Hypothyroidism

Hypothyroidism Hypothyroidism

What is Hypothyroidism?

Hypothyroidism is the medical term used when a person does not make enough thyroid hormone and is a common thyroid disorder.

What is Thyroid?

There is a gland in our neck called the thyroid gland. It produces thyroid hormones such as T3 and T4. This hormone helps our body to control various metabolism. The functioning of thyroid  is controlled by the pituitary gland. The pituitary produces thyroid-stimulating hormone (TSH), which stimulates the thyroid to produce T3 and T4.

What are the causes for Hypothyroidism?

In most of the cases, hypothyroidism is due to a problem in the thyroid gland itself and is called primary hypothyroidism. It can be due to autoimmunity, post thyroidectomy (surgical removal of the thyroid) or radioactive iodine treatment. In some cases, hypothyroidism can be the result of decreased production of TSH by the pituitary gland, called secondary hypothyroidism.

Sometimes patients with hypothyroidism may not have any symptoms. Most of the symptoms of Hypothyroidism are vague and can mimic multiple other conditions.  Symptoms of hypothyroidism include tiredness, lack of energy, cold intolerance, loss of hair, and constipation.  If hypothyroidism is not treated properly, it can cause slowness of heart rate and fluid accumulation in the body. Poorly treated hypothyroidism can also cause hypertension and altered cholesterol levels. In women, untreated hypothyroidism can cause irregular menstrual cycle, difficulty in getting pregnant and miscarriages. 

How to diagnose hypothyroidism?

Some blood tests can help to detect hypothyroidism at an early stage. Testing can be done if the person has signs and symptoms, or as a part of screening test. The most common blood test done to diagnose is thyroid-stimulating hormone (TSH). TSH gets abnormal even with small alterations in thyroid function, so it is used as a screening test. Thyroxine (T4) helps in assessing the degree of hypothyroidism. We label the person as having "Subclinical" hypothyroidism when the TSH is elevated and the T4 is normal. "Overt" hypothyroidism is diagnosed when the TSH is elevated and the T4 is low.

How to treat hypothyroidism?

Treatment for hypothyroidism is very simple. It involves taking thyroid hormone pills every day in an empty stomach. After taking a tablet, it’s advisable to give a 30 to 60 minutes gap for any food, beverages or medications. Most people with this problem need to take thyroid pills for the rest of their life. Don’t stop or adjust the dose on your own. Both under or over treatment can cause both short term and long-term problems.  Frequency of testing and dose adjustment will be decided by treating Endocrinologist according to the patient’s status and co-morbid conditions. The TSH target will be again decided based on age, comorbid conditions, indication for the treatment and other factors.

Most of the women with hypothyroidism  will have healthy pregnancies. The targets for women planning pregnancy are different. The same has to be assessed periodically by the treating Endocrinologist. Thyroid hormone requirement will be more during pregnancy, so frequent monitoring and dose adjustment will be required. 

Autoimmunity in Thyroid

One of the most common causes for Primary hypothyroidism is Autoimmunity. It means the body produces antibodies which attack its own body organs. It is more common in females compared to males. It can lead to hypothyroidism or hyperthyroidism, though hypothyroidism is more common. Anti-TPO and Anti-TG antibodies are commonly produced in Autoimmune Thyroid disease. TSH Receptor Antibody (TRAb) is produced in Graves’ Disease. Evaluation of Antibody helps in assessing the aetiology, making treatment decisions and monitoring of thyroid cancer patients. 

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