What is hypothyroidism. How common is this condition. Who is at risk of developing hypothyroidism. What are the symptoms of an underactive thyroid. How is hypothyroidism diagnosed and treated. What complications can arise from untreated hypothyroidism. How does hypothyroidism affect pregnancy and fertility.

Understanding Hypothyroidism: A Comprehensive Overview

Hypothyroidism, also known as an underactive thyroid, is a condition where the thyroid gland fails to produce sufficient thyroid hormones to meet the body’s needs. This small, butterfly-shaped gland located in the front of the neck plays a crucial role in regulating various bodily functions, including metabolism, heart rate, and energy levels.

When the thyroid gland underperforms, it can lead to a slowdown of many bodily functions, affecting overall health and well-being. Understanding the causes, symptoms, and treatment options for hypothyroidism is essential for managing this common endocrine disorder effectively.

Prevalence and Risk Factors of Hypothyroidism

Hypothyroidism is a relatively common condition, affecting nearly 5 out of 100 Americans aged 12 years and older. However, many cases are mild or present with few obvious symptoms, making it challenging to diagnose without proper screening.

Certain factors increase the likelihood of developing hypothyroidism:

• Gender: Women are significantly more likely than men to develop the condition.
• Age: The risk increases in individuals over 60 years old.
• Previous thyroid issues: A history of thyroid problems, such as goiter, increases the risk.
• Thyroid treatments: Prior surgery or radioactive iodine treatment for thyroid problems can lead to hypothyroidism.
• Radiation exposure: Treatment to the thyroid, neck, or chest area can affect thyroid function.
• Family history: Genetic predisposition plays a role in thyroid disorders.
• Recent pregnancy: Women who have given birth within the past 6 months are at higher risk.
• Turner syndrome: This genetic disorder affecting women is associated with an increased risk of hypothyroidism.

Additionally, certain health conditions can increase the likelihood of developing an underactive thyroid, including autoimmune diseases, pituitary gland disorders, and iodine deficiency (though rare in developed countries).

Recognizing the Symptoms of Hypothyroidism

The symptoms of hypothyroidism can be subtle and develop slowly over time, often making them difficult to recognize. Common signs and symptoms include:

• Fatigue and weakness
• Weight gain or difficulty losing weight
• Increased sensitivity to cold
• Joint and muscle pain
• Dry skin and hair
• Hair thinning or loss
• Irregular or heavy menstrual periods
• Fertility problems
• Slowed heart rate
• Depression or mood changes
• Constipation
• Memory problems or difficulty concentrating

It’s important to note that these symptoms can be associated with various other conditions, and not everyone with hypothyroidism will experience all of these symptoms. If you suspect you may have an underactive thyroid, consult with a healthcare professional for proper evaluation and diagnosis.

Causes and Types of Hypothyroidism

Hypothyroidism can result from various factors, with some causes being more common than others:

1. Hashimoto’s Disease

The most frequent cause of hypothyroidism is Hashimoto’s disease, an autoimmune disorder where the body’s immune system mistakenly attacks the thyroid gland. This leads to inflammation and impaired thyroid hormone production.

2. Thyroiditis

Inflammation of the thyroid gland, known as thyroiditis, can cause thyroid hormone to leak into the bloodstream. Initially, this may lead to temporary hyperthyroidism (overactive thyroid), followed by hypothyroidism as the gland becomes depleted. There are three main types of thyroiditis:

• Subacute thyroiditis: Characterized by a painfully inflamed and enlarged thyroid
• Postpartum thyroiditis: Occurs in women after giving birth
• Silent thyroiditis: A painless form, likely autoimmune in nature

3. Congenital Hypothyroidism

Some infants are born with an underdeveloped or dysfunctional thyroid gland. Early detection and treatment are crucial to prevent intellectual disability and growth problems.

4. Surgical Removal or Treatment of the Thyroid

Partial or complete removal of the thyroid gland, as well as radiation treatment for thyroid cancer or other conditions, can result in hypothyroidism.

5. Medications

Certain medications, such as lithium and amiodarone, can interfere with thyroid hormone production and lead to hypothyroidism.

6. Iodine Imbalance

While rare in developed countries, both excessive and insufficient iodine intake can affect thyroid function and potentially cause hypothyroidism.

7. Pituitary or Hypothalamic Disorders

In some cases, problems with the pituitary gland or hypothalamus can disrupt the production of thyroid-stimulating hormone (TSH), leading to secondary hypothyroidism.

Diagnosis and Treatment of Hypothyroidism

Diagnosing hypothyroidism typically involves a combination of clinical evaluation and blood tests. The primary test used to assess thyroid function is the thyroid-stimulating hormone (TSH) test. Elevated TSH levels usually indicate an underactive thyroid. Additional tests, such as free T4 and T3 levels, may be conducted to confirm the diagnosis and determine the severity of the condition.

Once diagnosed, the standard treatment for hypothyroidism is hormone replacement therapy. This involves taking synthetic thyroid hormone (levothyroxine) daily to restore normal hormone levels and alleviate symptoms. The dosage is carefully adjusted based on individual needs and regular blood tests to ensure optimal thyroid function.

Can hypothyroidism be cured? While hypothyroidism is generally a lifelong condition, it can be effectively managed with proper treatment. Most people with hypothyroidism can lead normal, healthy lives by maintaining their prescribed medication regimen and attending regular follow-up appointments with their healthcare provider.

Complications of Untreated Hypothyroidism

Left untreated, hypothyroidism can lead to various complications, some of which can be severe:

• High cholesterol: Hypothyroidism can contribute to elevated cholesterol levels, increasing the risk of heart disease and stroke.
• Heart problems: An underactive thyroid can lead to an enlarged heart and heart failure.
• Mental health issues: Depression and cognitive impairment may worsen if hypothyroidism is not properly managed.
• Peripheral neuropathy: Prolonged hypothyroidism can damage peripheral nerves, causing pain, numbness, and tingling in affected areas.
• Myxedema: In rare cases, severe untreated hypothyroidism can progress to myxedema, a life-threatening condition characterized by extreme cold intolerance, drowsiness, and unconsciousness.
• Infertility: Hypothyroidism can interfere with ovulation and reduce fertility in women.
• Birth defects: Untreated hypothyroidism during pregnancy can lead to developmental problems in the fetus.

Is hypothyroidism fatal? While hypothyroidism itself is rarely fatal, severe untreated cases can lead to life-threatening complications, particularly myxedema coma. This underscores the importance of early diagnosis and proper management of the condition.

Hypothyroidism and Pregnancy: Special Considerations

Hypothyroidism during pregnancy requires special attention due to the crucial role thyroid hormones play in fetal development. Untreated hypothyroidism in pregnant women can lead to several complications:

• Increased risk of miscarriage
• Preeclampsia
• Anemia
• Low birth weight
• Stillbirth
• Congenital disabilities
• Developmental delays in the child

How does pregnancy affect thyroid hormone requirements? Pregnancy increases the body’s demand for thyroid hormones. Women with pre-existing hypothyroidism often require higher doses of thyroid medication during pregnancy. Regular monitoring and dose adjustments are essential to maintain optimal thyroid function throughout gestation.

It’s crucial for women with hypothyroidism who are planning to become pregnant or who are already pregnant to work closely with their healthcare providers. Thyroid function should be closely monitored, and medication doses adjusted as needed to ensure the health of both mother and baby.

Living with Hypothyroidism: Lifestyle and Management Strategies

While medication is the cornerstone of hypothyroidism treatment, certain lifestyle factors can support thyroid health and overall well-being:

1. Maintain a balanced diet: Focus on nutrient-rich foods, including those containing iodine, selenium, and zinc, which are important for thyroid function.
2. Exercise regularly: Physical activity can help combat fatigue, manage weight, and improve mood.
3. Manage stress: Chronic stress can exacerbate thyroid problems. Incorporate stress-reduction techniques such as meditation, yoga, or deep breathing exercises into your routine.
4. Get adequate sleep: Prioritize good sleep hygiene to support overall health and energy levels.
5. Monitor medication interactions: Be aware of foods and supplements that may interfere with thyroid hormone absorption, such as calcium and iron supplements.
6. Stay informed: Keep up-to-date with your condition and communicate openly with your healthcare provider about any changes in symptoms or concerns.

How often should thyroid function be checked in people with hypothyroidism? Generally, individuals with stable, well-controlled hypothyroidism should have their thyroid function tested annually. However, more frequent testing may be necessary during pregnancy, when changing medication doses, or if symptoms change.

Emerging Research and Future Directions in Hypothyroidism Treatment

While levothyroxine remains the standard treatment for hypothyroidism, ongoing research is exploring new approaches to improve management and outcomes for patients:

• Combination therapy: Some studies are investigating the potential benefits of combining T4 (levothyroxine) with T3 (liothyronine) for certain patients who continue to experience symptoms despite normal TSH levels on T4 alone.
• Personalized medicine: Researchers are exploring genetic factors that influence thyroid hormone metabolism and response to treatment, aiming to develop more tailored therapeutic approaches.
• Novel drug delivery systems: New formulations and delivery methods for thyroid hormones are being developed to improve absorption and consistency of treatment.
• Autoimmune modulation: For Hashimoto’s thyroiditis, research is ongoing into therapies that may modulate the immune response and potentially slow or halt the progression of thyroid damage.
• Thyroid regeneration: Early-stage research is exploring the possibility of stimulating thyroid tissue regeneration or creating bioengineered thyroid tissue as alternative treatment options.

What potential breakthroughs in hypothyroidism treatment can we expect in the coming years? While it’s difficult to predict specific breakthroughs, the focus on personalized medicine and understanding the genetic and molecular basis of thyroid disorders holds promise for more targeted and effective treatments in the future.

As research progresses, individuals with hypothyroidism may benefit from more precise diagnostic tools, improved treatment options, and potentially even preventive strategies for those at high risk of developing the condition.

In conclusion, hypothyroidism is a common and manageable endocrine disorder that affects millions of people worldwide. By understanding its causes, recognizing its symptoms, and adhering to appropriate treatment regimens, individuals with hypothyroidism can lead healthy, productive lives. Ongoing research continues to expand our knowledge of this condition, offering hope for even better management strategies and potential new therapies in the future. As always, working closely with healthcare providers and staying informed about one’s condition are key to effectively managing hypothyroidism and maintaining overall health and well-being.

Hypothyroidism (Underactive Thyroid) | NIDDK

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What is hypothyroidism?

Hypothyroidism, also called underactive thyroid, is when the thyroid gland doesn’t make enough thyroid hormones to meet your body’s needs. The thyroid is a small, butterfly-shaped gland in the front of your neck. Thyroid hormones control the way your body uses energy, so they affect nearly every organ in your body, even the way your heart beats. Without enough thyroid hormones, many of your body’s functions slow down.

The thyroid is a small gland in your neck that makes thyroid hormones.

How common is hypothyroidism?

Nearly 5 out of 100 Americans ages 12 years and older have hypothyroidism, although most cases are mild or have few obvious symptoms.¹

Who is more likely to develop hypothyroidism?

Women are much more likely than men to develop hypothyroidism. The disease is also more common among people older than age 60. ¹

You are more likely to have hypothyroidism if you

• had a thyroid problem before, such as a goiter
• had surgery or radioactive iodine to correct a thyroid problem
• received radiation treatment to the thyroid, neck, or chest
• have a family history of thyroid disease
• were pregnant in the past 6 months
• have Turner syndrome, a genetic disorder that affects women

Your thyroid is also more likely to be underactive if you have other health problems, including

Is hypothyroidism during pregnancy a problem?

Left untreated, hypothyroidism during pregnancy can affect both mother and baby. However, thyroid medicines can help prevent problems and are safe to take during pregnancy. Many women taking thyroid hormone medicine need a higher dose during pregnancy, so contact your doctor right away if you find out you’re pregnant.

What are the complications of hypothyroidism?

Hypothyroidism can contribute to high cholesterol. If you have high cholesterol, you should get tested for hypothyroidism. Rarely, severe untreated hypothyroidism may lead to myxedema coma, an extreme form of hypothyroidism in which the body’s functions slow to a life-threatening point. Myxedema coma requires immediate medical treatment.

What are the symptoms of hypothyroidism?

Hypothyroidism has many symptoms that can vary from person to person. Some common symptoms of hypothyroidism include

• fatigue
• weight gain
• trouble tolerating cold
• joint and muscle pain
• dry skin or dry, thinning hair
• heavy or irregular menstrual periods or fertility problems
• slowed heart rate
• depression

Dry, thinning hair is one of many symptoms that might indicate hypothyroidism.

Because hypothyroidism develops slowly, you may not notice symptoms of the disease for months or even years.

Many of these symptoms, especially fatigue and weight gain, are common and do not necessarily mean you have a thyroid problem.

What causes hypothyroidism?

Hypothyroidism has several causes, including

• Hashimoto’s disease
• thyroiditis, or inflammation of the thyroid
• congenital hypothyroidism, or hypothyroidism that is present at birth
• surgical removal of part or all of the thyroid
• radiation treatment of the thyroid
• some medicines

Less often, hypothyroidism is caused by too much or too little iodine in the diet or by disorders of the pituitary gland or hypothalamus.¹ Iodine deficiency, however, is extremely rare in the United States.

Hashimoto’s disease

Hashimoto’s disease, an autoimmune disorder, is the most common cause of hypothyroidism. With this disease, your immune system attacks the thyroid. The thyroid becomes inflamed and can’t make enough thyroid hormones.

Thyroiditis

Thyroiditis, an inflammation of your thyroid, causes stored thyroid hormone to leak out of your thyroid gland. At first, the leakage increases your blood’s hormone levels, leading to thyrotoxicosis, a condition in which thyroid hormone levels are too high. The thyrotoxicosis may last for many months. After that, your thyroid may become underactive and, over time, the condition may become permanent, requiring thyroid hormone replacement.

