All about Hypothyroidism

Picture this. A gland the size and shape of a butterfly, sitting in the middle of the neck releasing a hormone that plays an active role in almost every part of the body; be it something as superficial as skin and hair or something more significant and deeper like our hearts and wombs. That, is the thyroid gland for you. Needless to say, when the thyroid gland becomes over or under active, there are repercussions. For the purpose of this article, I will use layman’s language and stick to the under-active version, commonly known as hypothyroidism.

DEFINITION

meccanismo d'azione di un ormone steroideo

The body needs thyroxine which is made with the help of TSH and when the levels of T4 or thyroxine go down or TSH goes up we call it hypothyroidism.

SYMPTOMS

The deficiency of thyroxine creeps up on an individual slowly over a period of months to years. Some of these symptoms overlap with depression, anaemia and in general we might blame them as part of life and not even consider that there is a medical issue at hand.

The symptoms include tiredness, fatigue, weight gain, mental slowing, hoarse voice, aches and pains, constipation, dry skin, lackluster hair, low mood, memory issues, irregular or heavy periods, infertility etc.

DETECTION

Blood sample for thyroid hormone testing

A blood test called TSH and T4 is the gold standard. Some patients are also tested for auto antibodies for thyroid gland due to association with auto immune conditions. Occasionally, your doctor might decide on repeating the blood test in 2-3 months’ time before commencing any treatment. Please be aware that hypothyroidism goes hand in hand many a times with other autoimmune conditions like diabetes, vitiligo, Addison’s disease and it would be worth discussing other relevant blood tests with your doctor.

Thyroxine helps in regulation of cholesterol; hence it is of utmost importance to get the TSH levels under control to ensure your cholesterol levels are acceptable.

CAUSES

Autoimmune association either personal or family history, previous thyroid surgery or radioactive iodine treatment causing inability of the gland to make enough thyroxine, iodine deficiency, side effects of certain medication like Lithium and Amiodarone, failure of the pituitary, inflammation of the thyroid gland or thyroiditis are some of the common causes for developing this condition.

TREATMENT

prescription medication

Except for special circumstances this treatment is for life. What you have to understand is that your body is struggling to make something in adequate amounts and hence you need to replace it externally. Just as you would do if you had any vitamin deficiency which you are unable to sort by dietary means. Always take thyroxine on an empty stomach, first thing in the morning with no food or drink for thirty minutes afterwards. If you also take iron tablets you need to leave some time between taking the two medication as there is some evidence that iron tablets can reduce the efficacy of thyroxine.

Side effects of thyroxine treatment are rare and tend to occur if there is over correction of the thyroxine levels like irritability, sweating, palpitations, diarrhoea etc, which again is something that can be picked up with a blood test. If there is history of angina, it should be informed to your doctor before starting the medication.

SPECIAL CONSIDERATIONS

Homeopathy: Being an allopathic doctor, I cannot comment on the ‘efficacy’ of homeopathic treatment for hypothyroidism. However, if TSH levels return to normal on regular blood tests then I would say your homeopathic treatment is working effectively. If not, then consider discussing increase of dose or changing to allopathic treatment.

Foods to avoid: Worldwide, iodine deficiency has been known to cause underactive thyroid gland but the consumption of iodised salt has removed this problem to a large extent. Of late, there has been some discussion on whether caffeine, soy products, phytates in wheat and millets, brassicas like cabbage, broccoli, cauliflower and green leafy vegetables are causative; the evidence is still very little from my understanding. However, you have to take this with a pinch of salt. As long as all foods are eaten in moderation, it is unlikely to have significant impact. Aim for an early dinner as part of a healthy lifestyle.

Take home message: If TSH and T4 levels are normal then these foods are unlikely to be causing significant effect on the thyroid gland. Some people find that if their TSH is running on the lower end of the normal range, their symptoms are much better controlled. This is something you should definitely consider discussing with your doctor even if your TSH is normal and you are still experiencing some of the symptoms mentioned.

HYPOTHYROID AND PLANNING A PREGNANCY

Doctor endocrinologist checking thyroid pregnant

If you have hypothyroidism and are planning to conceive, you must discuss this with your endocrinologist or obstetrician for the simple reason that in the first trimester of pregnancy slightly higher levels of thyroxine are required as your baby has still not started making thyroxine on its own. However, this is not a cause for panic. As long as you are aware, this can be very easily managed with no effect to the baby whatsoever, as long as you are compliant with your medication.

POST DELIVERY or POST PARTUM THYROIDITIS

Some women develop hypothyroidism 3 – 6 months after delivery which usually resolves spontaneously in a few months time, although some women may need treatment for the same. It is important to have regular blood tests as there is a small chance of some of these women whose thyroid was normal initially to go on to develop hypothyroidism in future.

