Hypothyroidism

October 18, 2021

Hypothyroidism

Hypothyroidism is a medical condition characterized by low thyroid hormones in the body affecting vital physiological functions. Thyroid hormones, including T3 and T4, are secreted by a small, butterfly-shaped Thyroid Gland located in the front of the neck. Different factors impair the function of the thyroid gland that results in underactive thyroid or insufficient production of the hormone to meet the daily body requirements. [1, 2]

Remember that a low thyroid hormone level or hypothyroidism negatively affects lung function, metabolism, neurological function, body mass index, heart rate, and gastrointestinal health. It is estimated that about 4.6 percent of the US population, or approximately 10 million Americans have hypothyroidism.

Hypothyroidism Symptoms

The hypothyroidism symptoms vary among individuals. However, it involves the following signs and symptoms. [1, 2, 3]

  • Lethargy
  • Weight gain, Constipation
  • An enlarged Thyroid (Goiter)
  • Numbness and Tingling in Hands
  • Drooping Eyelids, Cold Intolerance 
  • Puffy Face and Eyes 
  • Forgetfulness or Brain fog
  • Fatigue, Impaired Speech, and Movement
  • Hoarseness of voice, 
  • Decreased Sweating, Slowed Heart Rate
  • Skin dryness, Thinning of Hair
  • Brittle Hair or Fingernails 
  • Decreased taste, vision, or hearing
  • Weakness, Muscle aches, Joints pain
  • Depression, Disturbed Sleep Pattern 
  • Fertility issues in Women, Loss of Libido
  • Irregular menstrual periods
  • High Cholesterol, Anemia

Hypothyroidism risk factors

Hypothyroidism can occur in any individual, but certain risk factors increase the chances of its development. These risk factors include:

  • Female Gender
  • Older than age 60 years 
  • Thyroid problems or any thyroid surgery
  • Radiotherapy
  • Family history
  • Pregnancy

Also, the presence of certain medical conditions increases the risk of hypothyroidism. These conditions include pernicious anemia, Sjogren's syndrome, lupus, diabetes, Turner syndrome, and rheumatoid arthritis. [1, 2, 3]

Causes of Hypothyroidism

Different factors significantly impact the function of the thyroid gland and lead to the development of hypothyroidism. [1, 2, 3] These include:

  • Medical Conditions: Certain medical conditions of the thyroid gland, such as Hashimoto's disease and Thyroiditis (Atrophic and Viral), are the most common causes of hypothyroidism. It is important to know that Hashimoto's disease is an autoimmune disorder where the immune system attacks the thyroid gland and impair its functions. In comparison, Thyroiditis is an inflammation of the thyroid gland caused by various factors.
  • Congenital hypothyroidism: Congenital hypothyroidism or cretinism is a low level of thyroid hormone present at birth. It is highly associated with a low intake of iodine or iodine deficiency during pregnancy. 
  • Other Causes of Hypothyroidism: Other causes of hypothyroidism include radiation treatment, certain medication, a minimal amount of iodine consumption, surgical removal of any thyroid part, and sometimes associated with pituitary diseases. 

Hashimoto's Thyroiditis is the most common cause of hypothyroidism. It is an autoimmune disease where the body's immune system attacks the thyroid gland. That results in the development of thyroid inflammation and leads to an impaired thyroid hormone level. Hashimoto's disease is the most common thyroid disorder in America, affecting around 14 million people. It is seven times more prevalent in women than men. Individuals with Hashimoto's disease are also at high risk of other autoimmune diseases. [7]

Types of Hypothyroidism

Hypothyroidism is divided into three main types based on the etiology of low thyroid hormone in the body. These include:

  • Primary Hypothyroidism: An impaired function of the thyroid gland results in the development of primary hypothyroidism. The most common cause of primary hypothyroidism is Hashimoto's Thyroiditis. In primary hyperthyroidism, the thyroid gland will not respond to the high thyroid-stimulating hormone in the body. Additionally, drugs such as amiodarone, thalidomide, lithium, antiepileptic drugs, sunitinib, interferon-alpha, some monoclonal antibodies, and second-line agents for multidrug-resistant tuberculosis can also cause primary hypothyroidism. [1]
  • Secondary Hypothyroidism: Secondary hypothyroidism or Central Hypothyroidism is referred to impaired secretion of thyroid-stimulating hormone by the pituitary gland or when the hypothalamus does not produce enough thyrotropin-releasing hormone (TRH). The leading causes include pituitary or hypothalamic dysfunction, genetic, pituitary apoplexy, infections, surgery, Sheehan's syndrome radiotherapy, and drugs affecting the hypothalamic-pituitary-thyroid axis (panel). [1]
  • Tertiary Hypothyroidism: In tertiary hypothyroidism, the hypothalamus does not secrete sufficient thyrotropin-releasing hormone (TRH). That leads to an inadequate release of Thyroid Stimulating Hormone, resulting in an underactive thyroid. [1]

Moreover, a rare type of hypothyroidism caused by an abnormal expression of the deiodinase three enzyme in tumor tissues is termed Peripheral or Consumptive hypothyroidism. The elevated concentration of the deiodinase three enzyme inactivates thyroid hormone. 