Three types of thyroiditis can cause thyrotoxicosis followed by hypothyroidism.²

• Subacute thyroiditis involves a painfully inflamed and enlarged thyroid.
• Postpartum thyroiditis develops after a woman gives birth.
• Silent thyroiditis is painless, even though your thyroid may be enlarged. Experts think it is probably an autoimmune condition.

Congenital hypothyroidism

Some babies are born with a thyroid that is not fully developed or does not work properly. If untreated, congenital hypothyroidism can lead to intellectual disability and growth failure—when a baby doesn’t grow as expected. Early treatment can prevent these problems. That’s why most newborns in the United States are tested for hypothyroidism.

Surgical removal of part or all of the thyroid

When surgeons remove part of the thyroid, the remaining part may produce normal amounts of thyroid hormone. But some people who have this surgery may develop hypothyroidism. Removing the entire thyroid always results in hypothyroidism.

Surgeons may remove part or all of the thyroid as a treatment for

• hyperthyroidism
• a large goiter
• thyroid nodules, which are noncancerous tumors or lumps in the thyroid that can produce too much thyroid hormone
• small thyroid cancers

Radiation treatment of the thyroid

Radioactive iodine, a common treatment for hyperthyroidism, gradually destroys thyroid cells. If you receive radioactive iodine treatment, you probably will eventually develop hypothyroidism. Doctors also treat people who have head or neck cancers with external radiation therapy, which can also damage the thyroid if it is included in the treatment.

Medicines

Some medicines can interfere with thyroid hormone production and lead to hypothyroidism, including certain

Several recently developed cancer medicines, in particular, can either affect the thyroid directly or affect it indirectly by damaging the pituitary gland.

How do doctors diagnose hypothyroidism?

Your doctor will take your medical history and perform a physical exam. A hypothyroidism diagnosis can’t be based on symptoms alone because many of its symptoms are the same as those of other diseases.¹ That’s why your doctor may use several thyroid blood tests and imaging tests to confirm the diagnosis and find its cause.

Because hypothyroidism can cause fertility problems, women who have trouble getting pregnant often get tested for thyroid problems.

A blood test might confirm a diagnosis of hypothyroidism.

How do doctors treat hypothyroidism?

Hypothyroidism is treated by replacing the hormones that your own thyroid can no longer make. You will take levothyroxine, a thyroid hormone medicine identical to a hormone a healthy thyroid makes.³ Usually prescribed in pill form, this medicine is also available as a liquid and as a soft gel capsule. These newer formulas may help people with digestive problems to absorb the thyroid hormone. Your doctor may recommend taking the medicine in the morning before eating.

Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine, adjusting your dose if needed. Each time your dose is adjusted, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will probably repeat the blood test in 6 months and then once a year.

Your hypothyroidism most likely can be completely controlled with thyroid hormone medicine, as long as you take the recommended dose as instructed. Never stop taking your medicine without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis. ¹

How does eating, diet, and nutrition affect hypothyroidism?

Your thyroid uses iodine to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to iodine’s harmful side effects. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed—may cause or worsen hypothyroidism. Taking iodine supplements can have the same effect.

Talk with members of your health care team

• about what foods to limit or avoid
• if you take iodine supplements
• about any cough syrups you take because they may contain iodine

If you are pregnant, you need more iodine because the baby gets iodine from your diet. Talk with your doctor about how much iodine you need.

Clinical Trials for Hypothyroidism

The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for hypothyroidism?

Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of hypothyroidism, such as

• understanding how the disease progresses, its clinical presentation, and genetics
• investigating how effective and safe levothyroxine is for people with chronic kidney disease

Find out if clinical studies are right for you.

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical studies for hypothyroidism are looking for participants?

You can view a filtered list of clinical studies on hypothyroidism that are open and recruiting at www. ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

References

[1] Patil N, Rehman A, Jialal I. Hypothyroidism. In: StatPearls [Internet]. StatPearls Publishing; 2020. Updated August 10, 2020. Accessed January 5, 2021. www.ncbi.nlm.nih.gov/books/NBK519536

[2] Pearce EN, Farwell AP, Braverman LE. Thyroiditis. New England Journal of Medicine. 2003;348(26):2646–2655. doi: 10.1056/NEJMra021194. Erratum in: New England Journal of Medicine. 2003;349(6):620. www.nejm.org/doi/10.1056/NEJMra021194

[3] Jonklaas J, Bianco AC, Bauer AJ, et al; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24(12):1670–1751. doi: 10.1089/thy.2014.0028

Hypothyroidism | Michigan Medicine

Condition Overview

Is this topic for you?

This topic provides information about hypothyroidism. Hypothyroidism means your thyroid is not making enough thyroid hormone. If you are looking for information about when the thyroid makes too much thyroid hormone, see the topic Hyperthyroidism.

What is hypothyroidism?

Hypothyroidism means your thyroid is not making enough thyroid hormone. The thyroid is a butterfly-shaped gland in the front of your neck. It makes hormones that control the way your body uses energy.

Having a low level of thyroid hormone affects your whole body. It can make you feel tired and weak. If hypothyroidism is not treated, it can raise your cholesterol levels. During pregnancy, untreated hypothyroidism can harm your baby. But hypothyroidism can be treated with medicine that can help you feel like yourself again.

People of any age can get hypothyroidism, but older adults are more likely to get it. Women age 60 and older have the highest risk. You are more likely to get the disease if it runs in your family.

What causes hypothyroidism?

In the United States, the most common cause is Hashimoto’s thyroiditis. It causes the body’s immune system to attack thyroid tissue. As a result, the gland can’t make enough thyroid hormone.

Other things that can lead to low levels of thyroid hormone include surgery to remove the thyroid gland and radiation therapy for cancer. Less common causes include viral infections and some drugs, such as amiodarone and lithium.

What are the symptoms?

Hypothyroidism can cause many different symptoms, such as:

• Feeling tired, weak, or depressed.
• Dry skin and brittle nails.
• Not being able to stand the cold.
• Constipation.
• Memory problems or having trouble thinking clearly.
• Heavy or irregular menstrual periods.

Symptoms occur slowly over time. At first you might not notice them, or you might mistake them for normal aging. See your doctor if you have symptoms like these that get worse or won’t go away.

How is hypothyroidism diagnosed?

Your doctor will ask questions about your symptoms. You will also have a physical exam. If your doctor thinks you have hypothyroidism, a simple blood test can show if your thyroid hormone level is too low.

How is it treated?

Doctors usually prescribe pills to treat hypothyroidism. Most people start to feel better in a week or two. Your symptoms will probably go away within a few months. But you will likely need to keep taking the pills from now on.

It’s important to take your medicine just the way your doctor tells you to. You will also need to see your doctor for follow-up visits to make sure you have the right dose. Getting too much or too little thyroid hormone can cause problems.

If you have mild hypothyroidism, you may not need treatment now. But you’ll want to watch for signs that it is getting worse.

If you are diagnosed with severe hypothyroidism, you will need to be treated right away in the hospital. Severe hypothyroidism can lead to a rare but dangerous disease called myxedema coma.

Cause

In the United States, the most common cause of hypothyroidism is Hashimoto’s thyroiditis. This is a condition that causes the body’s natural defenses—the immune system—to produce antibodies that over time destroy thyroid tissue. As a result, the thyroid gland cannot make enough thyroid hormone.

Worldwide, iodine deficiency is the number one cause of hypothyroidism. But iodine added to salt, food, and water has nearly eliminated this problem in the U.S. and other Western countries.

Other common causes of hypothyroidism include:

• Thyroid surgery. Part or all of the thyroid gland may be removed to treat disorders such as having too much thyroid hormone (hyperthyroidism), an enlarged thyroid gland (goiter) that makes swallowing difficult, thyroid cancer, or thyroid nodules that may be overactive or cancerous. Hypothyroidism results when the thyroid gland is removed or when remaining thyroid tissue does not function properly.
• Radioactive iodine therapy, which is often used to treat hyperthyroidism. Radioactive iodine therapy can destroy the thyroid gland, leading to hypothyroidism.
• External beam radiation, which is used to treat some cancers, such as Hodgkin lymphoma. This radiation treatment can destroy the thyroid gland.

Less common causes include:

• Infections. Viral and bacterial infections can temporarily damage the thyroid gland. This causes a short-term form of the condition. Hypothyroidism caused by infection usually does not result in permanent hypothyroidism.
• Medicines. Some medicines can interfere with normal production of thyroid hormone. Lithium is one of the most common medicines that causes hypothyroidism. Others include amiodarone and interferon alfa (such as Intron A or Roferon A).
• In rare cases, disorders of the pituitary gland or the hypothalamus (secondary and tertiary forms of hypothyroidism). The pituitary gland and hypothalamus produce hormones that control the thyroid and, as a result, affect its ability to produce thyroid hormone.
• Excessive iodine, which, in food or medicines, can reduce the function of the thyroid gland. This is usually temporary.
• Congenital hypothyroidism. In rare cases, an infant is born without a properly functioning thyroid gland. All children born in a hospital in the U.S. are tested at birth for hypothyroidism.

Symptoms

Symptoms of hypothyroidism usually appear slowly over months or years. Symptoms and signs may include:

• Coarse and thinning hair.
• Dry skin.
• Brittle nails.
• A yellowish tint to the skin.
• Slow body movements.
• Cold skin.
• Inability to tolerate cold.
• Feeling tired, sluggish, or weak.
• Memory problems, depression, or problems concentrating.
• Constipation.
• Heavy or irregular menstrual periods that may last longer than 5 to 7 days.

Some less common symptoms may include:

• An enlarged thyroid gland (goiter).
• Modest weight gain, often 10 lb (4.5 kg) or less.
• Swelling of the arms, hands, legs, and feet, and facial puffiness, particularly around the eyes.
• Hoarseness.
• Muscle aches and cramps.

In general, how bad your symptoms are depends on your age, how long you have had hypothyroidism, and the seriousness of the condition. The symptoms may be so mild and happen so slowly that they go unnoticed for years.

Mild (subclinical) hypothyroidism
often causes no symptoms or vague symptoms that may be attributed to aging, such as memory problems, dry skin, and fatigue.

Symptoms of hypothyroidism during and after pregnancy include fatigue, weight loss, dizziness, depression, and memory and concentration problems.

Because of the range of symptoms, hypothyroidism can be mistaken for depression, especially during and after pregnancy. In older people, it may be confused with Alzheimer’s disease, dementia, and other conditions that cause memory problems.

Symptoms of hypothyroidism in infants, children, and teens

Although rare, hypothyroidism can occur in infants, children, and teens. In infants, symptoms of a goiter include a poor appetite and choking on food. Symptoms of hypothyroidism may include dry, scaly skin. In children and teens, symptoms include behavior problems and changes in school performance. Children and teens may gain weight and yet have a slowed growth rate. Teens may have delayed puberty and look much younger than their age.

What Happens

Untreated hypothyroidism may get better or worse over time, depending on its cause and your age.

Hypothyroidism in infants and children

Although rare, hypothyroidism can occur in infants and children. If hypothyroidism is treated within the first month of life, a child will grow and develop normally. Untreated hypothyroidism in infants can cause brain damage, leading to intellectual disability and developmental delays. In the United States, all children are tested for hypothyroidism at birth.

Intellectual disability usually does not occur if hypothyroidism develops after age 3. But untreated childhood hypothyroidism typically delays physical growth and sexual development, including the onset of puberty. Children may gain weight yet have a slowed growth rate.

Hypothyroidism in adults

Hypothyroidism caused by Hashimoto’s thyroiditis sometimes will disappear on its own. More often, the disorder causes a gradual loss of thyroid function. Your symptoms may develop slowly and be so mild that you do not notice them for years. But symptoms usually grow worse. And health problems may develop as the disease continues.

If untreated, hypothyroidism may lead to:

• Myxedema, a condition that causes swelling of tissues, increased fluid around the heart and lungs, slowed muscle reflexes, and a slowed ability to think.
• Myxedema coma, a rare, life-threatening condition. This can occur if you have had hypothyroidism for many years that becomes markedly worse. It usually occurs when older adults who have severe hypothyroidism become ill with another condition, suffer from cold exposure, or take painkillers or sleeping pills. Symptoms include mental deterioration, such as apathy, confusion, and psychosis. You may lose consciousness (coma) and may have an extremely low body temperature (hypothermia), slow heartbeat (fewer than 60 beats per minute), heart failure, and trouble breathing.
• Complications, such as:
  • Increased levels of cholesterol and triglycerides (increasing the risk of coronary artery disease and stroke).
  • Fluid around the heart (pericardial effusion).
  • Sleep apnea, which causes you to stop breathing for 10 seconds or longer while sleeping.
  • A decrease in mental abilities.

People with mild (subclinical) hypothyroidism have only slightly abnormal thyroid blood test results and often do not have obvious symptoms or health problems. Some people who have mild hypothyroidism regain normal thyroid function.

If your thyroid gland has been removed during surgery, hypothyroidism will occur within a few weeks. If you have been treated with radioactive iodine therapy, hypothyroidism may develop within a year. In these cases, thyroid function typically does not return, and you will need to take thyroid hormone medicine from now on.

Hypothyroidism during and after pregnancy

Women who have hypothyroidism or mild hypothyroidism before they become pregnant may have more severe hypothyroidism during their pregnancy. If not treated, pregnant women who have hypothyroidism can develop preeclampsia and have a premature delivery. Children born to women who have untreated hypothyroidism during pregnancy are at risk for having hypothyroidism at birth and low birth weight and may score lower on intelligence tests than children of healthy mothers.^{footnote 1}

After delivery, women may have a thyroid disorder called postpartum thyroiditis. This condition occurs in about 5% of women who do not have a history of thyroid disease.^{footnote 1} It is often mistaken for depression.

