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Definition
Hypothyroidism is a disease in which the thyroid gland does not produce enough thyroid hormone. The thyroid gland is a butterfly-shaped gland in the front of the neck. It produces hormones that control metabolism. Hashimoto's thyroiditis is the most common cause of hypothyroidism.
Thyroid Gland
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Causes
Hashimoto's thyroiditis is an autoimmune disease. Your own immune system creates antibodies that attack the cells of the thyroid gland. This causes chronic thyroid inflammation and loss of thyroid function. Other causes of hypothyroidism include:
- Idiopathic thyroid atrophydestruction of thyroid tissue for unknown reasons
- Iodine deficiencywhen a thyroid gland needs iodine to produce thyroid hormone (rare in the US)
- Subacute thyroiditisfollowing a viral upper respiratory tract infection
- Medical treatmentsradiation to the neck or surgical removal of part of the thyroid gland (called subtotal thyroidectomy)
- Medications (lithium, iodine, alpha-interferons, thiourea, amiodarone, interleukins)
- Infiltrative disease (eg, cancer or infection)
- Pituitary adenoma benign tumor of the pituitary gland
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include: Age: risk increases with age, especially over 65 years oldSex: female, with a female to male ratio of 5-10:1Genetics: multiglandular autoimmune syndromeEthnicity: Caucasian, HispanicHistory of family members with hypothyroidism History of other autoimmune diseases: Pernicious anemiaType 1 diabetesUnderactive adrenal or parathyroid glandsRheumatoid arthritisLupus SymptomsSymptoms develop gradually and may go unnoticed for years. Symptoms include: FatigueWeaknessCoarse, brittle hair; hair lossFacial puffinessDry skinSwollen hands or feetCold intoleranceWeight gainConstipationAchy feeling all overDepression and irritability Memory lossDifficulty with concentrationBlurred vision Menstrual abnormalities or infertility Symptoms of severe or prolonged cases include: Stupor or comaSlow heart rateDepressed breathingHypothermia (low body temperature) Hoarseness DiagnosisThe doctor will ask about your symptoms and medical and family history, and perform a physical exam. Blood tests will be done to confirm the diagnosis, which include thyroid stimulating hormone (TSH), free T4 and free T3, and antibodies that attack the thyroid gland.
TreatmentIn the early stages of Hashimoto's thyroiditis, there is no specific treatment. However, most people with this condition eventually develop hypothyroidism. At that point, you will need to start taking medication (levothyroxine and/or triiodothyronine) that replaces the thyroid hormones. You will have to take this medication indefinitely. To reduce the discomfort from constipation, you will be asked to eat a high-fiber diet. If you are overweight or obese , you will be given a low-fat, low-calorie diet. PreventionIf you are 50 years old or older, you should have a screening test (TSH) every five years.You should be screened regularly if you have the following risk factors:Type 1 diabetesInfertility (females)Depression Treatment with certain medications RESOURCES: The American Thyroid Associationhttp://www.thyroid.org Women's Health.govhttp://womenshealth.gov/ CANADIAN RESOURCES: Canadian Institute for Healthhttp://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e Thyroid Foundation of Canadahttp://www.thyroid.ca References: American Association of Clinical Endocrinologists. AACE medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocrine Practice . 2002;8:457-469.
Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, et al. Treatment of hypothyroidism with combinations of levothyroxine plus liothyronine. J Clin Endorinol Metab . 2005;90:4946-4954. Harrison's Principles of Internal Medicine. 15th ed. McGraw Hill; 2001. Roberts CG, Ladenson PW. Hypothyroidism. Lancet . 2004;363:793-803. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management JAMA . 2004;291:228-238. Last reviewed March 2008 by David Juan, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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