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Hypothyroidism - Causes, Clinical Features, Complications, Diagnosis, and Treatment

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Hypothyroidism - Causes, Clinical Features, Complications, Diagnosis, and Treatment

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When the thyroid gland cannot make adequate thyroid hormones, it results in hypothyroidism. To know more, read the article below.

Medically reviewed by

Dr. Zulfiqar Ahmed

Published At August 4, 2022
Reviewed AtJanuary 4, 2024

What Is Hypothyroidism?

The thyroid is one of the most important body parts, as it is responsible for maintaining many vital body functions such as heart rate, managing the digestive system, and more. The term hypo means low, and hence the name hypothyroidism or underactive thyroid indicates a low thyroid level in the body. Though women are more affected by this condition, it is one of the most common conditions among people over 60 years of age. Hypothyroidism is not a serious health condition and can be easily treated with proper medical treatment.

Who Gets Affected by Hypothyroidism?

Hypothyroidism can affect the population of any age and gender. It is a very common condition that usually affects women mostly after menopause than in the initial stages of life.

What Causes Hypothyroidism?

There are several causes of hypothyroidism, and it can be due to either,

  • Primary thyroid gland disorders (primary hypothyroidism).

  • Decreased TSH (thyroid-stimulating hormone) secretion by the pituitary gland (secondary hypothyroidism).

  • Post-surgeries like thyroidectomy for hyperthyroidism or large goiter.

  • Post-ablative causes (radio-iodine therapy for hyperthyroidism).

Causes of the following thyroid conditions are:

  • Primary Hypothyroidism:

    • Removal of some or all parts of the thyroid gland.

    • Following iodine 131 administration for hyperthyroidism.

    • Congenital hypothyroidism.

    • Goitrous (an enlargement of the thyroid gland, often due to iodine deficiency).

  • Hashimoto's thyroiditis is also called acquired thyroiditis. The immune system attacks the thyroid, which is the most common cause.

  • Iodine deficiency.

  • Drug-induced such as lithium, Amiodarone, and Methimazole.

  • Genetic enzyme defects (dys-hormonogenesis).

  • Inflammation of the thyroid.

  • Secondary Hypothyroidism: This condition occurs when the pituitary gland produces insufficient TSH (thyroid-stimulating hormone). This hormone is important for stimulation and normal functioning of the thyroid gland.

  • Destruction of the Pituitary Gland:

    • After surgery.

    • Radiation treatment.

    • Tumor.

What Are the Disorders of the Hypothalamus?

The common cause of hypothyroidism worldwide is iodine deficiency. However, hypothyroidism might occur in areas where iodine deficiency is absent, known as autoimmune thyroiditis. Autoimmune hypothyroidism is initially associated with goiter (Hashimoto's thyroiditis). Later, it becomes atrophic, namely atrophic thyroiditis (organ-specific autoimmune disease).

What Is Known as Central Hypothyroidism?

Central hypothyroidism is a condition where any defect in the pituitary gland can result in thyroid hormone deficiency such as thyroid stimulating hormone or thyrotropin-releasing hormone. This condition can be treated through thyroid hormone replacement therapy.

Who Is at Risk for Hypothyroidism?

The risk of getting hypothyroidism is greater in,

  • Women - Older women are more prone to hypothyroidism than men.

  • People whose close relatives have hypothyroidism or autoimmune disease.

The other risk factors are seen in people with:

  • Type 1 diabetes.

  • Have had surgery for a thyroid problem.

  • Turners syndrome.

  • Autoimmune disorders such as multiple sclerosis, celiac disease, rheumatoid arthritis, Addison's disease, vitiligo, or pernicious anemia.

  • Radiation treatment to the thyroid, chest, or neck.

  • Pregnant or became a mother recently.

  • Lupus (a chronic autoimmune disease).

What Are the Clinical Manifestations of Hypothyroidism?

The initial symptoms of hypothyroidism are gaining weight and fatigue. The symptoms seen in other populations are

1) In Adults: The signs and symptoms vary from person to person, and the important symptoms of hypothyroidism in adults are,

  • General symptoms:

  • Weakness.

  • Cold intolerance.

  • Hair loss.

  • Tiredness.

  • Dry, coarse skin.

  • Loss of color of the skin and mucous membrane.

  • Puffy face, hand, and feet.

  • Goiter (swelling of the thyroid gland).

  • Myxedema (a severe form of hypothyroidism).

  • Poor appetite.

  • Weight gain.

  • Hypothermia (faster loss of body heat).

  • Hoarse voice.

  • Gastrointestinal symptoms:

  • Constipation.

  • Enlarged tongue.

  • Bloating.

  • Reproductive symptoms:

  • Menorrhagia (abnormal menstrual bleeding).

  • Amenorrhea (absence of menstrual bleeding).