Women who have postpartum thyroiditis often develop hypothyroidism 3 to 6 months after delivery. The hypothyroidism may last up to several months. It sometimes occurs after an initial episode of postpartum thyroiditis that causes symptoms from too much thyroid hormone. Hypothyroidism may become permanent in women with postpartum thyroiditis. Even if thyroid gland function returns to normal, postpartum thyroiditis usually comes back during later pregnancies.

What Increases Your Risk

Many things may increase your risk for hypothyroidism. These include:

• Age and being female. Older adults are more likely to develop hypothyroidism than younger people. And women are more likely than men to develop thyroid disease.

• Family history
  . Hypothyroidism tends to run in families.

• Previous thyroid problems. Thyroid disease, an enlarged thyroid (goiter), and surgery or radiation therapy to treat thyroid problems increase the likelihood of having hypothyroidism in the future.
• Some lifelong conditions. Type 1 diabetes, vitiligo (an autoimmune disease that causes patches of light skin), pernicious anemia, and leukotrichia (premature gray hair) are seen more often in people who have hypothyroidism.
• Iodine deficiency. This is rare in the United States but common in areas where iodine is not added to salt, food, and water.
• Medicines. Some medicines can interfere with normal thyroid function, particularly lithium, amiodarone, and interferon alfa (such as Intron A or Roferon A).

When To Call

Call 911 or other emergency services immediately if you or a person you know has hypothyroidism and has signs of myxedema coma, such as:

• Mental deterioration, such as apathy, confusion, or psychosis.
• Extreme weakness and fatigue that progress to loss of consciousness (coma).
• Severe breathing difficulties, slow heart rate (less than 60 beats per minute), or low body temperature [95°F (35°C) or below].

See your doctor if you have any symptoms that don’t go away, including:

• Feeling tired, sluggish, or weak.
• Memory problems, depression, or difficulty concentrating.
• An inability to tolerate cold.
• Dry skin, brittle nails, or a yellowish tint to the skin.
• Constipation.
• Heavy or irregular menstrual periods that may last longer than 5 to 7 days.

If you have one or two of the above symptoms that have not changed or have changed very little over a long period of time, it is less likely that the symptoms are caused by hypothyroidism. Consult your doctor.

Talk to a doctor if you are pregnant and have some of the above symptoms. Also talk to a doctor if you have hypothyroidism and are pregnant or are trying to become pregnant. Your dose of thyroid hormone medicine may need to be changed.

Watchful waiting

Watchful waiting—a period of time during which you and your doctor observe your symptoms or condition without using medical treatment—is not appropriate for hypothyroidism that is causing symptoms. Treatment should begin as soon as the condition is diagnosed.

Watchful waiting may be appropriate for certain adults with mild (subclinical) hypothyroidism whose blood tests show only modest changes. Talk to your doctor about treatment, its cost and possible risks and benefits. Watch for any signs that your hypothyroidism is getting worse. Doctors often want people to have yearly thyroid function blood tests to check to see if thyroid hormone production is normal.

Who to see

Hypothyroidism can be diagnosed by a:

Hypothyroidism also may be diagnosed by a specialist, such as a gastroenterologist, gynecologist, or psychiatrist, depending on the symptoms you have and who you see to evaluate the symptoms.

Complicated or unusual cases of hypothyroidism may require consultation with an endocrinologist.

Exams and Tests

A thorough medical history and physical exam are the first steps in diagnosing hypothyroidism or mild (subclinical) hypothyroidism. If the results lead your doctor to suspect you have hypothyroidism or subclinical hypothyroidism, you will have tests to confirm the diagnosis.

Blood tests are always used to confirm a diagnosis of hypothyroidism or mild hypothyroidism. The tests used most often are:

If the above tests are not normal, antithyroid antibody tests may determine whether you have the autoimmune disease Hashimoto’s thyroiditis, in which the body’s defense system attacks the thyroid gland.

In rare cases, a thyroid ultrasound may be used to evaluate a thyroid gland that during a physical exam seems to be abnormal.

A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the hypothalamus or pituitary gland may be done to look for any changes in these areas of the brain.

Early detection

Because of the possibility of intellectual disability in infants with hypothyroidism, every state in the United States tests newborns for hypothyroidism. If your baby was not born in a hospital, or if you believe your baby may not have been tested, talk to your doctor. Screening tests for hypothyroidism are not always accurate. Even if test results show no problem, watch your child for symptoms of hypothyroidism, such as poor appetite, not gaining weight, and dry skin.

Experts do not agree on whether adults who don’t have symptoms should have a thyroid test. The American Thyroid Association and the American Association of Clinical Endocrinologists recommend that testing be considered for those older than age 60. ^{footnote 2}The U.S. Preventive Services Task Force makes no recommendation for or against screening for people who do not have symptoms of thyroid problems. The USPSTF states that there is not enough evidence to support screening. ^{footnote 3}

Talk to your doctor about whether testing is right for you.

Treatment Overview

Hypothyroidism can be easily treated using thyroid hormone medicine. The most effective and reliable thyroid replacement hormone is man-made (synthetic). After starting treatment, you will have regular visits with your doctor to make sure you have the right dose of medicine.

In most cases, symptoms of hypothyroidism start to improve within the first week after you start treatment. All symptoms usually disappear within a few months. Infants and children with hypothyroidism should always be treated. Older adults and people who are in poor health may take longer to respond to the medicine.

• If you have had radiation therapy and have hypothyroidism, or if your thyroid gland has been removed, you will most likely need treatment from now on. If your hypothyroidism is caused by Hashimoto’s thyroiditis, you might also need treatment from now on. Sometimes, thyroid gland function returns on its own in Hashimoto’s thyroiditis.
• If a serious illness or infection triggered your hypothyroidism, your thyroid function most likely will return to normal when you recover.
• Some medicines may cause hypothyroidism. Your thyroid function may return to normal when you stop the medicines.
• If you have mild (subclinical) hypothyroidism, you may not need treatment but should be watched for signs of hypothyroidism getting worse. You and your doctor will talk about the pros and cons of taking medicine to treat your mild hypothyroidism. The dose of thyroid medicine must be watched carefully in people who also have heart disease, because too much medicine increases the risk of chest pain (angina) and irregular heartbeats (atrial fibrillation).

Initial treatment

Your doctor will treat your hypothyroidism with the thyroid medicine levothyroxine (for example, Levothroid, Levoxyl, or Synthroid). Take your medicine as directed. You will have another blood test 6 to 8 weeks later to make sure the dose is right for you.

If you take too little medicine, you may have symptoms of hypothyroidism, such as constipation, feeling cold or sluggish, and gaining weight. Too much medicine can cause nervousness, problems sleeping, and shaking (tremors). If you have heart disease, too much medicine can cause irregular heartbeats and chest pain. People who also have heart disease often start on a low dose of levothyroxine, which is increased gradually.

If you have severe hypothyroidism by the time you are diagnosed, you will need immediate treatment. Severe, untreated hypothyroidism can cause myxedema coma, a rare, life-threatening condition.

Treatment during pregnancy is especially important, because hypothyroidism can harm the developing fetus.

• If you develop hypothyroidism during pregnancy, treatment should be started immediately. If you have hypothyroidism before you become pregnant, your thyroid hormone levels need to be checked to make sure that you have the right dose of thyroid medicine. During pregnancy, your dose of medicine may need to be increased by 25% to 50%.^{footnote 4}
• If you develop hypothyroidism after pregnancy (postpartum hypothyroidism), you also may need treatment. You will be retested for hypothyroidism if you become pregnant again. In some cases hypothyroidism will go away on its own. In other cases it is permanent and requires lifelong treatment.

Ongoing treatment

You are likely to need treatment for hypothyroidism from now on. As a result, you need to take your medicine as directed. For some people, hypothyroidism gets worse as they age and the dosage of thyroid medicine may have to be increased gradually as the thyroid continues to slow down.

Most people treated with thyroid hormone develop symptoms again if their medicine is stopped. If this occurs, medicine needs to be restarted.

If a serious illness or infection triggers your hypothyroidism, your thyroid function most likely will return to normal when you recover. To check whether thyroid function has returned to normal, thyroid hormone medicine may be stopped for a short time. In most people, a brief period of hypothyroidism occurs after thyroid medicine is stopped. There is often a delay in the body’s signals that tell the thyroid to start working again. If the thyroid can produce enough hormone on its own, treatment is no longer needed. But if hormone levels remain too low, you need to restart thyroid medicine.

While taking thyroid hormone medicine, you need to see your doctor once a year for checkups. You will have a blood test (thyroid-stimulating hormone [TSH] test) to make sure you have a normal hormone level.

Treatment if the condition gets worse

Sometimes symptoms of hypothyroidism continue, such as sluggishness, constipation, confusion, and feeling cold. This may occur if you are not taking enough thyroid hormone or if your medicine is not absorbed from your gastrointestinal tract. Having a bowel disease or taking certain other medicines may block thyroid hormone. If needed, your doctor will increase your dose.

Your doctor may suggest you try the combination therapy of T3/T4 medicine if T4 medicine is not controlling your symptoms.

If your dose of thyroid hormone is too high, you may develop complications such as irregular heartbeats and, over time, osteoporosis. If you have heart disease, too much medicine can cause pain (angina) and irregular heartbeats. Your doctor will watch your thyroid levels using a thyroid-stimulating hormone (TSH) test. If needed, your doctor will lower your dose.

Prevention

Most cases of hypothyroidism in the United States are caused by Hashimoto’s thyroiditis, which cannot be prevented.

Although you can’t prevent hypothyroidism, you can watch for signs of the disease so it can be treated promptly. Some people who are at high risk for having hypothyroidism but do not have symptoms can be tested to see whether they have mild, or subclinical, hypothyroidism.

Expert groups differ in their recommendations for screening. For example:

• The American Thyroid Association and the American Association of Clinical Endocrinologists recommend that testing be considered for those older than age 60.^{footnote 2}
• The U.S. Preventive Services Task Force makes no recommendation for or against screening for people who do not have symptoms of thyroid problems. The USPSTF states that there is not enough evidence to support screening.^{footnote 3}

Talk to your doctor about whether testing is right for you.

Self-Care

If you have hypothyroidism, see your doctor once a year so your condition can be closely checked and your treatment adjusted, if needed.

Be sure to take thyroid hormone medicine correctly. Talk with your doctor if you don’t understand the reason for taking medicine regularly or if you think you have any side effects from the medicine. You usually need to have regular blood tests to find out whether you are receiving the correct amount of thyroid hormone.

Children who have hypothyroidism also need to see a doctor regularly, because the amount of thyroid hormone medicine they need changes as they grow. Untreated hypothyroidism in infants and very young children can have severe consequences. As soon as you think your child is able to understand (usually around age 9 or 10), teach him or her about hypothyroidism, the importance of taking medicine correctly, and why regular health checkups are important.

Some health food stores in the United States sell “natural” forms of thyroid hormone. The quality and effectiveness of these natural agents are unregulated. Some may not work at all. Others may have an active ingredient that does work but that may be dangerous to certain people.

Medicines

Thyroid hormone medicine is the only effective way to treat hypothyroidism. In most cases, thyroid hormone medicine:

• Reduces or eliminates symptoms of hypothyroidism. Symptoms usually improve within the first week after you begin therapy. All symptoms usually disappear within a few months.
• May reduce the risk of slowed physical growth, intellectual disability, and behavioral problems in infants and children.

Thyroid hormone medicine does not cause side effects if you take the correct dose.

What to think about

People who have hypothyroidism need treatment with thyroid hormone medicine. Depending on the cause of their hypothyroidism, they may need treatment for the rest of their lives.

Taking certain supplements, such as calcium or iron (or both), at the same time as thyroid hormone medicine may reduce the amount of thyroid hormone medicine absorbed by the body. Take calcium supplements at least 4 hours before or after taking thyroid hormone medicine. Also avoid taking iron supplements at the same time as thyroid medicine.

Talk to your doctor about whether you need to change your dose of thyroid medicine if you also take birth control pills or other hormones. You may need to take more thyroid hormone medicine than you would if you were not taking these hormones.

Follow-up visits with your doctor are important to make sure that you are taking the correct dose of medicine. Most people have blood tests 6 to 8 weeks after starting treatment. After thyroid hormone levels return to normal, thyroid function tests are typically rechecked once a year.

References

Citations

1. American College of Obstetricians and Gynecologists (2002, reaffirmed 2010). Thyroid disease in pregnancy. ACOG Practice Bulletin No. 37. Obstetrics and Gynecology, 100(2): 387–396.
2. Garber JR, et al; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults (2012). Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocrinology Practice, 18(6): 988–1028.
3. LeFevre ML (2015). Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, published online Mar 24, 2015. DOI: 10.7326/M15-0483. Accessed April 10, 2015.
4. Brent GA, Davies TF. (2011). Hypothyroidism and thyroiditis. In S Melmed et al., eds., Williams Textbook of Endocrinology, 12th ed., pp. 406–439. Philadelphia: Saunders.

Credits

Current as of:
March 31, 2020

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Matthew I. Kim MD – Endocrinology

Thyroid – hypothyroidism – Better Health Channel

The thyroid gland is situated at the front of the throat, below the Adam’s apple (larynx). It comprises two lobes that lie on either side of the windpipe, joined in front by an isthmus. The thyroid gland secretes hormones to regulate many metabolic processes, including growth and energy expenditure. Hypothyroidism means the thyroid gland is underactive and fails to secrete enough hormones into the bloodstream. This causes the person’s metabolism to slow down.

Hypothyroidism is the most common thyroid disorder, and it is thought to affect around six to 10 per cent of women. The prevalence rises with age – up to a quarter of women over the age of 65 years may be affected. Men are also affected, but less frequently. Hypothyroidism can be either primary or secondary. Primary hypothyroidism means that the thyroid gland itself is diseased, while secondary hypothyroidism is caused by problems with the pituitary gland, the brain structure that supervises the thyroid gland. The most common cause of primary hypothyroidism is the autoimmune condition Hashimoto’s disease.

