WHAT IS HYPOTHYROIDISM?
Because thyroid hormone affects virtually
every cell in your body, your doctor might have suspected hypothyroidism from the
diversity of your complaints. If your thyroid produces too little thyroid hormone, your
heartbeat may be slowed and you may feel tired, depressed and rundown. A low thyroid
hormone level may cause your skin, hair, and fingernails to grow more slowly, so they
become rough, dry and brittle.
You may be uncomfortable in cold
temperatures moreso than before. Other symptoms of hypothyroidism include constipation,
loss of appetite, weight gain, irregular, heavy or absent menstrual periods, puffiness
about the face and swollen ankles.
Other physical symptoms of hypothyroidism
include cramps, dizziness, a deepening voice and hypothyroidism may also increase blood
cholesterol levels.
It has been postulated by many
investigators that these increased cholesterol levels can be responsible for accelerated
atherosclerosis or hardening of the arteries leading to high blood pressure and heart
disease.
Finally, hypothyroidism may cause an
inability to concentrate as well as forgetfulness. These mental symptoms have lead to
instances where hypothyroidism was misdiagnosed as senility, madness or psychosis.
WHO GETS HYPOTHYROIDISM?
Best estimates are that at least six
million Americans have hypothyroidism - but only half have been diagnosed. Most of the
remainder feel varying degrees of discomfort or lethargy, and some may incorrectly
attribute such symptoms to "getting older and slowing down."
Hypothyroidism affects mainly women in the
age group 30 to 60 years of age. However, it affects both sexes and people of any age.
Hypothyroidism has many different causes. In the United States, however, the most common
cause of hypothyroidism is Hashimoto's thyroiditis.
WHERE DOES HYPOTHYROIDISM COME FROM?
In the body, white blood cells frequently
produce substances known as antibodies. These antibodies are much like darts that the
white blood cells send out against invading germs or substances to help immobilize them
and kill them to protect the body against infection and invasion. There are a group of
diseases in which, for some inexplicable reason, a group of white blood cells turns
against the body and starts to make antibodies against various parts of the body causing
damage therein. For example, rheumatoid arthritis is an autoimmune illness in which the
body's white blood cells start to make antibodies against the person's joints. These
joints then become swollen, painful, stiff and ultimately become deformed.
In the same way, Hashimoto's thyroiditis is
a disease in which the white blood cells of the body begin to produce antibodies which
attack the thyroid gland. These antibodies can inflame, irritate, and possibly destroy the
thyroid. It is this irritation, or inflammation, which causes the thyroid to become
enlarged to varying degrees, thus producing a goiter (the medical term for an enlarged
thyroid).
In addition, should the inflammation or
destruction of the thyroid gland be extensive enough, the thyroid is unable to put out
enough thyroid hormone to keep up with the body's needs and hypothyroidism ensues.
HOW IS HYPOTHYROIDISM DIAGNOSED AND TREATED?
Fortunately, endocrinologists (doctors
specializing in the evaluation and treatment of all hormonal disorders - including thyroid
disorders) can diagnose hypothyroidism. Once the problem is diagnosed, treatment is as
simple as a once a day tablet. The tablet contains thyroid hormone to compensate for the
thyroid's diminished output. In a physical exam, looking for hypothyroidism, the doctor
carefully feels the thyroid to see if it is abnormally enlarged or changed in its texture.
In addition, various confirming blood tests
can be ordered to document the thyroid situation. There are specific instances in which
hypothyroidism may be exquisitely difficult to diagnose, such as in the elderly, the
extremely ill and the mentally compromised. Unless doctors suspect a thyroid problem, it
may be mistaken for varied symptoms of psychosomatic complaints or the normal aging
process.
The patient himself is often fooled too.
Hypothyroidism usually comes on gradually, over several months or even years. The early
clues may be scarcely noticeable, or you may attribute them to other causes. You may feel
tired most of the time, have weak or aching muscles, feel cold, be constipated or gain
weight even though you are eating less. The risks of hypothyroidism differ depending on
when and in whom this disorder is discovered.
In newborns who cannot make enough thyroid
hormone, prompt treatment is crucial. Infants who are not treated will become mentally
retarded and have delayed growth, facial deformities, and other severe abnormalities. That
is why all newborns today are tested for hypothyroidism. Children or adolescents who
become hypothyroid also risk abnormal mental and physical developments if they are not
treated promptly.
Adults are susceptible to the above
mentioned hypercholesterolemia that hypothyroidism can cause with its presumed increase in
heart disease. In addition, the many signs and symptoms of hypothyroidism are socially and
physically disabling, profoundly affecting one's happiness and lifestyle. Because of the
severe effects of hypothyroidism, if it is left untreated long enough, and if it is severe
enough, the mental changes can progress to coma at which point hypothyroidism becomes a
potentially fatal illness.
The vast majority of patients with
hypothyroidism are treated with synthetic thyroid hormone called Levothyroxine. This
substance works in the body exactly the way natural hormone does. Synthetic thyroid
hormone causes no allergic reactions and if taken correctly, no adverse effects on any
body tissues. This newer, man-made version of natural thyroid hormone costs approximately
15 cents a day.
