Hypothyroidism

Hypothyroidism, also known as an underactive thyroid, is a common condition where the thyroid gland doesn't produce enough of certain crucial hormones. Since thyroid hormones control how the body uses energy, a lack of them can slow down many bodily functions. 

Common causes 

  • Autoimmune disease (Hashimoto's thyroiditis): The most common cause in the United States, this is when your body's immune system mistakenly attacks and damages your thyroid gland.

  • Iodine deficiency: The thyroid needs iodine to produce hormones. A diet with too little iodine is a major cause of hypothyroidism worldwide, though it's rare in places where table salt is fortified with iodine.

  • Thyroid surgery or radiation: If all or part of the thyroid gland is surgically removed, or if it's been treated with radiation for cancer or other thyroid conditions, it may not produce enough hormone.

  • Thyroiditis: Inflammation of the thyroid gland, often caused by a viral infection or an autoimmune issue, can cause a temporary period of high hormone levels followed by low levels.

  • Certain medications: Drugs used to treat psychiatric or heart conditions, such as lithium and amiodarone, can interfere with the thyroid's ability to produce hormones. 

Signs and symptoms 

The symptoms of hypothyroidism often develop slowly over time and can be mistaken for other conditions or the natural process of aging. They can include:

  • Fatigue: Feeling tired and sluggish, even with enough sleep.

  • Weight gain: Gaining weight without changes in diet or exercise.

  • Increased sensitivity to cold: Feeling cold all the time.

  • Dry skin and hair: Having skin that is dry and coarse, or hair that is thinning.

  • Constipation: Changes in digestion can lead to infrequent bowel movements.

  • Puffy face: Facial swelling, especially around the eyes.

  • Hoarseness: A deeper, rougher voice.

  • Muscle and joint aches: Pain, stiffness, and weakness.

  • Depression: Mood changes or depression can be a symptom. 

Diagnosis 

Diagnosing hypothyroidism requires a visit to your doctor, who will typically follow these steps:

  • Reviewing your medical history and symptoms: Your doctor will ask about your symptoms and discuss any family history of thyroid or autoimmune diseases.

  • Physical exam: A doctor may feel your neck to check for an enlarged thyroid, known as a goiter. They may also look for physical signs of hypothyroidism, like dry skin or brittle hair.

  • Blood tests: A simple blood test is the definitive way to confirm a diagnosis.

    • TSH Test: This measures your level of thyroid-stimulating hormone. A high TSH level can mean the pituitary gland is working overtime to get a sluggish thyroid to produce more hormone.

    • T4 Test: This measures the amount of thyroid hormone in your blood. Low levels of T4, especially with a high TSH, confirm hypothyroidism.

  • Antibody tests: If Hashimoto's disease is suspected, a blood test can check for specific antibodies that indicate an autoimmune attack on the thyroid. 

Treatment 

For most people, hypothyroidism is a highly manageable condition.

  • Hormone replacement therapy: The standard treatment involves taking a synthetic thyroid hormone pill, most commonly levothyroxine, every day. This medication replaces the hormones your thyroid isn't making enough of.

  • Finding the right dose: Finding the correct dose of levothyroxine is a process that involves your doctor, and it may be adjusted over time based on follow-up blood tests.

  • Lifelong commitment: In most cases, treatment for hypothyroidism is lifelong. Stopping the medication will cause symptoms to return.

  • Symptom improvement: With the correct dose of medication, many people start to feel better within a couple of weeks, and their symptoms often resolve completely.

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