What are the signs of extreme hypothyroidism. How is severe hypothyroidism diagnosed. What treatments are available for advanced hypothyroidism. Can extreme hypothyroidism be reversed. How does severe hypothyroidism affect daily life.

The Fundamentals of Hypothyroidism: An In-Depth Look

Hypothyroidism, also known as underactive thyroid disease, is a common endocrine disorder that affects millions of people worldwide. This condition occurs when the thyroid gland, located in the lower front part of the neck, fails to produce sufficient thyroid hormone. The thyroid hormone plays a crucial role in regulating various bodily functions, including metabolism, heart rate, and body temperature.

How does hypothyroidism affect the body’s overall functioning. The thyroid hormone influences nearly every organ system, and when production is inadequate, it can lead to a slowdown of many bodily processes. This results in a sluggish metabolism, which can manifest in various symptoms that affect multiple aspects of a person’s health and well-being.

Recognizing the Symptoms of Extreme Hypothyroidism

Extreme hypothyroidism, also referred to as severe or advanced hypothyroidism, can present with more pronounced and debilitating symptoms compared to milder forms of the condition. Identifying these symptoms is crucial for early diagnosis and treatment.

Physical Manifestations of Severe Hypothyroidism

• Profound fatigue and weakness
• Significant weight gain despite reduced appetite
• Severe cold intolerance
• Dry, coarse skin and brittle nails
• Hair loss or changes in hair texture
• Muscle aches and joint pain
• Constipation
• Puffy face and extremities

Cognitive and Emotional Symptoms

How does extreme hypothyroidism affect mental health. Severe cases of hypothyroidism can lead to significant cognitive and emotional disturbances, including:

• Depression and mood swings
• Memory problems and difficulty concentrating
• Slowed speech and thought processes
• Anxiety and irritability

The Underlying Causes of Extreme Hypothyroidism

Understanding the root causes of extreme hypothyroidism is essential for effective management and treatment. While there are several potential triggers, some causes are more common than others.

Hashimoto’s Thyroiditis: The Leading Cause

Hashimoto’s thyroiditis, an autoimmune disorder, is the most prevalent cause of hypothyroidism. In this condition, the immune system mistakenly attacks the thyroid gland, leading to inflammation and impaired hormone production. Over time, this can result in severe hypothyroidism if left untreated.

Other Significant Causes

1. Radiation therapy to the neck area
2. Radioactive iodine treatment for hyperthyroidism
3. Thyroid surgery
4. Certain medications (e.g., amiodarone, lithium)
5. Iodine deficiency (rare in developed countries)
6. Pituitary gland disorders
7. Congenital hypothyroidism

Diagnosing Extreme Hypothyroidism: A Comprehensive Approach

Accurate diagnosis of extreme hypothyroidism is crucial for appropriate treatment and management. Healthcare providers employ various methods to confirm the condition and assess its severity.

Blood Tests: The Gold Standard

What blood tests are used to diagnose hypothyroidism. The primary diagnostic tool for hypothyroidism is a thyroid function test, which measures the levels of thyroid hormones in the blood. This typically includes:

• Thyroid-stimulating hormone (TSH) – elevated in hypothyroidism
• Free thyroxine (T4) – decreased in hypothyroidism
• Free triiodothyronine (T3) – may be tested in some cases

Additional Diagnostic Tools

In cases of extreme hypothyroidism, healthcare providers may employ additional tests to assess the impact on various organ systems:

• Lipid profile to check cholesterol levels
• Complete blood count to assess anemia
• Liver function tests
• Thyroid antibody tests to confirm autoimmune thyroiditis

Treatment Strategies for Extreme Hypothyroidism

Treating extreme hypothyroidism requires a comprehensive approach tailored to the individual’s specific needs and the severity of their condition.

Hormone Replacement Therapy: The Cornerstone of Treatment

How is thyroid hormone replacement administered. The primary treatment for hypothyroidism is thyroid hormone replacement therapy. This typically involves daily oral administration of levothyroxine, a synthetic form of thyroxine (T4). In severe cases, treatment may be initiated at lower doses and gradually increased to avoid overloading the body’s systems.

Monitoring and Adjusting Treatment

Regular monitoring of thyroid hormone levels is essential to ensure optimal treatment. Healthcare providers will adjust the dosage based on blood test results and the patient’s symptoms. This process may take several weeks or months to achieve the right balance.

Addressing Complications

In cases of extreme hypothyroidism, additional treatments may be necessary to manage complications:

• Lipid-lowering medications for high cholesterol
• Iron supplements for anemia
• Medications to manage depression or other mental health issues

Living with Extreme Hypothyroidism: Lifestyle Considerations

Managing extreme hypothyroidism extends beyond medical treatment. Lifestyle modifications can play a significant role in improving symptoms and overall quality of life.

Dietary Considerations

While there is no specific “thyroid diet,” certain dietary considerations can support thyroid health:

• Ensuring adequate iodine intake through iodized salt or seafood
• Consuming selenium-rich foods like brazil nuts and fish
• Avoiding excessive consumption of goitrogenic foods (e.g., raw cruciferous vegetables)
• Maintaining a balanced diet rich in fruits, vegetables, and lean proteins

Exercise and Physical Activity

How does exercise benefit individuals with hypothyroidism. Regular physical activity can help manage symptoms of hypothyroidism by:

• Boosting energy levels and combating fatigue
• Improving mood and reducing depression
• Supporting weight management
• Enhancing cardiovascular health

Potential Complications of Untreated Extreme Hypothyroidism

Left untreated, extreme hypothyroidism can lead to severe complications affecting various organ systems. Understanding these potential risks underscores the importance of prompt diagnosis and treatment.

