Hypothyroidism, a common endocrine disorder of the thyroid, affects almost 200 million people worldwide. In India, Hypothyroidism affects around 42 million people, and that is quite alarming. Hypothyroidism is an underactive thyroid occurring when the thyroid gland, located at the base of your neck, doesn’t produce enough thyroid hormones, particularly thyroxine (T4) and triiodothyronine (T3). These hormones play a crucial role in regulating various bodily functions, so when their levels are insufficient, it can lead to a range of health problems, like elevated cholesterol and cardiac problems, over time. Common causes are autoimmune diseases, such as Hashimoto’s thyroiditis, surgical removal of the thyroid, and radiation treatment.

What is Hypothyroidism, an Overview

Your thyroid is a small, butterfly-shaped gland in the front of your neck below the Adam’s apple (in males) or near the larynx in females. The thyroid’s job is to produce hormones that contribute to energy use and bodily function in almost every organ of the body. Thyroid hormones affect your breathing, heart rate, weight, digestion, and mood. The main hormones produced by the thyroid gland are thyroxine or tetraiodothyronine (T4) and triiodothyronine (T3). Sometimes, the thyroid malfunctions, producing too much or too little of these hormones, resulting in hypothyroidism or hyperthyroidism.

Hypothyroidism is also diagnosed by a sensitive serum marker called TSH or Thyroid Stimulating Hormone. In hypothyroidism, the body produces more TSH to force the thyroid to work, which means HIGH TSH indicates hypothyroidism. One of the possible common causes of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune condition where the immune system attacks the thyroid gland.

Symptoms of Hypothyroidism

Hypothyroidism can be a sneaky condition, as its symptoms often overlap with those of other health issues. In its early phases, hypothyroidism may not cause noticeable symptoms, but untreated Hypothyroidism can lead to a slowdown of the body’s metabolic processes. Understanding the symptoms is essential for early detection and management. Here are some common signs of Hypothyroidism:

Fatigue: Unexplained fatigue and a constant feeling of exhaustion are often among the earliest signs. Hypothyroidism can make even the simplest daily tasks feel overwhelming.

Weight Gain: Unintended weight gain, despite maintaining a healthy diet and exercise routine, is a classic symptom. This occurs because a sluggish thyroid can slow down your metabolism.

Cold Sensitivity: Hypothyroidism can cause an increased sensitivity to cold temperatures. You might find yourself shivering in situations where others feel comfortable.

Muscle Weakness: Weakness in the muscles and joint pain can be experienced. These issues may interfere with your daily activities and exercise routines.

Constipation: Sluggish digestion is another common symptom. Many people with hypothyroidism experience constipation due to the slowdown in gut motility.

Dry Skin and Hair: Dry, flaky skin and brittle hair are often associated with Hypothyroidism. Your skin may become dry, pale, and coarse.

Irregular Periods: Women with Hypothyroidism may experience irregular menstrual cycles or even heavy, prolonged periods.

Memory and Cognitive Issues: Thyroid hormones are vital for brain function. Hypothyroidism can lead to memory problems, difficulty concentrating, depression, irritability, and mental fogginess.

High Cholesterol: Elevated levels of LDL cholesterol (the “bad” cholesterol) can result from an underactive thyroid, increasing the risk of heart disease.

Bradycardia: Hypothyroidism is commonly associated with sinus bradycardia or low heart rate, low QRS complexes, prolonged QT interval, and conduction blocks but rarely may cause arrhythmias.

Causes of Hypothyroidism

Understanding the underlying causes of Hypothyroidism is crucial for proper diagnosis and treatment. There are several reasons why the thyroid gland may not produce enough hormones:

Autoimmune Thyroiditis (Hashimoto’s Disease): This is the most common cause of Hypothyroidism. In Hashimoto’s disease, the immune system mistakenly attacks and damages the thyroid gland, mistaking thyroid gland cells as invaders. This leads to a lack of thyroid cells and enzymes needed to make enough thyroid hormone. Hashimoto’s is more common in women than men. The most common forms are Hashimoto’s thyroiditis and atrophic thyroiditis.

Thyroid Surgery or Radiation Therapy: If you’ve had thyroid surgery or received radiation therapy in the neck area, there’s a risk of developing Hypothyroidism. In some cases, the thyroid gland may be partially or entirely removed to treat other conditions, such as thyroid cancer.

Medications: Certain medications, like lithium and amiodarone, can interfere with thyroid hormone production. If you’re on such medications, your doctor should monitor your thyroid function regularly.

Lack of Iodine. The thyroid gland needs iodine to produce thyroid hormones. Insufficient intake of iodine or iodine deficiencies can lead to Hypothyroidism. Excess iodine can worsen Hypothyroidism in those already having the condition.

