Hypothyroidism: Symptoms, Treatment, and Prevention

What is the Thyroid Gland?

The thyroid gland is a small but vital organ that regulates the body's metabolic processes and energy consumption by producing two hormones: thyroxine (T4) and triiodothyronine (T3). Iodine is essential for the synthesis of these hormones; therefore, insufficient dietary iodine intake can have adverse consequences, particularly during pregnancy and childhood. T4 and T3 circulate in the blood bound to transport proteins, with only the small free portion (FT3 and FT4) exhibiting hormonal activity. TSH, a hormone secreted by the pituitary gland (located at the base of the skull), stimulates thyroid function and growth. In hypothyroidism (underactive thyroid), TSH levels are elevated, while in hyperthyroidism (overactive thyroid), TSH levels are low. Laboratory tests reveal low TSH, high FT4, and high FT3 in hyperthyroidism, and high TSH with low FT3 and FT4 in hypothyroidism.

 

What is Hypothyroidism?

Hypothyroidism is a condition where the thyroid gland doesn't produce enough hormones.

 

The thyroid gland, located at the base of the neck, produces thyroid hormones, thyroxine (T4) and triiodothyronine (T3) (Video). Thyroid-stimulating hormone (TSH), secreted by the pituitary gland (within the skull), controls their production.

 

Thyroid hormones regulate crucial bodily functions, including metabolic processes (chemical transformations in cells producing energy and maintaining cellular functions), respiration, heart rate, body temperature, central nervous system development, and body growth.

 

Insufficient thyroid hormone production, known as hypothyroidism, presents with varying symptoms and signs depending on the age of onset.

 

What are the causes of Hypothyroidism?

Major causes of hypothyroidism include:

 

  • Iodine deficiency: Thyroid hormones require iodine; deficiency leads to "iodine deficiency disorders."
  • Thyroiditis, especially chronic autoimmune thyroiditis (Hashimoto's thyroiditis), a common cause. This autoimmune disease damages thyroid cells, often triggered by an immune system error or viral infection. Some forms can be temporary.
  • Thyroid removal, sometimes necessary due to nodules, tumors, or treatment-resistant hyperthyroidism.
  • Radioactive treatment, used for hyperthyroidism, goiter, or thyroid tumors.
  • Pituitary lesions (tumors, surgery, or radiotherapy) affecting TSH production, leading to insufficient thyroid hormone production.
  • Medications such as lithium, amiodarone, and interferon.
  • Congenital hypothyroidism (CH), present at birth.

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Who is Affected?

In adults, Hashimoto's thyroiditis is the most frequent cause. It can also occur after radioactive iodine treatment or thyroid surgery for hyperthyroidism. Less commonly, it results from reduced pituitary TSH production. Congenital hypothyroidism is present from birth due to abnormal thyroid development.

 

What are the Risk Factors?

Certain factors increase the risk:

  • Sex: Women are more prone to thyroid dysfunction.
  • Age: Over 50 years old.
  • Prior thyroid problem: Previous thyroid issues during pregnancy or family history increases risk.
  • Smoking: Smokers and former smokers have a higher risk of autoimmune thyroid dysfunction.

What are the main symptoms of hypothyroidism?

In adults, symptoms develop gradually and are often subtle.

 

These include:

  • Fatigue
  • Cold sensitivity
  • Constipation
  • Dry skin
  • Weight gain
  • Facial swelling
  • Hoarseness
  • Muscle weakness and pain
  • Joint stiffness, swelling, or pain
  • High cholesterol (hypercholesterolemia)
  • Irregular menstrual cycles
  • Hair loss
  • Slow heart rate (bradycardia)
  • Depression
  • Memory problems

How to prevent hypothyroidism?

Iodine is obtained solely through diet. Iodine deficiency can cause decreased IQ, neurological deficits, goiter, nodules, or hyperthyroidism, depending on severity and age. A varied diet including fish, milk, and cheese, and iodized salt, helps prevent this.

 

What is the treatment?

Treatment typically involves daily levothyroxine (T4) to restore hormone levels and alleviate symptoms. It's usually taken orally in tablet form, on an empty stomach in the morning, at least 30 minutes before eating.

 

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