Hypothyroidism – Causes , Symptoms, Treatments, and More

Overview 

Hypothyroidism is a prevalent condition in which the thyroid produces and releases inadequate thyroid hormone into the bloodstream.

Hypothyroidism or an underactive thyroid can result in weight gain, lethargy and an inability to withstand cold temperatures.

There may be no visible signs of Hypothyroidism in its early stages. However, untreated Hypothyroidism can lead to various health issues, including obesity, joint discomfort, infertility and heart disease.

According to a study in the Lancet, In India, the prevalence of Hypothyroidism is 11%, compared to 2% in the United Kingdom and 4.6% in the United States.

This might be connected to the country’s long-standing iodine deficit, which has only become better in the last 20 years.

Causes of Hypothyroidism

The following are the most prevalent causes of Hypothyroidism

• Hashimoto’s Thyroiditis
• Radioactive iodine therapy
• Thyroid gland surgical removal
• Radiation therapy
• Medications
• Iodine deficiency

Less common reasons are

• Pituitary dysfunction
• Pregnancy
• Congenital disease
• Pregnancy
• de Quervain Thyroiditis 

1. Hashimoto’s Thyroiditis

The immune system protects the cells from invading germs and viruses. When foreign bacteria or viruses enter the body, the immune system responds by producing fighter cells to destroy them.

The body occasionally confuses normal, healthy cells with invading ones. This is known as an autoimmune reaction. The immune system might target healthy tissues if the autoimmune reaction is not managed or treated.

This can result in significant medical problems, such as Hypothyroidism.

It primarily affects middle-aged women, although it can also affect males and children. This condition is also hereditary. If a family member has been diagnosed with this condition, the chances of getting it are higher.

2. Radioactive iodine therapy

Hyperthyroidism occurs when the thyroid gland produces an excessive amount of thyroid hormone. This condition’s treatment tries to limit and control thyroid hormone production.

The standard therapy for hyperthyroidism is radioactive iodine, which kills thyroid cells and may result in thyroid hormone levels becoming permanently low.

3. Thyroid gland surgical removal

People may develop Hypothyroidism if their entire thyroid gland is removed from thyroid disorders. The primary therapy is long-term thyroid medication use.

Even if only a piece of the gland is removed, the thyroid gland may be able to produce enough hormones on its own. Blood tests will help to determine how much thyroid medication they may require.

4. Radiation therapy

Someone might have gotten radiation therapy if diagnosed with head or neck cancer, lymphoma or leukaemia. Radiation used to treat certain conditions may delay or stop thyroid hormone production, resulting in Hypothyroidism.

5. Medications

Several drugs can cause Hypothyroidism by decreasing thyroid hormone production. These include medications that treat mental health issues, cancer and heart problems.

6. Iodine deficiency

Iodine deficiency is the most prevalent cause of Hypothyroidism in India. Iodine, which is required for thyroid hormone production, can be found in foods such as:

• Dairy 
• Seafood 
• Eggs 
• Iodised salt

If someone is deficient in iodine, they may develop swelling around the base of their neck. This is known as a goitre, and an enlarged thyroid gland may cause goitre. 

7. Pituitary dysfunction

Hypothyroidism can also be caused by pituitary gland dysfunction. This small gland in the brain produces hormones that influence various biological systems, including the thyroid gland.

Pituitary gland dysfunction can lead to thyroid problems. They can be caused by

• Pituitary tumours 
• Medicines such as dopamine and opioids 
• Sheehan syndrome, which causes pituitary gland damage
• Radiation therapy near the brain

The thyroid gland functions properly, and this kind of Hypothyroidism is known as secondary Hypothyroidism. It is less prevalent than primary Hypothyroidism, which is caused by a thyroid gland disease.

8. Pregnancy

Approximately 5% to 10% of pregnant women will develop postpartum thyroiditis months following their pregnancy. While only some may require therapy, others will acquire Hypothyroidism permanently.

