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Understanding Hypothyroidism

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Understanding Hypothyroidism

Understanding Hypothyroidism

November 06, 2008

By Doris Dickson for Diabetes1

Hypothyroidism is the underproduction of thyroid hormone by the butterfly-shaped thyroid gland located in the front of the neck. This can occur from pathologies at three different levels. Primary hypothyroidism involves a disorder of the thyroid gland itself, which is often a result of an autoimmune disorder. Secondary hypothyroidism involves a failure of the pituitary gland to produce thyroid stimulating hormone (TSH), which acts on the thyroid gland to make thyroid hormone. Tertiary hypothyroidism occurs as a result of a deficiency in thyrotropin-releasing hormone from the hypothalamus. This hormone stimulates the production of TSH in the pituitary which then stimulates secretion of thyroid hormone by the thyroid gland.

What are some of the risk factors of developing hypothyroidism?

Some people are more prone to developing hypothyroidism. You may be at increased risk if you are:

  • The parent or sibling of someone with type 1 diabetes
  • A woman age 50 or older
  • A man age 60 or older
  • Diagnosed with an autoimmune disease such as diabetes, rheumatoid arthritis or lupus.
  • A person who has had thyroid surgery
  • Currently undergoing radiation therapy or have in the past (particularly with radioactive iodine)
  • Taking medications containing iodine or lithium, or amiodarone (Cordarone)

What are the symptoms?

Symptoms of hypothyroidism are vast and varied. Please note that not all patients have all symptoms and that some symptoms may have causes other than hypothyroidism.

  • Absence of sweating
  • Allergy symptoms
  • Anemia
  • Body/joint aches
  • Brain fog (forgetfulness, sluggish thinking, etc.)
  • Bruising
  • Coarse, dry scalp and hair
  • Constantly feeling cold
  • Constantly feeling drained of energy
  • Constipation followed by diarrhea (especially during a woman’s menstrual flow)
  • Depression
  • Droopy eyelids
  • Dry and/or thick skin
  • Edema
  • Frequent colds and flu (immune suppression)
  • Hair loss
  • Headaches
  • Heart palpitations
  • High blood sugar immediately following a meal followed by over insulin production
  • High lipid levels
  • High systolic blood pressure
  • Higher levels of homocysteine
  • Hoarse voice
  • Impaired coordination
  • Infertility/miscarriage
  • Insomnia and sudden waking disrupting sleep
  • Irritable bowel syndrome
  • Joint stiffness
  • Low libido
  • Muscle cramps
  • Muscle weakness
  • Nail brittleness
  • PMS (pre-menstrual syndrome)
  • Puffy face, hands, and feet
  • Reduced heart rate (bracycardia)
  • Seasonal affective disorder (SADS)
  • Swelling around the eyes
  • Swollen abdomen
  • Weak reflexes
  • Weight gain

In Adolescence:

  • Aches
  • Decreased appetite
  • Delayed or premature puberty
  • Depression
  • Fatigue
  • Goiter
  • Headaches
  • Insomnia
  • Irritability
  • Menstrual abnormalities
  • Slowed growth rate

How is a diagnosis of hypothyroidism made?

Primary hypothyroidism is typically diagnosed by a blood test measuring levels of TSH (thyroid stimulating hormone). If a patient has normal levels of TSH, but has many of the above symptoms of hypothyroidism, doctors may complete further tests for secondary or tertiary hypothyroidism. This involves measuring both the total and free levels of T4 (thyroxine) and T3 (triiodothyronine) in the blood. If still inconclusive, doctors may require other diagnostics such as a urine test, cholesterol test, or prolactin measurements.

What are the treatments?

Hypothyroidism is treated by replacing the missing hormone(s). Most doctors prescribe T4 only. However, if a patient continues to be symptomatic, they should discuss a combination of T3 and T4 with their endocrinologist. In addition, some patients are allergic to the dyes in T4 products. Some also have additives that affect their performance. Dye-free formulations are available.

T4 – levothyroxine (e.g. Levoxyl, Synthroid, etc.)
T3/T4 combination (i.e. Thyrolar (aka Liotrix))
T3 – triiodothyronine (i.e. Cytomel (aka Liothyronine))

What if you do not treat hypothyroidism?

If hypothyroidism is left untreated, patients will continue to experience the previously-discussed symptoms. According to Dr. Ken Blanchard, however, even more serious consequences can arise as a result of improper treatment. Hypothyroidism can mask various cardiovascular problems including arteriosclerosis, high blood pressure, reduced heart rate, and a reduced stroke volume, which can reduce blood flow to vital tissues such as the brain and kidneys. Patients experiencing symptoms of hypothyroidism should thus seek medical diagnosis and treatment.

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