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The thyroid is a small gland at the base of the front of the neck, just below the protuberance commonly known as the "Adam's apple". It is a vital part of the body's metabolic system. When the thyroid malfunctions, it can become either overactive or underactive. Each of these conditions can cause a wide variety of puzzling and often debilitating symptoms. This article will focus on the causes, symptoms and treatment of underactive thyroid.
Underactive thyroid, called hypothyroidism, affects as many as 5 million Americans. Although the likelihood of developing thyroid disease may increase with age, it can occur at any time. Hypothyroidism can be caused when the thyroid is damaged by inflammation, destroying some portion of the gland. Portions of the thyroid gland may also be surgically removed if necessary for the treatment of goiter, cancer or benign nodules. The remaining, smaller portion of the thyroid can often continue to work effectively; but it may, at some point, become unable to bear the burden of the body's needs, and hypothyroidism could result. Your risk of developing hypothyroidism increases if one or more family members has thyroid disease.
Unfortunately, the most common presenting symptom of hypothyroidism, fatigue, can be caused by a wide variety of other ailments, so it can easily be undiagnosed or misdiagnosed. Other common symptoms of hypothyroidism may be so vague and varied that many patients do not even report them to their doctors. In addition to profound fatigue, those symptoms may include:
chronic anemia
chronic constipation
unexplained weight gain
pale or yellowish dry, itchy skin
thick nails that break or split easily
Even less obvious symptoms may include:
reduction in body hair, including eyebrows and groin
bloating or puffiness around the eyes
"feeling cold all the time"
heavy, irregular menstruation with clotting
history of miscarriage, low birth weight babies or early delivery
weak muscles or muscle cramps
vision disturbances, including "flickering" in the peripheral field
decreased sexual desire
memory loss
Since hypothyroidism often develops as we age and many of its symptoms may appear to be natural results of the aging process, we may chalk them up as "normal". It's important that we take a look at the whole picture before resigning ourselves to what many people refer to as "I'm just falling apart!" Indeed, hypothyroidism can feel just like that.
Most patients do not experience all these symptoms. Just because you may not have most of the symptoms, does not mean you should rule out hypothyroidism as the cause of your other symptoms. Ten different people may exhibit ten different combinations of symptoms, in varying numbers and levels of intensity.
Many people don't find the symptoms, taken individually, to be bothersome enough to even report to their doctors. Their accumulated effect, however, can be quite disturbing. The extreme fatigue associated with underactive thyroid can result in depression, impaired mental processes, and emotional disturbances. Frequent infections are often noted. The cardiac system can also be affected, causing irregular heartbeat, slow pulse rate and fluctuations in blood pressure.
Most patients are not routinely screened for thyroid problems. If you suffer from extreme fatigue that is not relieved by proper sleep and have two or more of the other symptoms noted, you should ask your doctor to test you for hypothyroidism. A simple blood test measures the levels of T4 (the main hormone produced by the thyroid gland) and TSH (thyroid stimulating hormone) in the system. Typically, if the thyroid is underactive, the level of T4 will be low while the TSH level will be high compared to what is considered "normal range". The high TSH level indicates that the body is lacking T4 and is "ordering more" from the thyroid, which, being diseased, is unable to supply it. The remaining healthy portion of the thyroid may react then by "growing" in an attempt to do its job. The result can be what is known as a goiter, an unnatural growth on the thyroid gland. Allowed to grow, a goiter can be seen as a bulge in the lower part of the neck.
Once diagnosed, thyroid disease, including hypothyroidism should be treated. It will not spontaneously heal or go away by itself and will continue to get worse. Treatment for underactive thyroid is usually in the form of a once-a-day prescription tablet called Levothyroxine. Several brand names of this drug are now available, and they are generally low-priced and covered by most insurance. All brands now available will be comparable in their effectiveness.
Generally, side effects of levothyroxine are negligible at the appropriate dosage. However, care must be taken to see that a patient is not overdosed on thyroid hormone, as this can result in hyperthyroidism (overactive thyroid), which is also dangerous. Patients on seizure control medications and some medications to control cholesterol may see adverse affects when thyroid supplement is added. Pregnant women should be sure to consult their physician as they may need to have their dosage adjusted accordingly.
It may be a delicate balance for patient and physician as they try to get the proper treatment for hypothyroidism. Once starting levothyroxine treatment, It takes a few weeks for the medicine to get "into the system" before improvement in symptoms can be seen. After beginning therapy, the doctor should conduct periodic blood tests to monitor TSH and T4 levels. She may find upon rechecking that the "numbers" are within normal range and the patient may feel much better. This would be the ideal.
However, even if "levels" appear normal, some patients may still not have relief from symptoms. If this occurs, don't be afraid to tell your doctor. It may be necessary for her to consult a specialist, called an endocrinologist, who can do further, more comprehensive testing and offer other treatments. It's important that your dosage and treatment be correct for YOU and not just the general population or the average patient. Once hypothyroidism has been diagnosed, you will continue on treatment for the rest of your life. Make sure that the result you get is the best available for YOU.
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