HYPOTHYROIDISM
WHAT IS THE THYROID GLAND?
The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.
WHAT IS HYPOTHYROIDISM?
Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can’t make enough thyroid hormone to keep the body running normally.
WHAT ARE THE SYMPTOMS?
When thyroid hormone levels are too low, the body’s cells can’t get enough thyroid hormone and the body’s processes start slowing down. As the body slows, you may notice that you feel colder, you tire more easily, your skin is getting drier, you’re becoming forgetful and depressed, and you’ve started getting constipated. The symptoms are generally variable and nonspecific.
KEEPING OTHER PEOPLE INFORMED
Tell your family members. Because thyroid disease runs in families, you should explain your hypothyroidism to your relatives and encourage them to get periodic TSH tests. Tell your other doctors and your pharmacist about your hypothyroidism and the drug and dose with which it is being treated.
WHAT CAN YOU EXPECT OVER THE LONG TERM?
There is no cure for hypothyroidism, and most patients have it for life. There are exceptions: many patients with viral thyroiditis have their thyroid function return to normal, as do some patients with thyroiditis after pregnancy. Hypothyroidism may become more or less severe, and your dose of thyroxine may need to change over time. You have to make a lifetime commitment to treatment. But if you take your pills every day and work with your doctor to get and keep your thyroxine dose right, you should be able to keep your hypothyroidism well controlled throughout your life.
HOW IS HYPOTHYROIDISM DIAGNOSED?
The correct diagnosis of hypothyroidism depends on the following:
• Symptoms: Hypothyroidism doesn’t have any characteristic symptoms. One way to help figure out whether your symptoms are due to hypothyroidism is to think about whether you’ve always had the symptom (hypothyroidism is less likely) or whether the symptom is a change from the way you used to feel (hypothyroidism is more likely).
• Medical and family history: whether any of your family members have thyroid disease.
• Physical exam: The doctor will check your thyroid gland and look for changes such as dry skin, swelling, slower reflexes, and a slower heart rate.
• Blood tests: There are two blood tests that are used in the diagnosis of hypothyroidism. • TSH (thyroid-stimulating hormone) test. This is the most important and sensitive test for hypothyroidism. It measures how much of the thyroid hormone thyroxine (T4) the thyroid gland is being asked to make. An abnormally high TSH means hypothyroidism. • T4 tests.
HOW IS HYPOTHYROIDISM TREATED?
THYROXINE (T4) REPLACEMENT: Hypothyroidism can’t be cured. But in almost every patient, hypothyroidism can be completely controlled. It is treated by replacing the amount of hormone that your own thyroid can no longer make, to bring your T4 and TSH levels back to normal levels. So even if your thyroid gland can’t work right, T4 replacement can restore your body’s thyroid hormone levels and your body’s function.
SIDE EFFECTS AND COMPLICATIONS.
The only dangers of thyroxine are caused by taking too little or too much. If you take too little, your hypothyroidism will continue. If you take too much, you’ll develop the symptoms of hyperthyroidism—an overactive thyroid gland. The most common symptoms of too much thyroid hormone are fatigue but inability to sleep, greater appetite, nervousness, shakiness, feeling hot when other people are cold, and trouble exercising because of weak muscles, shortness of breath , and a racing, skipping heart. Patients who have hyperthyroid symptoms at any time during thyroxine replacement therapy should have their TSH tested. If it is low, indicating too much thyroid hormone, their dose needs to be lowered.
FOLLOW-UP
You’ll need to have your TSH checked 6 to 10 weeks after a thyroxine dose change. The goal of treatment is to get and keep your TSH in the normal range. Babies with hypothyroidism must get all their daily treatments and have their TSH levels checked as they grow, to prevent mental retardation and stunted growth. Once you’ve settled into a thyroxine dose, you can return for TSH tests about once a year.
YOU NEED TO RETURN SOONER IF
• Your symptoms return or get worse.
• You gain or lose a lot of weight
• You start or stop taking certain medicines
• You’re not taking all your thyroxine pills. Tell your doctor honestly how many pills you’ve missed.
• You want to try stopping thyroxine treatment. If ever you think you’re doing well enough not to need thyroxine treatment any longer, try it only under your doctor’s close supervision. Rather than stopping your pills completely, you might ask your doctor to try lowering your dose. If your TSH goes up, you’ll know that you need to continue treatment.