Cardiovascular Complications

Severe hypothyroidism can significantly impact heart health, potentially leading to:

• Increased risk of heart disease
• Elevated cholesterol levels
• Hypertension
• Pericardial effusion (fluid around the heart)

Neurological and Mental Health Issues

Extreme hypothyroidism can affect brain function and mental health, resulting in:

• Severe depression
• Cognitive decline and memory problems
• Peripheral neuropathy
• Myxedema coma (a rare but life-threatening condition)

Reproductive and Developmental Concerns

How does extreme hypothyroidism affect fertility and pregnancy. Untreated severe hypothyroidism can lead to:

• Infertility or difficulty conceiving
• Increased risk of miscarriage
• Complications during pregnancy and delivery
• Developmental issues in infants born to mothers with untreated hypothyroidism

Emerging Research and Future Directions in Hypothyroidism Management

As our understanding of thyroid function and dysfunction continues to evolve, researchers are exploring new avenues for diagnosis, treatment, and management of hypothyroidism, including extreme cases.

Personalized Medicine Approaches

Advances in genetic research are paving the way for more personalized treatment strategies. Studies are investigating how genetic variations influence an individual’s response to thyroid hormone replacement therapy, potentially leading to more tailored treatment plans.

Novel Therapeutic Targets

Researchers are exploring new therapeutic targets beyond traditional hormone replacement. This includes investigating the potential of thyroid hormone analogs and compounds that may enhance the body’s sensitivity to thyroid hormones.

Improved Diagnostic Tools

What advancements are being made in hypothyroidism diagnosis. Ongoing research is focused on developing more sensitive and specific diagnostic tools, including:

• Advanced imaging techniques to assess thyroid function
• Biomarkers for early detection of thyroid dysfunction
• Artificial intelligence algorithms to improve diagnostic accuracy

As research in the field of thyroidology progresses, it holds promise for improving the lives of those affected by extreme hypothyroidism. Continued advancements in understanding the complexities of thyroid function and dysfunction will likely lead to more effective strategies for prevention, diagnosis, and treatment of this challenging condition.

In conclusion, extreme hypothyroidism represents a severe manifestation of thyroid dysfunction that requires prompt recognition, thorough evaluation, and comprehensive management. By understanding the symptoms, causes, and potential complications of this condition, individuals and healthcare providers can work together to implement effective treatment strategies and improve overall quality of life. As research continues to uncover new insights into thyroid function and regulation, the future holds promise for even more targeted and personalized approaches to managing extreme hypothyroidism.

Hypothyroidism (Underactive Thyroid): Symptoms, Causes, Tests, Treatments

Written by Kelli Miller

• What Is Hypothyroidism?
• Symptoms of Hypothyroidism
• Causes of Hypothyroidism
• Hypothyroidism Risk Factors
• Diagnosis of Hypothyroidism
• Hypothyroidism Treatment
• Complications of Hypothyroidism
• More

Hypothyroidism, also called underactive thyroid disease, is a common disorder. With hypothyroidism, your thyroid gland does not make enough thyroid hormone.

The thyroid gland is located in the front lower part of your neck. Hormones released by the gland travel through your bloodstream and affect nearly every part of your body, from your heart and brain, to your muscles and skin.

The thyroid controls how your body’s cells use energy from food, a process called metabolism. Among other things, your metabolism affects your body’s temperature, your heartbeat, and how well you burn calories. If you don’t have enough thyroid hormone, your body processes slow down. That means your body makes less energy, and your metabolism becomes sluggish.

Symptoms of hypothyroidism may be vague and can often mimic other conditions. They may include:

• Changes in the menstrual cycle
• Constipation
• Depression
• Dry hair and hair loss
• Dry skin
• Elevated cholesterol
• Fatigue
• Greater sensitivity to cold
• Hoarse voice
• Joint pain, stiffness, and swelling
• Problems with memory
• Muscle aches and stiffness
• Muscle weakness
• Puffy face
• Slow heart rate
• Swelling of the thyroid gland (goiter)
• Unexplained weight gain or difficulty losing weight
• Carpal tunnel syndrome

Babies with hypothyroidism may have no symptoms. If symptoms do occur, they can include:

• Cold hands and feet
• Constipation
• Extreme sleepiness
• Hoarse cry
• Little or no growth
• Low muscle tone (floppy infant)
• Persistent jaundice (yellowing of the skin and whites of the eyes)
• Poor feeding habits
• Puffy face
• Stomach bloating
• Swollen tongue
• Umbilical hernia

Make an appointment with your health care provider if you or your baby has any of these symptoms. It’s important to note that these symptoms can be due to other medical conditions.

Children and teens may also have hypothyroidism with the signs and symptoms seen in adults. Kids and teens may also have:

• Delays in puberty
• Delays in growth and shorter stature
• Slow mental development
• Slower development of permanent teeth

The most common cause of hypothyroidism is Hashimoto’s thyroiditis. “Thyroiditis” is an inflammation of the thyroid gland. Hashimoto’s thyroiditis is an autoimmune disorder. With Hashimoto’s, your body produces antibodies that attack and destroy the thyroid gland. Thyroiditis may also be caused by a viral infection.

Other causes of hypothyroidism include:

