases with increasing age and is up to 10 times more common in women.
• A review of UK national databases found the prevalence of treated hypothyroidism increased from 2.3% to 3.5% of the total UK population between 2005 and 2014. The prevalence of treated hypothyroidism was positively associated with female sex, white ethnicity, and obesity.
• The British Thyroid Association notes that subclinical hypothyroidism affects 5-10% of the population.
• The true prevalence of subclinical hypothyroidism may have been overestimated in older people, due to the physiological increase in TSH levels with increasing age, that may be misinterpreted as thyroid disease.
• Secondary hypothyroidism is rare. The estimated incidence varies between 1 per 20,000 and 1 per 80,000 people
• The European Thyroid Association guidelines state that the prevalence of overt hypothyroidism in pregnancy is 0.2-0.5%, and subclinical hypothyroidism in pregnancy is 2-2.5%.
• The prevalence of postpartum thyroiditis in iodine-sufficient areas is stated as being about 5-7%.

Adult hypothyroidism

Hypothyroidism results from insufficient secretion of thyroid hormones and can be due to a variety of abnormalities. The severest form is myxoedema where there is accumulation of mucopolysaccharides in the skin and other tissues, causing thickening of the facial features and associated with ventilatory dysfunction and coma.^[2]

Hypothyroidism causes (aetiology)

Primary hypothyroidism

• Autoimmune hypothyroidism – Hashimoto’s thyroiditis (associated with a goitre) and atrophic thyroiditis.
• Iatrogenic – radio-iodine treatment, surgery, radiotherapy to the neck – eg, lymphoma (no goitre usually).
• Iodine deficiency – the most common cause worldwide and goitre is present.
• Drugs – amiodarone, contrast media, iodides, lithium and antithyroid medication.
• Congenital defects – eg, absence of thyroid gland or dyshormonogenesis.
• Infiltration of the thyroid – eg, amyloidosis, sarcoidosis and haemochromatosis.

Secondary hypothyroidism

• Isolated TSH deficiency.
• Hypopituitarism – neoplasm, infiltrative, infection and radiotherapy.
• Hypothalamic disorders – neoplasms and trauma.

Transient hypothyroidism

• Withdrawal of thyroid suppressive therapy.
• Postpartum thyroiditis.
• Subacute/chronic thyroiditis with transient hypothyroidism.

Hypothyroidism symptoms (presentation)

Often insidious onset with nonspecific symptoms.^[3]

Symptoms

• Tiredness, lethargy, intolerance to cold.
• Dry skin and hair loss.
• Slowing of intellectual activity – eg, poor memory and difficulty concentrating.
• Constipation.
• Decreased appetite with weight gain.
• Deep hoarse voice.
• Menorrhagia and later oligomenorrhoea or amenorrhoea.
• Impaired hearing due to fluid in middle ear.
• Reduced libido.

A relationship between hypothyroidism and depression has been assumed for many years. However, the true nature of this association has been difficult to define, with many conflicting studies. Large epidemiological studies generally suggest no association between thyroid function and depression in people without thyroid disease. Patients taking thyroxine have poorer psychological well-being than those with no thyroid disease, even if biochemically euthyroid.^[4]

Signs

• Dry coarse skin, hair loss and cold peripheries.
• Puffy face, hands and feet (myxoedema).
• Bradycardia.
• Delayed tendon reflex relaxation.
• Carpal tunnel syndrome.
• Serous cavity effusions – eg, pericarditis or pleural effusions.

In autoimmune hypothyroidism, patients may have features of other autoimmune diseases – such as, vitiligo, pernicious anaemia, Addison’s disease and diabetes mellitus.

Although most people with hypothyroidism do not have any associated eye problems, hypothyroidism may cause swelling around the eyes, a loss of the hairs in the outer part of the eyebrows, eye discomfort, protruding eyeballs and visual disturbance.^[5]

Other presentations

• Acute kidney injury.^[6]
• Hypercholesterolaemia.

This can develop into myxoedema:

• Expressionless dull face with peri-orbital puffiness, swollen tongue, sparse hair.
• Pale, cool skin with rough, doughy texture.
• Enlarged heart.
• Megacolon/intestinal obstruction.
• Cerebellar ataxia.
• Psychosis.
• Encephalopathy.

