Hypothyroidism, underactive thyroid; symptoms and treatment

Hypothyroidism, or an underactive thyroid gland, is a condition in which the thyroid gland produces too little thyroid hormone (thyroxine or T3/T4). Thyroxine regulates the energy balance in the body. With an underactive thyroid there is a deficiency of this hormone and this can lead to various symptoms. Common symptoms of hypothyroidism include fatigue, weight loss, constipation, dry flaky skin and chills.

What is hyperthyroidism – underactive thyroid

Thyroxine is a hormone that is produced by the thyroid gland located in the lower neck region. It circulates in the blood and regulates energy use in the tissues. There are many different cells and tissues that require thyroxine for their metabolism.

Hypothyroidism is the result of an underactive thyroid gland that produces too little thyroxine, which causes many bodily functions to be put on the back burner. Hypothyroidism can also occur because part of the thyroid gland has been surgically removed, resulting in the remaining part not being able to produce enough hormone. Related to hypothyroidism is hyperthyroidism in which the thyroid gland is overactive.

What are the symptoms of hypothyroidism?

The symptoms of hypothyroidism are caused by the body producing too little thyroxine. The result is that body functions become slower. Common symptoms of hypothyroidism include:

  • Fatigue,
  • Weight gain, because the tissues burn less energy.
  • Constipation
  • Cold shivers
  • Lifeless hair
  • Retaining moisture
  • Mentally less sharp and often also depression

Less common symptoms are; a rough voice, irregular and heavy menstruation, loss of libido, memory loss and carpal tunnel syndrome. However, all of the above symptoms of an underactive thyroid can also be caused by other conditions, so it is sometimes difficult to diagnose hypothyroidism. Symptoms often develop gradually and become more severe over several months as the concentration of thyroxine in the blood decreases.

What complications are related to hypothyroidism

If hypothyroidism is not treated, it can lead to the following complications:

  • Firstly, the risk of cardiovascular disease is significantly increased. This is caused by a low thyroxine concentration increasing the concentration of lipids (such as cholesterol) in the blood.
  • With hypothyroidism during pregnancy there is an increased risk of pregnancy complications. Examples include preeclampsia, anemia, premature birth, low birth weight and severe bleeding after delivery.
  • A rare coma is a coma due to myxedema.
  • Fortunately, the prospects for patients who are treated for their underactive thyroid are very good. During treatment, the symptoms gradually disappear and complications resulting from the treatment are rare.

Who Gets Hypothyroidism?

About 1 in 50 women and only 1 in 1000 men develop hypothyroidism during their lifetime. It usually develops in adult women and becomes more common with increasing age. Although older women are especially susceptible to this condition, anyone can develop hypothyroidism at any age.

Cause hypothyroidism / underactive thyroid

What causes hypothyroidism? The cause of a sluggish thyroid gland is often an autoimmune disease. This means that the immune system attacks the body’s own organs, in this case the thyroid gland. When the immune system makes antibodies against the thyroid gland, this causes autoimmune thyroiditis, or in better English; Graves’ disease. In Graves’ disease, the body is no longer able to produce sufficient thyroxine due to the attack by the immune system and over time hypothyroidism develops. At this time, medical science does not yet know what the “trigger” is for the immune system to attack the thyroid gland.

Underactive thyroid gland due to Graves’ disease is common in:

  • People with a family history of hypothyroidism,
  • down syndrome,
  • Turner syndrome
  • A history of Graves’ disease
  • Individuals who have other autoimmune diseases such as type 1 diabetes or Addison’s disease.

Some individuals with Hashimoto’s disease develop a goiter, which is a swollen thyroid gland that can be seen through the swollen neck, as a result of their disease.

Other causes of an underactive thyroid

  • Worldwide, hypothyroidism is often caused by a deficiency of iodine in the diet. Iodine is necessary for the production of thyroxine.
  • Hypothyroidism can also be a side effect of taking certain medications, especially Amiodarone and lithium.
  • The problem may also lie in the pituitary gland. The pituitary gland is a gland closely connected to the brain, it produces the hormone TSH. This hormone regulates the production of thyroxine in the thyroid gland. If the pituitary gland does not produce TSH, the thyroid gland no longer produces thyroid hormone.
  • Some children are born with an inactive thyroid gland, which is known as congenital hypothyroidism.

Recognition and diagnosis of hypothyroidism

Blood tests are used to diagnose hypothyroidism. A blood test can also rule out the possibility that the patient’s complaints are related to an underactive thyroid gland. The following determinations are usually made during a blood test.

TSH – the hormone produced by the pituitary gland that stimulates the thyroid gland to produce thyroxine. If there is too little thyroxine circulating in the blood, the pituitary gland produces more TSH to stimulate the thyroid gland. An increased concentration of TSH in the blood may indicate that the thyroid gland is working too slowly.

Thyroxine (T3, T4) T3 and T4 are the names for thyroid hormone in its active and inactive form. If the concentrations are too low, this confirms the diagnosis of hypothyroidism.

Treatment of hypothyroidism.

An underactive thyroid gland is treated by oral intake of Levothyroxine (thyroxine). This replaces the thyroxine that the body does not produce itself. Most patients feel much better soon after starting treatment. It is recommended to take the tablet on an empty stomach (before breakfast).

Dose of Levothyroxine

Most adults need between 50 and 150 micrograms per day. People often start with a low dose and increase it slowly. Especially in elderly people over 60 with heart problems, a lower dose is started. The blood is regularly tested for the thyroxine concentration and the dose is increased or kept stable based on the test results. The tests mainly look at TSH. If the TSH level in the blood is normal, this means that the dose of Levothyroxine is sufficient. During pregnancy, the daily dose of thyroxine can be temporarily reduced due to the development of the fetus.

Side effects of Levothyroxine use in hypothyroidism

The side effects of Levothyroxine are usually limited because it replaces the natural hormone. Although the side effect is rare, it does happen that patients with angina pectoris experience an exacerbation of their complaints. If this is the case, a doctor should be consulted.

When taking Levothyroxine, it is possible that you may experience symptoms associated with an overactive thyroid or hyperthyroidism. Examples include diarrhea, excessive sweating and rapid irritation.

Some medications may interact with Levothyroxine. These include iron supplementation tablets, carbamazepine, phenytoin, warfarin and rifampicin. When you start taking these medications or change the dose, it may be necessary to adjust the thyroxine dose. Your doctor can advise you about this.

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