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Hypothyroidism – Causes, Symptoms and Treatment

Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones, leading to symptoms such as fatigue, weight gain, and cold sensitivity.

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Things worth knowing about "Hypothyroidism"

Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones, leading to symptoms such as fatigue, weight gain, and cold sensitivity.

What is Hypothyroidism?

Hypothyroidism, also known as an underactive thyroid, is a condition in which the thyroid gland fails to produce sufficient amounts of thyroid hormones. The thyroid is a butterfly-shaped gland located at the front of the neck. It produces the hormones thyroxine (T4) and triiodothyronine (T3), which regulate metabolism, body temperature, heart function, and many other vital processes. When thyroid hormone levels are too low, all of these functions slow down.

Causes

There are several possible causes of hypothyroidism:

Hashimoto thyroiditis: The most common cause in developed countries. This is an autoimmune condition in which the immune system attacks and gradually destroys the thyroid gland.
Iodine deficiency: Iodine is an essential component for thyroid hormone synthesis. A lack of iodine can lead to underproduction.
Thyroid surgery or radiation therapy: Partial or complete removal of the thyroid gland, or radiation treatment in the neck area, can result in hypothyroidism.
Congenital hypothyroidism: Some infants are born with an underdeveloped or absent thyroid gland.
Medications: Certain drugs such as lithium or amiodarone can interfere with thyroid function.
Pituitary gland disorders: If the pituitary gland does not produce enough TSH (thyroid-stimulating hormone), the thyroid is not adequately stimulated to produce hormones.

Symptoms

Because thyroid hormones affect virtually every system in the body, the symptoms of hypothyroidism are wide-ranging and often develop gradually:

Persistent fatigue and low energy
Unexplained weight gain
Increased sensitivity to cold
Constipation
Dry skin and brittle hair or nails
Slowed heart rate (bradycardia)
Depression and slowed thinking
Hoarse voice
Puffiness around the face, especially around the eyes
Muscle aches, tenderness, or weakness
Irregular menstrual cycles in women

Diagnosis

Hypothyroidism is primarily diagnosed through a blood test. The following values are typically measured:

TSH level: An elevated TSH level is usually the first sign of an underactive thyroid. The pituitary gland increases TSH production in an attempt to stimulate the sluggish thyroid.
Free T4 and free T3: These free thyroid hormone levels are typically low in confirmed hypothyroidism.
Antibodies (TPO antibodies, Tg antibodies): If Hashimoto thyroiditis is suspected, specific autoantibodies are measured in the blood.

An ultrasound examination of the thyroid may also be performed to assess the size, structure, and tissue characteristics of the gland.

Treatment

The standard treatment for hypothyroidism is daily oral supplementation with levothyroxine, a synthetic form of the T4 hormone. It replaces the missing thyroid hormone and restores normal metabolic function. The dosage is individually tailored and regularly monitored through blood tests.

Levothyroxine is typically taken in the morning on an empty stomach, about 30 minutes before breakfast.
Most patients need to take this medication for the rest of their lives.
In cases of Hashimoto thyroiditis, an anti-inflammatory or gluten-free diet may provide additional support, but does not replace medical treatment.
If iodine deficiency is the underlying cause, targeted iodine supplementation may be recommended.

References

Garber JR et al. - Clinical Practice Guidelines for Hypothyroidism in Adults. Thyroid. 2012;22(12):1200-1235. DOI: 10.1089/thy.2012.0205
World Health Organization (WHO): Iodine deficiency disorders. www.who.int
Jonklaas J et al. - Guidelines for the Treatment of Hypothyroidism. Thyroid. 2014;24(12):1670-1751. DOI: 10.1089/thy.2014.0028

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