Patients can go on to develop myxoedema coma (see below).

Hashimoto’s and atrophic thyroiditis

• Subclinical autoimmune thyroiditis probably represents the early stages of chronic thyroiditis with a soft or firm thyroid gland which is usually normal in size or slightly enlarged.
• Subclinical autoimmune thyroiditis is associated with normal thyroid function.
• Hashimoto’s thyroiditis and atrophic thyroiditis probably represent two ends of the same spectrum of chronic thyroiditis. In Hashimoto’s thyroiditis there is a painless goitre of varying size with a rubber consistency and irregular surface. Thyroid function varies from normal to subclinical or overt hypothyroidism.
• Atrophic thyroiditis represents the end stage of autoimmune hypothyroidism and patients are overtly hypothyroid.
• Excessive iodine intake can lead to autoimmune hypothyroidism.
• Autoimmune hypothyroidism is uncommon in children. It presents as delayed growth and facial maturation. Puberty may also be delayed. In very young children there may be intellectual impairment.

Postpartum thyroiditis

This occurs in 5-7% of pregnancies within the first six months postpartum.^[7] Most women show complete remission but some may progress to permanent hypothyroidism.

Subacute thyroiditis

Also referred to as granulomatous, giant cell or de Quervain’s thyroiditis – a viral infection produces local symptoms and exquisite tenderness of the thyroid gland with nodularity. Initially patients are thyrotoxic but later they become hypothyroid.

Investigations

The symptoms of hypothyroidism are not specific to underactivity of the thyroid gland and it is therefore essential to diagnose hypothyroidism with thyroid function tests (TFTs) because it can be dangerous to take levothyroxine or other thyroid hormones if they are not clinically indicated.

Offer tests for thyroid dysfunction to adults, children and young people with type 1 diabetes or other autoimmune diseases, or new-onset atrial fibrillation. Also consider tests for those with depression or unexplained anxiety. In addition for children and young people with abnormal growth, or unexplained change in behaviour or school performance.

Be aware that symptoms of thyroid dysfunction may be mistaken for menopause.

The National Institute for Health and Care Excellence (NICE) suggests measuring thyroid stimulating hormone (TSH) alone for adults and if the TSH is above the reference range, measure free thyroxine (FT4) in the same sample. If the TSH is below the reference range, measure FT4 and free tri-iodothyronine (FT3) in the same sample.^[8]

• Anti-thyroid peroxidase (anti-TPO) antibodies or anti-thyroglobulin antibodies are found in 90-95% of patients with autoimmune thyroiditis. NICE recommends measuring thyroid peroxidase antibodies (TPOAbs) for adults with TSH levels above the reference range, but not repeating TPOAbs testing.^[8]
• Untreated hypothyroidism may be associated with a raised CK, raised cholesterol and triglycerides and anaemia (normocytic or macrocytic). These abnormalities usually resolve with treatment.
• If the patient has an asymmetrical goitre then they may need imaging of their thyroid gland – eg, ultrasonography – to rule out neoplastic lesions.

Neonates – investigations include ultrasonography or ¹²³I scintigraphy, serum thyroglobulin and low molecular weight iodopeptides to differentiate different types of defects. Total urinary iodine excretion will differentiate between inborn errors of metabolism and hypothyroidism due to iodine deficiency or excess.

Hypothyroidism treatment and management

^{[8, 9]}

Referral

^[1]

• Arrange emergency admission if a serious complication such as myxoedema coma is suspected.
• Arrange urgent referral to an endocrinologist for specialist assessment of the underlying cause if secondary hypothyroidism is suspected.
• Arrange referral or discuss with an endocrinologist the urgency, depending on clinical judgement, if the person:
• Has suspected subacute thyroiditis.
• Has a goitre, nodule, or structural change in the thyroid gland. If malignancy is suspected, refer using a suspected cancer pathway.
• Has suspected associated endocrine disease, such as Addison’s disease. Do not start thyroid hormone replacement before specialist glucocorticoid replacement in suspected adrenal failure, as this can precipitate an adrenal crisis.
• Is female and is planning a pregnancy.
• Has atypical or difficult to interpret thyroid function tests (TFTs), such as a low thyroid-stimulating hormone (TSH) with low free thyroxine (FT4) level.
• Has a suspected underlying cause of hypothyroidism, such as drug treatment with amiodarone or lithium.
• Consider referral to an endocrinologist if a person is taking:
• Adequate or escalating LT4 doses and the TSH level is persistently raised, and underlying causes have been excluded or managed.
• Adequate or escalating LT4 doses and symptoms of hypothyroidism persist, and alternative causes for symptoms have been excluded.
• Combination therapy or LT3 monotherapy on specialist advice with uncertain benefits, and a switch to LT4 is being considered.

