Hypothyroidism: Symptoms, Risk Factors and Treatments

Fatigue. Weight gain. Sensitivity to cold. Constipation. Anxiety/depression. Hair loss. Joint/muscle weakness. When these symptoms are unexplained and found in conjunction with one another, they are often a sign of hypothyroidism, which is a very common disorder. The thyroid is a small, butterfly shaped gland located at the base of the neck, just below the Adam’s apple. It is fairly large and consists of two lobes joined by a central mass called the isthmus. It is responsible for making two hormones, thyroid hormone and calcitonin.

Thyroid hormone is often referred to as the body’s major metabolic hormone. (Keller, 2016) When the thyroid does not produce enough of this hormone, homeostasis is upset. Hypothyroidism slows metabolism and decreases growth or repair of many parts of the body. If left untreated, it can cause many health problems, such as obesity, joint pain, infertility and heart disease. Fortunately, there are many accurate thyroid function tests to aid in diagnosis of hypothyroidism, and treatment with synthetic thyroid hormone is usually simple, safe and effective once the right dose is determined.

Signs and Symptoms

Hypothyroidism presents with many symptoms that are common to many other disorders. However, when found in conjunction, they very well may signal dysfunction of the thyroid gland. Fatigue is often a common complaint, as the thyroid controls energy balance. Patients often complaint of feeling unrested though they might be sleeping more. This leads to feeling exhausted and sluggish often without good reason or explanation. Weight gain is another common complaint.

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Lack of thyroid hormone signals the body’s metabolism to switch modes, and the basal metabolic rate decreases. Rather than burning calories for energy and growth, the liver, muscles and fat tissue hold onto calories. More of these calories are stored as fat, thus leading to weight gain. Patients experience an average weight gain of 15-30 pounds despite a good diet and exercise program. (Healthline) This switch in metabolism also translates to catabolism, which causes the body to break down tissues like muscle for energy. This leads to muscle and joint weakness. In fact, patients with hypothyroidism are twice as likely to complain of weakness compared to a healthy person. (Healthline) Patients also report feeling cold. Heat is generated by burning calories. The reduction in the metabolic rate decreases calories burned, hampering normal heat production.

Hypothyroidism also plays upon brown fat, a specialized type of fat that generates heat. Overall, normal heat production is slowed, leaving the patient feeling cold. Constipation, due to effects on the colon, can also be associated with the disorder, especially when it accompanies other symptoms. Many with later onset symptoms may experience a slower than normal heart rate, hoarse voice and decreased hearing, taste and smell. In women, thyroid hormones directly affect the ovaries and uterus, and abnormal levels of thyroid hormone can cause heavy or irregular periods, or even infertility. Many men with untreated hypothyroidism experience decreased libido, erectile dysfunction, and delayed ejaculation. (Mayo Clinic Staff, 2018) Other physical symptoms include hair loss and dry, itchy skin. Hair follicles are regulated by thyroid hormone, and they have stem cells that have a short life span and fast turnover, as do skin cells. Both are very sensitive to losing growth signals from the thyroid hormone. Since the normal cycle of renewal is disrupted, skin may take longer to grow. The outer layer of skin takes longer to shed, leading to flaky, dry skin.

Myxedema, a red, swollen rash, is a condition that it is sometimes a characteristic of thyroid problems. In one study, 25-30% of patients seeking treatment for hair loss were found to be deficient in thyroid hormone. This increased to 40% in patients over 40 years of age. (Healthline) Mental health can also be affected greatly by hypothyroidism. Many patients note trouble concentrating or focusing, described as mental fogginess. Memory may also be impaired. In one study, 22% of patients reported increased difficulty doing everyday math, 36% thinking more slowly and 39% poorer memory. Hypothyroidism is also associated with depression. In patients diagnosed with the disorder, 44% of women and 57% of men admit to feelings of depression, with the same percentage experiencing anxiety. (Healthline) Fortunately, all these symptoms seem to improve with thyroid hormone replacement therapy and tend to become more severe without treatment.

Prevalence and Statistics

Hypothyroidism is common, with approximately 12% of people experiencing abnormal thyroid function at some time during their lives. Women are 8 times more likely to develop it than men, and the risk of thyroid problems increases with age. (Healthline) Children and adolescents can develop hypothyroidism, or it can be congenitally conferred. Hypothyroidism tends to affect adults differently than children, and younger patients can develop intellectual and physical disabilities if they remain untreated.

Cause

The most common cause of hypothyroidism in the United States is Hashimoto’s Disease. Hashimoto’s thyroiditis is an autoimmune disorder, in which the immune system produces antibodies that attack the body’s own tissues. The antibodies affect the thyroid’s ability to produce thyroid hormone. It is unknow if the disorder is caused by bacteria or virus or a congenital defect. Sometimes treatment for hyperthyroidism, which is when the body produces too much thyroid hormone, will tip a person into permanent hypothyroidism. Surgery to remove all or part of the thyroid gland can cause decrease or stop in production of thyroid hormone. Radiation to treat cancers of the head and neck can often affect thyroid function. Some medication can contribute to a decrease in thyroid function as well. In less common instance, congenital factors can cause hypothyroidism. Some babies are born without a thyroid or with a defective gland. Others inherit a form of the disorder. Sometimes, it is caused by a pituitary tumor, which causes a lack of thyroid stimulating hormone, or TSH. Some women develop hypothyroidism during or after pregnancy due the to creation of antibodies that attack the thyroid gland. Another cause can be attributed to iodine deficiency, which is essential to the production of thyroid hormone. Iodine deficiency can cause what is called a goiter, or enlargement of the thyroid gland. Sometimes the opposite is true, and it can occur in response to too much iodine. (Mayo Clinic Staff, 2018)

