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Hypothyroidism

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This picture shows multiple symptoms that plague the different parts and systems of the body for someone with hypothyroidism.

Hypothyroidism is a common disease involving the thyroid gland wherein there is a low level of thyroid hormones being produced. It mostly targets women of older age and people with preexisting thyroid issues. Many variables are involved in developing an under active thyroid and who it will affect. There is a wide variety of symptoms shown with this thyroid disease. A lot of the symptoms of hypothyroidism are shared with other diseases, however, making it difficult to diagnose without a blood test. Doctors will prescribe replacement hormones if a patients blood work shows signs of hypothyroidism.

The Thyroid

Thyriod Hormone Chart.jpg

Hypothyroidism is the most common thyroid disorder. But to understand what hypothyroidism is, first the knowledge of what the thyroid is and what it does for the human body is needed. The thyroid is a butterfly shaped hormonal gland which sits beneath the voice box and encloses the windpipe. The gland is involved in metabolism, growth, and helps regulate functions within the body by releasing hormones into the bloodstream almost continuously. The thyroid produces T3, T4, and calcitonin [1]. T3 is also called tri-iodothyronine and T4 is known as thyroxine or tetraiodothyronine. Of all the thyroid hormones within the blood, T3 accounts for 1% and T4 for 99%. Activated T3 hormone affects the metabolism of cells when the thyroid releases it into the blood, even converting T4 when needed[2].

Hypothyroidism and Causes

Hypothyroidism is classified as an underactive thyroid. Which means that for some reason the thyroid is not releasing enough of the T3 and T4 hormones[3]. There are many causes of hypothyroidism. Hashimoto’s thyroiditis, or autoimmune hypothyroidism, is the the most common cause. Other common causes include thyroid inflammation caused by the immune system; which affects 10 million in the United States and approximately 10% of women over the age of 30 are diagnosed. A partial or full thyroidectomy (having the thyroid surgically removed) or congenital thyroid agenesis (being born without a thyroid gland) is another common reason why patients develop hypothyroidism due to the lack of hormone production, although they are usually given synthetic hormones to help fight developing it[4].This lack of thyroid hormones upsets the normal balance of chemical reactions within the body[3].

Who does it affect?

Hypothyroidism is a very common condition[3] that affects five out of one hundred people in the U.S.[5]. Many factors play into how one can end up with this disorder. Genetics can play a large role in developing hypothyroidism. If the disorder runs in a family line, then those members are more likely to develop hypothyroidism. A person has had thyroid issues present at some time in their life can also be affected by it [6] . Generally people over the age of 60 [7] are more likely to obtain hypothyroidism. It is also 10 times more likely to be seen in women than in men[2]. Women who have been pregnant or given birth with 6 months are also at risk for developing the disorder. Other factors that play into who may be affected include those with conditions such as type 1 diabetes, vitiligo, pernicious anemia[6] which is a vitamin B12 deficiency[5] , and leukotrichia[6], autoimmune disease like Sjögren's syndrome [7] that causes dry eyes and mouth[5], rheumatoid arthritis[7] that affects the joints[5], lupus[7] a chronic inflammatory condition[5], or Turner syndrome[7]. From a broader view, about ⅓ of the world’s population lives in places deficient in iodine[2]. This is significant because the presence of iodine in the body is necessary for hormone production in the thyroid[8]. People living in the South-East Asia’s mountains, and both Latin and Central America have low iodine intake[2] because iodine is not added to salt, food, and water[6]. Therefore people in these areas are between 1% and 2% more likely to develop spontaneous hypothyroidism[2].

Symptoms

Symptoms vary patient to patient. The amount and severity of the symptoms will depend on if the disorder is in the early stages, where it is milder, or in the later stages. In the mild stages symptoms may not be recognized or even exhibited by patients. However the hormone levels decrease and affect metabolism which affects the rest of the body and it’s systems [4]. As the condition worsens more symptoms will be visible. Symptoms include fatigue [3], irritability, depression, memory loss [4], increased sensitivity to cold [3], weight gain and difficulty losing weight [4], constipation [3], abnormal menstrual cycles, muscle cramps and aches [4], pain, stiffness, and swelling in the joints, puffy face, dry skin, hoarseness, elevated blood cholesterol level, slowed heart rate [3], coarse and dry hair, and hair loss [4]. In kids and teens an additional few may be present: poor growth, resulting in short stature, delayed development of permanent teeth, delayed puberty, and poor mental development. Hypothyroidism can also cause obesity, infertility, and heart disease [3].