Overt hypothyroidism

• Offer levothyroxine sodium as first-line treatment and aim to maintain thyroid-stimulating hormone (TSH) levels within the reference range. If symptoms persist, even after achieving normal TSH levels, consider adjusting the dose to achieve optimal well-being whilst avoiding doses that cause TSH suppression or thyrotoxicosis.
• For patients whose TSH level was very high before starting treatment or who have had a prolonged period of untreated disease, the TSH level can take up to six months to return to the reference range.
• Consider measuring TSH levels every three months until a stable level has been achieved, then yearly thereafter. Monitoring free thyroxine (FT4) should also be considered in those who continue to be symptomatic.
• Due to the uncertainty around the long-term adverse effects and the insufficient evidence of benefit over levothyroxine monotherapy, the use of natural thyroid extract is not recommended. Liothyronine (either alone or in combination with levothyroxine) is not routinely recommended but see the section on liothyronine immediately below.

Liothyronine^[10] .
NHS England guidance states that liothyronine (L-T3) should not be initiated in primary care for any new patient, and that individuals currently prescribed liothyronine should be reviewed by a consultant NHS endocrinologist with consideration given to switching to levothyroxine (L-T4) where clinically appropriate. Prescriptions for individuals receiving liothyronine should continue until that review has taken place.

The majority of patients can be treated effectively with levothyroxine alone, but liothyronine is perceived to be an important medicine for a small proportion of patients in order to maintain health and well-being.

The prescribing of liothyronine monotherapy or combination therapy with levothyroxine is only supported if initiated by, or considered appropriate following a review by, an NHS consultant endocrinologist. The withdrawal or adjustment of liothyronine treatment should also only be undertaken by, or with the oversight of, an NHS consultant endocrinologist.

Where General Practitioners are involved in such treatment changes this should be with NHS consultant endocrinologist support.

If a patient is initiated on treatment, prescribing responsibility should remain with the hospital consultant for at least three months. TSH levels should be monitored, and free L-T4/free L-T3 levels measured where clinically appropriate.

Subclinical hypothyroidism

Subclinical hypothyroidism occurs when a patient has a TSH level above the upper limit of the reference range (but usually less than 10 mU/L) and free T4 levels are within the reference range. See also the separate article on Subclinical Hypothyroidism.

Children

• Very rarely, levothyroxine therapy can cause pseudotumour cerebri in children.
• It is an idiosyncratic reaction and presents with raised intracranial pressure and can occur months after treatment.

See also the separate article on Childhood and Congenital Hypothyroidism.

Pregnancy

Refer all females with hypothyroidism who are planning a pregnancy or are pregnant, to an endocrinologist. For those planning a pregnancy and whose thyroid function tests (TFTs) are not within range, advise delaying conception until stabilised on levothyroxine sodium treatment. If there is any uncertainty about treatment initiation or dosing, discuss this with an endocrinologist whilst awaiting review.

TFTs may produce misleading results in pregnancy and trimester-related reference ranges should be used. If pregnancy is confirmed, urgently measure TFTs. Discuss the initiation, or changes to levothyroxine sodium treatment and TFT monitoring with an endocrinologist whilst awaiting review, to reduce the risk of obstetric and neonatal complications.

See also the article on Thyroid Disease in Pregnancy.

Older patients and comorbidity

There are certain patients for whom the recommended initial dose of levothyroxine is 25 micrograms once daily, adjusted in steps of 25 micrograms every four weeks according to response. These include:

• Patients with cardiac disease.
• Patients with severe hypothyroidism.
• Patients aged over 50 years.