The following factors can increase the likelihood of postpartum thyroiditis:

• Postpartum Thyroiditis history
• Type 1 diabetes 
• Presence of thyroid peroxidase antibodies

9. de Quervain Thyroiditis

De Quervain Thyroiditis, also known as subacute granulomatous thyroiditis, is a rare illness caused by an upper respiratory infection that affects thyroid cells.

De Quervain thyroiditis symptoms include:

• Neck, jaw and throat pain 
• Swollen and painful thyroid gland 
• Fever, tiredness and body ache

The condition can cause Hyperthyroidism, followed by Hypothyroidism and can last 2 to 8 weeks. Thyroid function should subsequently return to normal. However, Hypothyroidism may be lifelong in some circumstances.

Symptoms of Hypothyroidism

Depending on the degree of the hormone deficiency, the signs and symptoms of Hypothyroidism differ.

Problems usually emerge gradually over the years.

Initially, signs of Hypothyroidism, such as tiredness and weight gain, may go unnoticed. They could also be attributed to ageing; however, if the metabolism slows, people might experience more obvious issues. 

Some of the symptoms of Hypothyroidism are:

• Fatigue or excessive tiredness
• Increased sensitivity to cold
• Constipation
• Weight gain
• Face puffiness
• Hoarseness
• Muscle weakness
• High blood cholesterol levels
• Aches, soreness and rigidity in the muscles
• Joint pain, stiffness or edoema
• Menstrual cycles that are heavier than usual or irregular
• Hair thinning
• Slowed heart rate
• Depression
• Memory impairment
• Thyroid gland enlargement (goitre)

Hypothyroidism in infants

Although Hypothyroidism most commonly affects middle-aged and older women, it may affect anybody, even infants.

Babies born without a thyroid gland or with a thyroid gland that does not function properly may initially have few signs and symptoms. When babies suffer from Hypothyroidism, the following issues may arise:

• The skin and eye whites turn yellow (jaundice)

This usually happens when a baby’s liver cannot metabolise bilirubin, produced when the body recycles old or damaged red blood cells.

• A large protruding tongue 
• Difficulty breathing
• Loud crying
• An umbilical hernia

As the condition progresses, babies may struggle to eat and may fail to grow and develop appropriately. They might also have:

• Constipation
• Muscle tone problems
• Excessive sleepiness

Even mild episodes of Hypothyroidism in babies can lead to severe physical and mental impairment if not treated.

Hypothyroidism in children and teens 

The signs and symptoms of Hypothyroidism in children and teens are generally the same as those in adults; however, they may also include:

• Short stature because of poor growth.
• Permanent teeth form more slowly than normal
• Delayed puberty
• Poor mental development

Treatment for Hypothyroidism

To treat Hypothyroidism, the doctor will prescribe a synthetic (human-made) thyroid hormone (levothyroxine) to patients.

Patients need to take this medication daily, and certain other drugs may affect how the body absorbs synthetic thyroid hormones.

Patients should ensure that the doctor is aware of every medication, herbal treatment, and dietary supplement they use, including over-the-counter medications.

To monitor the levels of thyroid hormones, patients will require routine blood tests. The medicine dosage may occasionally need to be modified by the doctor.

Soon after starting treatment, patients are likely to start feeling better. The medication may be able to reverse any weight gain while progressively lowering cholesterol levels raised by the condition.

Levothyroxine therapy is likely to be lifelong, although doctors will probably monitor their TSH level once a year because the dosage patients need may change.

Getting the dosage right

After six to eight weeks, doctors typically check the level of TSH to set the initial levothyroxine dosage. Six months later, blood levels are often examined again. The following side effects may occur if the hormone is used in excess:

• Increased appetite
• Insomnia
• Heart palpitations
• Shakiness

People with severe Hypothyroidism or heart disease may take synthetic hormones at low doses and gradually raise them so their hearts can get used to them.

The hormones shouldn’t cause negative effects after patients get the right dosage. But patients must keep taking their medication; skipping doses could worsen hypothyroidism symptoms.