  • Infertility.

  • Galactorrhea (milky nipple discharge).

  • Nervous system symptoms.

  • Poor memory.

  • Poor concentration.

  • Numbness.

  • Tingling.

  • Delayed relaxation of deep reflexes.

  • Weakness of hands.

  • Cardiovascular symptoms:

  • Bradycardia (slower than normal heartbeat).

  • Hypertension.

  • Ischemic heart disease (damage to major blood vessels of the heart).

  • Pericardial effusion (extra fluid in the space around the heart).

Prolonged hypothyroidism causes the deposition of hydrophilic mucopolysaccharides in tissues. This results in non-pitting edema (myxedema). As hypothyroidism develops slowly, many people will not be able to notice the signs and symptoms of the disease for several months or years.

2) In Infants or Babies: Infants with hypothyroidism will not have any symptoms. However, if symptoms occur, they may show up the following.

  • Little or no growth.

  • Constipation.

  • Poor feeding habits.

  • Extreme sleepiness.

  • Hoarse cry.

  • Stomach bloating.

  • Cold hands and feet.

  • Low muscle tone.

  • Persistent jaundice (yellowish discoloration of the skin and whites of the eyes).

  • Puffy face.

  • Umbilical hernia (an abnormal opening that makes the organ or the tissue bulge).

  • Swollen tongue.

3) In Children and Teens:

They might also have hypothyroidism with symptoms seen in adults. In addition, they also have:

  • Delayed growth.

  • Delay in puberty.

  • Slower mental development.

  • Delayed eruption of permanent teeth.

What Are the Complications of Hypothyroidism?

If hypothyroidism is untreated, it might lead to various complications such as:

  • Increasing the risk for heart problems.

  • Contributes to high cholesterol.

  • Leading to myxedema coma, a condition where the body's functions slow down to a point, resulting in a life-threatening condition.

  • Increased body weight.

  • Joint pain.

  • Pregnancy complications such as miscarriage, high blood pressure in pregnancy, and premature birth. In addition, it slows down the growth and development of the baby.

complications of hyperthyroidism

How Is Hypothyroidism Diagnosed?

If the patient experiences the symptoms of hypothyroidism, the doctor will ask for the following to confirm the diagnosis.

  • Family history of hypothyroidism.

  • Past and present medical history.

  • Physical examination.

  • Thyroid Function Tests: High serum TSH (thyroid-stimulating hormone) is the earliest indicator of primary hypothyroidism, and when it is low, it indicates secondary hypothyroidism. The serum T4 (thyroxine) is low in hypothyroidism. High serum thyroid-stimulating hormone and normal serum thyroxine might indicate subclinical or mild hypothyroidism, which is the early stage of hypothyroidism. High titer antibodies against thyroglobulin and thyroid peroxidase (TPO) are found in patients with acquired and atrophic thyroiditis.

  • Blood Tests: The blood reports of people with hypothyroidism show,

    • Anemia (normocytic or macrocytic).

    • Increased serum creatine kinase.

    • High serum cholesterol.

    • Increased triglycerides.

    • Elevated LDH (lactate dehydrogenase).

    • Decreased sodium levels in the blood.

If the doctor suspects hypothyroidism with the above diagnosis, then further diagnosis with imaging tests is taken to check for nodules or inflammation.

  • Thyroid scan.

  • Ultrasound.

How Is Hypothyroidism Treated?

Hypothyroidism should be treated with oral Levothyroxine. The treatment usually starts with a low dose (50 to 100 micrograms daily) and gradually increases. In elderly individuals, a smaller starting dose (25 micrograms) is preferred to avoid cardiac side effects. Thyroid-stimulating hormone is monitored periodically, and the dosage adjustment of thyroxine is made accordingly. The ideal goal is to maintain thyroid-stimulating hormone at the lower half of the reference range, and the treatment is needed for the rest of one’s life. The prescription for hypothyroidism can be easily obtained even through teleconsultation.

How Is Hypothyroidism Different From Hyperthyroidism?

Hypothyroidism versus hyperthyroidism is based on the quantity. In the case of hypothyroidism, the amount of thyroid hormone produced is less, whereas, in the case of hyperthyroidism, more amount of hormone is produced. Due to increased thyroid hormone, the metabolism rate is enhanced in the case of hyperthyroidism, whereas in the case of hypothyroidism, the metabolism rate decreases. People affected by hypothyroidism will have difficulty in handling colds, whereas those with hyperthyroidism cannot handle heat. So hypothyroidism and hyperthyroidism are two different extremes where the person should balance the thyroid hormone production.

Hypothyroidism causes face changes as reduced production of thyroid hormone can result in a change in facial features and can cause the following.

  • Facial puffiness.

  • Loss of hair from the eyebrows.