• Radiation therapy to the neck area. Treating certain cancers, such as lymphoma, requires radiation to the neck. Radiation damages the cells in the thyroid. This makes it more difficult for the gland to produce hormones.
• Radioactive iodine treatment. This treatment is commonly prescribed to people who have an overactive thyroid gland, a condition known as hyperthyroidism. However, radiation destroys the cells in the thyroid gland. This usually leads to hypothyroidism.
• Use of certain medications. Certain medicines to treat heart problems, psychiatric conditions, and cancer can sometimes affect the production of thyroid hormone. These include amiodarone (Cordarone, Pacerone), interferon alpha, and interleukin-2.
• Thyroid surgery. Surgery to remove the thyroid will lead to hypothyroidism. If only part of the thyroid is removed, the remaining gland may still be able to produce enough hormone for the body’s needs.
• Too little iodine in the diet. The thyroid needs iodine to produce thyroid hormone. Your body doesn’t make iodine, so you need to get it through your diet. Iodized table salt is rich in iodine. Other food sources of iodine include shellfish, saltwater fish, eggs, dairy products, and seaweed. Iodine deficiency is rare in the U.S.
• Pregnancy. The reason isn’t clear, but sometimes, inflammation of the thyroid occurs after pregnancy. This is called postpartum thyroiditis. Women with this condition usually have a severe increase in thyroid hormone levels followed by a sharp drop in thyroid hormone production. Most women with postpartum thyroiditis will regain their normal thyroid function.
• Problems with the thyroid at birth. Some babies may be born with a thyroid gland that did not develop correctly or does not work properly. This type of hypothyroidism is called congenital hypothyroidism. Most hospitals in the U.S. screen babies at birth for this disease.
• Pituitary gland damage or disorder. Rarely, a problem with the pituitary gland can interfere with the production of thyroid hormone. The pituitary gland makes a hormone, called thyroid-stimulating hormone (TSH), which tells your thyroid how much hormone it should make and release.
• Disorder of the hypothalamus. An extremely rare form of hypothyroidism can occur if the hypothalamus in the brain does not produce enough of a hormone called TRH. TRH affects the release of TSH from the pituitary gland.

Primary hypothyroidism is caused by a problem with the thyroid gland itself.

Secondary hypothyroidism occurs when another problem interferes with the thyroid’s ability to produce hormones. For example, the pituitary gland or hypothalamus produce hormones that trigger the release of thyroid hormone. A problem with one of these glands can make your thyroid underactive.

Sometimes, an underactive thyroid that results from a problem with the hypothalamus is called tertiary hypothyroidism.

Women, particularly older women, are more likely to develop hypothyroidism than men. You are also more likely to develop hypothyroidism if you have a close family member with an autoimmune disease. Other risk factors include:

• Race (being white or Asian)
• Age (growing older)
• Prematurely graying hair
• Autoimmune disorders such as type 1 diabetes, multiple sclerosis, rheumatoid arthritis, celiac disease, Addison’s disease, pernicious anemia, or vitiligo
• Bipolar disorder
• Down syndrome
• Turner syndrome

If you have symptoms of hypothyroidism, your doctor will order blood tests to check hormone levels. These may include:

• Thyroid-stimulating hormone (TSH)
• T4 (thyroxine)

Lower-than-normal T4 levels usually mean you have hypothyroidism. However, some people may have increased TSH levels while having normal T4 levels. This is called subclinical (mild) hypothyroidism. It is believed to be an early stage of hypothyroidism.

If your test results or physical exam of the thyroid are abnormal, your doctor may order a thyroid ultrasound, or thyroid scan, to check for nodules or inflammation.

If you have hypothyroidism, your doctor will prescribe a synthetic (human-made) thyroid hormone T4. You take this pill every day. Certain other medications can interfere with how your body absorbs synthetic thyroid hormone. Make sure your doctor knows about all the medicines, herbs, and supplements you take, including over-the-counter products.

You will need regular blood tests to check your thyroid hormone levels. Your doctor may need to adjust your medication dose from time to time.

It may take a little time to figure out the correct dosage of thyroid hormone that you need. Your doctor will give you a blood test to check your TSH levels 6 to 8 weeks after you start taking synthetic hormones, and then once every 6 months.

If your dosage is too high and you get too much hormone, you could have these side effects:

• Appetite increases
• Can’t sleep
• Heart palpitations
• Shakiness

People with severe hypothyroidism or heart disease may start out with a low dose of synthetic hormone, and then gradually increase the amount so their heart can adjust to it.

Once you have the correct dosage, you shouldn’t have any side effects from your hormones. But don’t stop or skip your medication, because your hypothyroidism symptoms could come back.

If you gain or lose even as much as 10 pounds of body weight, you may need to get your TSH levels checked again to see if your hormone dosage should be adjusted.

Untreated, hypothyroidism may cause complications, such as:

• Balance problems. Older women are at extra risk for balance problems if their thyroid hormone levels are too low.
• Goiter. If your thyroid is always trying to produce more hormones, the gland can swell and change the appearance of your neck. You may also have trouble swallowing.
• Heart problems. Hypothyroidism puts you at greater risk for heart disease and can raise your levels of LDL or “bad” cholesterol.
• Infertility. Too little thyroid hormone may disrupt your production of eggs (ovulation) and make it harder to conceive.
• Joint pain. Low levels of thyroid hormone can cause you to have aches and pains in your joints and muscles, as well as tendonitis.
• Mental health issues. Low thyroid hormones can cause memory or concentration lapses, as well as decreased interest in activities you used to enjoy. See your doctor if you notice these changes, as they could also be due to depression unrelated to your thyroid.
• Obesity. Although hypothyroidism may curb your appetite, you can gain weight because your metabolism slows down too, and you don’t burn enough calories.
• Peripheral neuropathy. Over time, low thyroid hormones can damage your peripheral nerves. You may notice pain, tingling, or numbness in your limbs.

Thyroid problems in a pregnant woman can affect the developing baby. During the first three months of pregnancy, the baby receives all thyroid hormone from its mother. If the mother has hypothyroidism, the baby does not get enough thyroid hormone. This can lead to problems with mental development.

Extremely low levels of thyroid hormone can cause a life-threatening condition called myxedema. Myxedema is the most severe form of hypothyroidism. A person with myxedema can lose consciousness or go into a coma. The condition can also cause the body temperature to drop very low, which can cause death.

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About underactive thyroids

An underactive thyroid gland (hypothyroidism) is where your thyroid gland doesn’t produce enough hormones.

Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed.

An underactive thyroid can often be successfully treated by taking daily hormone tablets to replace the hormones your thyroid isn’t making.

There’s no way of preventing an underactive thyroid. Most cases are caused either by the immune system attacking the thyroid gland and damaging it, or by damage to the thyroid that occurs during some treatments for an overactive thyroid or thyroid cancer.