Risk Factors

Although anyone can develop hypothyroidism, there is increased risk for those who:

• Are a woman older than age 60
• Have an autoimmune disease
• Have a family history of thyroid disease
• Have other autoimmune diseases, such as rheumatoid arthritis or lupus, a chronic inflammatory condition
• Have been treated with radioactive iodine or anti-thyroid medications
• Received radiation to your neck or upper chest
• Have had thyroid surgery (partial thyroidectomy)
• Have been pregnant or delivered a baby within the past six months (Mayo Clinic Staff, 2018)

Prevention

Unfortunately, there is not really anything that can be done to prevent the onset of hypothyroidism. In developed countries, diets adequate in iodine are staple. The focus is then switched to preventing hypothyroidism from becoming a serious health issue. Educating oneself and understanding the risk factors, your symptoms, getting diagnosed early on and beginning treatment are the best ways to prevent serious health complications. Some believe more natural means such as following a Mediterranean diet, avoiding certain foods such as soy products, processed foods and cruciferous vegetables such broccoli, cabbage and kale, and supplementation of selenium, vitamin D and probiotics contribute to a healthy thyroid and avoiding hypothyroidism. (Berber, 2011)

Tests and Diagnosis

Blood tests are the primary means for diagnosing hypothyroidism. Three of these tests ate the TSH test, T4 test and thyroid autoantibody test. Tests measure the level of TSH and sometimes the level of thyroxine. A low level of thyroxine and high level of TSH indicate an underactive thyroid. This is due to the pituitary producing more TSH to stimulate your thyroid gland into producing more thyroid hormone. Positive thyroid antibodies in combination with elevated TSH serum or alone are often associated with significantly increased risk of developing hypothyroidism. The blood tests are very sensitive, and physicians are often able to diagnose hypothyroidism often before symptoms appear. (Smith)

Complications

If left untreated, hypothyroidism can lead to several complications and health issues. Due the lowered metabolism, obesity can occur. There is an increased risk of heart disease due to elevated levels of low-density lipoprotein (LDL) or “bad cholesterol.” It can also lead to an enlarged heart and heart failure. Peripheral neuropathy can be caused by damage to the peripheral nerves, leading to pain numbness and tingling of the affected area. Myxedema is a rare, life-threatening condition can occur as result long-term untreated hypothyroidism. It is characterized by intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness. It requires immediate, emergency medical treatment. Since thyroid hormone directly affects the ovaries, fertility can be impaired, and there is a higher risk of birth defects in untreated mothers. Goiter, or enlargement of the thyroid gland, can occur in response to the constant stimulation of the thyroid gland. It can affect breathing and swallowing, as well as outward appearance. Mental health issues can be a serious complication of untreated hypothyroidism due to increased incidence of depression and anxiety, which tend to increase in severity over time. (Mayo Clinic Staff, 2018)

Treatment and Drugs

Based on blood tests, doctors typically prescribe the synthetic thyroid replacement hormone, levothyroxine. It is often sold under the brand names Levothroid or Synthroid. TSH tests are usually repeated every few months to determine and maintain the proper dosage of the medication. The medication restores appropriate hormone levels and reverses the symptoms of the disorder. Levothyroxine has virtually no side effects if the proper dose is being received and it is fairly inexpensive. Contraindications to the medication include certain foods, such as soy, and certain supplements such as calcium and iron, which can interfere with absorption. (Mayo Clinic Staff, 2018) Natural recommendations would include following a healthy diet rich in proteins and fat, such as the Mediterranean diet, avoiding soy products and caffeine, and supplementing with a probiotic. Other recommendations include managing stress levels, which can affect thyroid function, and following a regular exercise program. (Mulpeter, 2015) (Grunewald)

Prognosis

Although hypothyroidism cannot be cured, the symptoms and potential health issues can be reduced or eliminated with proper diagnosis and treatment. Medications can be administered with minimal side effects and often reduce or reverse symptoms of the disorder, which leads to improved quality or life. Of course, it is always recommended to incorporate a healthy diet and exercise into your lifestyle for maximum benefit and overall wellbeing.

Bibliography

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3. Healthline. (n.d.). 10 Signs and Symptoms of Hypothyroidism. Retrieved from Healthline.com: https://www.healthline.com/nutrition/hypothyroidism-symptoms
4. Keller, S. M. (2016). Essentials of Human Anatomy and Physiology. New York, New York: Pearson.
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8. Smith, M. T. (n.d.). How to Recognize Symptoms of Hypothyroidism. Retrieved from WikiHow: https://www.wikihow.com/Recognize-Symptoms-of-Hypothyroidism
9. Steinberg, M. (2018). Signs and Symptoms of Hypothyroidism. Retrieved from Bellingham Naturopathic Clinic: https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiQj9yoy_DeAhUOT98KHco6AJMQjhx6BAgBEAM&url=http%3A%2F%2Fwww.bellinghamnaturopathic.com%2Fhypothyroidism-low-thyroid-causes-and-treatments%2F&psig=AOvVaw3m3r5xhd5mKIercqK7Iwdg&ust=
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