Hypothyroidism

1 What is Hypothyroidism?

Hypothyroidism is a disorder that occurs when the thyroid gland does not make enough thyroid hormone to meet the body’s needs.

Thyroid hormone regulates metabolism—the way the body uses energy—and affects nearly every organ in the body. Without enough thyroid hormone, many of the body’s functions slow down.

Hypothyroidism

About 4.6 percent of the U.S. population age 12 and older has hypothyroidism.

2 Symptoms

Hypothyroidism commonly manifests as a slowing in physical and mental activity but may be asymptomatic. Symptoms and signs are often subtle and neither sensitive nor specific.

The following are symptoms of hypothyroidism:

  • Fatigue, loss of energy, lethargy
  • Weight gain
  • Decreased appetite
  • Cold intolerance
  • Dry skin
  • Hair loss
  • Sleepiness
  • Muscle pain, joint pain, weakness in the extremities
  • Depression
  • Emotional labiality, mental impairment
  • Forgetfulness, impaired memory, inability to concentrate
  • Constipation
  • Menstrual disturbances, impaired fertility
  • Decreased perspiration
  • Paresthesia and nerve entrapment syndromes
  • Blurred vision
  • Decreased hearing
  • Fullness in the throat, hoarseness

The following are symptoms more specific to Hashimoto thyroiditis:

  • Feeling of fullness in the throat
  • Painless thyroid enlargement
  • Exhaustion
  • Transient neck pain, sore throat, or both

Physical signs of hypothyroidism include the following:

  • Weight gain
  • Slowed speech and movements
  • Dry skin
  • Jaundice
  • Pallor
  • Coarse, brittle, straw-like hair
  • Loss of scalp hair, axillary hair, pubic hair, or a combination
  • Dull facial expression
  • Coarse facial features
  • Periorbital puffiness
  • Macroglossia
  • Goiter (simple or nodular)
  • Hoarseness
  • Decreased systolic blood pressure and increased diastolic blood pressure
  • Bradycardia
  • Pericardial effusion
  • Abdominal distention, ascites (uncommon)
  • Hypothermia (only in severe hypothyroid states)
  • Nonpitting edema (myxedema)
  • Pitting edema of lower extremities
  • Hyporeflexia with delayed relaxation, ataxia, or both

Myxedema coma is a severe form of hypothyroidism that most commonly occurs in individuals with undiagnosed or untreated hypothyroidism who are subjected to an external stress. Features are as follows:

  • Altered mental status
  • Hypothermia
  • Bradycardia
  • Hypercarbia
  • Hyponatremia
  • Cardiomegaly, pericardial effusion, cardiogenic shock, and ascites may be present
Have a question aboutHypothyroidism?Ask a doctor now

3 Causes

Here are the major causes of hypothyroidism, from the most to the least common:

Autoimmune disease

In some people’s bodies, the immune system that protects the body from invading infections can mistake thyroid gland cells and their enzymes for invaders and can attack them. Then there aren’t enough thyroid cells and enzymes left to make enough thyroid hormone. This is more common in women than men. Autoimmune thyroiditis can begin suddenly or it can develop slowly over years. The most common forms are Hashimoto’s thyroiditis and atrophic thyroiditis.

Surgical removal of part or all of the thyroid gland: Some people with thyroid nodules, thyroid cancer, or Graves’ disease need to have part or their entire thyroid removed. If the whole thyroid is removed, people will definitely become hypothyroid. If part of the gland is left, it may be able to make enough thyroid hormone to keep blood levels normal.

Radiation treatment

Some people with Graves’ disease, nodular goiter, or thyroid cancer are treated with radioactive iodine (I-131) for the purpose of destroying their thyroid gland. Patients with Hodgkin’s disease, lymphoma, or cancers of the head or neck are treated with radiation. All these patients can lose part or all of their thyroid function.

Congenital hypothyroidism (hypothyroidism that a baby is born with)

A few babies are born without a thyroid or with only a partly formed one. A few have part or their entire thyroid in the wrong place (ectopic thyroid). In some babies, the thyroid cells or their enzymes don’t work right.