Read more about the causes of an underactive thyroid

When to see your GP

Symptoms of an underactive thyroid are often similar to those of other conditions, and they usually develop slowly, so you may not notice them for years.

You should see your GP and ask to be tested for an underactive thyroid if you have symptoms including:

• tiredness
• weight gain
• depression 
• being sensitive to the cold
• dry skin and hair
• muscle aches

The only accurate way of finding out whether you have a thyroid problem is to have a thyroid function test, where a sample of blood is tested to measure your hormone levels.

Read more about testing for an underactive thyroid

Who’s affected

Both men and women can have an underactive thyroid, although it’s more common in women. In the UK, it affects 15 in every 1,000 women and 1 in 1,000 men. Children can also develop an underactive thyroid.

Around 1 in 3,500-4,000 babies are born with an underactive thyroid (congenital hypothyroidism). All babies born in the UK are screened for congenital hypothyroidism using a blood spot test when the baby is about five days old.

Treating an underactive thyroid

Treatment for an underactive thyroid involves taking daily hormone replacement tablets, called levothyroxine, to raise your thyroxine levels. You’ll usually need treatment for the rest of your life. However, with proper treatment, you should be able to lead a normal, healthy life.

If an underactive thyroid isn’t treated, it can lead to complications, including heart disease, goitre, pregnancy problems and a life-threatening condition called myxoedema coma (although this is very rare).

Read more about treating an underactive thyroid and the complications of an underactive thyroid

Symptoms of an underactive thyroid

Many symptoms of an underactive thyroid (hypothyroidism) are the same as those of other conditions, so it can easily be confused for something else.

Symptoms usually develop slowly and you may not realise you have a medical problem for several years.

Common symptoms include:

• tiredness
• being sensitive to cold
• weight gain
• constipation
• depression
• slow movements and thoughts
• muscle aches and weakness
• muscle cramps
• dry and scaly skin
• brittle hair and nails
• loss of libido (sex drive)
• pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome)
• irregular periods or heavy periods

Elderly people with an underactive thyroid may develop memory problems and depression. Children may experience slower growth and development. Teenagers may start puberty earlier than normal.

If you have any of these symptoms, see your GP and ask to be tested for an underactive thyroid.

Read more about getting tested for an underactive thyroid

If an underactive thyroid isn’t treated

It’s unlikely that you’d have many of the later symptoms of an underactive thyroid, because the condition is often identified before more serious symptoms appear.

Later symptoms of an underactive thyroid include:

• a low-pitched and hoarse voice
• a puffy-looking face
• thinned or partly missing eyebrows
• a slow heart rate
• hearing loss
• anaemia

Causes of an underactive thyroid

An underactive thyroid (hypothyroidism) is when your thyroid gland doesn’t produce enough of the hormone thyroxine (also called T4).

Most cases of an underactive thyroid are caused by the immune system attacking the thyroid gland and damaging it, or by damage that occurs as a result of treatments for thyroid cancer or an overactive thyroid.

Immune system

An underactive thyroid often occurs when the immune system, which usually fights infection, attacks the thyroid gland. This damages the thyroid, which means it’s not able to make enough of the hormone thyroxine, leading to the symptoms of an underactive thyroid.

A condition called Hashimoto’s disease is the most common type of autoimmune reaction that causes an underactive thyroid.

It’s not clear what causes Hashimoto’s disease, but it runs in families. It’s also common in people with another immune system disorder, such as type 1 diabetes and vitiligo.

Previous thyroid treatment

An underactive thyroid can also occur as a side effect or complication of previous treatment to the thyroid gland, such as surgery or a treatment called radioactive iodine therapy.

These treatments are sometimes used for an overactive thyroid (where the thyroid gland produces too much hormone) or thyroid cancer.

Less common causes

Worldwide, a lack of dietary iodine is a common cause of an underactive thyroid, because the body needs iodine to make thyroxine. However, iodine deficiency is uncommon in the UK.

Babies are sometimes born with an underactive thyroid because the thyroid gland doesn’t develop properly in the womb. This is called congenital hypothyroidism and is uncommon, affecting around 1 in 3,000 babies. It’s usually picked up during routine screening soon after birth.

A problem with the pituitary gland could lead to an underactive thyroid. The pituitary gland sits at the base of the brain and regulates the thyroid. Therefore, damage to the pituitary gland may lead to an underactive thyroid.

An underactive thyroid has also been linked to some viral infections or some medications used to treat other conditions, such as:

• lithium – a medication sometimes used to treat certain mental health conditions, including depression and bipolar disorder
• amiodarone – a medication sometimes used to treat irregular heartbeats (arrhythmias)
• interferons – a class of medication sometimes used to treat certain types of cancer and hepatitis C

Speak to your GP or specialist if you’re concerned that a medication you’re taking may be affecting your thyroid hormone levels.

Diagnosing an underactive thyroid

It’s very important that an underactive thyroid (hypothyroidism) is diagnosed as soon as possible.

Low levels of thyroid-producing hormones, such as triiodothyronine (T3) and thyroxine (T4), can change the way the body processes fat.

This can cause high cholesterol and atherosclerosis (clogging of the arteries), which can potentially lead to serious heart-related problems, such as angina and heart attack.

Therefore, you should see your GP and ask for a blood test if you repeatedly have symptoms of an underactive thyroid.

Thyroid function test

A blood test measuring your hormone levels is the only accurate way to find out whether there’s a problem.

The test, called a thyroid function test, looks at levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) in the blood.

A high level of TSH and a low level of T4 in the blood could mean you have an underactive thyroid.

If your test results show raised TSH but normal T4, you may be at risk of developing an underactive thyroid in the future.

Your GP may recommend that you have a repeat blood test every so often to see whether you eventually develop an underactive thyroid.

