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Hypothyroidism

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The thyroid hormones namely thyroxine (T4) and the triiodothyronine (T3) secreted by the thyroid gland affect almost all the parts of our body — the heart, the brain, the muscles; metabolism and other physiological functions. A malfunctioning of the thyroid gland can either make it go on an overdrive or make it under active.

A condition wherein the thyroid gland becomes underactive and secrets less hormones than needed is called hypothyroidism. Low levels of thyroid hormones can set the stage for numerous health problems such as obesity, heart problems, joint pains, infertility, etc.

This condition affects women more than men and is usually silent at the onset. It is not until late that one gets diagnosed for the same. But due to some congenital defects, this condition can affect a person right from birth. Here are few quick facts about thyroid disease you are not aware of!

Also Read

Causes

There are various reasons that can lead to hypothyroidism. Some of the common causes are as follows:

Hashimoto disease: This is an autoimmune disease in which the immune system produces antibodies which attacks and destroys the thyroid cells. This results in a malfunctioning of the gland which interferes with the production of the hormones and lessens the secretions. Hashimoto disease is one of the most common causes of hypothyroidism. Though the exact reason of this autoimmune disease is not known but experts believe that a genetic flaw could be a probable cause.

Radioactive iodine therapy: Radioactive iodine therapy or ablation used to treat hyperthyroidism, a condition where the thyroid gland produces excessive thyroid hormones, can lead to hypothyroidism. The radioactive therapy brings the thyroid gland in control to produce less amounts of the hormone. Sometimes the outcome of the treatment is an underactive thyroid gland with a condition like hypothyroidism. Though rare but this is a probable cause for the condition. Here are few reasons your thyroid is an underperformer.

Thyroid surgery: A surgery usually done to treat hyperthyroidism in case radioactive therapy or ablation fails to remove the diseased part of the gland that goes on an overdrive, can again lead to same.

Medication: Certain medications used to treat heart problems, psychiatric disorders or cancers can make the thyroid gland become underactive. Also if one is treated for hyperthyroidism where medications are given to control the thyroid functioning it can also lead to the same.

Congenital disease: Sometimes some congenital defects like an underdeveloped thyroid gland or a defective thyroid can lead to a condition like hypothyroidism. Though such babies appear to be normal by birth, the condition only comes to light during the early years of childhood with dependency of medication for life.

Pregnancy and postpartum: For some unknown reasons the thyroid gland starts to act up in many women during pregnancy and after. Low production of thyroid hormones during pregnancy can lead to miscarriages, premature delivery, and preeclampsia. While post pregnancy sometimes women develop thyroditis, inflammation of the gland which interferes with the hormone production. Though the condition remains put for six months after delivery, but if untreated and ignored it can lead to other consequences later. Here's more on thyroid problems during pregnancy. 

Other health conditions: Sometimes a medical condition like a tumor in the pituitary gland or a malfunctioning in the hypothalamus can initiate less secretion of TSH or thyroid stimulating hormone.  TSH is the hormone that stimulates the thyroid gland to produce the right amount of thyroid hormones. Low levels of TSH can lead to hyper secretion of the thyroid hormone leading to the condition.

Iodine deficiency: Iodine in the diet is responsible for the production of thyroid hormones. A deficiency of iodine can lead to hypothyroidism in many. Here are signs your body is lacking iodine.

Risk Factors

The following are the risk factors for hypothyroidism:


  • Being a woman. Thyroid problems for some reason side more with women than men. Hypothyroidism can be common in women aged 60 and beyond. Also read about thyroid problem in men.

  • Suffering from an autoimmune disease. A condition like Hashimoto disease or a genetic disposition of the condition can be a risk factor.

  • Intake of radioactive therapy, ablation, anti-thyroid medications or a thyroid surgery. Though these are done to treat an underlying condition or other health crisis but they also increase ones chances of getting hypothyroidism.

  • Pregnancy. A little thyroid dysfunction during pregnancy and postpartum is natural. Regular monitoring can help deal with this better.

Symptoms

The symptoms of hypothyroidism can be passed on as those of the normal wear and tear of life, that’s reason why a thyroid condition is not diagnosed right at its onset.