Thyroiditis

Thyroiditis is an inflammation of the thyroid gland, usually caused by an autoimmune attack or by a viral infection. Thyroiditis can make the thyroid dump its whole supply of stored thyroid hormone into the blood at once, causing brief hyperthyroidism (too much thyroid activity); then the thyroid becomes underactive.

Medicines

Medicines such as amiodarone, lithium, interferon alpha, and interleukin-2 can prevent the thyroid gland from being able to make hormone normally. These drugs are most likely to trigger hypothyroidism in patients who have a genetic tendency to autoimmune thyroid disease.

Too much or too little iodine

The thyroid gland must have iodine to make thyroid hormone. Iodine comes into the body in food and travels through the blood to the thyroid. Keeping thyroid hormone production in balance requires the right amount of iodine. Taking in too much iodine can cause or worsen hypothyroidism.

Damage to the pituitary gland

The pituitary, the “master gland,” tells the thyroid how much hormone to make. When the pituitary is damaged by a tumor, radiation, or surgery, it may no longer be able to give the thyroid instructions and the thyroid may stop making enough hormones.

Rare disorders that infiltrate the thyroid: In a few people, diseases deposit abnormal substances in the thyroid and impair its ability to function. For example, amyloidosis can deposit amyloid protein, sarcoidosis can deposit granulomas, and hemochromatosis can deposit iron.

4 Making a Diagnosis

A diagnosis of hypothyroidism is made after a thorough review of the patient’s symptoms, medical and family history, physical examination, and most effectively, a blood test.

Be sure to discuss with your doctor:

  • Your general state of health—particularly any changes you have noticed in your general overall health.
  • Your family’s health history—especially if a close relative has been diagnosed with hypothyroidism (or any other thyroid-related issues).
  • Whether you’ve ever had thyroid surgery, or radiation to your neck to treat cancer.
  • Any medicines you may be taking that could cause hypothyroidism (eg, amiodarone, lithium, interferon alpha, interlukin-2, or prior chemotherapy).

Physical Examination—Looking for Signs of Hypothyroidism

Your physician will perform a thorough examination and look for physical signs of hypothyroidism, including:

  • Evidence of dry skin
  • Swelling around the eyes and legs
  • Slower reflexes
  • Slower heart rate

A health care provider may order several blood tests to check thyroid function, including the following:

  • TSH test
  • T4 tests
  • T3 test
  • thyroid-stimulating immunoglobulin (TSI) test
  • antithyroid antibody test, also called the thyroid peroxidase antibody test (TPOab)

Many complex factors affect thyroid function and hormone levels. Health care providers take a patient’s full medical history into account when interpreting thyroid function tests.

TSH Test

The TSH test is the most accurate test for diagnosing hypothyroidism. An abnormally high TSH level suggests hypothyroidism.

Normally, the pituitary boosts TSH production when thyroid hormone levels in the blood are low. The thyroid responds by making more hormones.

Then, when the body has enough thyroid hormone circulating in the blood, TSH output drops. The cycle repeats continuously to maintain a healthy level of thyroid hormone in the body.

In people whose thyroid produces too much thyroid hormone, the pituitary shuts down TSH production, leading to low or even undetectable TSH levels in the blood.

In people whose thyroid is not functioning normally and produces too little thyroid hormone, the thyroid cannot respond normally to TSH by producing thyroid hormone. As a result, the pituitary keeps making TSH, trying to get the thyroid to respond.

If results of the TSH test are abnormal, a person will need one or more additional tests to help find the cause of the problem.

Normal and Abnormal TSH Ranges

  • 0.4 mU/L to 4.0 mU/L is considered the reference range (there may be slight variation depending on the laboratory), and people who have a normally functioning thyroid gland usually fall within this range.
  • If TSH measures >4.0 mU/L, a second test (T4) is performed to verify the results. TSH >4.0/mU/L with a low T4 level indicates hypothyroidism.
  • If your TSH is >4.0 mU/L and your T4 level is normal, this may prompt your physician to test your serum anti-thyroid peroxidase (anti-TPO) antibodies. When these antibodies are present, it may indicate an autoimmune thyroid disorder, which is a risk factor for developing hypothyroidism. If you have these anti-bodies, your doctor will most likely perform and TSH test at least once per year.