Symptoms of hypothyroidism

The symptoms of hypothyroidism can be mild, moderate or severe. In its severest form (myxoedema coma), hypothyroidism is potentially fatal and requires urgent medical treatment. Symptoms of hypothyroidism can include:

• fatigue and low energy levels
• depression
• slow heart rate
• unexplained weight gain
• intolerance to cold temperatures
• fatigued and aching muscles
• dry, coarse skin
• puffy face
• hair loss
• constipation
• problems with concentration
• goitre (enlarged thyroid gland).

The thyroid hormones

The pituitary gland, located in the brain, prompts the thyroid to make its hormones by releasing thyroid stimulating hormone (TSH). The thyroid gland makes two main hormones – thyroxine (T4) and tri-iodothyronine (T3). These hormones contain atoms of iodine. Around 150 mcg (millionths of a gram) of dietary iodine is needed each day to produce adequate levels of thyroid hormones. Seafoods are particularly rich in iodine.

Causes of hypothyroidism

The causes of hypothyroidism include:

• Iodine deficiency disorder – lack of sufficient iodine in the diet can prevent the thyroid gland from making hormones. The thyroid enlarges as it attempts to comply with the pituitary gland’s ceaseless chemical messages to produce more hormones. An enlarged thyroid is known as a goitre. Babies and children can be stunted and severely brain damaged by iodine deficiency because thyroid hormones are needed for normal growth and development.
• Hashimoto’s disease – an autoimmune disorder. White blood cells and antibodies of the immune system attack and destroy the cells of the thyroid gland. Without treatment, death can occur within 10 to 15 years.
• Treatment for hyperthyroidism – treatments for hyperthyroidism (including drugs, surgery and radioactive iodine) frequently lead to hypothyroidism.
• Surgery – the primary treatment for thyroid cancer, and also a treatment for hyperthyroidism, surgery will lead to hypothyroidism if the thyroid gland is removed or if insufficient is left in place.
• X-rays – radiation treatments (in the past used for acne, tonsillitis and adenoid problems) can lead to hypothyroidism in later life. These treatments are not used today.
• Particular drugs – including lithium and the heart drug amiodarone can interfere with the normal processing of iodine and the production of thyroid hormone.
• Birth defects – sometimes, a baby is born with a congenital defect of the thyroid gland (which affects hormone production) or the thyroid may be completely absent. Without treatment, this can lead to brain damage and stunted growth.
• Pituitary gland dysfunction – the pituitary gland doesn’t make enough thyroid stimulating hormone to prompt the thyroid to produce T3 and T4.
• Hypothalamic dysfunction – the functioning of the pituitary is influenced by another brain structure called the hypothalamus, through the thyrotropin-releasing hormone. Problems with the hypothalamus can affect the pituitary and, in turn, the thyroid gland.

Diagnosis of hypothyroidism

Hypothyroidism is diagnosed by physical examination and blood tests. The doctor may also order ultrasound or radioactive iodine scans to check the internal structure of the thyroid.

Treatment for hypothyroidism

Iodine deficiency can be easily relieved by increasing the intake of iodine through iodised salt or iodine rich foods. Hypothyroidism may be caused by the failure of – or damage to – the thyroid gland, pituitary or hypothalamus. In these cases, treatment focuses on boosting thyroid hormone levels with thyroxine tablets, a form of hormone replacement.

From underactive to overactive

There is no cure for autoimmune hypothyroidism, so medication will have to be taken for the rest of the person’s life. The dose must be carefully monitored. Too little medication won’t relieve the symptoms. Too much medication can result in hyperthyroidism (resulting from too much thyroxin). It is important to see your doctor if you experience any symptoms of hyperthyroidism, including:

• heart palpitations
• unexplained and sudden weight loss
• agitation and nervousness
• increased sweating
• insomnia
• diarrhoea
• intolerance to hot temperatures.

Where to get help

Things to remember

• The thyroid gland secretes hormones to regulate many metabolic processes, including growth and energy expenditure.
• Hypothyroidism means the thyroid gland is underactive and fails to secrete enough hormones into the bloodstream.
• Causes include the autoimmune condition Hashimoto’s disease and insufficient dietary iodine.
• Treatment is lifelong hormone replacement with thyroxine tablets.

Hashimoto Disease | Hormone Health Network

What is Hashimoto disease?

Hashimoto disease, also known as Hashimoto’s thyroiditis, is an autoimmune disease. This means your immune system, which normally protects your body and helps fight disease, produces antibodies which attack the thyroid gland. The damaged thyroid gland is less able to make thyroid hormone and this results in hypothyroidism. Hypothyroidism means that the thyroid gland does not produce enough thyroid hormone to meet the body’s needs.

Anyone can develop Hashimoto disease, but it occurs more often in women and those with a family history of thyroid disease. It also occurs more often as people get older. People with other autoimmune disorders are more likely to develop Hashimoto disease. The hypothyroidism caused by Hashimoto disease progresses slowly over months to years. Its symptoms vary from person to person.

What are the symptoms of Hashimoto disease?

Possible symptoms include:

• Enlarged thyroid (or goiter)
• Trouble swallowing or breathing due to enlarged thyroid 
• Intolerance to cold
• Mild weight gain
• Fatigue
• Constipation
• Dry skin
• Hair loss
• Heavy and irregular menses
• Infertility or miscarriage
• Difficulty concentrating or thinking
• Decreased libido 

What are the complications of Hashimoto disease?

If left untreated, hypothyroidism caused by Hashimoto disease can lead to serious complications:

• Goiter, which can interfere with swallowing or breathing.
• Heart problems such as enlarged heart or heart failure.
• Mental health issues such as depression, decreased sexual desire, slowed mental functioning.
• Myxedema coma, a rare life-threatening condition that can result from long-term untreated hypothyroidism. Myxedema coma requires immediate emergency treatment.
• Birth defects. Babies born to women with untreated hypothyroidism are more likely to be stillborn or premature. They may also have lower IQ (intelligence) later in life due to underdevelopment of the brain while in the womb.

How is Hashimoto disease diagnosed?

Your doctor will perform a physical examination and order blood tests to measure your hormone levels; we collectively call these labs thyroid function tests (TFTs) – TSH, free T4, and total T3. 

• TSH test: TSH is hormone released from your pituitary gland when there is not enough thyroid hormone in the system. TSH will be high if there is not enough thyroid hormone in the system. Normal ranges for TSH vary lab by lab and also are dependent on age (TSH normally rises as we age). 
• Free T4 and total T3 test: T3 and T4 are thyroid hormones. A low level of free T4 and/or T3 test also suggest hypothyroidism 
• Thyroid peroxidase (anti-TPO) antibody blood test: This test detects the presence of antibodies directed against the thyroid. Most people with Hashimoto disease have these antibodies, but people whose hypothyroidism is caused by other conditions may not. TPO antibodies may also be present in normal people without hypothyroidism.

How is Hashimoto disease treated?

Not everyone with Hashimoto disease has hypothyroidism. If you have positive TPO antibodies but thyroid hormone levels are normal, then observation with repeated thyroid function tests is often times recommended.  If thyroid hormone levels are low, then treatment often involves thyroid hormone replacement therapy.  If you have symptoms of hypothyroidism but the thyroid function tests are normal, then it is most likely that the symptoms are coming from a different cause than the thyroid.  The most effective treatment is a synthetic (man-made) T4 medicine called levothyroxine.

Levothyroxine is identical to the T4 produced by your body. A daily pill can restore normal levels of thyroid hormone and TSH in your bloodstream and make your thyroid function normal. You will probably need to take this medicine daily for the rest of your life, but your dose may need to be adjusted from time to time related to multiple aspects such as your weight, if you remember to take medication, and how it is spaced out from food and other medication. To maintain consistent thyroid hormone levels in your blood, you should always take the same brand since not all medicines are exactly the same. You should not take calcium supplements or anti-acid medications with your thyroid medication.

People are not routinely screened for hypothyroidism. However, if you are at risk for thyroid disease and are thinking about getting pregnant, you should be tested. Hypothyroidism is easily treated and you can protect your child from birth defects.

Questions to ask your doctor

• Do my symptoms mean I have hypothyroidism?
• How can I tell if my hypothyroidism is caused by Hashimoto’s disease?
• What should I do about my hypothyroidism if I want to get pregnant? 
• What medicines do I need? When should I take them? What medications or supplements should I avoid with my thyroid medications?
• How often should I see my doctor or get testing of my thyroid?
• What else can I do to stay healthy? 
• Should I see an endocrinologist for my care?

Editor(s):

Natalia Genere , M.D., Bryan Haugen, M.D., Fady Hannah-Shmouni, MD FRCPC, Leonard Wartofsky, M.D., MACP

Last Updated:
May 2020

Sudden Cardiac Death Due to Untreated Hypothyroidism

DOI: 10.19102/icrm.2013.040202

¹VASUNDHARA MUTHU, MBBS and ²LUNA BHATTA, MD, FACC

¹SUNY Upstate Medical University, Syracuse, NY
²Division of Cardiology/Clinical Cardiac Electrophysiology, SUNY Upstate Medical University, Syracuse, NY

ABSTRACT. Hypothyroidism is a common disorder which can have protean systemic manifestations including cardiac disease. Impairment in cardiac structure, function, and conduction can be seen in this disorder. Sinus bradycardia is the most commonly seen arrhythmia, but rare cases of serious ventricular arrhythmias such as ventricular tachycardia and torsades de pointes (TDP) have been reported in the literature. These arrhythmias can be fatal. However, if promptly identified and treated, complete recovery is possible with excellent long-term prognosis. We describe a patient with untreated hypothyroidism presenting with sudden cardiac death and prolonged QT not attributable to any other identifiable cause who responded to thyroid replacement therapy. Genetic analysis failed to detect common mutations for hereditary long QT syndromes.

KEYWORDS. sudden cardiac death, long QT, female, levothyroxine, steroids.

The authors report no conflicts of interest for the published content.
Manuscript received October 18, 2012, final version accepted November 30, 2012.

Address correspondence to: Vasundhara Muthu, Fellow in Cardiology at SUNY Upstate Medical University, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210. E-mail: [email protected]

Case presentation

A 25-year-old African American female was brought to the emergency department (ED) in January 2011, after her mother found her unresponsive in bed. The mother noted she was pulseless, whereupon she promptly began cardiopulmonary resuscitation (CPR) and called 911. Paramedics found the patient in ventricular fibrillation (VF) and defibrillated her twice. En route to the ED, a third shock was administered with return of spontaneous circulation (ROSC). Her heart rate ranged from 40-50 beats/minute and she remained without measurable automatic blood pressure (BP) on initial arrival to the ED. Atropine was administered with resultant supraventricular tachycardia (SVT) at a rate of 185 beats/minute. This was followed by return of VF. She was defibrillated again, CPR was continued and epinephrine was given. ROSC was attained.

In the coronary care unit (CCU), an electrocardiogram showed sinus bradycardia with QTc of 624 ms, T-wave inversion, and low lead voltage (Figure 1).

Further history was obtained, and it became apparent that the patient had undergone transnasal transsphenoidal endoscopic hypophysectomy for a pituitary tumor, measuring 2.5 cm. The biopsy had shown lymphocytic hypophysitis. She had been started on steroid therapy post surgery but had failed to continue treatment on an outpatient basis and was admitted to the hospital with adrenal insufficiency in July 2010. She was found to have central hypothyroidism in addition to central adrenal insufficiency and was started on levothyroxine. The mother revealed that she had stopped taking all her medications around a week prior to her current presentation for economic reasons. She had no other known medical problems and no psychiatric history or diagnosis. She was not on any medications except levothyroxine and hydrocortisone. There was no family history of sudden cardiac death (SCD) or cardiac dysrhythmias.

Initial laboratory work showed normal potassium of 4.0 mg/dl and magnesium of 1.4 mg/dl. The urine toxicology screen was positive for benzodiazepines (which were administered in the ED). Urine toxicology was negative for tricyclic antidepressants, cocaine, methadone, barbiturates, phencyclidine, opioids, and barbiturates. An echocardiogram showed the left ventricle to be normal in structure and function. A computed tomography scan of the thorax showed no pulmonary embolism. Cardiac magnetic resonance imaging was normal, with no evidence of myocardial scar or arrhythmogenic right ventricular dysplasia.

Thyroid function testing revealed decreased free levothyroxine (T4) at 0.22 ng/dl (normal range 0.9–1.7 ng/dl), decreased free tri-iodothyronine (T3) at 1.38 pg/ml (normal range 2.00–4.40 pg/ml), and normal thyroid stimulating hormone (TSH) at 1.890 µU/ml (normal range 0.27–4.2 µU/ml).

She was placed on the hypothermia protocol in view of SCD. Aggressive intravenous magnesium supplementation was started. Endocrine consultation was obtained and she was promptly begun on intravenous levothyroxine and stress dose steroids. With appropriate treatment, her heart rate improved, QTc normalized to 418 ms, and the lead voltage improved (Figure 2). There was no recurrence of any ventricular arrhythmias during her CCU stay. She was also treated for aspiration pneumonia. She improved progressively and was weaned off the ventilator and attained a full neurological recovery without any deficits except for mild residual memory impairment.

She was discharged home with a life vest and a follow-up appointment with the electrophysiologist. A genetic analysis done to screen for hereditary long QT syndromes was negative for SCN5A, KCNh3, KCNQ1, KCNE1, KCNE2, and KCNJ2 mutations. She was followed carefully to ensure treatment compliance and no further arrhythmias were documented. She was taken off the life vest and continues to do well.

Discussion

Hypothyroidism can cause structural, functional, and conduction abnormalities in the heart.¹ Bradycardia, low voltage, and heart block are the more commonly described effects, and sustained life-threatening ventricular arrhythmias are rarely seen. Our review of the literature did not reveal any previously reported cases of successfully resuscitated out-of-hospital SCD due to hypothyroidism-induced prolonged QT, although torsades de pointes (TDP) has been described previously.^2–6 None of these cases reported genetic analysis to rule out hereditary long QT syndromes. Interestingly, all the reported cases of TDP in hypothyroidism have been in women, mostly between the ages of 30 and 50 years.

