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Hypothyroidism
What is it?
Hypothyroidism means having lower than normal levels
of thyroid hormones. Thyroid hormones, which are
produced by the thyroid gland in the lower front
portion of the neck, are responsible for the body's
energy production. When levels of thyroid hormones are
abnormally low, the resulting decrease in energy
production interferes with many vital functions,
including heartbeat and temperature regulation.
In 95% of cases, hypothyroidism is due to a problem in
the thyroid gland itself, where the gland simply
produces inadequate amounts of thyroid hormones.
Causes of hypothyroidism includes complications of
either thyroid surgery or radioiodine ablation
treatments for hyperthyroidism (abnormally high levels
of thyroid hormones); an autoimmune disorder, where
the body's
own immune system attacks the thyroid; or an inborn
(congenital) thyroid defect. Short-term hypothyroidism
may also be the result of certain types of thyroid
inflammation or viral thyroid infections.
In about 5% of cases, the cause of hypothyroidism lies
in the hypothalamus or pituitary gland rather than in
the thyroid gland itself. Under normal circumstances,
the hypothalamus (a regulatory center on the underside
of the brain) signals the pituitary gland to produce
TSH, a hormone that stimulates the thyroid. When some
medical problem affects either the hypothalamus or
the pituitary gland, the chain of signals from the
brain to the thyroid may be interrupted. If this
happens, the thyroid gland may not receive the
pituitary's message to produce thyroid hormones, even
though the thyroid itself can function perfectly. This
type of hypothyroidism, called "secondary
hypothyroidism," is usually caused by deficient TSH
production because the pituitary is damaged by tumor,
infection, sarcoidosis, or metastatic cancer.
Hypothyroidism, less often, is the result of an injury
to the hypothalamus.
Currently, about 1% of American adults have some form
of hypothyroidism, although the problem is more common
in the elderly. About 1 in every 5000 babies is born
with congenital hypothyroidism.
Symptoms
In adults, hypothyroidism causes the following
symptoms: lack of energy; a constant tired feeling;
constipation; abnormal sensitivity to cold
temperatures; muscle cramps and stiffness; weight
gain (often in spite of poor appetite); dry skin and
hair; hair loss; hoarseness or husky voice; slowed
heart rate; and sometimes psychiatric symptoms,
including depression. If hypothyroidism remains
untreated, a cluster of symptoms called myxedema may
appear,including: a dull, expressionless face;
thin hair; puffiness around the eyes; large tongue;
and thick skin that feels cool and doughy. In babies
born with congenital hypothyroidism, there may be a
hoarse cry,
unusual sleepiness, constipation, and feeding
problems. If hypothyroidism is not treated, the child
may have unusually short stature, dry skin, thin hair,
an
unusual facial appearance, a protruding abdomen,
delayed eruption of teeth, and impaired mental
development. When hypothyroidism strikes an older
child, puberty may be delayed, and other symptoms are
similar to those seen in adults.
What your doctor looks for
Your doctor will perform a physical examination with
particular attention to the thyroid gland, which is
sometimes (but not always) enlarged. Your doctor will
also check for characteristic signs of hypothyroidism
in your skin, hair, heart, and abdomen.
Diagnosis
Your doctor will make the diagnosis of hypothyroidism
by ordering blood tests for levels of thyroid hormones
and serum TSH. An elevated TSH is the most sensitive
test for hypothyroidism resulting from abnormalities
of the thyroid itself. Your doctor may also order
blood tests for cholesterol and other blood
components, which are often abnormal in persons with
hypothyroidism. In patients with symptoms or physical
findings involving the heart, an electrocardiogram
(ECG or "EKG") and other cardiac tests may be done.
Expected duration
In patients with short-term hypothyroidism due to
certain types of thyroid inflammation or viral thyroid
infections, levels of thyroid hormones usually
return to normal after several months. In other
patients with hypothyroidism,the disorder is a
life-long problem.
Prevention
No lifestyle changes or immunizations can prevent
hypothyroidism.
Treatment
Hypothyroidism is treated with replacement doses of
thyroid hormones. Synthetic forms of these hormones
are used (levothyroxine, liothyronine, or liotrix). In
patients whose hypothyroidism is due to a problem in
the hypothalamus or pituitary gland, hydrocortisone
may be given first to prevent an adrenal insufficiency
triggered by thyroid replacement therapy.
When to call your doctor
Call your doctor if you have the symptoms of
