HYPOTHYROIDISM

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Introduction:

Thyroid gland is a butterfly shaped gland located in front lower part of the neck. It synthesizes and releases thyroid hormones (T3/triiodothyronine and T4/ thyroxine) that ultimately affects body metabolism.

Hypothyroidism or underactive thyroid disease is common and occurs when there is an insufficiency of thyroid hormones.

Causes of hypothyroidism includes Hashimoto's thyroiditis (autoimmune disorder), radiation treatment to the neck area, certain medications like lithium, amiodarone, IL-2 & interferon alpha, surgery (total or partial thyroidectomy), dietary deficiency of iodine, pregnancy, (postpartum thyroiditis), congenital hypothyroidism (structural or functional), pituitary gland disorders and in extremely rare case disorders of hypothalamus.

Risk factors:

• Females (commonly elderly)
• Increasing Age
• Race (Asian/White)
• History of close family members with autoimmune diseases
• Personal history of autoimmune disease
• Prematurely greying hair
• Down's syndrome
• Turner's syndrome
• Bipolar disorders

Symptoms of hypothyroidism can be tricky to associate with the disease as they are vague and often mimic other conditions. 

Symptoms in adults:

• Constipation
• Dry skin
• Dry hair and hair loss
• Difficulty in losing weight or unexplained weight gain
• Changes in menstrual cycle
• Depression
• Irritability
• Decreased libido
• Muscle cramps/aches
• Fatigue
• Cold intolerance
• Slow heart rate
• Anterior neck swelling (goitre)
• Carpel tunnel syndrome

Symptoms in babies:

• Cold extremities
• Hoarse cry
• Constipation
• Extreme sleepiness
• Floppy infant
• Little or no growth
• Poor feeding habits
• Puffy face
• Persistent jaundice
• Bloating of stomach
• Swollen tongue

Diagnosis therefore can be done with simple blood tests which measures thyroid hormones T4 (thyroxine) and Thyroid Stimulating Hormone (TSH). If need be, a thyroid scan can also be done.

Interpretation of thyroid test results:

• Lower than normal T4 implicates hypothyroidism
• Elevated TSH levels with normal T4 implies subclinical (mild) hypothyroidism.

Treatment

Supplementary thyroxine in form of pills with regular monitoring and titration until the correct individual dosage has been established.

Complications of untreated hypothyroidism:

• Joint pains
• Obesity
• Infertility
• Heart problems

Poor mental development in a baby could be due untreated thyroid problems in the mother during pregnancy.

Most severe form of hypothyroidism called myxedema can be life threatening and lead to coma, hypothermia and ultimately death if left unaddressed.