T4 Tests

The thyroid primarily secretes T4 and only a small amount of T3. T4 exists in two forms:

  • T4 that is bound to proteins in the blood and is kept in reserve until needed
  • a small amount of unbound or “free” T4 (FT4), which is the active form of the hormone and is available to enter body tissues when needed

A high level of total T4—bound and FT4 together—or FT4 suggests hyperthyroidism, and a low level of total T4 or FT4suggests hypothyroidism.
Severe illness or the use of corticosteroids—a class of medications that treat asthma, arthritis, and skin conditions, among other health problems—can decrease binding protein levels. Therefore, in these cases, the total T4 level may be low, yet the person does not have hypothyroidism.

T3 Test

The T3 test is not useful in diagnosing hypothyroidism because levels are not reduced until the hypothyroidism is severe.

Antithyroid Antibody Test

Antithyroid antibodies are markers in the blood that are extremely helpful in diagnosing Hashimoto’s disease. Two principal types of antithyroid antibodies are

  • anti-TG antibodies, which attack a protein in the thyroid called thyroglobulin
  • anti-thyroperoxidase, or anti-TPO, antibodies, which attack an enzyme in thyroid cells called thyroperoxidase

What imaging tests do health care providers use to diagnose and find the cause of thyroid disorders?

A health care provider may use one or a combination of imaging tests, such as an ultrasound of the thyroid, a computerized tomography (CT) scan, or nuclear medicine tests, to diagnose and find the cause of thyroid disorders.

  • Ultrasound: The images can show the size and texture of the thyroid, as well as a pattern of typical autoimmune inflammation. The images can also show nodules or growths within the gland that suggest a malignant tumor.
  • CT scan: CT scans are usually not needed to diagnose thyroid disease; however, health care providers will use them to view a large goiter. Also, a CT scan will often show a thyroid nodule when a person is having the scan for other health problems.

Nuclear medicine tests

Nuclear medicine tests of the thyroid include a thyroid scan and a radioactive iodine uptake test. People often have to follow a low iodine diet prior to having the tests.

Thyroid scan

A thyroid scan is used to look at the size, shape, and position of the gland. This test can help find the cause of hyperthyroidism and check for thyroid nodules. The scan also can help a health care provider evaluate thyroid nodules; however, it does not confirm whether the nodules are cancerous or benign.

Several thyroid disorders that cause inflammation of the thyroid, or thyroiditis, may cause leakage of thyroid hormone and iodine out of the thyroid into the bloodstream, which can lead to high T4 levels. When the thyroid is inflamed, it does not take up the radioactive iodine given as part of the thyroid uptake test.

For example, hyperthyroidism seen in Graves’ disease would be marked by high blood T4 and a high thyroid uptake reading. In thyroiditis, temporary hyperthyroidism may exist because of the release of T4 into the blood; however, the thyroid uptake reading is low because of the inflammation. Temporary hyperthyroidism in thyroiditis is often followed by a period of hypothyroidism before the thyroid heals.

Even though the amount of radiation used in this test is small, women who are pregnant or breastfeeding should not have this test because of the risks of exposing the fetus or infant to radiation.

PREVENTION

In countries where the diet does not contain enough iodine, taking iodine supplements can prevent hypothyroidism.

In the United States and other developed countries, where most people's diet contains enough iodine, there is no known way to prevent hypothyroidism.

Diagnosing hypothyroidism early by testing newborn babies, pregnant women, and people with symptoms or risk factors is the best way to prevent it from worsening. The biggest risk factor is having relatives with thyroid disease.

5 Treatment

Hypothyroidism is usually quite easy to treat (for most people).

The easiest and most effective treatment is simply taking a thyroid hormone pill (Levothyroxine) once a day, preferably in the morning.

It comes in multiple strengths, which means that an appropriate dosage can almost always be found for each patient. The dosage should be re-evaluated and possibly adjusted monthly until the proper level is established.

The dose should then be re-evaluated at least annually. If you are on this medication, make sure your physician knows it so he/she can check the levels at least yearly.

The goal is to make you feel better, make your body last longer, slow the risk of heart disease and osteoporosis, in addition to making your blood levels normal. Sometimes that's easy, when it’s not, you need a physician who is willing to spend the time with you that you deserve while you explore different dosages other types of medications (or alternative diagnoses).

