What is it?

Hypothyroidism is a medical condition characterized by an underactive thyroid gland, which results in reduced production of thyroid hormones. The thyroid gland, located in the front of the neck, produces hormones that play a crucial role in regulating various bodily functions, including metabolism, growth, and development(1).

The symptoms are wide ranging, affect each individual differently, making it hard to diagnose. There is also some disagreement on what characterizes hypothyroidism and what level to treat at. It more frequently affects women and shows up anytime after puberty (more frequently in the 20’s)  but is more likely to be diagnosed after the symptoms have become unbearable and permanent somewhere around 40 years old. A good rule of thumb though is: if your TSH levels are elevated, (some say between 5 and 10 mU/L and others as low as 2 or 4mU/L) it might be a good idea to get treated, or at least regularly monitored for problems  (2)(3). 

Symptoms

Generally the symptoms are: Fatigue, weight gain, sensitivity to cold, constipation, dry skin/hair, hair loss, muscle aches and weakness, joint pain and stiffness, memory problems, menstrual irregularities, hoarseness, slowed heart-rate, depression and swelling of the face and extremities. Symptoms can frequently vary in severity. Also, these symptoms can be caused by other health conditions but a simple blood test can easily clear that up (4).

For me, I had fatigue, to the point where I needed to sleep 10 hours a day to function at all -we thought it was just severe depression. I was never without a sweater and gloves even in the Southern California heat and I often struggled to walk down the stairs in the morning due to how stiff my legs and ankles were. I had other symptoms too, my memory was always foggy, my hair was always falling out and breaking easily, no amount of conditioner would improve it and I constantly felt faint and short of breath, I thought I had asthma that just wasn’t responsive to inhalers. 

Without treatment these symptoms can become permanent. It may also lead to goiters (visible swelling in the front of the neck at the gland), heart disease, high cholesterol -which can lead to higher risk of heart attacks, strokes and other cardiovascular complications. Infertility (in men and women) and pregnancy complications are also a big risk, pregnant women are more likely to experience preeclampsia , premature birth and developmental issues in the baby (5). 

There are three main types of hypothyroidism.

 Primary Hypothyroidism is when the thyroid gland itself is unable to produce sufficient thyroid hormones. It can be caused by Hashimoto’s thyroiditis (an autoimmune condition), iodine deficiency (crucial nutrient for hormone synthesis), removal of the thyroid gland, radiation therapy, certain medications and congenital (born with) hypothyroidism. 

Secondary Hypothyroidism, which occurs when there is a problem with the pituitary gland or hypothalamus which regulates thyroid hormone production. This can be caused by tumors, injuries, or radiation therapies.

Tertiary Hypothyroidism: Tertiary hypothyroidism is a rare form of hypothyroidism caused by dysfunction in the hypothalamus, specifically in the production and release of TRH. This condition is usually associated with structural damage or hypothalamic disorders (6).

Treatment:

Levothyroxine is the main form of treatment. A pill you have to take once in the morning, about an hour before breakfast. A blood test, once and awhile, along with your endocrinologist helps determine your dosage and make regular adjustments. It is a chronic condition, therefore these treatments have to go on for the rest of my life, which can get tiresome. But as far as chronic conditions go, it’s an easy treatment. Some folks find that adjusting and balancing their diet helps along with weight loss, exercise and regular sleep. It’s also a good idea to avoid goitrogenic foods (that cause goiters) such as broccoli and cauliflower. 

Sources:

1. Sheehan, Michael T. Biochemical Testing of the Thyroid: TSH is the Best and, Oftentimes, Only Test Needed – A Review for Primary Care. Clin Med Res. 2016 Jun; 14(2): 83–92.doi: 10.3121/cmr.2016.1309 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321289/

2. Underactive thyroid: Deciding whether or not to treat subclinical hypothyroidism – InformedHealth.org – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK279600/

3. What is a TSH (thyroid stimulating hormone) Test? UCLA Health. https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/tsh-test#:~:text=Normal%20values%20are%20from%200.4,hypothyroidism%20sometime%20in%20the%20future.

4. Hypothyroidism (Underactive Thyroid) – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism

5. Hypothyroidism (underactive thyroid). Mayo Clinic. Dec 10, 2022. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
6. Gupta, Vishal; Lee, Marilyn. Central Hypothyroidism. Indian J Endocrinol Metab. 2011 Jul;15(Suppl2):S99–S106.doi:10.4103/2230-8210.83337.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169862/
7. Patil,Nikkita; Rehman, Anis; Jialal, Ishwarlal. Hypothyroidism.StatPearls Publishing LLC.2023 https://www.ncbi.nlm.nih.gov/books/NBK519536/