Some of the common symptoms of hypothyroidism are -


  • Unexplained and extreme fatigue

  • Increased sensitivity to cold

  • Regular bouts of constipation

  • Dry skin and puffy face with hair fall

  • Unexplained weight gain

  • Hoarseness in voice

  • Muscle weakness along with fatigue, tenderness and stiffness at times

  • Elevated blood cholesterol level

  • Pain, stiffness or swelling in your joints

  • Heavier than normal or irregular menstrual periods in women

  • Slowed heart rate

  • Depression

  • Problems with concentration


In children, hypothyroidism can show symptoms like -

  • Prolonged neonatal jaundice

  • Recurrent episodes of choking

  • Puffy face with a large protruding tongue

  • Severe bouts of constipation

  • Excessive sleep

  • Poor growth and delayed puberty

  • Problems with concentration

  • Delayed development of permanent teeth

Diagnosis

Hypothyroidism can be diagnosed in the following ways:


  • Physical examination: Your doctor might slightly press your thyroid gland to check for any inflammation or any such anomaly.

  • Blood test: A blood test is usually done to check for the levels of thyroxine or T4, the triiodothyronine (T3) hormone and that of the TSH in the blood stream. With a condition like hypothyroidism the levels of T3 and T4 appear to be normal but the TSH levels would be low. Here's everything to know about thyroid profiling tests.

  • Thyroid scan: This is usually done if the doctor suspects any structural changes in the gland. An ultrasound or thyroid scan can detect the presence of cysts, their nature and also the extent of thyroid enlargement that has taken place along with hypothyroidism.


Here's how to read your medical test report: Thyroid function tests

Treatment

The treatment options are as follows:

Medications: The first line of treatment is to prescribe medications in oral form. Synthetic hormone T4 is given in pill form to be consumed daily. This resolves the signs and symptoms of hypothyroidism within a fortnight. Though, the pill has to be consumed for a longer period of time till your doctor advices. Iron and other antacids should be avoided along with the T4 intake as they interfere with the absorption. Read everything about medicines for Thyroid Disease – Types, Side-effects and Interactions.

Hormone replacement therapy: In young adults usually a hormone replacement therapy is suggested, but for older people with an underlying heart problem this could lead to adverse consequences.  Hence in such cases if a replacement is needed small doses of the hormone is given at regular intervals.

 

Complications

Untreated hypothyroidism can lead to a number of health problems like:


  • Goitre: To treat hypothyroidism, medications are given to stimulate the gland to produce more of the hormones. This over stimulation can lead to inflammation of the gland leading to a condition called goitre.  Apart from appearance a large goitre can affect and may interfere with swallowing or breathing. Here's more on goitre.

  • Irregular heart functions: Low levels of thyroid hormones can cause an increase in total cholesterol level coming in the way of smooth heart functioning. It can also lead to enlarged heart muscles and lead to heart failure.

  • Improper mental health: Apart from depression which is common with hypothyroidism there can also be a general retardation in the mental functioning of the patient if treatment is ignored.

  • Peripheral neuropathy: Long term uncontrolled hypothyroidism can cause damage to your peripheral nerves that are responsible for proper functioning of arms and legs, resulting in muscle weakness or loss of muscle control.

  • Myxedema: Undiagnosed hypothyroidism can lead to this life-threatening condition characterized by intense cold intolerance and drowsiness followed by extreme lethargy leading to unconsciousness or a state of coma. Though a rare occurrence but it calls for a medical emergency.

  • Infertility: Low levels of thyroid hormone can interfere with ovulation, which impairs fertility. Here's how hypothyroidism impacts your fertility.

  • Birth defects: Untreated hypothyroidism in women can lead to congenital defects in babies born to them.

Tips

Diet changes: There isn’t any particular diet to help deal with symptoms of this condition. But weight gain is common if one suffers from hypothyroidism. Hence it is essential and wise to check the calorie intake and have a healthy diet plan in place.

Be regular with exercise: Apart from weight gain the condition also interferes with muscle tone and strength. Flexibility training and some strengthening exercises can help gain back some vigor.

Take rest and relax: Even with medications as your symptoms come to a check make sure you take enough rest to counter hypothyroidism induced fatigue and practice some meditation techniques to also fight off depression.

Here's how Ayurveda and yoga can help manage hypothyroidism.

The content has been verified by Dr Avinash Phadke, President Technology & Mentor (Clinical Pathology), SRL Diagnostics.

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