Secondary hypothyroidism

If secondary hypothyroidism is suspected, refer the patient urgently to an endocrinologist to assess the underlying cause.

Complications

^[1]

The potential complications of untreated or undertreated hypothyroidism include:

• Impaired quality of life due to symptoms such as fatigue.
• Dyslipidaemia.
• Metabolic syndrome.
• Coronary heart disease (CHD) and stroke.
• Heart failure.
• Infertility and subfertility.
• Untreated overt hypothyroidism in pregnancy, which is associated with an increased risk of miscarriage, anaemia, pre-eclampsia, placental abruption, postpartum haemorrhage, and stillbirth.
• Adverse neonatal outcomes including preterm delivery, low birth weight, neonatal respiratory distress, congenital abnormalities, congenital hypothyroidism, and impaired fetal neurocognitive development.
• Untreated subclinical hypothyroidism and thyroid autoimmunity in pregnancy: may be associated with an increased risk of miscarriage, pregnancy loss, preterm delivery, low birth weight, gestational diabetes, gestational hypertension, and pre-eclampsia.
• Overt hypothyroidism, which is associated with decreased taste, vision, or hearing, and with impaired attention, concentration, memory, language, executive function, and psychomotor speed.
• Myxoedema coma.

The risks of over-treatment with thyroid hormones include atrial fibrillation, osteoporosis and bone fractures.

Prognosis

^[1]

• The prognosis of overt primary hypothyroidism is usually good, and most people will recover full physical and psychological well-being following adequate thyroid hormone replacement, which is usually needed for life.
• About 5-10% of people have persistent symptoms (such as impaired well-being and cognitive disturbance) after six months of thyroid hormone treatment, even when thyroid function tests have normalised.
• Spontaneous remission is rare.

Hypothyroidism – signs, symptoms, who treats

Hypothyroidism – signs, symptoms, who treats

Hypothyroidism is a condition in which the thyroid gland does not produce enough important hormones. In the early stages, the disease may not cause noticeable symptoms, but over time, a number of health problems appear, such as obesity, joint pain, infertility, and heart disease.

Symptoms of hypothyroidism of the thyroid gland

Signs of hypothyroidism vary depending on the severity of the hormone deficiency. Problems usually develop slowly, often over several years. Symptoms of hypothyroidism include:

• Fatigue
• Hypersensitivity to cold
• Constipation
• Dry skin
• Weight kit
• Swollen face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol
• Muscle pain, tenderness and stiffness
• Pain, stiffness or swelling in the joints
• More than usual or irregular menses
• Hair thinning
• Slow heart rate
• Depression
• Memory degradation
• Thyroid goiter.

Symptoms of hypothyroidism in infants

Although hypothyroidism most commonly affects middle-aged and older women, anyone can develop it, including infants. Initially, babies born without a thyroid gland or with a malfunctioning thyroid gland may have few symptoms at first. When newborns have problems with hypothyroidism, they include:

• Jaundice. Most of the time, this happens when the baby’s liver is unable to produce a substance called bilirubin, which is normally produced when the body processes old or damaged red blood cells.0010
• Long, protruding tongue
• Labored breathing
• Hoarse crying
• Umbilical hernia.

As the disease progresses, infants may experience feeding problems. Also available:

• Locks
• Weak muscle tone
• Excessive sleepiness.

If hypothyroidism in infants is left untreated, even mild hypothyroidism can lead to severe physical and mental retardation.

Symptoms of hypothyroidism in children and adolescents

In general, children and adolescents with hypothyroidism have the same symptoms as adults:

• Poor growth
• Delayed development of permanent teeth
• Delayed puberty
• Poor mental development.

Which doctor diagnoses and treats hypothyroidism

See an endocrinologist if you feel tired for no reason or have other signs of hypothyroidism, such as dry skin, a pale, puffy face, constipation, or a hoarse voice.