Blood tests are also sometimes used for other measurements, such as checking the level of a hormone called triiodothyronine (T3). However, this isn’t routine, because T3 levels can often remain normal, even if you have a significantly underactive thyroid.

The Lab Tests Online UK website has more information about the different types of thyroid function tests.

Referral

Your GP may refer you to an endocrinologist (a specialist in hormone disorders) if you:

• are younger than 16
• are pregnant or trying to get pregnant
• have just given birth
• have another health condition, such as heart disease, which may complicate your medication
• are taking a medication known to cause a reduction in thyroid hormones, such as amiodarone or lithium

Treating an underactive thyroid

An underactive thyroid (hypothyroidism) is usually treated by taking daily hormone replacement tablets called levothyroxine.

Levothyroxine replaces the thyroxine hormone, which your thyroid doesn’t make enough of.

You’ll initially have regular blood tests until the correct dose of levothyroxine is reached. This can take a little while to get right.

You may start on a low dose of levothyroxine, which may be increased gradually, depending on how your body responds. Some people start to feel better soon after beginning treatment, while others don’t notice an improvement in their symptoms for several months

Once you’re taking the correct dose, you’ll usually have a blood test once a year to monitor your hormone levels.

If blood tests suggest you may have an underactive thyroid, but you don’t have any symptoms or they’re very mild, you may not need any treatment. In these cases, your GP will usually monitor your hormone levels every few months and prescribe levothyroxine if you develop symptoms.

Taking levothyroxine

If you’re prescribed levothyroxine, you should take one tablet at the same time every day.  It’s usually recommended that you take the tablets in the morning, although some people prefer to take them at night.

The effectiveness of the tablets can be altered by other medications, supplements or foods, so they should be swallowed with water on an empty stomach, and you should avoid eating for 30 minutes afterwards.

If you forget to take a dose, take it as soon as you remember, if this is within a few hours of your usual time. If you don’t remember until later than this, skip the dose and take the next dose at the usual time, unless advised otherwise by your doctor.

An underactive thyroid is a lifelong condition, so you’ll usually need to take levothyroxine for the rest of your life.

If you’re prescribed levothyroxine because you have an underactive thyroid, you’re entitled to a medical exemption certificate. This means you don’t have to pay for your prescriptions. 

Side effects

Levothyroxine doesn’t usually have any side effects, because the tablets simply replace a missing hormone.

Side effects usually only occur if you’re taking too much levothyroxine. This can cause problems including sweating, chest pain, headaches, diarrhoea and vomiting.

Tell your doctor if you develop new symptoms while taking levothyroxine. You should also let them know if your symptoms get worse or don’t improve.

Combination therapy

In the UK, combination therapy – using levothyroxine and triiodothyronine (T3) together – isn’t routinely used because there’s insufficient evidence to show it’s better than using levothyroxine alone (monotherapy).

In most cases, suppressing thyroid-stimulating hormone (TSH) using high dose thyroid replacement therapy should be avoided because it carries a risk of causing adverse side effects, such as atrial fibrillation (an irregular and abnormally fast heart rate), strokes, osteoporosis and fracture.

However, this type of treatment may sometimes be recommended in cases where a person has a history of thyroid cancer and there’s a significant risk of it reoccurring.

Complications of an underactive thyroid

Several complications can occur if you have an underactive thyroid that isn’t treated.

Heart problems

If you have an untreated underactive thyroid, your risk of developing cardiovascular disease is increased.

This is because having low levels of the hormone thyroxine can lead to increased levels of cholesterol in your blood. High cholesterol can cause fatty deposits to build up in your arteries, restricting the flow of blood.

Contact your doctor if you’re being treated for an underactive thyroid and you develop chest pain, so that any problems can be detected and treated, if necessary. 

Goitre

A goitre is an abnormal swelling of the thyroid gland that causes a lump to form in the throat. Goitres can develop in people with an underactive thyroid when the body tries to stimulate the thyroid to produce more thyroid hormones.

Pregnancy complications

If an underactive thyroid isn’t treated during pregnancy, there’s a risk of problems occurring. These include:

• pre-eclampsia – which can cause high blood pressure and fluid retention in the mother and growth problems in the baby
• anaemia in the mother
• an underactive thyroid in the baby
• birth defects
• bleeding after birth
• problems with the baby’s physical and mental development
• premature birth or a low birthweight
• stillbirth or miscarriage

These problems can usually be avoided with treatment under the guidance of a specialist in hormone disorders (an endocrinologist). Therefore, tell your GP if you have an underactive thyroid and you’re pregnant or trying to get pregnant.

Myxoedema coma

In very rare cases, a severe underactive thyroid may lead to a life-threatening condition called myxoedema coma. This is where the thyroid hormone levels become very low, causing symptoms such as confusion, hypothermia and drowsiness.

Myxoedema coma requires emergency treatment in hospital. It’s usually treated with thyroid hormone replacement medication given directly into a vein. In some cases, other treatments such as breathing support, antibiotics and steroid medication (corticosteroids) are also required.

Hypothyroidism of the thyroid gland – causes, symptoms of the disease, diagnosis and treatment of the disease

Do you constantly feel tired and sleepy? Do you find it hard to take in new information? Collect all the colds? These signs suggest that it may be time to get your thyroid checked. We tell you what disease these symptoms are talking about and how they can be cured.

What is thyroid hypothyroidism in women and men?

The prefix “hypo” indicates that the organ cannot perform its function to the required extent. In the case of hypothyroidism, we are talking about the fact that the thyroid gland cannot produce enough hormones.

The thyroid gland is responsible for the production of thyroid hormones, which are responsible for regulating all metabolic processes in the body. When they decrease, the normal course of metabolism is disrupted, which affects all organs and tissues.

According to statistics, this diagnosis accounts for a third of cases of all diseases of this organ. Symptoms of a lack of thyroid hormones in women are as common as in men (19 cases per 1000 population versus 21 cases per thousand population). On average, hypothyroidism occurs in 4.6% of cases in the population.