Cardiac effects of hypothyroidism are related to the severity and duration of the disease. Functional effects include decreased inotropy and chronotropy. Decrease in stroke volume, heart rate, and ejection fraction (EF), and increase in peripheral vascular resistance and circulation time are seen. Structural effects can include dilated cardiomyopathy, septal and ventricular hypertrophy, and pericardial effusions.²

Physiologic chronotropic response and normal tension of the heart muscle in diastole depend on the proper expression of T3 in the heart cells and its stimulating influence on the Na⁺–K⁺ ATPase and Ca²⁺ ATPase in the endoplasmic reticulum. Normal heart contractility is also related to proper T3 stimulated transcription of the myosin heavy-chain alpha gene and inhibition of the myosin heavy-chain beta gene. Proper T3 expression in the cardiac muscle affects the number of beta adrenergic receptors and their sensitivity to catecholamines. Hypothyroidism causes decreased expression of T3 in the cardiac myocytes, resulting in decreased contractility, slower heart rate, and decreased conduction.³ Overall, hypothyroidism is believed to induce a sympathovagal imbalance, characterized by decreased cardiovascular sympathetic and vagal modulation. However, the sympathetic influence is believed to predominate. High plasma norepinephrine levels have been seen in hypothyroidism, but the responsiveness to endogenous catecholamines is decreased, because of a decrease in the number of beta adrenergic receptors and their desensitization to the effect of catecholamines. This autonomic dysfunction can be partly restored after replacement treatment with levothyroxine.⁷

Hypothyroidsm has also been associated with prolongation of QT and increased QT dispersion. This has been shown to be reversible with levothyroxine. The sympathovagal imbalance and increased inhomogeneity of ventricular recovery times can both predispose to potentially life-threatening arrhythmias.⁷

In patients with hypothyroidism, the occurrence of TDP in the milieu of a prolonged QT interval has been reported in only a few reports in the English literature. In most of these cases, no other predisposing factors could be ascertained, and the arrhythmogenic tendency abated with levothyroxine replacement. Predisposition to malignant arrhythmias appears to be promptly eradicated with thyroxine therapy, unlike most other cardiac abnormalities seen with hypothyroidism that are slow to resolve with replacement. Stress dose glucocorticoid coverage should be provided in the acute situation and the levothyroxine dose should be increased gradually to avoid precipitating angina in patients with underlying coronary artery disease.

Conclusion

The awareness of the protean effects of hypothyroidism on the heart is necessary for the prompt treatment of patients with life-threatening complications of hypothyroidism as seen in our patient. Rapid recovery is possible with appropriate treatment with a favorable long-term prognosis.

References

1. Klein I, Danzi S. Thyroid disease and the heart. Circulation 2007; 116:1725–1735. [CrossRef] [PubMed]
2. Schenck JB, Rizvi AA, Lin T. Severe primary hypothyroidism manifesting with torsades de pointes. Am J Med Sci 2006; 331:154–156. [CrossRef] [PubMed]
3. Shojaie M, Eshraghia A. Primary hypothyroidism presenting with torsades de pointes type tachycardia: a case report. Cases J 2008; 1:298. [CrossRef] [PubMed]
4. Nasher G, Zion MM. Recurrent ventricular tachycardia in hypothyroidism—report of a case and review of the literature. Cardiology 1988; 75:301–306. [CrossRef] [PubMed]
5. Yadav BS, Gupta B, Bharani AK. Long QT interval and torsades de pointes in hypothyroidism. Indian Heart J 1995; 47:261–262. [CrossRef] [PubMed]
6. Chojnowski K, Bielec A, Czarkowski M, Dmowska-Chalaba J, Kochanowski J, Wasowska A. Repeated ventricular “torsade de pointes” tachycardia and cardiogenic shock in the course of hypothyroidism. Cardiol J 2007; 14:198–201. [CrossRef] [PubMed]
7. Galetta F, Franzoni F, Fallahi P, et al. Changes in heart rate variability and QT dispersion in patients with overt hypothyroidism. Eur J Endocrinol 2008; 158:85–90. [CrossRef] [PubMed]

Hashimoto’s Syndrome Symptoms, Causes & Treatments

Complications of Hashimoto’s Syndrome

Because Hashimoto’s syndrome progresses slowly, many individuals with this condition do not experience symptoms for years. However, left untreated long-term, the syndrome can lead to a number of additional health issues including heart problems, mental health complications, or other diseases.

• An enlarged thyroid, called a goiter, can occur in some cases of Hashimoto’s syndrome. This can often cause visible swelling in the neck area. While the goiter itself is typically not painful or uncomfortable, it can interfere with swallowing or breathing if left untreated.
• Heart Problems. Individuals with an underactive thyroid gland (hypothyroidism), including underactivity due to Hashimoto’s syndrome, can experience higher levels of lipoprotein cholesterol, or “bad” cholesterol. This can result in heart disease including enlarged heart or heart failure.
• Mental Health Issues. Because of the decrease hormonal levels due to Hashimoto’s syndrome, individuals with this condition may experience depression. If Hashimoto’s syndrome is left untreated, this depression may increase over time. Hashimoto’s syndrome can also cause decreased libido and diminish or slow mental functioning.
• In rare cases, Myxedema may occur, which is the escalation of drowsiness and lethargy, followed by unconsciousness. This may be triggered in rare cases in individuals with Hashimoto’s syndrome exposed to cold, sedatives, infection, or other stressors. Myxedema requires immediate emergency medical treatment.
• Birth Defects in Children. Untreated hypothyroidism, including hypothyroidism due to Hashimoto’s syndrome, can increase the risks of birth defects as well as intellectual and developmental problems. There may be a link between hypothyroidism and being born with a cleft palate or a heart, brain, and kidney problems. If you have Hashimoto’s syndrome and are trying to get pregnant or are in the early stages of pregnancy, it’s important to meet with a doctor to discuss treatment.

Causes of Hashimoto’s Syndrome

While the exact cause of Hashimoto’s Syndrome is not known, it is thought that several factors may play a role in the development of this disease, including:

• It often affects people who have family members with thyroid disorders or autoimmune diseases. This suggests that there may be a genetic component to Hashimoto’s syndrome.
• Autoimmune Disorder. Individuals who have other autoimmune disorders such as Addison’s disease, autoimmune hepatitis, celiac disease, lupus, type 1 diabetes, pernicious anemia, rheumatoid arthritis, Sjögren’s syndrome, and vitiligo have been linked to Hashimoto’s syndrome.
• Hashimoto’s syndrome affects as many as 7-8X more women than men, which suggests that sex hormones may play a role in its occurrence.
• While the syndrome can occur even in teenage years or early adulthood, it more commonly occurs in middle-aged patients.
• Radiation Exposure. Individuals who have been exposed to excessive levels of radiation may be at increased risk of Hashimoto’s syndrome.

How is Hashimoto’s Syndrome Diagnosed?

In general, a doctor will test for Hashimoto’s disease if you are tired or fatigued and are experiencing constipation, dry skin, if you have a goiter, or if you have a history of thyroid problems. The diagnosis for Hashimoto’s syndrome usually consists of a hormone test and an antibody test.

Medical History

If you have a family history of Hashimoto’s syndrome, thyroid problems, or autoimmune disorders, you may be at higher risk. Getting your and your family’s medical history can help your doctor assess whether you’re at higher risk for this condition.

Hormone Test

A hormone test for Hashimoto’s syndrome consists of a blood test in which the doctor will look at your thyroid and pituitary gland hormone levels. If your thyroid hormone levels are low, this may be an indication of hypothyroidism, possibly as a result of Hashimoto’s syndrome.

The doctor will also look for increased pituitary hormones. While hypothyroidism can sometimes be caused by a lack of the pituitary hormone TSH (thyroid-stimulating hormone), this is typically not the case in Hashimoto’s syndrome. Instead, with untreated Hashimoto’s syndrome, the pituitary gland often releases additional TSH in an effort to stimulate the thyroid gland to produce more thyroid hormone. TSH levels are used as one of the main indicators for the syndrome, as well as to test the efficacy of treatment.

Antibody Test

As part of the blood test, your doctor may also perform an antibody test. Because Hashimoto’s syndrome is an autoimmune disorder, the presence of antibodies against thyroid peroxidase, an enzyme that plays an important role in producing, would indicate the possible presence of Hashimoto’s syndrome.

Ultrasound

Your doctor may also take an ultrasound of your thyroid. This will confirm that the enlarged thyroid isn’t caused by non-Hashimoto’s syndrome factors, such as thyroid nodules—small lumps found on the thyroid gland. An ultrasound is most commonly ordered if the patient has an enlarged thyroid but is not showing elevated levels of TSH in the blood.

Of the tests used to diagnose Hashimoto’s syndrome, the test for TSH is the most widely used. This is also the test used to measure the efficacy of the hormone therapy used to treat Hashimoto’s syndrome.

Hashimoto’s Syndrome – Hormone Replacement Therapy

At this time, there is no permanent cure for Hashimoto’s syndrome. However, hormone replacement therapy can help regulate hormone levels and help your biological functions and metabolism return to normal.

Most commonly, doctors will treat Hashimoto’s syndrome with hormone replacement therapy. This therapy typically includes the hormone replacement levothyroxine, which is identical to the hormone thyroxine which is normally produced by your thyroid gland.

Initially, your doctor may choose to retest your TSH level every few weeks after your hormone replacement therapy begins to ensure the right dosage. If you have severe hypothyroidism or a heart condition, your doctor may start you with a small dose of hormone replacement medication and will gradually increase the dose over time to give your heart time to adjust to your increased metabolism.

Since hormones regularly fluctuate, it will be important to routinely visit your doctor about every 12 months to check your TSH levels. This will ensure your dosage is still conducive to your current condition.

In addition, your doctor may also prescribe an anti-inflammatory like LDN. Anti-inflammatories like low-dose naltrexone (LDN) help manage inflammation associated with Hashimoto’s syndrome.

Natural Treatments

Hormone replacement therapy is the first line of defense for individuals with Hashimoto’s disease. There is no scientific evidence that natural remedies or lifestyle changes can cure or reverse the effects of hypothyroidism due to Hashimoto’s syndrome. However, some lifestyle changes can help support the function of your thyroid and contribute to your overall recovery plan.

Balancing the Gut Microbiome

Balancing the gut microbiome is important in helping to treat Hashimoto’s syndrome. This is because in an imbalanced microbiome trigger inflammation that drive up antibody levels.

Managing candida, bacterial overgrowth, and parasites are all a part of Hashimoto disease management.

Diets Free from Grains, Dairy, & Highly Processed Foods

While inflammatory foods such as grains, dairy, and highly processed foods aren’t the cause of Hashimoto’s syndrome, they can trigger an autoimmune response. This can exacerbate inflammation and tissue destruction. In these cases, a diet free from grains, dairy, and highly processed foods can be beneficial to individuals living with Hashimoto’s syndrome.

Diets such as paleo or gluten-free diets can be effective for individuals with Hashimoto’s syndrome, as can diets that focus on the following foods:

• Lean Meats
• Fish & Seafood
• Fruit
• Vegetables (avoid starches and excessive cruciferous vegetables)
• Nuts
• Seeds

Iodine

Since iodine is added to table salt in the United States, it’s uncommon for Americans to have an iodine deficiency. However, for individuals with Hashimoto’s syndrome, it can be helpful to be conscious of iodine in your diet. Too little iodine may contribute to goiters while too much can increase the symptoms of hypothyroidism.

Ask your doctor about adding more natural sources of iodine in your diet. Some examples of iodine-rich foods include:

• Seafood
• Dairy Product
• Eggs
• Prunes

Selenium

While the effects of selenium on Hashimoto’s syndrome are still being studied, some individuals living with the disorder experience a decrease in the number of antibodies attacking the thyroid when taking selenium supplements.

Ask your doctor about adding more selenium-rich foods to your diet, including:

• Eggs
• Pork
• Beef
• Chicken
• Tuna & Sardines
• Brazil Nuts

Zinc

While zinc deficits in developed countries are uncommon, in one 2009 study, some individuals with hypothyroidism syndrome saw increased thyroid hormone levels with zinc supplements.

Talk with your doctor about adding more zinc into your diet with foods such as:

• Beef
• Chicken
• Oysters & Shellfish
• Legumes

Living with Hashimoto’s Syndrome

While Hashimoto’s syndrome cannot be cured, with the right hormone replacement therapy and lifestyle changes, individuals can experience relief from many symptoms from this condition.

If you suspect you may have Hashimoto’s syndrome or are experiencing symptoms related to hypothyroidism such as fatigue, dry skin, depression, or constipation, or if you have an unexplained goiter, reach out to the experts at CentreSprings MD. Our integrative, functional, holistic approach can help you get to the underlying issue behind your symptoms and create a holistic approach to treatment.

Frequently Asked Questions About Hashimoto’s Syndrome

What does Hashimoto’s disease do to your body?

Hashimoto’s disease is an autoimmune disease that produces antibodies that attack your thyroid like it would a virus. Over time, this can cause tissue damage in your thyroid. This damage can decrease your thyroid’s ability to produce thyroid hormones, resulting in hypothyroidism. The damage to your thyroid can also cause a goiter, which is the swelling of your thyroid gland. A goiter can make your throat look and feel swollen and can impact your breathing or swallowing. Decreased thyroid hormones also slow the function of your body’s organs, which can decrease your heart rate, cause weight gain, slow your mental functioning, decrease functioning in your intestines (often causing constipation), and more.

What shouldn’t you eat when you have Hashimoto’s syndrome?