Causes of hypothyroidism of the thyroid gland

When the thyroid gland does not produce enough hormones, the balance of chemical reactions in the body is disturbed. There can be several reasons, including an autoimmune disease, hyperthyroidism treatment, radiation therapy, thyroid surgery, and certain medications. The thyroid gland is a small, butterfly-shaped gland located at the base of the front of the neck, just below the Adam’s apple. The hormones produced by the thyroid gland – triiodothyronine and thyroxine – have a huge impact on health, affecting all aspects of metabolism. Hormones affect the control of vital functions such as body temperature and heart rate. Hypothyroidism occurs when the thyroid gland does not produce enough hormones. The disease can be caused by a number of factors, including:

• Autoimmune disease. The most common cause of hypothyroidism is an autoimmune disease known as Hashimoto’s thyroiditis. Autoimmune diseases occur when the immune system produces antibodies that attack its own tissues. Sometimes this process affects the thyroid gland
• Excessive response to treatment for hyperthyroidism. Patients with hyperthyroidism are often treated with radioactive iodine or antithyroid drugs. The purpose of these methods is to bring the function of the thyroid gland back to normal. But sometimes the correction of hyperthyroidism can lead to too much decrease in the production of thyroid hormones
• Thyroid surgery. Removing all or a large part of the thyroid gland can reduce or stop hormone production. In this case, you will have to take thyroid hormones for life
• Radiation therapy. Radiation used to treat head and neck cancer can affect the thyroid gland and lead to hypothyroidism
• Medicines. A number of drugs can contribute to the development of hypothyroidism. For example, lithium, which is used to treat certain mental disorders.

More rarely, hypothyroidism may result from one of the following disorders:

• Congenital disease. Some babies are born with or without thyroid defects. In most cases, the thyroid gland does not develop normally for unknown reasons, but in some children this form of the disease is inherited. Often children with congenital hypothyroidism appear normal at birth
• Violation of the pituitary gland. A relatively rare cause of hypothyroidism is the inability of the pituitary gland to produce enough thyroid-stimulating hormone, usually due to a benign pituitary tumor
• Pregnancy. Some women develop hypothyroidism during or after pregnancy, often due to the production of antibodies to their own thyroid gland. If left untreated, hypothyroidism increases the risk of miscarriage, premature birth and preeclampsia, a condition that causes high blood pressure in the last 3 months of pregnancy. It also affects the developing fetus
• Iodine deficiency. The trace element iodine, found mainly in seafood, seaweed, plants grown in iodine-rich soil, and iodized salt, is essential for the production of thyroid hormones. An iodine deficiency can lead to hypothyroidism, and an excess of iodine can aggravate the condition.

Risk factors

Risk factors that increase the development of hypothyroidism:

• Female sex
• Age over 60
• Family history of thyroid disease
• Having an autoimmune disease such as type 1 diabetes or celiac disease
• Treatment with radioactive iodine or antithyroid drugs
• Irradiation of the neck or upper chest
• Thyroid surgery
• Pregnancy or childbirth within the last 6 months.

Complications of hypothyroidism

Hypothyroidism can lead to a number of health problems:

• Goiter. Constant stimulation of the thyroid gland to release more hormones can cause the gland to become enlarged. This condition, known as a goiter, can affect appearance and interfere with swallowing or breathing
• Heart problems. Hypothyroidism may also be associated with an increased risk of heart disease and heart failure. Primarily because high levels of low-density lipoprotein cholesterol are observed in patients with an underactive thyroid gland
• Mental health problems. Depression can occur early in the course of hypothyroidism and become more severe over time. Hypothyroidism causes mental retardation
• Peripheral neuropathy. Prolonged uncontrolled hypothyroidism can lead to damage to peripheral nerves. These are the nerves that carry information from the brain and spinal cord to the rest of the body. Peripheral neuropathy can cause pain, numbness, and tingling in affected areas
• Myxedema. This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its symptoms include severe cold intolerance and drowsiness followed by profound lethargy and loss of consciousness
• Myxedema coma may be triggered by sedatives, infection, or other stress to the body. If there are signs of myxedema, seek immediate emergency medical attention
• Infertility. Low levels of thyroid hormones can prevent ovulation, which impairs fertility. In addition, some causes of hypothyroidism – such as an autoimmune disorder – can also interfere with fertility
• Birth defects. Children born to women with thyroid disease may have a higher risk of birth defects. They are more prone to serious problems with intelligence and development.