Subclinical Hypothyroidism

Subclinical hypothyroidism is an early hypothyroidism form characterized by an abnormal thyroid-stimulating hormone and a normal thyroxine level with minimal or no symptoms. It occurs in about 15% and 8% of women and men respectively over the age of 60 years. Remember that subclinical hypothyroidism shares the same causes, similar symptoms, and treatment options to other hypothyroidism types. [6]

It is important to mention that levothyroxine is indicated during pregnancy or in women who want to conceive. It helps prevention of harmful effects of hypothyroidism both on pregnant women and fetal development.

Medical Complications of Hypothyroidism

Untreated hypothyroidism increases the risk of following medical conditions or aggravates their symptoms. [3]

  • Obesity, Nerve Injury
  • Heart Diseases, Impaired kidney function
  • Joint pain, Obstructive sleep apnea
  • Infertility, Carpal tunnel syndrome
  • Hair Problems, Goiter, Myxedema Coma

Hypothyroidism Diagnosis

Sometimes the diagnosis of hypothyroidism is difficult due to the number of symptoms confused with other medical conditions. Medical history, family history, physical examination (enlarged thyroid, dry skin, puffy eyes, etc.), medical symptoms, and different blood tests are performed to diagnose hypothyroidism. The blood tests such as thyroid-stimulating hormone tests and evaluating the level of thyroxin level are highly recommended for hypothyroidism diagnosis. Plus, the physician may order a blood test for Hashimoto's disease to confirm the presence of hypothyroidism. Note that high thyroid-stimulating hormone levels and low levels of thyroxine indicate an underactive thyroid or hypothyroidism. [2, 3]

Hypothyroidism Treatment

The hypothyroidism treatment involves the restoration of normal thyroid hormone levels in the body. Moreover, the treatment aims must include complete control over the hypothyroidism symptoms, normalization of thyroid-stimulating and thyroxine hormone level, avoidance of overtreatment, and prevention of medical complications associated with hypothyroidism. It is important to know that hormone replacement such as levothyroxine is the primary therapeutic approach for hypothyroidism management. [4, 8]

Hormone Replacement Therapy

In hormone replacement therapy, synthetic thyroid hormone levothyroxine is prescribed to restore normal thyroid hormone levels in the body. The administration of levothyroxine (T4) maintains an optimal level of thyroxine and thyroid-stimulating hormones that prevent or manage hypothyroidism symptoms. Moreover, it regulates the high cholesterol level, metabolic dysfunctions and also helps the management of weight gain. Primarily, hormone replacement therapy is indicated for a lifetime, but the dose may vary with the patient's condition. Sometimes, Liothyronine (T3) combined with Levothyroxine (T4) is given to the patients when they do not feel better with single hormone therapy. At the beginning of therapy, a levothyroxine dose of 50-75 µg/day is indicated to treat mild to moderate hypothyroidism. However, the initial dose of levothyroxine depends on the patient's weight, age, pregnancy status in women, lean body mass, hypothyroidism type, TSH level, and other medical comorbidities. [4, 8]  

Note that all hypothyroid patients respond well to hormone replacement therapy. However, in severe myxedema (life-threatening hypothyroidism), the treatment approaches involve the parenteral administration of levothyroxine (T4), antibiotics, steroids, and optimal oxygen supply. [4, 8]

It is important to know that always consult and take great care about the dosage of synthetic thyroxine as a low dose can't benefit the hypothyroidism symptoms. In comparison, the high doses will result in the development of hyperthyroidism. Thus, it is advised to regularly check the thyroid-stimulating hormone and levothyroxine level for the first 6-8 weeks during hormone replacement therapy; after getting stable, check the levels at an interval of 6 months or can be extended up to 12 months. [4, 8]

The clinical benefits of hormone replacement therapy appear within 3-5 days, but the complete restoration takes 4-6 weeks. Moreover, the normal TSH reference level regulation may take several months due to the modulation of the hypothalamic-pituitary axis. Plus, it is recommended not to switches between different brands or generic formulations of levothyroxine to avoid dose fluctuation. [4, 8]

Different thyroids hormone formulations are available in the market for the management of hypothyroidism. The most popular formulation include Armour Thyroid, Nature Thyroid Tablet, NP Thyroid, Synthroid, and Cytomel. These medications are natural thyroids hormone formulation obtained from animal thyroid glands (usually a pig's) intended for hypothyroidism treatment. Side effects involve temporary hair loss due to the drug-body adjustment. Note that regularly confirm the normal thyroid level to avoid the hyperthyroidism symptoms. [4, 8]