While Hashimoto’s syndrome is not caused by a poor diet, eating a diet that avoids inflammatory foods such as gluten, dairy, or highly processed foods can help prevent triggering an autoimmune response in your body, which may exacerbate symptoms. Those with Hashimoto’s syndrome may benefit from avoiding foods such as:

• Gluten
• Grains
• Dairy
• Highly-Processed Foods

What is the difference between Hashimoto’s disease and hypothyroidism?

Hashimoto’s disease is an autoimmune disease in which antibodies attack the thyroid as if it were a virus. Hypothyroidism is a condition in which the thyroid is not releasing enough of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Because of the damage to the thyroid in Hashimoto’s disease, this disease often leads to hypothyroidism. In fact, Hashimoto’s disease is one of the most common causes of hypothyroidism in the United States. However, other factors such as thyroid surgery, some medications, or postpartum thyroiditis can also cause hypothyroidism.

Can Hashimoto’s syndrome be cured?

There is no cure for Hashimoto’s syndrome at this time. However, hormone replacement therapy can be very effective in reducing the symptoms of hypothyroidism due to Hashimoto’s syndrome, usually helping those affected with the condition “feel back to normal” as long as they continue treatment.

Does Hashimoto’s affect life expectancy?

No. Because Hashimoto’s is very treatable, it doesn’t typically affect your life expectancy. However, left untreated Hashimoto’s can sometimes lead to heart conditions or heart failure. In extreme cases, it can also cause myxedema, a rare but life-threatening condition that includes progressive drowsiness followed by extreme fatigue and eventual unconsciousness. For these reasons, it’s important to see a doctor if you suspect you may have Hashimoto’s syndrome.

How can we help?

Would you like to learn more about Hashimoto’s syndrome or the treatment process? Contact CentreSprings MD to discuss your symptoms and treatment options or book an appointment today.

Thyroid Disease in Dogs

Thyroid disease is a relatively common problem in dogs. While it is usually treatable, learning that your dog has a thyroid condition is understandably concerning.

Here is some information about the more common thyroid diseases that can affect dogs to help you better understand your dog’s condition.

What Does the Thyroid Do?

In order to understand thyroid disease, it helps to have an understanding of what the thyroid actually does.

The thyroid gland is located in your dog’s neck, where it produces the hormone thyroxine (T4), along with several other important thyroid hormones. These hormones play a large role in your dog’s metabolism and can cause major problems when they are not produced at normal levels. The thyroid is like the thermostat of the body.

Hypothyroidism

Hypothyroidism occurs when your dog is not secreting enough of the thyroid hormones, causing your dog’s metabolism to slow. This condition is more common in dogs than in other domestic animals, but it usually responds well to appropriate medication.

What Causes Hypothyroidism?

In 95 percent of cases, the direct destruction of the thyroid gland causes hypothyroidism. This destruction is usually the result of either lymphocytic thyroiditis or idiopathic atrophy of the thyroid gland. Other, rarer causes of hypothyroidism include cancer and congenital defects.

What Are the Symptoms of Hypothyroidism in Dogs?

Low thyroid levels affect all your dog’s organ systems. The symptoms of hypothyroidism can vary greatly from dog to dog, but are all mostly related to your dog’s slowing metabolism.

Here are some of the more common symptoms:

• Lethargy
• Exercise intolerance
• Mental dullness
• Weight gain without a change in appetite
• Obesity
• Cold intolerance
• Changes in coat and skin, like increased shedding, hair thinning, and hair loss
• Thickening of the skin
• Reproductive disturbances in intact dogs

Some breeds do appear to be at greater risk of developing hypothyroidism than others. Medium-to-large-size breeds are more likely to develop the disease than toy and miniature breeds, and the Cocker Spaniel, Miniature Schnauzer, Dachshund, Doberman Pinscher, Golden Retriever, Airedale Terrier, and Irish Setter appear to be predisposed to developing the condition.

Diagnosing Hypothyroidism in Dogs

The Merck Veterinary Manual states that hypothyroidism is one of the most over-diagnosed diseases in dogs. This is because many diseases mimic hypothyroidism. Some conditions or clinical signs even improve with thyroid medication. Other diseases also affect the thyroid levels, but are not hypothyroidism. This can make diagnosing a thyroid condition tricky, so be patient as you work with your veterinarian to get to the root of your dog’s symptoms.

Your veterinarian will diagnose your dog based on clinical signs and careful diagnostic testing. This will probably require several blood tests to determine if your dog exhibits any of the abnormalities commonly associated with the disease, and regular monitoring of your dog’s thyroid levels.

One of these tests will probably be a test of your dog’s T4 concentration. This is a good initial screening test for hypothyroidism, however, your veterinarian may recommend running further tests to get a definitive result.

Treating Hypothyroidism in Dogs

Hypothyroidism is treatable. Your veterinarian will probably give your dog a prescription for thyroxine, a replacement hormone compound, to offset your dog’s low thyroid function.

The dosage will vary depending on your dog’s weight and thyroid levels. Your veterinarian may need to adjust your dog’s dosage over time, and you should expect to see results after one to two months. Once your veterinarian has determined a stable dose, your dog will most likely need to have his thyroid levels retested once or twice a year and continue the stable dose of medication, for the rest of his life.

Autoimmune Thyroiditis

Some breeds of dogs are predisposed to a type of thyroid disease called autoimmune thyroiditis. This disease occurs when the immune system attacks the thyroid gland and is more common in the Akita, Doberman Pinscher, Beagle, and Golden Retriever.

Hypothyroidism can be the only manifestation of this disease, but autoimmune thyroiditis can also be a symptom of another disorder, such as systemic lupus erythematosus, or panendocrinopathy. This is one of the reasons why getting an accurate diagnosis for hypothyroidism is so important.

Hyperthyroidism

Hyperthyroidism occurs when your dog’s body produces too much of the thyroid hormone, increasing your dog’s metabolic rate to dangerous levels. This disease is rare in dogs and is much more common in cats, but when it does affect dogs, it is usually serious.

A type of cancer, called thyroid carcinoma, is the primary cause of hyperthyroidism in dogs. Once diagnosed, your veterinarian will discuss the treatment options and prognosis for your dog. These options will depend on the stage of the cancer, the size of the tumor, and the extent of nearby tissue involvement.

There are several treatment options available for thyroid carcinoma. Your veterinarian may recommend surgery, chemotherapy, or radiation treatments, depending on your dog’s condition. In the meantime, there are medications available to counteract the excess hormone levels to keep your dog comfortable.

The symptoms of hyperthyroidism in dogs include:

• Weight loss
• Hyper-excitability
• Increased appetite
• Increased thirst
• Increased urination
• Enlargement of thyroid gland
• Vomiting
• Diarrhea
• Increased amount of stool
• Congestive heart failure
• Tachycardia (fast heart rate)
• Heart murmurs
• Cardiomegaly (enlarged heart)
• Dyspnea (shortness of breath)

Unfortunately, the long-term prognosis for dogs with hyperthyroidism and thyroid carcinoma is poor to grave. Talk with your veterinarian about your dog’s condition for the most accurate prognosis.

Goiters in Dogs

Not all thyroid enlargement is necessarily cancerous. In some cases, this enlargement, called a goiter, could be due to another cause entirely.

Goiters can affect all domestic mammals and birds. They can be caused by iodine deficiencies, eating goitrogenic substances (foods or other substances that affect thyroid function), too much iodine in a diet, and inherited defects that affect the synthesis of thyroid hormones.

Luckily, dietary imbalances are rare in dogs fed a commercial diet. Most goiters in dogs are caused by genetic defects, or they develop as a side effect of administration of trimethoprim-sulfa, an antibiotic used to treat a variety of infections in dogs ,according to veterinarians.

Goiters can be a symptom of congenital hypothyroidism, and Toy Fox Terriers, in particular, appear to be predisposed to congenital hypothyroidism with goiters.

Goiters often appear more alarming than they are. However, any swelling on your dog’s neck should be taken seriously. If you suspect your dog has a goiter, or if you find swelling in your dog’s neck, contact your veterinarian as soon as possible.

What should I do if I think my dog has a thyroid problem?

Thyroid disease in dogs requires medical treatment from a veterinarian. Make an appointment with your veterinarian if your dog is showing symptoms of thyroid disease.

90,000 Scientists told for whom the coronavirus is deadly

https://ria.ru/20200310/1568400794.html

Scientists told for whom the coronavirus is deadly

Scientists told for whom the coronavirus is deadly – RIA Novosti, 10.03. 2020

Scientists told who the coronavirus is deadly for

Scientists have prepared a specialized report in which they indicated the main factors that increase the likelihood of death from the new coronavirus Covid-19.RIA Novosti, 10.03.2020

2020-03-10T19: 15

2020-03-10T19: 15

2020-03-10T19: 51

science

spread of coronavirus

health

china

wuhan

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MOSCOW, March 10 – RIA Novosti.Scientists have prepared a specialized report, which indicated the main factors that increase the likelihood of death from the new coronavirus Covid-19. new coronavirus in China. Of this number of cases, 137 were discharged, and 54 died in hospital between December 29, 2019 and January 31, 2020.The researchers compared clinical records, treatment prescribed, laboratory results, and patient demographics. They studied the clinical course of the disease, its symptoms, the period of virus shedding and changes in laboratory data during hospitalization – blood tests, chest x-rays and CT scans – and used mathematical modeling to assess risk factors. The results showed that the main risk factors for death, which can be identified immediately upon admission to the hospital, are old age, signs of sepsis, and blood clotting problems.Scientists cite high blood pressure, diabetes and long-term use of non-invasive ventilation as additional risk factors, and the authors are publishing new data on the period during which patients on treatment were a threat to others. For those who were cured, this period ranged from eight to 37 days, an average of 20 days. In all 54 deaths, the virus remained active until the very last day. The authors of the study note that the duration of this period – and therefore the period of cure – is influenced primarily by the severity of the disease at the time of admission to the hospital.It is noted that two-thirds of patients were hospitalized in serious or critical condition. Scientists insist that patients be discharged from hospitals only after negative tests for Covid-19. The study describes the full picture of the progression of Covid-19 for the first time. The average duration of the fever was about 12 days, but the cough could last much longer. In 45 percent of the survivors, the cough persisted even upon discharge. Shortness of breath in those who went on the mend disappeared after about 13 days, and in those who did not survive, it continued until death.The study also cites the timing of various complications, such as sepsis, acute respiratory distress syndrome, acute heart injury, acute kidney injury, and secondary infection, with a median age of 52 survivors and 69 deaths. In the latter, already on admission to the hospital, there was a higher score for the assessment of sequential organ failure, which indicates sepsis; elevated blood levels of d-dimer protein, which is a marker of coagulation; a decreased level of leukocytes and an increased level of interleukin VI, a biomarker of inflammation and chronic diseases, as well as an increased concentration of troponin I, a marker of heart attack.”Poor outcomes in the elderly may be due, in part, to age-related weakening of the immune system and increased inflammation, which can promote viral replication, and a longer response to inflammation, causing long-term damage to the heart, brain and other organs,” notes Zhibo Liu (Zhibo Liu), one of the study authors.

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MOSCOW, March 10 – RIA Novosti. Scientists have prepared a specialized report in which they indicated the main factors that increase the likelihood of death from the new coronavirus Covid-19.

The results of the study were published in The Lancet.

Doctors analyzed the clinical picture of 191 adult patients with confirmed presence of Covid-19 in two hospitals in Wuhan, the center for the spread of the new coronavirus in China. Of this number of cases, 137 were discharged, and 54 died in hospital between December 29, 2019 and January 31, 2020.

Researchers compared clinical records, prescribed treatments, laboratory results, and patient demographics. They studied the clinical course of the disease, its symptoms, the period of virus shedding and changes in laboratory data during hospitalization – blood tests, chest x-rays and CT scans – and used mathematical modeling to assess risk factors.

March 10, 2020, 11:58 Scientists cite high blood pressure, diabetes and long-term use of non-invasive ventilation as additional risk factors.

In addition, the authors publish new data on the period during which patients who are on treatment were a threat to others.For those who were cured, this period ranged from eight to 37 days, an average of 20 days. In all 54 deaths, the virus remained active until the very last day.

The authors of the study note that the duration of this period – and therefore the period of cure – is influenced primarily by the severity of the disease at the time of admission to the hospital. It is noted that two thirds of patients were hospitalized in serious or critical condition.

“The long spread of the virus noted in our study has important implications for decisions regarding isolation precautions and antiviral treatment in patients with confirmed Covid-19 infection.<...> However, we must clearly understand that the time of virus isolation should not be confused with the quarantine time for people who may have been exposed to Covid-19, but did not have symptoms. The latter is based on the incubation time of the virus, “said Bin Cao, study leader and professor at the China-Japan Friendship Hospital and Beijing Capital Medical University.

Scientists insist that patients be discharged from hospitals only after negative Covid-19.

March 6, 2020, 17:40 The spread of coronavirus Chinese scientists have discovered changes in the symptoms of coronavirus

The study describes for the first time a complete picture of the progression of Covid-19. The average duration of the fever was about 12 days, but the cough could last much longer. In 45 percent of the survivors, the cough persisted even upon discharge. Shortness of breath in those who went on the mend disappeared after about 13 days, and in those who did not survive, it continued until death. The study also gives the timing of various complications such as sepsis, acute respiratory distress syndrome, acute heart injury, acute kidney injury, and secondary infection.

The average age of survivors is 52 years, of deaths – 69 years. In the latter, already on admission to the hospital, there was a higher score for the assessment of sequential organ failure, which indicates sepsis; elevated blood levels of d-dimer protein, which is a marker of coagulation; a decreased level of leukocytes and an increased level of interleukin VI, a biomarker of inflammation and chronic diseases, as well as an increased concentration of troponin I, a marker of heart attack.

“Poor outcomes in the elderly may be associated, in part, with age-related weakening of the immune system and increased inflammation, which can promote viral replication, and a longer response to inflammation, causing long-term damage to the heart, brain, and other organs,” notes Zhibo Liu, one of the study authors.

