Hypothyroidism: symptoms, causes and medical treatment

Hypothyroidism is one of the most common hormonal disorders, especially in women over 40 years of age. Although its symptoms—tiredness, dry skin, weight gain, or difficulty concentrating—can be confused with the pace of life or stress, there may be an imbalance in the thyroid gland.

This article has been revised with the collaboration of the Dr. Iris De Lunaspecialist in Endocrinology at Viacare Medical Center of Madridwhom we thank for his contribution and clinical experience.

What is hypothyroidism?

He hypothyroidism appears when the thyroid gland produces fewer hormones than the body needs. These hormones are called Free T4 (free thyroxine) and Free T3 (triiodothyronine); They regulate the rhythm of many organs (heart, intestine, brain, skin, muscles).

When they are missing, everything goes Slower: metabolism, energy and often mood.

• The most common way is primary hypothyroidismwhere the problem is in the thyroid.
• More rarely, the origin is in the brain (pituitary/hypothalamus) and we talk about central hypothyroidism.

Symptoms and signs

Not all people have the same symptoms or with the same intensity. Typical is a set of signs of body slowing:

• Fatigue persistent and sleepiness.
• Cold intolerance, dry skin, brittle hair and brittle nails.
• weight gain mild or difficulty losing it, even eating the same.
• Constipationfeeling of slow digestion.
• low moodirritability, difficulty concentrating or “clouded mind.”
• Irregular rules or more abundant; sometimes changes in fertility.
• Goiter (enlarged thyroid) in some cases.

In it central hypothyroidism The symptoms can be mixed with those of other hormonal deficiencies, so the diagnostic approach is different.

Causes of hypothyroidism

The why matters, because guides treatment and monitoring.

Autoimmune (most common)

• Hashimoto’s thyroiditis: The immune system progressively damages the thyroid and reduces its ability to produce hormones. It is usually accompanied by anti-TPO antibodies (antiperoxidase).

Post-therapeutic

• After thyroid surgery either RAI (radioiodine) due to hyperthyroidism or nodules: when removing or “turning off” thyroid tissue, it may be necessary replenish hormone for life.

Iodine deficiency or excess

• With iodized salt it’s strange deficit in our environment, but excess (by algae or supplements) can also alter thyroid function.

Drugs

• Some medications (e.g. amiodarone, lithiuminterferon, certain antineoplastics) can induce hypothyroidism.

Postpartum/subacute thyroiditis

• After a phase of thyrotoxicosis (transient excess of hormone) a temporary hypothyroidism.

central hypothyroidism

• problems in pituitary/hypothalamus (tumors, surgeries or radiotherapy) reduce the signal (TSH) that orders the thyroid to produce hormones.

Congenital

• It is detected in newborns by universal neonatal screening (heel test) and is treated early.

How is it diagnosed?

The diagnosis is based on symptoms and analytics:

• high TSH and Low free T4 → clinical hypothyroidism (manifest).
  • TSH (thyroid stimulating hormone) It is the signal that the pituitary gland sends to the thyroid; If the thyroid does not respond, the TSH go up to stimulate it.
• high TSH with normal free T4 → subclinical hypothyroidism (milder).
• central hypothyroidism: low or normal TSH with Low free T4 (the signal from the brain fails).
• Thyroid antibodies (anti-TPO, sometimes anti-thyroglobulin) help confirm Hashimoto.
• Other tests depending on the case: ultrasound if there is goiter or nodules, lipid profileblood count (to see anemia), etc.

The interpretation of TSH and free T4 is done in conjunction with your symptoms and other clinical data.

Treatment and personalized plan

The treatment of choice is replenish the missing hormone with levothyroxine (synthetic T4), adjusting the dose to each person.

Levothyroxine: how to take it well

The objective is normalize TSH and free T4 and that you feel good. For the drug to be absorbed correctly:

• On an empty stomachwith a glass of water, 30–60 minutes before of breakfast.
  • Valid alternative: at night, 3–4 hours after dinner (empty stomach).
• Set aside 4 hours levothyroxine iron, calciumantacids, supplements magnesium, soy/fiber very abundant or coffee very loaded: interfere in absorption.
• Take it always the same (same time and conditions) for stable doses.
• If you forget a dose, don’t duplicate the next day; Follow the usual pattern and check if you forget frequently.

Dose adjustment

• It is done in a way gradualespecially in older or in people with heart problems.
• After starting or changing doses, the analysis is repeated at 6–8 weeks (time it takes for TSH to stabilize).
• Once stable, check each 6–12 months or sooner if they change the weight, medication or there is pregnancy.

Subclinical hypothyroidism: does it always have to be treated?

Not always. It is valued case by case. It is usually recommended treat Yeah:

• TSH ≥ 10 mIU/L persistently.
• Pregnancy or gestational desire.
• Clear symptoms attributable to hypothyroidism.
• Positive antibodies (Hashimoto) and/or cholesterol alterations or other risk factors.

Pregnancy and postpartum

during pregnancy needs increase of thyroid hormone. If you already take levothyroxine:

• It is usually required increase dose (your team will tell you how much and when).
• Objective: maintain T4 free in rank and TSH according to each quarter.
• Ideal: check dosage before looking for pregnancy.
• After childbirth readjust to the previous dose and the postpartum thyroiditis if there were symptoms.

central hypothyroidism

Here TSH does not guide good fit. The objective is to maintain a T4 free in range that makes you feel good. The follow-up is personalized by Endocrinology.

Supplements and “natural” products

• Avoid algae or supplements with iodine high without medical indication.
• Do not self-medicate with “natural thyroid” or animal extracts: dose is unpredictable and they can be dangerous.
• In some selected cases the endocrinologist evaluates selenium or other supplements, but They are not substitutes of levothyroxine.

Complications if untreated

hypothyroidism uncontrolled can favor:

• Hypercholesterolemia and older cardiovascular risk.
• Fertility problems and complications during pregnancy.
• Mood disordersproblems of memory and quality of life reduced.
• In exceptional and serious cases: myxedema coma (vital emergency situation).

The good news: with correct treatment, these complications are prevented.

Daily life: diet, exercise and other tips

The treatment It’s not just the pill: your habits they make a difference.

• Mediterranean type diet: vegetables, fruits, legumes, whole grains, olive oilnuts and fish.
• iodized salt normally; avoid excess iodine (seaweed, supplements) without indication.
• Exercise regular to maintain weight and mood.
• Adherence: set reminders so you don’t forget the shot; if you change brand either formulationnotify the team and check analytics.
• Keep a list of your medicines and supplements for space correctly those that interfere with levothyroxine.

Monitoring and forecasting

With a well-adjusted dose of levothyroxine and periodic reviews, the majority of patients have a completely normal life. It is important to notify the team if:

• You change weight significantly (up or down).
• You start new drugs or relevant supplements.
• appear symptoms that suggest excess (palpitations, nervousness) or deficiency (tiredness, cold).

Hypothyroidism is common and has effective treatment. Take well levothyroxineadjust the dose with analytics and take care of your habits restores energy, protects your heart and improves your well-being. When in doubt, the safest thing is consult and do not modify the medication on your own.