Pituitary Gland Disorder: A rare condition where the pituitary gland fails to make enough thyroid-stimulating hormone (TSH). This could be due to a noncancerous tumor of the pituitary gland.

Pregnancy: Some women may develop Hypothyroidism during or after pregnancy, a condition known as postpartum thyroiditis. It usually resolves on its own but may require treatment in some cases.

Aging: As people age, the risk of hypothyroidism increases. This is often due to gradual wear and tear on the thyroid gland.

Diagnosing Hypothyroidism

Diagnosing hypothyroidism typically involves a combination of clinical evaluation, medical history, and laboratory tests. During a clinical Evaluation, your doctor will discuss your medical history and evaluate your symptoms if they are consistent with hypothyroidism and there are no other underlying issues. In more progressive cases of unchecked hypothyroidism, there may be swelling of the thyroid gland called goiter, dry skin, and brittle hair and nails.

Thyroid Function Tests

The primary way to diagnose hypothyroidism is through blood tests that measure the levels of thyroid hormones T4 and thyroid-stimulating hormone (TSH) in the blood. These tests typically include:

• TSH Test: Elevated TSH levels are often indicative of hypothyroidism, as the pituitary gland releases more TSH to stimulate the thyroid to produce more hormones when thyroid hormone levels are low.  If your TSH is high, and thyroid hormone T4 is low, then the diagnosis is hypothyroidism. In some cases, the thyroid hormone T-3 may be measured as well. If your T3 and T4 are normal with an elevated TSH, it is considered subclinical hypothyroidism.

• Free T4 (thyroxine) Test: Measures the levels of free thyroxine, the active form of thyroid hormone in the blood.

• Free T3 (triiodothyronine) Test: Measures the levels of free triiodothyronine, another thyroid hormone.

• Thyroid Antibody Tests: In some cases, autoimmune thyroid diseases like Hashimoto’s thyroiditis can cause hypothyroidism. Thyroid antibody tests, such as anti-thyroid peroxidase (TPO) and anti-thyroglobulin antibodies, can help identify autoimmune thyroid conditions.

• Imaging: In some cases, an ultrasound of the thyroid gland may be performed to check for abnormalities, such as the presence of nodules or inflammation.

• Other Tests: Rarely, additional tests, like a radioactive iodine uptake test, may be required to assess thyroid function in more complex cases.

Treatments for Hypothyroidism

Hypothyroidism is a manageable condition with several treatment options available, each tailored to the specific needs of the patient.

Thyroid Hormone Replacement

The most common and effective treatment for Hypothyroidism involves taking synthetic thyroid hormones like Levothyroxine (Eltroxin). Usually, a doctor will adopt a wait-and-watch if you really need medication or not because it is a lifelong dosage. In subclinical Hypothyroidism, with TSH >10 mIU/L, it isn’t always necessary to start medication because chances are your thyroid might return to normal or remain within a manageable level where minor symptoms aren’t visible or affecting the quality of life.

Regular Monitoring

After starting thyroid hormone replacement therapy, routine blood tests are necessary to monitor your hormone levels. Your doctor will adjust your medication dosage if needed to ensure your thyroid hormones are within the optimal range.

Lifestyle Modifications

While medication is the primary treatment, specific lifestyle changes can complement your treatment and improve your overall well-being. These may include a balanced diet, regular exercise, stress management, and getting enough sleep.

Iodine Supplements

If your Hypothyroidism is due to iodine deficiency, your doctor may recommend iodine supplements or dietary adjustments to increase your iodine intake. However, iodine deficiency as a cause of Hypothyroidism is rare in areas with iodized salt. Do not dose yourself with iodine unless advised by a doctor because it might just make your condition worse.

Surgery

In cases of thyroid nodules or goiters that do not respond to medication or other treatments, surgery to remove part or all the thyroid gland may be necessary. This is generally a last resort.

Management of Other Conditions

If Hypothyroidism is caused by an underlying condition, such as Hashimoto’s disease or pituitary gland issues, managing the root cause is an essential part of treatment.

Alternative and Complementary Therapies

Some individuals explore complementary therapies like acupuncture or dietary supplements. While these can provide symptom relief for some, it’s important to discuss these options with your healthcare provider to ensure they do not interfere with your prescribed treatment.

Hypothyroidism is a common condition with a wide range of symptoms, which can often be subtle and easily confused with other health issues. Understanding the symptoms and causes of the condition is essential for early diagnosis and treatment. Fortunately, with appropriate medication, lifestyle modifications, and regular monitoring, individuals with Hypothyroidism can lead healthy and fulfilling lives. If you suspect you have Hypothyroidism or are experiencing its symptoms, it’s crucial to consult a healthcare professional for a proper diagnosis and treatment plan tailored to your specific needs.