March 10, 2020, 18:09 Spread of Coronavirus The owner of Olympiacos and Nottingham Forest contracted coronavirus 90,000 US approved the use of atezolizumab in combination with cobimetinib and vemurafenib for the treatment of metastatic melanoma

Roche announces that the FDA has approved atezolizumab (Tecentriq®) in combination with cobimetinib (Cotellic®) and vemurafenib (Zelboraf®) for the treatment of patients with metastatic melanoma with BRAF V600 mutation *.The safety profile of the atezolizumab combination regimen was consistent with the safety profiles of each drug separately.

An additional indication for atezolizumab has been reviewed by the FDA on a priority basis. The review was also carried out as part of ProjectOrbis, an initiative of the FDA’s Center for Excellence in Cancer Care, which provides a platform for the simultaneous filing and review of applications for registration of anticancer drugs by international partners in the initiative.

“Patients with metastatic melanoma with the BRAF V600 mutation who received immunotherapy in combination with targeted drugs lived for more than 15 months without deterioration in health,” says Levy Garruay, PhD, Medical Director and Global Head of Drug Development, Genentech (part of the companies Roche). “The approval of the atezolizumab combination is an important step forward for many patients with metastatic melanoma.”

The approval of the combination is based on the results of the phase III clinical trial IMspire150, which showed that the addition of atezolizumab to cobimetinib and vemurafenib allowed patients to live longer without disease progression or death when compared with a combination of placebo, cobimetinib and vemurafenib (median progression-free survival) 15.1 months versus 10.6 months, respectively; hazard ratio (RR) = 0.78; confidence interval (CI): 0.63-0.97; P = 0.025).The most common adverse events (frequency ≥20%) in patients receiving combination therapy with atezolizumab, cobimetinib, and vemurafenib were rashes (75%), musculoskeletal pain (62%), fatigue (51%), hepatotoxicity (50%) , hyperthermia (49%), nausea (30%), pruritus (26%), edema (26%), stomatitis (23%), hypothyroidism (22%) and photosensitivity (21%).

Roche has an extensive clinical trial program for atezolizumab. It includes numerous ongoing and planned Phase III studies in lung, genitourinary, skin, breast, gastrointestinal, gynecological, head and neck cancers.In these studies, atezolizumab is evaluated both alone and in combination with other drugs.

About Clinical Study IMspire150

IMspire150 is a multicenter, double-blind, placebo-controlled, randomized, phase III clinical trial in patients with previously untreated metastatic or inoperable melanoma with the BRAF V600 mutation. The study compared the efficacy and safety of a combination of atezolizumab, cobimetinib, and vemurafenib versus placebo plus cobimetinib and vemurafenib.The primary endpoint was progression-free survival as assessed by the investigator. Key secondary endpoints include progression-free survival assessed by an independent committee, overall survival, objective response rate, duration of response, and other characteristics of the safety profile and pharmacokinetics.

The study involved 514 adult patients. The randomization was stratified by the level of lactate dehydrogenase (LDH) in the patients and their geography.Patients were randomized 1: 1 to one of two groups to receive one of the following regimens over 28-day cycles: atezolizumab plus cobimetinib and vemurafenib (atezolizumab group), or placebo plus cobimetinib and vemurafenib (control group). In the first cycle, all patients received orally 60 mg of cobimetinib once a day and 960 mg of vemurafenib twice a day for 21 days, and then for 7 days – 720 mg of vemurafenib in the atezolizumab group or 960 mg of vemurafenib in the control group. group.Patients in the atezolizumab group received 720 mg of vemurafenib (days 1 to 28) for all subsequent cycles. The reduced dose of vemurafenib in the atezolizumab group became a safety measure to mitigate the risk of increased toxicity while maintaining its effectiveness. The treatment continued until the investigator established either the progression of the disease, or the unacceptable toxicity of the drugs, or death, or the patient or doctor made a decision to discontinue treatment (regardless of what happened earlier).

About metastatic melanoma

Melanoma is a less common but more aggressive and potentially fatal form of skin cancer [1, 2]. When melanoma is diagnosed early, it is usually treatable [3, 4], but most people with advanced melanoma have a poor prognosis [2]. Melanoma is diagnosed in more than 287,000 people worldwide every year [5]. About half of melanoma patients have a mutation in the BRAF gene [6].In recent years, significant advances have been made in the treatment of progressive melanoma, and new therapeutic options have emerged in people with the disease. However, melanoma is still a serious public health problem with a high medical need and a steadily increasing incidence over the past 30 years [7].

About atezolizumab

Atezolizumab (Tecentrik®) is a monoclonal antibody that interacts with a protein called PD-L1.By binding to PD-L1 expressed on tumor and tumor-infiltrating immune cells, atezolizumab prevents PD-L1 from interacting with PD-1 and B7.1 receptors. By blocking PD-L1, atezolizumab normalizes T cell activation. Atezolizumab can also affect healthy cells.

About cobimetinib

Cobimetinib (Cotellic®) is designed to inhibit MEK1 / 2 (MAPK / ERK Kinase) kinases, proteins involved in the cellular signaling pathway that helps control cell growth and survival.Cobimetinib in combination with vemurafenib is approved for the treatment of patients with inoperable or metastatic melanoma with the BRAF V600 mutation in the United States and Europe, as well as in many countries around the world. Cobimetinib was discovered by Exelixis and is being developed by Genentech, a Roche Group, in collaboration with Exelixis.

About vemurafenib

Vemurafenib (Zelboraf®) is a prescription drug for the treatment of patients with inoperable or metastatic melanoma with the BRAF V600 mutation.Vemurafenib inhibits certain mutated forms of the BRAF gene that cause abnormal signaling within tumor cells, leading to tumor growth. BRAF is a protein involved in cellular signaling that helps control cell growth and survival. Vemurafenib is the first approved drug in its class. It was jointly developed under a 2006 licensing and collaboration agreement between Roche and Plexxikon Inc., part of the Daiichi Sankyo Group, which specializes in research and development in the field of low molecular weight compounds.

About Roche

Roche (Basel, Switzerland) is a global pharmaceutical and diagnostic innovator that uses cutting-edge science to improve people’s lives. In 2019, the company invested 11.7 billion Swiss francs in research and development. Roche is one of the largest developers and manufacturers of biotechnological medicines for the treatment of cancer, autoimmune, infectious and neurological diseases.The company is also one of the leaders in diagnostics invitro and histological diagnostics of oncological diseases, as well as a pioneer in the field of self-management of diabetes mellitus. The amalgamation of the pharmaceutical and diagnostic divisions allows Roche to be one of the leaders in personalized medicine. AO Roche-Moscow represents the pharmaceutical division of the company in Russia. Working with all stakeholders, the company strives to improve the access of Russian patients to innovative technologies in the treatment of diseases.27 of the company’s drugs are included in the VED list. Roche makes a long-term contribution to the development of medicine, science, public health and the pharmaceutical industry in Russia. More details at www.roche.ru.

All trademarks used or mentioned in this post are protected by law.

References

* The indication is not registered in the Russian Federation.

[1] Algazi AP, et al.Treatment of cutaneous melanoma: current approaches and future prospects. Cancer Manag Res. 2010; 2: 197-211.

[2] Finn L, et al. Therapy for metastatic melanoma: the past, present, and future. BMC Med. 2012; 10:23.

[3] Leong SP. Future perspectives on malignant melanoma. SurgClin North Am. 2003; 83: 453-6.

[4] Creagan ET. Malignant melanoma: an emerging and preventable medical catastrophe. Mayo Clin Proc. 1997; 72: 570-4.

[5] Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. https://gco.iarc.fr/today/home. Access: July 2020.

[6] Ascierto PA, Kirkwood JM, Grob JJ, et al. The role of BRAF V600 mutation in melanoma. J Transl Med. 2012; 10: 85.

[7] Bataille V. Risk factors for melanoma development.Expert Rev Dermatol. 2009; 4: 533-9.

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Hyperthyroidism in children – causes, symptoms, diagnosis and treatment

Hyperthyroidism in children is a clinical syndrome characterized by increased production of thyroid hormones. It occurs with diffuse toxic goiter, pituitary adenoma, in the initial stages of thyroiditis.The main symptoms: acceleration of metabolism, psychoemotional disorders, dysfunction of the digestive and cardiovascular systems. Diagnosis of the syndrome involves ultrasound and scintigraphy of the thyroid gland, a detailed analysis of the thyroid hormonal profile and specific antibodies. Treatment consists of thyrostatic therapy, radioactive iodine preparations and beta-blockers.

General information

Hyperthyroidism occurs with a frequency of up to 20-25 patients per 100 thousand.child population. Basically, children of prepubertal and pubertal age are ill, and girls are 6-8 times more likely than boys. In infants and young children, symptoms of hyperthyroidism are determined no more than 8 cases per 1 million population. The terms hyperthyroidism and thyrotoxicosis are commonly used synonymously, although the former denotes hyperthyroidism (thyroid) and the latter denotes the toxic effects of thyroid hormones on tissue. Often, a child develops both conditions, but sometimes hyperthyroidism can be isolated.

Hyperthyroidism in children

Causes

In newborns, thyroid hyperfunction is often associated with the presence of toxic goiter in the mother. At the same time, specific antibodies are produced in the body of the pregnant woman, which penetrate the placenta to the fetus, attach to thyrocyte receptors and enhance the synthesis of hormones. In older children, hyperthyroidism is triggered by the following reasons:

• Graves’ disease. Diffuse toxic goiter accounts for up to 90% of the causes of pathology in childhood.Due to the constant stimulation of thyrocyte TSH receptors, the thyroid gland increases evenly, and its hormonal function increases. Occasionally, hyperthyroidism forms with multinodular toxic goiter.
• Hashimoto’s thyroiditis. An increase in the synthesis and release of thyroid hormones is observed in the hyperthyroid phase, which often occurs in children at the onset of the disease. Autoimmune processes stimulate the thyroid gland and partially destroy cells, increasing the release of hormonal biomolecules into the bloodstream.
• Other types of thyroiditis. Symptoms of thyroid hyperfunction are sometimes seen in children with acute thyroiditis caused by bacterial flora. Thyroid hyperfunction is also possible with subacute thyroid inflammation, which is provoked by viral agents.
• Pituitary adenoma. With a hormonally active tumor of the central endocrine organ, the synthesis of TSH is increased, which stimulates thyrocytes and increases the production of thyroxine and triiodothyronine.Similar violations occur in the pathology of the hypothalamus, secreting thyroliberin.

Pathogenesis

An increase in the production of thyroid hormones in the thyroid gland is caused either by thyroid-stimulating antibodies, or by an increase in the concentration of hormonal regulators (TSH and thyroliberin) in the blood. As a result of these mechanisms, an inadequate amount of T3 and T4 enters the systemic circulation, which bind to cell receptors in various tissues and have negative physiological effects.

Normally, thyroid hormones are involved in many biochemical processes, so their excess is accompanied by systemic disorders. In children, pathological catabolic processes occur, carbohydrate and lipid metabolism is disturbed. Hormones have a toxic effect on the cardiovascular and nervous system, and negatively affect the psyche during childhood.

Classification

Depending on the localization of the pathology, 3 types of hyperthyroidism are distinguished: primary, which is caused by a lesion at the level of the thyroid gland, secondary, characterized by disorders of the pituitary gland, and tertiary, associated with diseases of the hypothalamus.In practical pediatric endocrinology, the classification of the syndrome according to clinical manifestations is important, in which 3 options are distinguished:

• Subclinical. Represents mild hyperthyroidism. Clinical symptoms are absent or minimal. The diagnosis is made only on the basis of changes in the hormonal profile.
• Manifed. The classic course of hyperthyroidism, which refers to moderate severity, is characterized by a detailed clinical picture in combination with laboratory changes.
• Complicated . An unfavorable course of the course, when the typical symptoms of hyperthyroidism are supplemented by signs of damage to the heart, nervous system and parenchymal organs.

Symptoms of hyperthyroidism in children

In infants, clinical manifestations occur in the first month of life. These include intestinal upset (vomiting, diarrhea), breastfeeding problems, increased anxiety, and sleep disturbances. Sometimes a newborn has an enlarged thyroid gland.Often, with neonatal hyperthyroidism, there is a regression of symptoms during the first half of life.

At the end of the neonatal period, psychoemotional symptoms predominate among the leading signs of hyperthyroidism. Children develop unreasonable irritability, hyperactivity, moodiness and a tendency to aggression. Schoolchildren do worse in their studies, since it becomes difficult for them to exert volitional efforts and concentrate on one thing for a long time.

Physiological symptoms are represented by intolerance to heat and stuffiness, increased sweating, trembling of the fingers.Many children complain of an unpleasant feeling of palpitations, headaches, which are caused by high blood pressure. Intestinal signs include increased bowel movements, recurrent intestinal cramps. The child is rapidly losing weight, although his appetite is not disturbed.

Another group of clinical manifestations includes the symptoms of the underlying pathology that provoked thyroid hyperfunction. In acute thyroiditis – febrile fever, severe pain on the front of the neck, swallowing disorders, in the subacute form – low-grade fever, moderate pain in the projection of the organ.Bulging of the eyes (exophthalmos) occurs only in hyperthyroidism caused by Graves’ disease.

Complications

In children with neonatal hyperthyroidism with thyrotoxicosis, the risk of negative consequences varies within 10-15%. In infants, psychomotor developmental disorders, growth retardation, and craniosynostosis occur – too early ossification of the cranial sutures, due to which a microcranium is formed. A delayed diagnosis of hyperthyroidism in a newborn can be fatal.

In all age groups, the most severe complication of the disease is a thyrotoxic crisis, which without emergency medical care can result in the death of a child. The emergency is manifested by life-threatening arrhythmias, hypertensive crisis, acute heart failure. Then delirium begins, which turns into coma and death.