WHAT ARE SOME PROBLEMS INVOLVED IN THYROID
TREATMENT?
Unfortunately, not everyone uses the
synthetic type. A study published in 1989 in the Journal of The American Medical
Association found that many older people still take the natural kind obtained from the
thyroid glands of slaughtered animals. In this case, natural may not be as healthy as
synthetic. The thyroid hormone obtained from animals is unpredictable. The kind of animals
used, what they ate, the season they were slaughtered, all can cause the hormone's potency
to vary from one batch to another.
In addition, the natural thyroid hormone
preparation contains the shorter, more potent acting T3 hormone which in older individuals
can cause potential problems with heart function by stimulating it too much, too quickly.
By contrast, the synthetic variety is pure,
standardized from batch to batch, and is identical in chemical structure to human thyroid
hormone. It does not contain any T3, containing only the smoother, longer acting T4. Most
doctors have switched their patients from natural to synthetic thyroid hormone and
certainly almost all endocrinologists agree that the treatment of choice is synthetic
thyroid hormone.
Doctors take special care to prescribe the
minimal effective thyroid hormone dose. This is especially important for the elderly and
those with coronary artery disease. There is recent evidence to suggest that
excruciatingly accurate manipulations of thyroid hormone dosage are important at any age.
In the last few years, studies have shown that too much thyroid hormone used for
replacement for those with hypothyroidism may increase a person's risk for osteoporosis,
the bone thinning disorder that can lead to fractures of the hip and spine.
Accurately changing the thyroid hormone
dose has been difficult until recently because doctors lacked a sensitive test of thyroid
function, a way to gauge if the gland was underactive or overactive and by how much. Now,
a sophisticated test can diagnose thyroid problems that have gone undiagnosed in the past.
It also allows doctors to accurately gauge the optimum dosage of replacement thyroid
hormone that suits each individual.
Older thyroid function tests measure blood
levels of the main thyroid hormone, thyroxine or T4. A wide range of thyroxine levels can
be considered "normal." A low normal reading may be okay for one person's
metabolism, but not enough for another. Using a highly sensitive technique, the new test
measures a different hormone, thyroid stimulating hormone or TSH.
TSH comes from the pituitary gland and does
what its names suggests; it stimulates the thyroid to release its hormone. The pituitary
sends out TSH in response to the amount of thyroid hormone it senses in the blood. A high
TSH level tells you the thyroid isn't making enough hormone.
In addition to endocrinologists being able
to use this highly sensitive TSH today, there is good reason to have yourself rechecked if
you had been on thyroid hormone for an extremely long period of time. Until about 1960,
doctors believed that a sluggish thyroid caused many common maladies.
Lacking accurate thyroid function tests,
doctors prescribed thyroid hormone on a hunch sometimes rather than with solid evidence
that people needed it. It is possible, therefore, that some people who have not checked
with their doctor since getting a prescription long ago for thyroid hormone may be taking
the medication for nothing, and possibly causing deleterious effects such as the
osteoporosis alluded to above.
It is now known that thyroid hormone should
be used only for specific disorders, such as hypothyroidism, benign goiter, thyroid nodule
and cancer of the thyroid. Taking unnecessary thyroid hormone is probably not dangerous
for most people, but can be risky for some. If you are on thyroid medication, but think
you might not need it, don't discontinue therapy on your own, you must confer with your
doctor.
Once thyroid hormone administration has
begun for the treatment of hypothyroidism, the symptoms do not disappear with the first
dose. You will have to be patient and continue taking the medication as you slowly and
gradually notice the improvements in your appearance and well-being. Even if you are
severely hypothyroid, however, a few months of treatment should relieve all of your
hypothyroid related symptoms.
Once you are feeling better, it is
important to continue taking your thyroid hormone for the remainder of your life! The
tablets you take replace hormones your thyroid no longer makes in sufficient quantities to
keep you healthy and alive. If you stop taking the medication, your body will use up the
remainder of the thyroid hormone in about 1 months time and then you will gradually become
more and more hypothyroid as you did at the beginning of your diagnosis.
In addition, not even all synthetic thyroid
hormone preparations are the same. If your physician prescribes a certain brand and your
pharmacist asks if you would like to switch from that brand, check with your physician
first. Two differing companies may not provide the exact same dose of thyroid hormone even
though the numbers may be the same.
WHAT HAPPENS TO MY THYROID HORMONE NEEDS OVER
TIME?
As you grow older or various life events
occur, your dosage of thyroid hormone might need to be changed. For this reason, it is
advisable to have your thyroid examination and thyroid hormone levels checked at your
interval physical examination.
If you change doctors, remind your new
physician that you have an ongoing thyroid problem that must be reevaluated when you see
him or her.
Since the most common type of thyroid gland
failure is an inherited condition, examination of the members of your family may reveal
other individuals with thyroid problems. Please urge to them to have their physicians
check to be sure that they do not possibly have a thyroid illness when they have their
checkups.
Finally, and in summary, if you are
hypothyroid, you have been diagnosed as having a fairly common, chronic medical condition:
too little thyroid hormone. Fortunately, it is a condition that can be treated easily,
inexpensively, painlessly and completely effectively.