If patients start losing at least 5kgs or more of body weight rapidly, they should get their TSH levels checked again. 

Risk factors of Hypothyroidism

Although anyone can get Hypothyroidism, the following factors put people at increased risk

• Race (being either White or Asian)
• Being a woman
• Age over 60
• Have thyroid disease running in the family
• Have an autoimmune condition, such as type 1 diabetes or Celiac disease
• Have received treatment with radioactive iodine or thyroid-blocking drugs
• Received radiation in the upper chest or neck
• Underwent thyroid surgery (partial thyroidectomy)
• Have given birth or become pregnant within the previous six months

Diagnosis of Hypothyroidism

To determine hormone levels, patients’ doctors will conduct blood tests if they show hypothyroidism symptoms. The tests are:

• TSH (thyroid-stimulating hormone) 
• T4 (thyroxine) 

Patients with lower-than-normal T4 levels usually have Hypothyroidism. 

Some patients may also have elevated TSH levels while having normal T4 levels. In such a case, patients suffer from subclinical (mild) Hypothyroidism, which is thought to be the beginning of Hypothyroidism.

The doctor may prescribe a thyroid ultrasound, often known as a thyroid scan, to look for nodules or inflammation if the thyroid test results or physical thyroid examination are abnormal.

Complications of untreated Hypothyroidism

Numerous health issues can result from untreated Hypothyroidism, including:

1. Goitre

A goitre is a condition where the thyroid gland enlarges due to persistent activation to release more hormones. Large goitres can impact your look and may cause breathing or swallowing difficulties.

2. Heart issues

Because individuals with an underactive thyroid might have high levels of low-density lipoprotein (LDL) cholesterol, generally known as the “bad” cholesterol, Hypothyroidism may be linked to an increased risk of heart disease and cardiac arrest.

3. Mental health issues 

Early signs of Hypothyroidism can include depression, which over time may worsen. Slower mental functioning can also be a symptom of Hypothyroidism.

4. Infertility

Low thyroid hormone levels can prevent ovulation, which affects fertility. Additionally, some hypothyroidism causes, like autoimmune conditions, might affect fertility.

5. Congenital disabilities

Compared to children born to mothers who are in good health, kids born to women who have untreated thyroid disease may be more likely to experience birth abnormalities. 

These kids are more likely to experience severe intellectual and developmental issues.

Untreated Hypothyroidism of mothers at birth puts infants at considerable risk for physical and mental development issues. However, the odds of normal development are very good if this disorder is diagnosed in the first few months of life.

6. Joint pain 

Patients may get tendonitis, aches and pains in their muscles and joints if their thyroid hormone levels are low.

7. Obesity

Even though Hypothyroidism may make patients feel less hungry, they still risk putting on weight because their metabolism slows down and they don’t burn enough calories.

8. Peripheral neuropathy

Low thyroid hormone levels over time can harm the peripheral nerves. The limbs could feel painful, tingly, or numb.

When should you see a doctor?

Consult a doctor or medical professional if you experience unexplained fatigue or other hypothyroidism signs or symptoms, such as dry skin, a pale, bloated face, constipation or a raspy voice.

When getting hormone therapy for Hypothyroidism, make follow-up appointments as frequently as the doctor advises. First and foremost, it’s crucial to confirm that you’re taking the right dosage of medication. And the dosage you require may change over time. 

Conclusion

If patients do not receive treatment from a healthcare professional, Hypothyroidism can develop into a life-threatening disease. Patients’ symptoms may worsen if they are not addressed, and they may also include:

• Developing mental health issues.
• Having difficulty breathing
• Being unable to maintain a normal body temperature.
• Having heart issues
• Developing a goitre (enlargement of the thyroid gland).
• Myxedema coma, a dangerous medical disease, can also develop. 

Therefore, seek medical attention as soon as any symptoms appear.

If doctors diagnose Hypothyroidism early and start treatment, it is very manageable.

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