Babies with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development. But if this disease is diagnosed within the first few months of life, the chances of normal development are high.

How a doctor diagnoses hypothyroidism

An endocrinologist will test the thyroid gland for hypothyroidism if the patient feels tired, has dry skin, constipation and weight gain. The diagnosis of hypothyroidism is based on symptoms and results of blood tests that measure TSH levels, the level of the thyroid hormone thyroxine. A low thyroxine level and a high TSH level indicate an underactive thyroid gland. This is because the pituitary produces more TSH to stimulate the thyroid to produce more thyroid hormone. Since a TSH test is the best screening test, your doctor will first check your TSH levels and, if necessary, test for thyroid hormones. TSH studies play an important role in the treatment of hypothyroidism. They help the endocrinologist determine the correct dosage of medications, both initially and over time. TSH tests are used to diagnose a condition called subclinical hypothyroidism, which usually causes no outward symptoms.

The best doctors in St. Petersburg

Serebryakova Inna Pavlovna

Rating: 4. 9 / 5

Enroll

Serine Vanik Adamyan

Rating: 4.8 / 5

Enroll

Badmaeva Danara Borisovna

Rating: 4.8 / 5

Enroll

Belikova Elena Yurievna

Rating: 5 / 5

Enroll

Boyarkina Marina Petrovna

Rating: 5 / 5

Enroll

Bryazgunov Vitaly Vasilievich

Rating: 4.6 / 5

Enroll

Share:

Scientific sources:

1. Petunina, N.A. Hypothyroidism: approaches to diagnosis and treatment / N.A. Petunina, L.V. Trukhina, N.S. Martirosyan // Consilium medicum. – 2012. – N 2. – P. 80-83.
2. Sereisky, M.Ya. Endocrine insufficiency and the brain / M.Ya. Sereysky // Medico-biological journal. – 1930. – N 3. – S. 129.
3. Fadeev, V.V. Hypothyroidism. A guide for doctors / V.V. Fadeev, G.A. Melnichenko. – M.: Severo press, 2002. – 437 p.
4. Balabolkin M.I. Diagnosis and treatment of hypothyroidism // Soviet medicine -1981.- No. 4.- P. 79-83.
5. Volkov A. N., Gamizov M.M. Diseases of the thyroid gland and their treatment//Cheboksary -1981.- 136 p.

Useful information

Thyroidectomy surgery

Thyroidectomy is the surgical removal of all or part of the thyroid gland, the butterfly-shaped organ at the base of the neck that produces hormones that control many aspects of metabolism, from heart rate to calorie burn rate.

read more +

Thyroid lymphoma

What should be done to diagnose and treat thyroid lymphoma? To solve this problem, the first step for the patient is to make an appointment with an endocrinologist. After the initial examination, the doctor may prescribe additional studies:

Thyroid ultrasound
Neck CT
Neck MRI
Fine needle aspiration biopsy.

read more +

MRI of the thyroid gland

In medical centers and Len. MRI of the thyroid gland is prescribed by an endocrinologist when there is a need to check the functioning of the thyroid gland. The hormones synthesized by it are responsible for many important life processes, and the violation of the functions of this organ immediately affects the state of the whole organism. In the case of thyroid dysfunction, a person may have metabolic problems

read more +

Enter your name*

Your e-mail*

Feedback text*

Name of medical institution*

Equipment Model*

Operating mode*

Contact number*

Area*

Address*

Metro*

Types of diagnostics*

MRI

CT

ultrasound

Price list*

Attach a file with a price list

I consent to the processing of my personal data

symptoms, treatment, signs and diagnosis of the disease

Contents of the article

1. Causes of pathology
2. Symptoms
3. Diagnostics
4. Treatment strategy
5. Recovery prognosis and prevention
6. Questions and answers

Hypothyroidism is a common endocrine pathology, manifested by a decrease in thyroid function and a sharp decrease in the amount of hormones produced by it. The disease occurs against the background of a slowdown in all processes in the body. The person feels weak, drowsy. A common complication is gaining excess body weight.