  • Swelling in the eyes.

Does Hypothyroidism Occur in Male?

Usually, hypothyroidism occurs in females of age more than 60 years when compared to males. In some cases, males also get affected where untreated hypothyroidism is related to erectile dysfunction. When hypothyroidism caused in males is associated with any problem in the pituitary gland, then the person can have reduced testosterone levels. If an imbalance in the thyroid hormone causes erectile dysfunction, then treating hypothyroidism can help sort out the problem.

What Is the Outlook of Hypothyroidism?

Hypothyroidism can affect the quality of life and can cause hypothyroidism disability to function normally. The dependency to perform the daily activity of the person depends on the severity of hypothyroidism.

Conclusion:

As a person gets older, it is natural for some changes to occur in our body, such as the low production of thyroid hormones. This is common and can be easily managed with proper medical treatment and a balanced diet. Since there might be other conditions associated with hypothyroidism, it is necessary to consult a doctor regularly to keep track of the treatment progress.

Frequently Asked Questions

1.

How Is Hypothyroidism Managed?

Hypothyroidism is manageable. Regular medication intake helps replace the hormones not secreted by the thyroid gland. Along with medication, proper dietary intake, stress relief, and peptide therapy can also help.

2.

Is Hypothyroidism a Serious Condition?

Hypothyroidism is not a serious condition, but in some rare cases, untreated hypothyroidism may result in fatal conditions like myxoedema. In this condition, the thyroid hormone level reduces drastically, causing confusion, hypothermia, and drowsiness. Myxoedema requires emergency care at the hospital.

3.

What Are the Consequences if the Tsh Level Is High?

When the TSH (thyroid stimulating hormone) is high, it results in hypothyroidism, a condition caused by reduced hormone levels. There are many causes for the occurrence of this condition. This can be treated by replacing the hormone not secreted through medication. 

4.

How Can the Tsh Level Be Reduced?

Through certain lifestyle changes and a healthy diet, the level of TSH can be reduced. Some ways are
- Stop intake of junk food.
- Regular exercise or yoga.
- Sugar-free diet.
- Intake of probiotics, selenium, and vitamin B.
- Gluten-free diet.

5.

Is Hypothyroidism a Lifetime Condition?

If the thyroid gland does not secret some hormones and is underactive, then it is a lifetime condition. Even though doctors prescribe medications and dietary and lifestyle changes help to manage the condition, it cannot be cured completely.
 

6.

What Is the Food That Helps to Manage the Thyroid?

Some dietary changes help to manage the condition. Certain food intake can help manage thyroid; some are
- Roasted seaweed.
- Salted nuts.
- Baked fish.
- Dairy.
- Fresh egg.

7.

What Is Meant by an Unhealthy Tsh Level?

The normal level of TSH is 0.4 to 4.0 milliunits per liter. Hypothyroidism is a condition that is caused when the TSH level exceeds 4.0 milliunits per liter. 

8.

What Is the Normal Range of Tsh?

The normal range of TSH IS 0.5 to 5.0 milliunits per liter.

9.

How Long Does a Thyroid Patient Survive?

Those patients affected by thyroid live longer if they take the medications properly. If the thyroid condition is not treated, then it can result in severe life-threatening complications such as heart disease.

10.

Can Hypothyroidism Revert to Normal?

In some mild cases of hypothyroidism, no symptoms are seen, or the symptoms may cease over time. In the case of these conditions, hypothyroidism will fade away shortly post-treatment and medications. 

11.

What Are the Complications of Hypothyroidism?

Untreated hypothyroidism can result in
- Goiter.
- Infertility.
- Birth defect.
- Myxoedema coma.
- Peripheral neuropathy.
- Heart conditions.

12.

Can Stress Induce Hypothyroidism?

In the case of stress, cortisol is produced, the stress hormone. Cortisol is produced in response to the stressful condition. This hormone can suppress pituitary function and prevent TSH from being secreted. This condition results in hypothyroidism.  

13.

Can Walking Help to Deal With the Thyroid?

One of the natural remedies to manage hypothyroidism is exercise or physical activity. Exercise helps deal with many symptoms like anxiety, fatigue, weight gain, mood swings, etc. Walking can be an alternative option instead of exercise, which helps to reduce weight and can help to deal with hypothyroidism. 

14.

How Is the Thyroid Treated Through Ayurveda?

In the case of thyroid problems, which are considered to be not wholly curable, ayurveda can help to manage the symptoms of this condition. Kanchanar Guggulu is an ayurvedic medicine that helps to deal with the thyroid as it reduces enlargement, increase the production of thyroid hormone, and helps to manage complication. 
Dr. Zulfiqar Ahmed
Dr. Zulfiqar Ahmed

Diabetology

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hypothyroidismunderactive thyroid
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