We’ve all experienced changes in our bodies from time to time that seem more of a nuisance than a medical issue. Take, for example, forgetfulness or fatigue, difficulty falling asleep or staying asleep, perhaps even muscle or joint pain. Too often we chalk these symptoms up to the stresses of modern life or simply getting older. And that may seem to be reasonable…..that is, until these changes become pervasive, persistent and bring day-to-day life as you know it to a grinding halt.
Hypothyroidism, an often-hidden health problem in which the thyroid, the master gland of metabolism, produces less hormones than the body needs, impacting virtually all organ systems in the body. It is one of the most misunderstood, misdiagnosed and prevalent medical conditions in the U.S. Studies estimate that more than 10 percent of the general population suffers from the disease. Yet hypothyroidism frequently goes undiagnosed.
Here are the fundamentals regarding what you need to know about the symptoms of hypothyroidism, how the disease is diagnosed and treatment options.
For a condition that affects so many and whose impact can be devastating, it might seem odd that there seems to be a lack of knowledge about hypothyroidism (and thyroid disease in general). But there are several reasons for this.
The early effects of hypothyroidism are often mild, appear gradually and aren’t concentrated in a single area of the body, so it’s easy to disregard them or attribute them to other causes. Also, two people with the disease may have entirely different symptoms, and one person’s symptoms can develop quickly, while the other person’s may take years to emerge. Some people with hypothyroidism have no symptoms at all. And as we age, diminished or faulty hormone production is common, so it’s understandable that older patients in particular often go undiagnosed. Plus the body has the ability to compensate somewhat over the short term by increasing the stimulation to the thyroid to produce more hormones.
However, as production of thyroid hormone decreases and the body slows down, the disease progresses and classic symptoms of the condition begin to appear. They may include any of the following:
• Constant fatigue: Low thyroid function results in less energy.
• Depression: Fatigue is often accompanied by depression. Body functions slow down, including the brain. Routine mental tasks become more difficult. Appetite may decrease and you may sleep more.
• Weight gain and fluid retention: An underactive thyroid slows down all your body processes (your metabolism). With lower energy needs, you require fewer calories, so your appetite can decline, but your body converts fewer calories into energy, leading to weight gain. Fluid retention occurs due to decreased excretion of sodium and water by the kidneys.
• Dry, brittle hair and nails: Nails and hair are composed of very active cells that are highly sensitive to the metabolic slowdown seen in hypothyroidism.
• Dry, itchy skin: Skin issues are among the most common symptoms of hypothyroidism. When your body slows down it produces less heat and you sweat less, leading to dry skin.
• Muscle or joint pain or stiffness: Many people with hypothyroidism experience aches and pains that resemble arthritis.
• Constipation: The muscles of the digestive tract contract to move its contents through the bowel. Hypothyroidism slows down these contractions.
• Sensitivity to cold: This is due to the body conserving heat energy by constricting the blood vessels to the skin, minimizing heat loss.
• Menstrual cycle changes: Hypothyroidism causes an imbalance of female hormones, leading to excessive and irregular menstrual bleeding.
• Slow pulse: Low levels of thyroid hormone commonly cause the heart to beat more slowly than normal, a condition called bradycardia.
• High cholesterol: Low levels of thyroid hormone cause the liver to make fewer LDL receptors, which pull LDL (bad) cholesterol out of the blood.
• Increased sensitivity to medication: A slower metabolism alters the way in which the body processes medication or clears it from the system, causing medications to be more potent or have more side effects.
Although symptoms can vary dramatically from person to person, and not every symptom means that you have an underactive thyroid, if you have been suffering from health issues and your physician has yet to determine what the underlying cause is, ask to have your thyroid function checked.
Before you can fully understand what doctors are looking for when they suspect hypothyroidism, it is helpful to know some details regarding how the complex interactions and connections between the thyroid and the body’s other endocrine systems work together to keep your body in balance.