Reasons for the development of pathology

Endocrinologists distinguish two types of the disease. The first – congenital hypothyroidism – is diagnosed in infants in the first days after birth and is formed under the influence of dozens of different factors. The second form of pathology is acquired. Its share in the total volume of clinically diagnosed cases reaches 99%. Acquired hypothyroidism appears in patients as a result of the development of chronic autoimmune thyroiditis – an attack on the thyroid gland by a person’s own immune system. The second reason is iatrogenic hypothyroidism against the background of partial or complete resection of the thyroid gland and treatment with radioactive iodine.

Symptoms

Acquired hypothyroidism has several important features that make it difficult to diagnose:

• no specific symptoms;
• as pathological processes in the thyroid gland develop, the clinical picture begins to resemble chronic somatic or mental disorders;
• The correlation between thyroid hormone levels and symptom severity is non-linear.

The clinical picture observed by the doctor depends on the age of the patient and the rate of formation of thyroid hormone deficiency. Representatives of different age groups complain of different symptoms. Because of this, the endocrinologist is not always able to make the correct diagnosis. Moderate hypothyroidism may not appear for a long time. Changes in the thyroid gland are accidentally discovered by doctors during tests that are not related to the functioning of the thyroid gland.

The long course of the disease gives the patient a characteristic appearance. Symptoms of hypothyroidism in men are almost the same as those that doctors observe in women. This is a puffy face, yellow skin, swollen eyelids and limbs. Common symptoms of hypothyroidism in women are menstrual irregularities and unsuccessful attempts to conceive a child with regular unprotected intercourse.

Adults and children complain of tingling, burning and muscle pain. Hands lose strength, become weak. The skin is dried out, the hair is characterized by increased fragility and dull color. The mood of a patient suffering from hypothyroidism is invariably apathetic. In a severe course of the disease, there is a general lethargy of a person, a low rate of speech. The timbre of the voice changes, becomes low and hoarse. Swelling of the larynx provokes hearing loss.

Diagnostics

The preliminary diagnosis and its confirmation are carried out by an endocrinologist. The doctor takes an anamnesis, examines the patient and records his complaints. The complex of laboratory and hardware research includes:

• Ultrasound – allows you to assess the structure of glandular tissues and changes in them;
• biopsy – makes it possible to exclude malignant neoplasms inside the organ from potential diagnoses;
• scintigraphy – provides doctors with information about the exact location of pathological foci in the tissues of the thyroid gland;
• biochemical blood test – provides data on the lipid composition of the liquid medium (the balance changes against the background of hypothyroidism).

As an additional measure, the laboratory may conduct a study of the level of thyroid and thyroid-stimulating hormones in the blood.

Congenital forms of hypothyroidism are confirmed during neonatal screening on the 4-5th day of life of infants.

Treatment strategy

The question of how to treat hypothyroidism has lost its relevance after the successful synthesis of thyroid hormones by pharmaceutical companies. Endocrinologists have gained extensive experience in managing the symptoms of this pathology. The therapeutic course is based on a synthetic analogue of L-thyroxine, called levothyroxine.

Clinical hypothyroidism suggests that patients receive replacement therapy at any age. Concomitant pathologies and the age of a person do not play a role. The purpose of the drug is carried out individually, the daily dose is determined by the clinical picture of the pathology. Latent hypothyroidism becomes a reason for drug therapy in only one case – a woman is planning a pregnancy or is already expecting the birth of a child.

Significant changes in the state of patients taking artificially synthesized hormones occur in the second week after the start of the course. The bulk of the symptoms cease to bother a person over the next few months. Older people respond worse to treatment for hypothyroidism, the reaction to the drug develops rather slowly. Owners of cardiovascular pathologies must strictly observe the dosage prescribed by the endocrinologist. An increased concentration of L-thyroxine in the body can lead to angina pectoris or atrial fibrillation.

Recovery prognosis and prevention

In congenital hypothyroidism, clinical guidelines call for the earliest possible initiation of replacement therapy. When treated from 1-2 weeks of life, the central nervous system of the child does not suffer, the cognitive and intellectual abilities of the infant correspond to age norms. Late initiation of replacement therapy can lead to oligophrenia, disturbances in the structure of the rally, and pathologies in the development of internal organs.