Some patients will notice a slight reduction in symptoms within 1 to 2 weeks, but the full metabolic response to thyroid hormone therapy is often delayed for a month or two before the patient feels completely normal.

It is important that the correct amount of thyroid hormone is used. Not enough and the patient may have continued fatigue or some of the other symptoms of hypothyroidism.

Too high a dose could cause symptoms of nervousness, palpitations or insomnia typical of hyperthyroidism. Some recent studies have suggested that too much thyroid hormone may cause increased calcium loss from bone increasing the patient's risk for osteoporosis.

For patients with heart conditions or diseases, an optimal thyroid dose is particularly important. Even a slight excess may increase the patient's risk for heart attack or worsen angina. Some physicians feel that more frequent dose checks and blood hormone levels are appropriate in these patients.

After about one month of treatment, hormone levels are measured in the blood to establish whether the dose of thyroid hormone which the patient is taking is appropriate.

We don't want too much given or subtle symptoms of hyperthyroidism could ensue, and too little would not alleviate the symptoms completely. Often blood samples are also checked to see if there are antibodies against the thyroid, a sign of autoimmune thyroiditis.

Remember, this is the most common cause of hypothyroidism. Once treatment for hypothyroidism has been started, it typically will continue for the patient's life. Therefore, it is of great importance that the diagnosis be firmly established and you have a good relationship with a physician you like and trust.

Synthetic T4 can be safely taken with most other medications. Patients taking cholestyramine (a compound used to lower blood cholesterol) or certain medications for seizures should check with their physician about potential interactions.

Women taking T4 who become pregnant should feel confident that the medication is exactly what their own thyroid gland would otherwise make.

However, they should check with their physician since the T4 dose may have to be adjusted during pregnancy (usually more hormone is needed to meet the increased demands of the mother's new increased metabolism).

There are other potential problems with other drugs including iron-containing vitamins.

Once again, pregnant women (and all women and men for that matter) taking iron supplements should discuss this with your physician.

6 Alternative and Homeopathic Remedies

Several alternative remedies exist for hypothyroidism.

Curing thyroid disease requires a long-term commitment for a period of at least a year. Creating this problem took years of self-poisoning, so fixing it is neither quick, nor easy.

Hypothyroidism medications are addictive, and the body becomes reliant on them, which is why the mainstream establishment maintains that people must take them forever.

Those who have been taking hypothyroidism medications for years must slowly wean themselves from the drugs. Abruptly stopping these medications will result in extreme fatigue and additional thyroid problems.

Treatment Recommendations

Eliminate and discard all non-stick cookware

Eliminate Soy

Soy suppresses thyroid functions, imbalances hormones, and it has been shown to cause goiters (an enlargement of the thyroid gland) in previously healthy individuals, which shows that it disrupts iodine usage.

Adhere to an Alkaline Diet

This is extremely helpful when curing any chronic disease.

Balance Estrogen Levels (Women)

Excess estrogen slows down the thyroid gland. This means eliminating birth control medications, increasing the fiber in the diet, and avoiding all non-organic meats. Growth hormones in meats lead to imbalanced hormones. Reduce dairy intake, because milk often contains lots of estrogen.

Exercise

Find a physical activity that is fun, and do it often. We believe that exercise could half the cure time in some cases, and curing is not possible without it.

Hemp Fiber

This is a broad-spectrum supplement and a mild laxative.

L-Tyrosine

Tyrosine is a natural amino acid which helps the body produces its own thyroid hormone. This is also known to help with the depressions that usually accompany hypothyroidism. Most naturopaths recommend that 500 mg. be taken 2-3 times daily.

L-Arginine

Arginine is known to stimulate the thyroid and its hormones. It also improves immune function, improves fertility, and alleviates erectile dysfunction.

Iodine

The thyroid needs iodine to function properly, and lots of people now suffer from iodine deficiencies. To test yourself, place some iodine (we use 2%) on your stomach. Make a dot the size of a silver dollar (or twice the size of a British 50p). If it disappears within 12 hours, then you are iodine deficient. Keep adding iodine in increasing amounts, until it no longer disappears in a 12-hour period.