The thyroid gland weighs less than 1 ounce and is located at the front of your throat below the voice box (larynx). Shaped like a butterfly, the thyroid has two lobes connected by a middle section of tissue called the isthmus. The thyroid extracts iodine that has been passed into the bloodstream from food that we eat and uses it to make two kinds of hormone: T4, or thyroxine, which is relatively inactive, and T3, or triiodothyronine, the more active thyroid hormone. As thyroid hormone is produced, it is stored in microscopic follicles in the thyroid gland. When your body needs the hormone, the thyroid releases a small amount of T3 into the bloodstream along with T4, which is converted to “active” T3. The T3 travels through the blood to the liver and other organs in quantities needed to meet your cells’ metabolic needs. The thyroid itself gets its direction from the pituitary gland, a pea-sized structure located at the base of the brain which releases thyroid stimulating hormone (TSH) that tells the thyroid how much hormone to make. When the thyroid does not produce enough hormone, the pituitary gland produces more TSH in order to stimulate it. Hence, an elevated TSH level indicates hypothyroidism.
When visiting a doctor to be assessed for possible thyroid problems, you will be asked to provide a medical history, highlight any troubling symptoms you are experiencing. The physician will also perform a physical exam to look for signs of the disease. He/she will assess the size of your thyroid gland and look for enlargement by manually feeling around your neck area. He/she will also check for any signs of hypothyroidism, such as dry skin, a puffy appearance and coarse or thinning hair.
If your doctor suspects thyroid dysfunction, diagnostic tests will be ordered, beginning with blood work. Only blood tests can confirm if you are hypothyroid, and a test that measures TSH levels in your blood is the single best indicator. Thyroid hormone levels may be checked to determine the severity of disease as well as antibodies against the thyroid to determine its cause.
If you are found to have a TSH level that does not fall within an established “reference range,” your doctor may likely recommend treatment. And if a primary care physician diagnoses your thyroid disorder, you may be referred to an endocrinologist, a medical doctor whose specialty is the body’s glandular, or endocrine, system.
The goal of hypothyroidism treatment is to replicate normal thyroid function and return your body to a balanced state. Standard treatment consists of daily intake of a synthetic thyroid hormone, levothyroxine sodium, which comes in pill form and works in the same way your own thyroid hormone would normally work. The initial dose is carefully selected by the physician based on your age, weight, gender, other medical conditions and the severity of your hypothyroidism. You should consult with your endocrinologist about other medications you are taking, such as iron or calcium supplements, antacids, and cholesterol-lowering medications, since they can interfere with the effectiveness of thyroid medicines.
Because each person’s thyroid hormone needs are very precise, finding the proper dose of levothyroxine can take some time and adjustments in medication dosage are typical until the patient’s TSH level is within normal range. Keep in mind that the medication is slow-acting, so you are unlikely to feel its full effects immediately.
Once the thyroid hormone dosage that is right for you has been determined, you should stick to the same dosage of the same medication, whether brand name or generic manufacturer, and take it at the same time each day.
Once you and your doctor agree on the brand and thyroid hormone dosage that is right for you, you should not switch the brand of hormone replacement medication you are taking. While each brand is FDA-approved and all have the same active ingredient, inactive ingredients vary from brand to brand and can have a significant impact on how much T4 your body absorbs. However, sticking with the same generic formulations may be difficult. Pharmacies often dispense different generic drugs based on what is in stock, the cost of the medicines and the formulation’s availability. If your insurance plan only covers generic drugs, make sure your pharmacist provides the same pills from the same manufacturer every time.
Patients should experience relief from some symptoms within a few weeks, while some changes such as dry skin may not improve until several months after starting treatment. Once your TSH levels are stabilized, they’ll typically be checked every six months and the dosage adjusted if necessary.
Since most cases of hypothyroidism in adults are permanent and often progressive, many patients need to take thyroid medication throughout their lives. The good news is that the medication is relatively inexpensive, has minimal side effects and can restore a hypothyroid patient to optimal health.