General Illness Information
Common Name:
Hypothyroidism
Medical Term: Hypothyroidism
Description:
The thyroid gland produces thyroid hormones, under the control of the pituitary gland in the brain. Thyroid hormone is essential to the body in the consumption of oxygen by the cells, and in protein synthesis.
The condition in which the thyroid gland produces low levels of thyroid hormone is termed hypothyroidism.
It affects both sexes, but is more common among women.
Causes:
Sometimes unknown. Most common causes include:
- Auto-immune disease, in which the body’s immune system functions abnormally and attacks the thyroid gland depleting its thyroid hormone producing cells;
- Radioactive iodine treatment. for Graves Disease;
- Surgery for hyperthyroidism;
- Iodine deficiency in the diet. This is common in mountainous areas in the underdeveloped world;
- Decreased activity of the pituitary gland, which secretes a thyroid-stimulating hormone;
- Use of drugs, such as lithium, that may depress thyroid function.
Prevention:
No known measures to prevent primary hypothyroidism.
However the addition of iodized salt prevents goiter and hypothyroidism in mountainous areas in the under developed world.
Signs & Symptoms
- Onset may be insidious, subtle;
- Weakness, fatigue, lethargy;
- Cold intolerance;
- Decreased memory;
- Hearing impairment;
- Constipation;
- Muscle cramps;
- Arthralgias;
- Paresthesias;
- Modest weight gain (10 pounds [4.5 kg]);
- Decreased sweating;
- Menorrhagia;
- Depression;
- Hoarseness;
- Carpal tunnel syndrome;
- Dry, coarse skin;
- Dull facial expression;
- Coarsening or huskiness of voice;
- Puffiness around the eyes;
- Swelling of hands and feet;
- Slow heart beat;
- Hypothermia;
- Reduced systolic blood pressure;
- Increased diastolic blood pressure;
- Reduced body and scalp hair;
- Delayed relaxation of deep tendon reflexes;
- Anemia;
- Enlarged heart on chest x-ray (often due to pericardial effusion).
Risk Factors
- Five times more common in females;
- Risk increases with increasing age;
- Autoimmune diseases.
Diagnosis & Treatment
- Laboratory blood studies of thyroid hormones. Laboratory studies can confirm the diagnosis of hypothyroidism, but they cannot indicate how much replacement therapy is needed. Radio-immuno assay may be done. Imaging studies are not generally required;
- Goals of treatment are long-term thyroid replacement and recognition of symptoms to avoid over or under-dosing.
General Measures:
- Goals of treatment are to restore and maintain a normal thyroid state;
- Need for lifelong treatment;
- Report to physician any signs of infection, heart problems, or signs of toxicity from thyroid replacement therapy.
Medications:
- The drug of choice is Levothyroxine (Synthroid, Levothroid);
- Dosage requirements may vary with age, sex, residual capacity of thyroid gland, other drugs being taken by patient, intestinal function;
- Elderly patients may require lower dose.
Activity:
As tolerated.
Diet:
No restrictions. High fiber diet to avoid constipation.
Possible Complications:
- Treatment induced congestive heart failure in people with coronary artery disease;
- Myxedema coma – life threatening complication of hypothyroidism;
- Increased susceptibility to infection;
- Mega colon;
- Organic psychosis with paranoia;
- Adrenal crisis with vigorous treatment of hypothyroidism;
- Infertility;
- Over treatment for long periods may lead to osteoporosis.
Prognosis
Excellent, with treatment.
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