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Managing hypothyroidism
HYPOTHYROIDISM IS A very common disorder affecting mostly women, but men could also be affected by it.
It results from the underproduction of thyroxine, a hormone that primarily regulates the metabolism of the body and also responsible for the proper functioning of other hormones in the body. Thyroxine is produced by the thyroid gland, a butterfly-shaped gland in the middle of the neck, located below the larynx (voice box).
The common reason for Hypothyroidism is under activity of the gland itself (called, primary hypothyroidism). Other causes include prior neck surgery, certain medications and prior exposure to radiation.
Even though thyroxine is produced by the gland in the neck, it is the brain that regulates the quantity of hormone produced and any defect of this brain signal can affect its production (secondary or central hypothyroidism).
The brain signal is called TSH and its measurement determines whether there is enough hormone in the body.
Hypothyroidism is frequently hereditary and associated with presence of antibodies. The term used to to distinguish this form of thyroid disease is Hashimotos Thyroiditis.
A milder form of hypothyroidism called subclinical hypothyroidism is diagnosed when blood tests for thyroid function are abnormal but there are no symptoms. There is no general agreement whether or not to treat the condition but most physicians tend to treat it. Even though the patient may not notice any change, the cholesterol levels tend to improve after treatment.
A more complicated form of hypothyroidism is central or secondary hypothyroidism, caused by disturbance of brain signal to the thyroid. The symptoms may be similar but the diagnosis requires a number of tests and may include imaging studies of the brain with a CT scan or MRI. This condition is usually associated by other hormone abnormalities as well and requires treatment of all the abnormal hormones.
Symptoms:
Depending on the degree of severity some or all of the symptoms described below may occur.
Fatigue and weakness: Maybe associated with increased sleep and lethargy.
- Weight gain: Patients feel they cannot lose weight in spite of exercise and a poor appetite.
õ Constipation: There may be a sudden or gradual decrease in bowel movement or a change from the usual habit. It may be associated with bloating and abdominal pain.
- Neck swelling and hoarseness of voice: There may be a gradual or some times sudden increase in the size of the lower neck due to enlargement in the thyroid gland (goiter). It is usually painless but at times it may be associated with pain. Hoarseness in voice is usually a feature of severe hypothyroidism.
- Cold intolerance (inability to bear cold climate): Patients are usually cold at night and feel colder than others around them even when the room temperature is normal.
- Coarse dry skin: The skin usually feels rough even with regular application of creams and lotions. There may be decreased sweating, acne and brittle nails, and swelling around the eyes.
- Hair Loss: Sudden falling of hair is reported in more than 50 per cent of cases.
- Menstrual abnormalities: Menses may be heavy, irregular and painful. It may lead to difficulty in getting pregnant.
- Muscle pain: Muscle ache and back pain is common.
- Respiratory disturbance: Respiratory muscles may be weak causing shortness of breath and inability of exercise or climb stairs.
- Memory Loss: Loss in memory and poor concentration.
Hypothyroidism may also lead to elevated cholesterol, anemia (low red blood cells), slow heart beat and edema (swelling in the legs).
In extreme conditions, it leads to Myxedema Coma which may be life threatening if not treated early and appropriately. In this condition patients may lose consciousness and may have difficulty breathing.
Thyroxine is an essential hormone for brain development in infants and children under 2 years. A low level of this hormone at that early age could lead to mental retardation.
All infants born in hospitals are screened for the adequacy of this hormone and if found to be low must be treated early to prevent mental problems.
Diagnosis:
Hypothyroidism, if suspected, must be confirmed before treatment is initiated. A simple laboratory blood test can confirm this. The usual test obtained is thyroid function tests which include TSH, T4 and T3 levels in the blood. The test results are usually back the same day or the next day.
Treatment:
Treatment requires a synthetic form of the hormone thyroxine called LEVOTHYROXINE (or L-Thyroxine). It is in the form of a tablet and has to be taken once a day on an empty stomach (usually before breakfast). The medication is generally safe for children and adults as long as the appropriate dose is followed.
In most cases, symptoms of hypothyroidism begin to improve within two weeks. However, those with more severe symptoms may require several months of treatment for full recovery.
Most people require to take the medication life long. Blood tests are needed every 6 weeks to 6 months to adjust the dose.
Pregnant women need a slightly higher dose of the medication and women who are on levothyroxine and get pregnant are asked to get a thyroid function test at the time they find out they are pregnant. This medication is safe to take during pregnancy.
Dr. Zain Gulzar is Specialist Endocrinologist at The Dubai Mall Medical Centre
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