In newborns, the statistics of the manifestation of this pathology is slightly different. Girls experience hypothyroidism 2 times more often than boys. In general, this disease occurs in one child out of three and a half thousand newborns. The reason for this increase in frequency is still unknown.

99% of cases are due to primary hypothyroidism and is associated with congenital or acquired thyroid dysfunction. Secondary and tertiary hypothyroidism accounts for only 1% of cases. It develops due to a decrease in the level of thyroid-stimulating hormone (TSH).

Hypothyroidism as an independent disease was isolated only in the middle of the 19th century. Moreover, for children, the disease was described earlier than for adults. The children’s variant was described in 1850, the adult one only after 23 years – in 1873. The term “myxedema”, which characterizes the extreme degree of hypothyroidism in adults, was proposed in 1878.

Reduced thyroid function can be either congenital or acquired. Due to the difficulties with diagnosis and the blurring of the symptom of hypothyroidism, it is diagnosed in the later stages. If it is not treated and the function of the gland is not compensated, hypothyroidism causes serious health consequences and leads to mental retardation, profound disability and a deterioration in the quality of life.

Etiology and pathogenesis

Primary hypothyroidism develops due to insufficient development of glandular tissue. Because of what, it cannot perform its function completely and produces a reduced amount of hormones. Lack of glandular tissue develops due to insufficient intake of iodine and selenium, underdevelopment of the gland, autoimmune processes and operations.

One of the most common causes of hypothyroidism is autoimmune thyroiditis. Primary hypothyroidism is characterized by inflammation of the glandular tissue of the thyroid gland, which leads to a decrease in its performance and inhibition of its functions.

Secondary hypothyroidism develops against the background of a decrease in the function of the pituitary gland and a decrease in its production of thyrotropin. This hormone regulates the functioning of the thyroid gland, therefore, with its deficiency, the production of hormones by the thyroid gland is also disturbed.

Tertiary hypothyroidism is also distinguished, which develops against the background of dysfunction of the hypothalamus.

Several risk factors influence the development of the disease:

• malnutrition with iodine and selenium deficiencies;
• hereditary factors;
• intrauterine underdevelopment of tissues;
• influence of harmful factors;
• surgical operations on the thyroid gland;
• autoimmune diseases.

Women over the age of 50 are also at risk for developing this disease. Hypothyroidism of the thyroid gland in women of this age is associated with postmenopausal hormonal changes.

Classification and stages of development

Hypothyroidism is classified according to several criteria. So, according to the severity of the course of the disease and its stage, clinical recommendations distinguish:

If the disease is not treated, it continues to progress. As a result, complicated autoimmune hypothyroidism of a severe course develops. If the patient does not receive treatment at this stage of the development of the disease, he begins a hypothyroid coma, against which confusion develops, the respiratory center and the adrenal cortex are depressed.

Important! Due to the fact that for a long time it is possible to diagnose the disease only by blood tests, and there are no obvious symptoms of insufficient production of thyroid hormones, it is very difficult to determine hypothyroidism.

Symptoms of hypothyroidism

The multifactorial and polysystem nature of hypothyroidism leads to the fact that the symptoms of the disease manifest themselves in a malfunction in the work of various organs. In addition, it can be difficult to find a direct relationship between a decrease in the production of thyroid hormones and the clinical manifestations of the disease. Reduced function or hypothyroidism of the thyroid gland in women has the following symptoms of hypothyroxinemia:

• hair loss;
• constant sleepiness;
• fast fatiguability;
• dry skin;
• swelling of the fingers and toes;
• forgetfulness;
• feeling cold;
• hoarseness;
• decrease in mood.

Also, hypothyroidism can “mask” as other diseases. The main ones are:

However, hypothyroidism does not cause shortness of breath. The diagnosis is made on the basis of clinical symptoms, laboratory and instrumental studies. If you notice any of these symptoms, be sure to consult a doctor.

The symptoms of hypothyroidism are similar to those of other diseases. Do not engage in self-diagnosis and self-treatment! Delay in treatment threatens with serious complications. Do not delay and contact our doctors by phone. They will make a clinical picture and recommend treatment or necessary examinations.

Diagnosis of disease

Primary diagnosis is carried out by an ordinary therapist. If necessary and according to indications, he directs a patient with suspected hypothyroidism for consultation and treatment to a specialized endocrinologist.

Diagnosis begins with the collection of complaints and a detailed history. The doctor also conducts a visual examination. With a long lack of thyroid hormones, their external manifestations can be detected – puffiness of the face, icteric skin tone, swelling of the extremities.

Also, patients with suspected hypothyroidism are assigned laboratory tests:

• the presence in the blood of antibodies to the tissues of the thyroid gland;
• blood test for T3 and T4 levels;
• determination of the level of pituitary hormones;
• blood test for lipids and cholesterol;
• testing for thyroxine-binding proteins.

Sometimes blood tests are carried out several times to track hormone levels over time.

Also, the patient must undergo an ultrasound examination of the thyroid gland. It determines its dimensions and their changes. These studies are enough to make an accurate diagnosis.

If, despite the severe symptoms, the doctor does not find changes in the thyroid gland and all tests are normal, then the person has a different disease, and additional studies should be ordered.

Complications of hypothyroidism

Thyroid hormones are actively involved in the regulation of metabolism, therefore, with their deficiency, absolutely all systems and organs suffer. Changes occur at the cellular level. Their main cause is oxygen starvation, a decrease in ATP synthesis, and a violation of intracellular metabolism.

It is for this reason that thyroid insufficiency leads to a variety of clinical manifestations and complications. The main ones are:

Also, with hypothyroidism, complications can develop that can threaten the life of the patient. The main ones are respiratory failure and hypothyroid coma.

Lack of hormones affects children worse than adults. In childhood, hypothyroidism causes severe developmental delays, the extreme degree of which is called cretinism. If you suspect a decrease in thyroid function, be sure to contact our doctor by phone.

