Diagnosis and treatment of hypothyroidism

Hypothyroidism is a disease that occurs if the thyroid gland doesn’t produce enough of the thyroid hormones T4 and T3.  Women are more affected by the condition than men.  A deficiency of thyroid hormones can lead to other health complications,so it’s important to know the symptoms of hypothyroidism and to obtain the right treatment.

Symptoms
Metabolism will slow down and common symptoms of hypothyroidism include fatigue, weight gain, intolerance to cold, dry, coarse skin, thinning hair, and constipation.  Muscle weakness and muscle pain can also occur.  Cognitive issue such as impaired memory can arise. The voice might become hoarse, and the patient could have very slow reflexes.  A slow heart rate and high blood cholesterol levels can occur. The thyroid gland can be increased in size (goiter), normal, or non-palpable.

If hypothyroidism isn’t treated, the thyroid gland enlarges, producing more severe symptomssuch as depression.  Myxedema, although rare, is advanced hypothyroidism, and can be life-threatening. Symptoms include decreased breathing, low blood pressure, low body temperature, unresponsiveness and coma.

Causes
The main causes of hypothyroidism are:

1. Hashimoto’s thyroiditis, an autoimmune disease that causes inflammation of the thyroid gland.
2. Treatment of Graves’ hyperthyroidism with radioactive iodine.
3. Congenital hypothyroidism, where someone is born with a defective thyroid gland, or no gland.
4. Surgery to treat thyroid cancer.
5. Although rare, hypothyroidism can occur because of disorders of the pituitary gland or the hypothalamus. The thyroid gland needs normal secretion of thyroid stimulating hormone (TSH) from the pituitary gland and thyrotropin releasing hormone (TRH) from the hypothalamus.
6. Postpartum thyroiditis is inflammation of the thyroid gland that can occur after delivery of a baby.

Diagnosis
You should have check-ups and blood tests at least once a year to detect health problems, and measuring hormones that affect your thyroid should be a part of those tests.  Your doctor will also palpate (feel) your thyroid gland.

A blood test that measures the level of TSH and thyroxine (T4) can detect hypothyroidism.  High TSH levels and low thyroxine levels indicate hypothyroidism.  Sometimes, no symptoms of hypothyroidism occur, so you really need regular blood testing to detect problems.  This is the case with subclinical hypothyroidism, where TSH levels are elevated but T4 is in the normal range.

Treatment
The standard treatment is the synthetic thyroid hormone levothyroxine.  The dosage could be adjusted after two to three months based on how you react to the drug and blood test results.  Do not take levothyroxine with calcium or iron supplements, or with aluminum antacids.

Evidence suggests that some patients feel better if they are also supplemented with T3 as liothyronine, and the combination of levothyroxine and liothyronine was linked with improved metabolic profiles.  Liothyronine might cause heart problems in the elderly, and other side effects in other patients.

A small study showed that natural thyroid hormones also makes some patients feel better than synthetic ones.  The study used desiccated thyroid extract and compared it levothyroxine, and most patients expressed a preference for the desiccated thyroid extract.

Nutrients
Too much or too little iodine can cause thyroid problems.  If you try to avoid all salt, then you could become iodine deficient and this could lead to hypothyroidism.  This is because salt is iodized and can help you obtain sufficient amounts of iodine.  Use table salt that says “iodized” on the label or that has iodine as an ingredient.  Don’t use iodine supplements as you could use too much, and this too can cause hypothyroidism.

Low levels of vitamin D are linked to autoimmune thyroid disease such as Hashimoto thyroiditis.  You should have your vitamin D levels tested to check if you are deficient, and to supplement if required.

Low thyroid hormone levels don’t just make you feel tired, they could lead to more serious issues.  It’s important to get regular blood tests to prevent hypothyroidism, and to get prompt treatment to prevent complications.