Hypothyroidism, or underactive thyroid, develops when the thyroid gland fails to produce or secrete as much thyroxine (T4) as the body needs. Because T4 regulates such essential functions as heart rate, digestion, physical growth, and mental development, an insufficient supply of this hormone can slow life-sustaining processes, damage organs and tissues in every part of the body, and lead to life-threatening complications.
Hypothyroidism is one of the most common chronic diseases in the United States. Symptoms may not appear until years after the thyroid has stopped functioning and they are often mistaken for signs of other illnesses, menopause, or aging. Although this condition is believed to affect as many as 11 million adults and children, as many as two of every three people with hypothyroidism may not know they have the disease.
Nicknamed "Gland Central" because it influences almost every organ, tissue, and cell in the body, the thyroid is shaped like a butterfly and located just below the Adam's apple. The thyroid stores iodine the body gets from food and uses this mineral to create T4. Low T 4 levels can alter weight, appetite, sleep patterns, body temperature, sex drive, and a variety of other physical, mental, and emotional characteristics.
There are three types of hypothyroidism. The most common is primary hypothyroidism, in which the thyroid doesn't produce an adequate amount of T4. Secondary hypothyroidism develops when the pituitary gland does not release enough of the thyroid-stimulating hormone (TSH) that prompts the thyroid to manufacture T4. Tertiary hypothyroidism results from a malfunction of the hypothalamus, the part of the brain that controls the endocrine system. Drug-induced hypothyroidism, an adverse reaction to medication, occurs in two of every 10,000 people, but rarely causes severe hypothyroidism.
Hypothyroidism is at least twice as common in women as it is in men. Although hypothyroidism is most common in women who are middle-aged or older, the disease can occur at any age. Newborn infants are tested for congenital thyroid deficiency (cretinism) using a test that measures the levels of thyroxine in the infant's blood. Treatment within the first few months of life can prevent mental retardation and physical abnormalities. Older children who develop hypothyroidism suddenly stop growing.
Factors that increase a person's risk of developing hypothyroidism include age, weight, and medical history. Women are more likely to develop the disease after age 50; men, after age 60. Obesity also increases risk. A family history of thyroid problems or a personal history of high cholesterol levels or such autoimmune diseases as lupus, rheumatoid arthritis, or diabetes can make an individual more susceptible to hypothyroidism.
Causes and symptoms
Hypothyroidism is most often the result of Hashimoto's disease, also known as chronic thyroiditis (inflammation of the thyroid gland). In this disease, the immune system fails to recognize that the thyroid gland is part of the body's own tissue and attacks it as if it were a foreign body. The attack by the immune system impairs thyroid function and sometimes destroys the gland. Other causes of hypothyroidism include:
Hypothyroidism is sometimes referred to as a "silent" disease because early symptoms may be so mild that no one realizes anything is wrong. Untreated symptoms become more noticeable and severe, and can lead to confusion and mental disorders, breathing difficulties, heart problems, fluctuations in body temperature, and death.
Someone who has hypothyroidism will probably have more than one of the following symptoms:
Hypothyroidism usually develops gradually. When the disease results from surgery or other treatment for hyperthyroidism, symptoms may appear suddenly and include severe muscle cramps in the arms, legs, neck, shoulders, and back.
It's important to see a doctor if any of these symptoms appear unexpectedly. People whose hypothyroidism remains undiagnosed and untreated may eventually develop myxedema. Symptoms of this rare but potentially deadly complication include enlarged tongue, swollen facial features, hoarseness, and physical and mental sluggishness.
Myxedema coma can cause unresponsiveness; irregular, shallow breathing; and a drop in blood pressure and body temperature. The onset of this medical emergency can be sudden in people who are elderly or have been ill, injured, or exposed to very cold temperatures; who have recently had surgery; or who use sedatives or anti-depressants. Without immediate medical attention, myxedema coma can be fatal.
Diagnosis of hypothyroidism is based on the patient's observations, medical history, physical examination, and thyroid function tests. Doctors who specialize in treating thyroid disorders (endocrinologists) are most apt to recognize subtle symptoms and physical indications of hypothyroidism. A blood test known as a thyroid-stimulating hormone (TSH) assay, thyroid nuclear medicine scan, and thyroid ultrasound are used to confirm the diagnosis. A woman being tested for hypothyroidism should let her doctor know if she is pregnant or breastfeeding and all patients should be sure their doctors are aware of any recent procedures involving radioactive materials or contrast media.
The TSH assay is extremely accurate, but some doctors doubt the test's ability to detect mild hypothyroidism. They advise patients to monitor their basal (resting) body temperature for below-normal readings that could indicate the presence of hypothyroidism.
Natural or synthetic thyroid hormones are used to restore normal (euthyroid) thyroid hormone levels. Synthetic hormones are more effective than natural substances, but it may take several months to determine the correct dosage. Patients start to feel better within 48 hours, but symptoms will return if they stop taking the medication.
Most doctors prescribe levothyroxine sodium tablets, and most people with hypothyroidism will take the medication for the rest of their lives. Aging, other medications, and changes in weight and general health can affect how much replacement hormone a patient needs, and regular TSH tests are used to monitor hormone levels. Patients should not switch from one brand of thyroid hormone to another without a doctor's permission.
Regular exercise and a high-fiber diet can help maintain thyroid function and prevent constipation.
Alternative treatments are primarily aimed at strengthening the thyroid and will not eliminate the need for thyroid hormone medications. Herbal remedies to improve thyroid function and relieve symptoms of hypothyroidism include bladder wrack (Fucus vesiculosus), which can be taken in capsule form or as a tea. Some foods, including cabbage, peaches, radishes, soybeans, peanuts, and spinach, can interfere with the production of thyroid hormones. Anyone with hypothyroidism may want to avoid these foods. The Shoulder Stand yoga position (at least once daily for 20 minutes) is believed to improve thyroid function.
Foods that depress the thyroid include broccoli, cabbage, brussels sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens. Avoid refined foods, dairy products, wheat, caffeine, and alcohol.
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. For best results, these herbs should be used under the guidance of an experienced practitioner.
Disclaimer: This information is intended as a guide only. This information is offered to you with the understanding that it not be interpreted as medical or professional advice. All medical information needs to be carefully reviewed with your health care provider.
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