Treatment of subclinical hypothyroidism: clinical guidelines

It is impossible to cure the disease completely, but it is possible to slow down its development and reduce the severity of symptoms and complications. With hyperthyroidism of the thyroid gland in women and the severity of the symptom, treatment is prescribed as soon as possible. So it is easier to stop it and avoid serious consequences.

The main directions of treatment:

1. Drug treatment includes hormone replacement therapy and taking pills that help normalize the metabolism and work of other organs affected by a lack of hormones. In some cases, drugs are prescribed for life.
2. Maintenance therapy consists in normalizing nutrition and eliminating harmful factors that affect the functioning of the thyroid gland, pituitary gland and hypothalamus.

In the presence of complications, a patient with hypothyroidism is referred for consultations to specialized specialists who select treatment and correct concomitant diseases, taking into account contraindications. Also, the patient is selected an individual diet. Treatment is usually at home. Hospital is rarely needed

Important! Since hypothyroidism is associated with a decrease in the normal size of the glandular tissue or a malfunction of the pituitary and hypothalamus, surgical treatment of this disease is not carried out. They are limited only to medical and supportive therapy.

Prevention and prognosis

In general, with timely and adequate treatment, a decrease in thyroid function is quite easily corrected by hormones. Their number and combination is determined by the doctor based on the history and severity of the course of the disease. If necessary, appointments are adjusted, so you need to visit an endocrinologist at least once a year.

Therapy for hypothyroidism is prescribed for life. Failure to take medication will cause the disease to return, and the symptoms will constantly increase. Do not adjust or cancel hormones on your own. This may worsen the condition. This is especially dangerous for small children. If therapy is successful, then they talk about drug-compensated hypothyroidism. If with the help of treatment, it is not possible to restore the normal amount of hormones, then hypothyroidism is considered uncompensated.

Prevention consists in avoiding factors provoking hypothyroidism:

• The diet should include sufficient amounts of iodine and selenium.
• It is necessary to avoid traumatization of the thyroid gland and the influence of harmful substances on it.
• It is necessary to periodically check the state of health and take tests if you are at risk.

To prevent drug-induced hypothyroidism during treatment with tyrosol and to prevent overdose, a periodic visit to the doctor is prescribed to adjust the dose of the drug.

FAQ

What causes hypothyroidism?

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Reduced thyroid function and its symptoms can be congenital or acquired. The first is associated with the underdevelopment of the organ and the harmful factors that affect it. The second is with the disruption of the pituitary gland.

Which doctor should I contact for the diagnosis and treatment of hypothyroidism?

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Endocrinology deals with the study of the thyroid gland, and the endocrinologist prescribes the treatment of the disease. But primary examinations for suspected hypothyroidism can also be done by a general practitioner.

Is there a difference in the symptoms and treatment of thyroid hypothyroidism in women and men?

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No, the treatment depends on the severity of the course and the reasons that led to the hypofunction of the thyroid gland. It is prescribed by a doctor based on the clinical picture.

Outcomes of pregnancy and childbirth due to thyroid gland diseases in women living in the Arctic

In recent years, the prevalence of thyroid gland (thyroid) diseases in pregnant women has been growing, which affects the physical and mental health of children, since it has been established that even subclinical forms thyroid pathology in the mother can adversely affect the condition of the fetus and newborn [1, 2]. Normal development of the fetus is impossible without an adequate supply of thyroid hormones, especially at the stage of embryogenesis, when there is no activity of the thyroid gland and the pituitary gland of the fetus [3, 4]. Iodine deficiency in the diet leads to disruption of the synthesis of thyroid hormones and the development of a number of conditions, united under the general term, iodine deficiency diseases [5–7]. Iodine deficiency diseases have a negative impact on the course of pregnancy and childbirth [8]. Diseases of the thyroid gland, accompanied by a violation of its function, often lead to menstrual disorders, reduced fertility, have a negative effect on all parts of the metabolism, microcirculation, vascular tone, immune and hormonal homeostasis, which in turn cannot but affect the processes embryogenesis, placentation and the course of pregnancy [1]. Iodine deficiency increases the incidence of congenital hypothyroidism, leading to irreversible brain damage in the fetus and newborn and, in the most severe cases, to severe mental retardation. In regions with severe iodine deficiency, the frequency of congenital hypothyroidism, according to screening data, can reach 9—11% [9]. The prevalence of thyroid diseases among pregnant women living in adverse conditions in the Arctic is high [10, 11].

The purpose of the study was to determine the outcomes of pregnancy and childbirth in patients with thyroid diseases living in the conditions of the Arctic.

Material and methods

In the period from 2012 to 2014, a prospective study was conducted at the State Budgetary Institution Labytnangskaya City Hospital (Yamal-Nenets Autonomous Okrug), including an examination of 191 pregnant woman registered in the antenatal clinic. In all women up to 12 weeks of gestation, thyroid function was examined by studying the level of hormones – determining the level of thyroid-stimulating hormone and free thyroxine, as well as performing an ultrasound scan of the thyroid gland and examining an endocrinologist.

At 24-28 weeks of gestation, all pregnant women underwent an oral glucose tolerance test. Women with thyroid pathology identified during the study were given recommendations for further follow-up by an endocrinologist after delivery. Depending on the results of the examination, the patients were divided into two groups: the main group – 68 patients with thyroid diseases, the comparison group – 123 patients without thyroid pathology. Criteria for exclusion from the study: patients who were observed and treated before pregnancy for thyroid pathology. The following methods were used to statistically assess the differences in the course of pregnancy and its outcomes: the proportions were compared using criterion Z , with Yates correction, the mean values ​​for quantitative traits were compared by testing statistical hypotheses in comparison of the obtained value p with the accepted level of significance. The criterion Z was used to determine the shares and was applied under the standard normal distribution. The critical value Z for the 5% significance level is 1.96.