METABOLISM AND WEIGHT LOSS

The concept of a healthy lifestyle, diet, sports, weight loss, anti-obesity, exercise, healthy diet. Centimeter on a plate, knife, dumbbells and fork, top view, closeup

The big question remains. Agreed that metabolism slows down in this condition but once the levels have normalised, I can’t stress this enough, we need to look towards our diet and lifestyle again and again, as they remain the culprit in our weight gain. The first step to weight loss is logging everything that goes into our body diligently. Unless you do this log it is unlikely to recall where the issues are. To read about weight loss ideas click here.

Hypothyroidism has almost become a crutch for many of our problems, which is partially true, but not entirely. Whether a glass is half full or half empty depends on how you want to look at things. There are several success stories of weight loss, recovering from slow metabolism and general improvement in health by introducing good habits into our diet and lifestyle which honestly speaking, remains the remedy for most of the medical conditions. This also needs certain amount of mental discipline which is a daily tussle and struggle. Beat it, get past the crutches. Change your thyroid story!

References

  1. http://www.nhs.uk/conditions/Thyroid-under-active/Pages/Introduction.aspx
  2. http://patient.info/health/underactive-thyroid-gland-hypothyroidism
  3. http://patient.info/doctor/hypothyroidism
  4. http://www.rightdiagnosis.com/t/thyroid/stats-country.htm

 

 

  • Keerthi

    Thank you so much for this self explanatory article! I have this problem since 8 years. Initially with slightly high range of tsh, endocrinologist prescribed me Thyronorm 100mcg. Immediately after a month my reports turned out to be normal in range. From then I have been using 50mcg. My periods are always irregular. Post marriage I underwent treatment and got conceived. Now my kid is 1 year old. Yet my periods are irregular. Though I take medication for this hypothyroidism , doing yoga nothing is helping me out to regularise the cycle. Mam can you please let me know if there is any chance of regularizing them or will they be irregular forever.

    • Hi Keerthi,

      Since being on 50 mcg of thyronorm, have you had a TSH level check to make sure your hypothyroidism is under control?
      If it is under control then please consider visiting a gynaecologist to have a check to ensure all is normal at the uterine end.
      If the TSH level is not under control then this could be contributing to the irregular periods.

  • tasneem

    Superb explanation….never had been aware of it so deeply …suffering from hypothyroidism since nine years

  • Shaista

    Thank you. …we’ll explained….mainly wt food to avoid in thyroid …..& the solution to loose weight…plz help

    • Hi Shaista,

      Thank you. The article mentions about foods and its correlation. There is no magic trick to weight loss. It is a slow and steady process. If you would like us to guide you further, you can provide the details as mentioned on the Q and A section on the CaL website and we will be happy to help. :)

  • Neelam

    Thankyou so much for detailed explanation. Am taking thyronorm25 mcg since 2 yrs now n yes diabetes n very heavy periods for long duration , low on energy. Very irritable , losing temper at the drop of a hat are the norms of my life.

    • Thank You Neelam. I am sorry to hear about your symptoms. However, have you considered having a blood test for Iron deficiency anaemia, B12 and folate deficiency? These can contribute to your symptoms. Also, have you recently checked if your diabetes and TSH are under control?

      I suggest you do these to ensure there is no medical cause for the way you are feeling as these can be corrected and you will feel much better.

      Heavy periods for long duration could be a symptom of uterine conditions. Do consider seeing a gynaecologist to have this checked out.

  • Neha

    My TSH is 7
    Do I need medicine ?
    Please advice – Thank you !

  • Hi Neha,

    You need to have the TSH repeated and then discuss treatment with your doctor.

  • Swetha Sundar

    Sushma, tq so much for explaining about Hypothyroidism. I have developed postpartum hypothyroidism with TSH at 12.5. Currently I’m on Thyronorm 50 Mcg. Ironically I have lost 10 kgs weight, getting irritated often. What I fail to understand is how am I losing weight when the basic symptom of hypothyroidism is weight gain?. Also after I started taking Thyronorm my appetite seems to have been erratic.

    • Hi Swetha,

      Usually in most cases postpartum hypothyroidism treatment is not required except in some circumstances. If you are losing weight and your appetite has gone erratic I suggest, consulting your physician for a repeat thyroid function test and dose adjustment based on the result. Hope this makes sense.

  • Pingback: 12 reasons You're Still Overweight()

  • Dr.Nalini Kopalle

    Well written article..
    One of hyperthyroidism is also needed for gen public