Diagnostics

During a physical examination, a pediatric endocrinologist draws attention to an enlargement of the thyroid gland, the appearance of functional heart murmurs during auscultation, and the presence of pathological eye symptoms.When assessing the neurological status, the doctor usually detects a decrease in muscle strength and tone. Then instrumental and laboratory diagnostics of hyperthyroidism is carried out:

• Ultrasound of the thyroid gland. In autoimmune thyroiditis and diffuse goiter, an enlarged gland with a heterogeneous structure is visualized. For multinodular goiter, separate pathological foci are characteristic against the background of normal organ parenchyma. An unfavorable sign is considered to be a hypoechoic formation with fuzzy contours and calcifications.
• Thyroid scintigraphy. The study is performed for a detailed assessment of the functional activity of the organ. In hyperthyroidism, an increased uptake of the radiopharmaceutical is observed; occasionally, individual “hot knots” are visible on the results of scintigraphy.
• ECG. Electrocardiographic data are needed to assess how the cardiovascular system is functioning and to identify secondary damage. If the endocrinologist sees pathological signs on the ECG, he additionally prescribes an EchoCG, a consultation with a pediatric cardiologist.
• Hormonal research . With hyperthyroidism in the blood, the levels of free T3, T4 are increased, the titer of antibodies to thyroperoxidase (TPO), thyroglobulin (TG), and TSH receptors is increased. The level of the pituitary hormone TSH is reduced in the primary form of the disorder, increased in secondary and tertiary hyperthyroidism.

Treatment of hyperthyroidism in children

Conservative therapy

In case of thyrotoxicosis, physical activity is limited so as not to aggravate thermoregulation disorders and not to overload the heart muscle.Children are prohibited from giving coffee and strong tea, adolescents are strictly prohibited from using energy drinks and alcoholic beverages. Before the normalization of the hormonal background, the intake of iodine with contrast agents into the body is limited. Drug treatment for hyperthyroidism includes:

• Thyrostatics . The drugs are used to suppress hormonal production and normalize the child’s health. The therapy lasts 1-1.5 years. Treatment involves constant monitoring of free T4 levels and the gradual introduction of replacement therapy with levothyroxine.
• Radioactive iodine. This regimen is used after prolonged and unsuccessful use of thyreostatic therapy. The appointment of iodine is possible in children over 5 years of age with severe hyperthyroidism and thyrotoxicosis.
• Beta-blockers . Medicines normalize the heart rate and increase the efficiency of the myocardium. They eliminate symptoms, prevent the development of severe cardiac complications of hyperthyroidism.

Surgical treatment

Surgery (thyroidectomy) is performed in children with recurrent hyperthyroidism, with ineffectiveness of drug therapy for 12-18 months, the presence of large nodular neoplasms.Before surgical treatment, the child is recommended therapy with thyreostatics until the state of euthyroidism is reached. After the operation, parathyroid hormone and calcium are monitored, according to indications, vitamin D is prescribed.

Prognosis and prevention

With a timely start of treatment, stable remission occurs in 75% of children. The prognosis depends on the cause and degree of the increase in the level of thyroid hormones, the rate of decrease in goiter and the presence of concomitant diseases in the patient. Primary prevention of hyperthyroidism is the prevention of endocrine diseases, accompanied by dysfunction of the thyroid gland.

90,000 Types of contraindications for tooth implantation

Implantation, like any type of surgical intervention, has its own contraindications, in the presence of which the doctor can deny the visitor of the dental office in this procedure. If the client has expressed a desire to install implants, he is offered to undergo an examination and pass tests that will help identify contraindications to implantation, if any, and prevent health problems.There are several categories of contraindications, ranging from absolute, when the installation of implants is completely impossible, to temporary, when the procedure can be carried out after a lapse of time or it is required to first eliminate the current health problems.

For what diseases is implantation absolutely contraindicated

• HIV infection at any stage of development.
• Oncology: malignant tumor, cancers or indurations, sarcoma, neoplasms in the stage of metastasis.
• Intolerance to metals.
• Any blood diseases (thalassemia, leukemia, lymphogranulomatosis and others).
• Somatic pathologies of the chronic course: tuberculosis, diabetes, diseases of the oral mucosa.
• Diseases of the immune system that will prevent tissue healing: polymyositis, thymic hypoplasia, and others.
• Ailments associated with the condition of the connective tissue: lupus erythematosus, scleroderma, rheumatic and rheumatoid diseases.
• Hypertonicity of masticatory muscle tissues, bruxism.
• Diseases of the mucous membrane: Sjogren’s syndrome, pemphigus, aphthous stomatitis.
• Endocrine disorders: abnormal state of the adrenal glands, pituitary gland, hypothyroidism, hypoparathyroidism, hyperthyroidism, hyperparathyroidism.
• Problems with bone tissue regeneration: dysplasia, osteoporosis, osteonecrosis, osteopathy.
• Diseases associated with the heart and blood vessels.
• Mental disorders: schizophrenia, paranoia, dementia, psychosis.
• Alcohol and drug addiction in the last stages.

With absolute contraindications, a person cannot use the implant installation service, otherwise deterioration of the condition, accelerated development of the existing pathology or death may follow.

Temporary contraindications for implantation

Certain health problems or special conditions that can be cured or can pass over time are considered relative contraindications for implantation.In these cases, the implant can be placed if you wait until the cause of the contraindication is eliminated, appropriate treatment will be carried out and if the doctor regularly monitors the patient’s condition.

Temporary contraindications include the following:

• Rehabilitation of the oral cavity: caries, gingivitis, periodontitis.
• Avitaminosis, in particular lack of vitamins C and P.
• The period of pregnancy and lactation.
• Incorrect bite.
• Increased abrasion of dental tissue.
• Metal implants in the body.
• Diseases of the temporal and mandibular region.
• Lack of regular, proper nutrition.
• Extreme and high physical activity.
• Problematic jaw structure: bone atrophy, retention of teeth, closely spaced maxillary sinuses.
• Irradiation or radiation therapy for 1 year.
• Exacerbation of chronic diseases before the transition of relapse into stable remission.
• The stage of rehabilitation after any illness.

Relative (temporary) contraindications are not an obstacle to the installation of the implant, however, these conditions must be controlled, wait for their end or cure, depending on the type of problem.

Misconceptions about contraindications for implantation

One of the main myths in this area is that the implant can only be placed at a certain age.This can be done regardless of age category.

The second dangerous misconception is that implantation is not an operation. A patient adhering to this opinion ignores general contraindications to surgery, for example, high blood pressure or intolerance to anesthesia. Implantation is an operation that has limitations and needs to be prepared for.

The third common misconception concerns oral hygiene. Some do not take this issue seriously enough, considering it not very important.However, if the patient does not care for the teeth, the dentist may consider the implantation risky.

It is unlikely that anyone would want to risk their health (and sometimes life) in order to use the implantation services, having serious contraindications for such an operation. However, this does not mean that the “Hollywood smile” is not available to a person. With modern methods of prosthetics, dentists will be able to offer various types of replacement of the dentition.

Thyrotoxicosis (hyperthyroidism), sanatoriums, treatment, prices for 2021

Thyrotoxicosis syndrome is a condition characterized by an increased amount of thyroid hormones.This syndrome causes various disorders in the body and malfunction of many organs.

Causes

The factors that influence the onset of hyperthyroidism are fairly well known:

• Plummer’s disease – which is caused by the release of hormones not by the entire thyroid gland, but only a part of it;
• thyroiditis of autoimmune origin – characterized by damage and destruction of thyroid cells and the contents of these cells enters the bloodstream;
• Basedow’s disease – the thyroid gland in this disease increases and begins to produce a lot of hormones;
• fecal diseases;
• heredity;
• Malfunction of the immune system.

Symptoms

Hyperthyroidism can cause damage to many organs and the symptoms are as follows:

• sleep disturbances occur;
• unstable psychoemotional state in patients with hyperthyroidism;
• there are visible changes in the eyeballs – they protrude;
• disorders of the cardiovascular system: tachycardia, high blood pressure;
• weakness, fatigue, lethargy;
• Frequent urge to urinate, frequent and strong desire to drink;
• in a patient with thyrotoxicosis, the neck significantly increases in volume.

Types and forms

Depending on how pronounced the symptoms are, several forms of hyperthyroidism are distinguished:

• mild form of hyperthyroidism – proceeds almost imperceptibly and does not violate the functions of other organs;
• thyrotoxicosis (hyperthyroidism) of moderate severity – caused by a violation of the cardiovascular system: tachycardia, palpitations. This form of the disease leads to disruption of many organs and systems of the human body;
• severe form of thyrotoxicosis – manifests itself in the exacerbation of all symptoms and is very difficult.

This disease leads to complications. These include a thyrotoxic crisis. With this complication, a very rapid heartbeat is observed, the body temperature rises sharply, chills and tremors appear, and a violation of the psychoemotional state is observed. If you do not start treatment, then the thyrotoxic crisis can become fatal.

Methods

Therapy for hyperthyroidism depends on the severity and symptoms of the course of the disease. It is necessary to undergo examinations and pass the necessary tests.Based on the results obtained, the endocrinologist can correctly diagnose and determine the severity of the disease. Treatment methods include:

• drug treatment, which includes drugs that normalize the secretion of thyroid hormones;
• treatment with surgical intervention – it is used very rarely and only in complicated cases of the disease, if drug therapy has not yielded results.

Prevention

Prevention of thyrotoxicosis is based on adherence to a healthy lifestyle and proper nutrition.In the sanatoriums of Russia, which specialize in the treatment of diseases of the endocrine system, qualified doctors will help you choose therapeutic and preventive measures on the way to recovery.

90,000 disease, symptoms, treatment, causes, diagnosis

Hypertensive crisis is one of the most frequent and dangerous complications of hypertension (arterial hypertension ), caused by an excessive increase in blood pressure.This pathological condition is one of the most common reasons for calling an ambulance. In Russia, only 58% of sick women and 37.1% of men know about the presence of the disease, while the prevalence of the disease is 39.2% among men and 41.1% among women. Of those who know that they have this disease, only 45.7% of women and 21.6% of men receive medication of varying degrees of adequacy. In this regard, the number of hypertensive crises naturally increases.

During a hypertensive crisis, symptoms of impaired blood supply to organs and systems, most often to the brain and heart, are observed: an increase in diastolic blood pressure above 110-120 mm Hg, headache, shortness of breath, chest pain, neurological disorders (vomiting, convulsions, impairment of consciousness, paralysis).

Hypertensive crisis poses a danger of death for patients with pre-existing heart and brain diseases.

Considering that in 60% of cases of hypertensive crisis, the cause is uncontrolled arterial hypertension, effective treatment of hypertension is an important factor.In case of untimely seeking medical help, the outcome of the condition may be disability or death.

Service benefits

Convenient working hours

We work until late in the evening, so that it is convenient for you to take care of your health after work

No queues

The patient registration system has been debugged over many years of work and operates in such a way that you will be received exactly at the chosen time

Cozy interior

It is important for us that patients feel comfortable within the walls of the clinic, and we have done everything to surround you with coziness

Attention to the patient

At your service – attentive staff who will answer any question and help you navigate

90,000 A new type of newborn screening is being tested in the capital

Moscow has expanded its newborn screening program for fatal diseases.Testing is now detecting DNA abnormalities in infants that lead to spinal muscular atrophy. This means that doctors have a chance to save the lives of thousands of children.

The long-awaited son made Yevgeny happy with his first successes: he turned over, held his head, was about to sit down. But six months later, her active baby began to fade away before our eyes. The muscles weakened, the child did not eat and could not even breathe on his own.

“The worst fear was confirmed, they revealed spinal muscular atrophy,” says Evgenia Chernonog.

A rare or, as doctors say, orphan disease – 1 case per 6 thousand newborns. The diagnosis is dangerous, without treatment, a lethal outcome is inevitable, and extremely insidious – it does not appear immediately. When the first symptoms are already present, it is extremely difficult to avoid disability. The main task is to detect a genetic malfunction even before the disease manifests itself.

“Neonatal screening is carried out on the fourth day of the life of children, it is carried out for all newborns. The purpose of this screening is to identify severe hereditary diseases at the preclinical stage,” says Mziya Makieva, head of the department of newborns No. 2 of the Federal State Budgetary Institution “National Medical Research Center for Obstetrics, Gynecology and Perinatology. named after academician V.I. Kulakov “.

The Kulakov Center was one of the first to add a test for spinal muscular atrophy to 11 studies that are mandatory in Moscow, including cystic fibrosis (a disorder of the digestive and respiratory systems) and hypothyroidism (thyroid disease).

The project is pilot, the day before it was presented by leading Russian geneticists and doctors. The program included four maternity hospitals in the capital. Blood is taken from the newborn, samples on special filter blanks are sent to the laboratory.

“We are working at the DNA level, the child is born, he still does not have any spinal muscular atrophy, it will develop only at 3-5 months, and we already see that there is damage at the DNA level,” explains Alexander Polyakov, head of the DNA laboratory -diagnostics of the Medical Genetic Research Center of the Russian Academy of Sciences.

If a genetic abnormality is found, the patient is immediately prescribed treatment. It is expensive, there are only two licensed drugs in the world. Therefore, pharmacological companies were also involved in the program. Sick children will receive the necessary medicines free of charge.

“The drugs that have now been developed help to produce a fully functional protein due to a spare gene. Accordingly, by producing protein, we preserve motor neurons, and motor neurons preserve muscles,” explains Dmitry Vladovets, and.O. the head of the Pirogov Children’s Neuromuscular Center.

“Every year from 150 to 200 children are born with this diagnosis in our country. Of course, we hope that the program will develop, we hope to expand neonatal screening,” says Sergei Kutsev, director of the Academician Bochkov Medical Genetic Center , chief freelance specialist in medical genetics of the Ministry of Health of Russia.

If atrophy is detected in the first days of life and the patient is provided with drugs, in the future such a child will not differ in any way from his genetically healthy peers.