Results

The average age of patients in the main group was 28.9±6.2 years. The average length of stay of women in the Far North was 17.9±10.6 years. The average number of pregnancies is 2.5±1.8. The average number of births was 1.7±0.8. The level of thyroid-stimulating hormone (TSH) in patients with thyroid pathology was 3. 7 ± 2.2 µIU/ml, the average TSH value in the main group was higher than the laboratory norm for the first trimester of pregnancy (0.1–2.5 µIU/ml). Consequently, the pathology present in pregnant women was associated mainly with a lack of thyroid hormones and, as a result, with an increase in TSH levels. The level of free thyroxine was 14.0±3.1 pmol/l, the volume of the thyroid gland was 14.4±6.7 cm ³ .

When examining women by an endocrinologist in pregnancy up to 12 weeks, thyroid diseases that were not diagnosed before gestation were detected in 36.4% of cases. In the first place was subclinical hypothyroidism, detected in 46 (24.1%) women out of 191, in the second – diffuse euthyroid goiter – in 14 (7.3%), in the third – nodular goiter – in 5 (2.6%) , on the fourth – autoimmune thyroiditis – in 3 (1.6%). To assess the differences in complications of pregnancy, childbirth, extragenital pathology (EGP), percentages in the examined groups were calculated. The results are presented in table. 1. Table 1. Gestational complications and extragenital pathology

Analysis of complications of pregnancy, childbirth, EGP showed statistically significant differences according to the following criteria: acute fetal hypoxia during childbirth, large fetus, edema caused by pregnancy, gestational diabetes mellitus. Indications for caesarean section in the main group were uterine scar after caesarean section (49%), acute fetal hypoxia (21%), labor anomalies (12%), clinically narrow pelvis (7%), premature detachment of the placenta (7% ), abnormal position of the fetus (4%). In the comparison group, the reasons for caesarean section were uterine scar after cesarean section (63%), labor anomalies (18%), clinically narrow pelvis (2%), placental abruption (9%), acute fetal hypoxia (8%). Obstetric forceps and vacuum extraction of the fetus were not used in complicated births. In addition, a comparison was made of the average values ​​for quantitative signs (anamnestic, clinical, laboratory, instrumental data, doses of drugs) (Table 2). Table 2. Comparison of the average values ​​of quantitative characteristics of the examined groups

When comparing the mean values ​​in the examined groups, there was a statistically significant difference in age: in the main group – older patients ( p = 0.0001). With age, the proportion of extragenital pathology in women, including thyroid diseases, increased. At the same time, the groups of patients were identical in terms of parity of pregnancies and childbirth.

The fundamental difference was revealed in the analysis of the TSH level: in patients of the main group, the level of TSH was higher ( p = 0.0001), and higher than the reference values ​​for this period of pregnancy. This indicates that thyroid diseases detected during examination by an endocrinologist in the first trimester of pregnancy are accompanied by a decrease in its function. When analyzing the average levels of thyroxin, no statistically significant differences were found; this indicates that subclinical forms of hypothyroidism prevailed, in which the level of thyroxin remains unchanged, and the level of TSH increases.

Determination of the volume of the thyroid gland during ultrasound also revealed statistically significant differences: in patients of the main group, the volume of the thyroid gland was greater ( p = 0.0036), which indicates the presence of iodine deficiency, in which thyroid hypertrophy occurs. A statistically significant difference was also obtained when comparing the average volume of the thyroid gland of newborn mothers of the examined groups. So, in the presence of thyroid diseases in a mother, her volume in a newborn was greater ( p = 0.044) than in a newborn mother without thyroid diseases. Thus, the pathology of the thyroid gland in the mother indicates the presence of iodine deficiency in the fetus and newborn.

Patients in both groups took iodine during pregnancy. There was no statistically significant difference in the dose of iodine taken by patients in both groups. All pregnant women were recommended an iodine dose of 250 mcg/day. According to personal beliefs, some pregnant women either completely refused to take iodine, or independently reduced the recommended dose.

Talk

The results of the study showed that 36.4% of pregnant women in the city of Labytnangi (Arctic) had thyroid diseases, with subclinical hypothyroidism in the first place in their structure (in 24%). In patients with subclinical hypothyroidism, edema caused by pregnancy was more often observed among pregnancy complications, and acute fetal hypoxia was among the complications of childbirth. According to foreign authors [10, 11], among the complications in pregnant women with severe and subclinical hypothyroidism, spontaneous abortions in early pregnancy are more common. According to other researchers [12], subclinical changes in thyroid hormone levels in a pregnant woman can affect the risk of preterm birth, and the strength of these associations depends on the age of the pregnant woman. Our studies have shown that pregnant women with thyroid pathology living in the conditions of the Arctic have an older age.

There is evidence from studies showing that subclinical hypothyroidism not only increases the incidence of abortion and preterm birth, but also gestational hypertension, gestational diabetes, and fetal growth retardation. At the same time, the use of thyroxin at the beginning of pregnancy can reduce the incidence of these complications [13–16]. Other studies [17] have shown that a decrease in the level of thyroid hormones T ₃ and T ₄ , an increase in TSH and the presence of antibodies against the globulin antigen and antithyroid peroxidase lead to the development of preeclampsia.

Our studies have shown that in newborn mothers with pathology of the thyroid gland, its hypertrophy is noted, which is expressed in an increase in its volume during ultrasound scanning. According to foreign researchers [13, 18], newborns were more likely to have macrosomia associated with gestational diabetes, or fetal growth retardation.

Given the adverse maternal and fetal outcomes of pregnancy, some scientists recommend universal screening for hypothyroidism during pregnancy in the population because the prevalence of hypothyroidism is high [19]. At the same time, data from other researchers [20] confirm the recommendations that pregnant women with asymptomatic hypothyroidism and a low risk of developing complications of gestation should not be regularly screened for thyroid dysfunction or autoimmunity.