This works due to the fact that the body transdermally absorbs iodine at the rate at which it is needed. Do not use povidone iodine and do not orally consume iodine. This is especially an important precaution for those with Hashimoto's thyroiditis. Red marine algae are the only means to safely orally supplement with iodine, but beware of other types of underwater vegetation.

Baked fish is the safest and most natural way to consume iodine, but beware of bottom feeders, shell fish, krill, and etc.

Avoid all sources of fluoride

Fluoride suppresses the thyroid, and is likely to be the leading cause of hypothyroidism. Drink spring water, avoid soft drinks, use fluoride-free toothpaste, use a shower filter, and throw away non-stick cookware. Both coffee and tea naturally contain fluoride, so use iodine to compensate if these drinks are indispensable.

Eat a natural diet

To help the body to heal itself, remove burdens on its immune system. This means that all processed foods, artificial flavors, colors, preservatives, white flour, white sugar, table salt; hydrogenated oils, aluminum, high fructose corn syrup, and etcetera should be eliminated from the diet.

Organic food is the ideal. Do not trust marketing that reads "All Natural", because this phrase is intentionally unregulated, so that anyone may use it for anything. Read labels carefully.

Chlorophyll

Supplementing with chlorophyll provides essential copper, helps oxygenate the body, and builds healthy red blood cells and it overall assists with skin health. Chlorophyll is a safe method of orally supplementing with copper.

Pears and Apples

The ancient Chinese discovered that pears have a powerful tendency to balance hormones; especially in women. Pears help most when mixed with or juiced with apples.

Zinc and Selenium

Studies indicate that severe zinc or selenium deficiencies can cause decreased thyroid hormone levels. Never take zinc on an empty stomach. Brazil nuts are high in both zinc and selenium.

Coconut Oil

Buy organic, cold-pressed, coconut oil from a health food store. Take around 1 teaspoon of it daily. You can also use it to cook with, but be warned that it smokes at low cooking temperatures, so it should only be used for low-heat cooking. Coconut oil speeds the metabolism, encourages production of the thyroid hormone, and kills Candida yeast.

Avoid Canola Oil

Canola oil interferes with the production of thyroid hormones, amongst its many other dangers.

Additional Notes

Chronic constipation can be addressed by adding additional dietary fiber to the diet, such as psyllium or the superior hemp fiber. Sufferers will also want to take flax seed oil, and combine it with a food containing sulfur proteins; for example, yogurt. This follows the Bud wig Protocol's methodology, which decreases inflammation, increase oxygen intake, stimulates beneficial intestinal flora, and it provides a mild laxative effect.

Heavy metals and toxins can cause the thyroid to malfunction. This is particularly true in cases of Hashimoto's Disease, wherein the thyroid is so poisoned that the immune system begins attacking it. Most people with thyroid disease will benefit from a heavy metal and liver cleanse, because thyroid impairment is generally the result of toxicity.

Hashimoto's Thyroiditis

Dosage is especially important in these cases, as an overdose of iodine can cause the thyroid to shut down completely. However, a small amount of iodine does help this condition.

Problems usually occur for those who take potassium iodide supplements, and those who take internal iodine drops. However, there is no evidence of adverse effects for those who moderately apply iodine transdermally. Applying iodine to the skin allows the body to regulate the iodine's absorption rate.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with hypothyroidism.

If you have been treated for thyroid conditions, you should understand:

  • When to take your thyroid hormone medication.
  • Signs or symptoms of too much or not enough thyroid hormone.
  • When to go to your doctor for blood tests to check thyroid hormone levels, or to check for nodules.
  • Those other drugs you may be taking for other medical conditions could affect your health or interact with the medication for your thyroid problems. Ask your doctor about possible interactions, side effects, or warning signs.

You can further protect your health by:

  • eating a balanced diet,
  • getting enough sleep,
  • exercising several times a week,
  • and getting fresh air and relaxation.

Healthy living is an important part of recovery from thyroid conditions. These steps may also help to prevent future problems.

8 Risks and Complications

Hypothyroidism can cause a range of complications including:

  • an enlarged thyroid, or goitre, which may cause problems with swallowing and breathing
  • high cholesterol and associated heart disease
  • nerve damage causing tingling, numbness and pain in your arms, legs or other affected areas
  • infertility
  • birth defects
  • miscarriage or premature birth
  • mental health issues such as depression
Top