Diagnosis

When dealing with diagnosing hypothyroidism it is usually never diagnosed by symptoms alone due to how similar they can be to other diseases[5]. In fact, it used to be extremely difficult to catch the disease until advanced symptoms were present. Now it can be discovered before symptoms even begin to show due to sensitive TSH tests. Typically older women will be screened during annual physical exams because of the prevalence of underactive thyroid in women of an older age. In women who are, or plan to be pregnant, some doctors recommend for them to be tested. Doctors determine if a patient has developed an underactive thyroid through blood test results, which measure TSH and T4 levels. A low T4 and high TSH level indicates hypothyroidism and occurs when the pituitary gland over produces TSH to try to promote higher thyroid hormone production. Screening test for TSH are the best indicators, so doctors typically perform it first, or after a thyroid hormone test in the process of diagnosing the disease. TSH tests results assist doctors in knowing the correct initial, and progressing dosage of medication needed by that individual[3]. Medical history and a physical exam aid the process as well[5]. To determine the exact underlying cause for hypothyroidism that a blood test can’t point out, doctors use the patient’s clinical history, an antibody screening, and a thyroid scan[8].

Treatments

Hypothyroidism is regularly treated by replacing the hormones your thyroid is not producing anymore[5] in order to restore and rebalance hormone levels[3]. With a few exceptions, this disease requires lifelong treatment [8]. Doctors prescribe daily oral medication such as levothyroxine, levothroid, synthroid, and other synthetic thyroid hormones[3] which should be taken thirty minutes before eating in the morning. Patients on said synthetic replacement hormones should avoid taking iron and or antacids because they interfere with the bodies ability to absorb the hormones [8]. Before synthetic thyroid hormones were available, desiccated thyroid tablets were prescribed. These tablets were gathered from animal thyroid glands. However, the tablets lacked consistent potency from one batch to the next [8]. Now patients receive synthetic hormones identical to the ones the human thyroid makes[5]. Patients are typically treated with T4 replacement regardless which hormone is lacking. This is because T3 doesn’t last as long and therefore must be taken multiple times a day. Despite this, in most patients the T4 naturally converts into T3 when it enters into the bloodstream. Within one to two weeks the replacement hormones begin to take visible effect in lower cholesterol, weight gain reversal, and loss of other symptoms[3]. Six to eight weeks later a blood test will be taken to adjust the dose as needed[5]. The hormone levels will be monitored at six week intervals until stable [8]. Then another blood test will be taken six months later, and eventually, once yearly[5].

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Immune diseases

References

  1. Howdoesthethyroidwork? PubMed Health. Last Updated January 7, 2015. Unknown Author.
  2. 2.0 2.1 2.2 2.3 2.4 Vanderpump, Mark P.J.. The epidemiology of thyroid disease British Medical Bulletin. Web. September 1, 2011.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Hypothyroidism Mayo Foundation for Medical Education and Research. Web. Last Edited May 19, 2017. Unknown Author.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 Norman, James MD, FACS, FACE. Hypothyroidism: Overview, Causes, and Symptoms Vertical Health LLC. Web. Last Edited April 10, 2017.
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 Hypothyroidism (Under active Thyroid) National Institute of Diabetes and Digestive and Kidney Diseases. Web. Accessed October 21, 2017. Unknown Author.
  6. 6.0 6.1 6.2 6.3 Hypothyroidism-What Increases Your Risk WebMD. Accessed on October 21, 2017. Unknown Author.
  7. 7.0 7.1 7.2 7.3 7.4 The Thyroid and You:Coping with a Common Condition Friend’s of the National Library of Medicine. Accessed on October 21, 2017. Unknown Author.
  8. 8.0 8.1 8.2 8.3 8.4 8.5 Mathur, Ruchi. Hypothyroidism Medicine Net. Web. October 21, 2017.