The American thyroid association recommended the evaluation of certain situations or conditions that may alter the thyroxine level. Such as examine the patients for gastrointestinal disorders who need a higher dose of levothyroxine. Plus, always talk with a qualified physician about the initiation or discontinuation of other hormone replacement therapies such as androgen and estrogen hormone during TSH level assessment or levothyroxine therapy. Moreover, other medications such as tyrosine kinase inhibitors, phenobarbital, sertraline, phenytoin, carbamazepine, and rifampin may also alter the Thyroxine level. Also, the concomitant use of proton pump inhibitors, sucralfate, and supplements such as calcium, magnesium, etc., interfere with the levothyroxine absorption. Furthermore, consume the levothyroxine before 35-45 min before breakfast or at least 3 hours post-meal at bedtime for optimal absorption.   

Remember that if the hypothyroidism symptoms do not ease with hormone replacement therapy, one must consider and check for other medical causes instead of increasing the levothyroxine dosage. [4, 8]

Surgery

Hypothyroidism is rarely treated with surgical procedures. Surgery has opted in case of large goiters that negatively impact the function of trachea-esophageal tracts. [4, 8]

Treatment Concerns:

Medical studies reported that thyroid replacement therapy exacerbates the co-existing adrenal insufficiency condition. So, remember that treat or evaluate the adrenal insufficiently condition before initiation of thyroid replacement treatment. Moreover, it is important to know that adrenal insufficiency can also occur with subclinical hypothyroidism. Plus, always treat or confirm the adrenal insufficiency during severe hypothyroidism (such as during myxedema coma) for rational treatment options. Furthermore, in heart conditions such as coronary artery disease, ischemic heart disease, etc., medical studies suggested that always start with the lower dose of hormones. Then gradually increase the dosage over time for adjustment with heart conditions. At normal doses, levothyroxine does not cause any severe side effects. But overconsumption of overdosage of levothyroxine hormone increases the risk of poor muscle coordination, fatigue, disturbed sleep pattern, nervousness, excitability, tremors, feeling hotter than normal, osteoporosis, breathing difficulty, muscle weakness, atrial fibrillation, arrhythmias, heart palpitation, and increased appetite. [4, 5]

Natural remedies for hypothyroidism

Different natural interventions are also used to help the hypothyroidism symptoms. These include diet changes and administration of Supplements. Studies reported that selenium levels decrease during Hashimoto's disease and impair thyroxine levels. Selenium Supplementation helps regulate normal T4 levels and improve hypothyroidism symptoms. Moreover, a sugar-free diet also helps prevent aggravation of hypothyroidism symptoms. Studies showed that sugar consumption increases the risk of inflammation that impairs the conversion of T4 to T3 and thus may aggravate or favor the progression of hypothyroidism.

Further, the supplementation of Vitamin B12 improves certain hypothyroidism symptoms, including tiredness and healthy metabolism. Also, the consumption of probiotics restores healthy gut microbiota and improves gastrointestinal symptoms associated with hypothyroidism. Additionally, the supplementation of Zinc, Iron, Iodine, Vit D3 and Tyrosine combined with Iodine help regulate both the stimulating tissue hormone and thyroxine levels. [9] 

References:

  1. Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. Lancet (London, England), 390(10101), 1550–1562. https://doi.org/10.1016/S0140-6736(17)30703-1
  2. Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in Context: Where We've Been and Where We're Going. Advances in therapy, 36(Suppl 2), 47–58. https://doi.org/10.1007/s12325-019-01080-8
  3. Patil N, Rehman A, Jialal I. Hypothyroidism. [Updated 2021 Jan 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519536/
  4. Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., Sawka, A. M., & American Thyroid Association Task Force on Thyroid Hormone Replacement (2014). Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid : official journal of the American Thyroid Association, 24(12), 1670–1751. https://doi.org/10.1089/thy.2014.0028
  5. Qari F. (2014). Hypothyroidism in clinical practice. Journal of family medicine and primary care, 3(2), 98–101. https://doi.org/10.4103/2249-4863.137609
  6. Gosi SKY, Garla VV. Subclinical Hypothyroidism. [Updated 2021 Jan 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536970/
  7. Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/
  8. McAninch, E. A., & Bianco, A. C. (2016). The History and Future of Treatment of Hypothyroidism. Annals of internal medicine, 164(1), 50–56. https://doi.org/10.7326/M15-1799
  9. https://www.everydayhealth.com/hs/healthy-living-with-hypothyroidism/vitamins/

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

2 comments on “Hypothyroidism”

  1. Wow amazing thyroid article! I just happened to stumble upon your page and this was very helpful. I have Hashimotos and feel like this is one of the best articles to explain the different types of thyroid problems. Kudos!

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