HYPOTHYROIDISM

INTRODUCTION

Hypothyroidism is a condition that occurs when your thyroid gland doesn't produce enough thyroid hormones.  There are many glands in the body, but the thyroid gland is the small, butterfly-shaped organ at the base of your neck that makes hormones that regulate your metabolism — which affects how the body uses energy — and other processes.

While your body goes through hormonal changes every day (hello, mood swings!), big dips — like those that occur during hypothyroidism — can signal danger, as a lack of thyroid hormone production causes the body’s functions to slow down.

Not to mention, an underactive or overactive thyroid (called hyperthyroidism) can affect your waistline. People with hypothyroidism experience a slower metabolic rate, which is generally associated with some amount — about 5 to 10 pounds — of weight gain, usually due to accumulation of salt and water in the body.

Your thyroid is responsible for providing energy to nearly every organ in your body. It controls functions like how your heart beats and how your digestive system works. Without the right amount of thyroid hormones, your body’s natural functions begin to slow down.

Also called underactive thyroid, hypothyroidism affects women more frequently than men. It commonly affects people over the age of 60, but can begin at any age. It may be discovered through a routine blood test or after symptoms begin.

If you’ve recently been diagnosed with the condition, it’s important to know that treatment is considered simple, safe, and effective. Most treatments rely on supplementing your low hormone levels with artificial varieties. These hormones will replace what your body isn’t producing on its own and help return your body’s functions to normal.

Pathophysiology of Hypothyroid:

Most common symptoms of hypothyroid

• fatigue
• depression
• constipation
• feeling cold
• dry skin
• weight gain
• muscle weakness
• decreased sweating
• slowed heart rate
• elevated blood cholesterol
• pain and stiffness in your joints
• dry, thinning hair
• impaired memory
• fertility difficulties or menstrual changes
• muscle stiffness, aches, and tenderness
• hoarseness
• puffy, sensitive face

Hypothyroidism Symptoms in Adults

Women who are over age 60, as well as men who are aging, should look out for these potential symptoms of hypothyroidism:

Weight gain

Fatigue

Sensitivity to cold temperatures

Depression

Dry skin

Thinning hair

Heavy menstrual periods (in women)

Trouble sleeping

Difficulty concentrating

Pain or swelling of the joints

Constipation

High cholesterol levels

Muscle weakness

Hypothyroidism Symptoms in Infants

Hypothyroidism is most common in middle-aged and older women. But sometimes infants and children can develop the condition, such as infants who were born without a thyroid gland or who have a thyroid gland that doesn’t function properly. Congenital hypothyroidism occurs in about 1 in 2,000 to 1 in 4,000 newborns. If undiagnosed, it can lead to increasingly severe symptoms, and even physical and mental disabilities.

Symptoms of hypothyroidism in infants may include:

• ·         Jaundice (yellowing of the skin and whites of the eyes)
• ·         Frequent choking
• ·         Puffy face
• ·         Constipation

Hypothyroidism Symptoms in Children and Teens

Symptoms of hypothyroidism in children and teens are similar to symptoms in adults and can include:

• ·         Poor growth or short stature
• ·         Delayed puberty
• ·         Slow reaction time
• ·         Weight gain
• ·         Coarse, dry hair or skin
• ·         Muscle cramps
• ·         Delayed mental development
• ·         Increased menstrual flow for girls

Facts and statistics about hypothyroidism

1. Hypothyroidism is a fairly common condition. About 4.6 percent of Americans ages 12 and over have hypothyroidism. That’s about 10 million people in the United States living with the condition.
2. The disease gets more common with age. People over age 60 experience it more frequently.
3. Women are more likely to have an under active thyroid. In fact, 1 in 5 women will develop hypothyroidism by age 60.
4. Very common More than 10 million cases per year (India) 

Common Tests for Diagnosing Hypothyroidism

If you have many of the common symptoms of hypothyroidism, such as dry skin, constipation, fatigue, and a hoarse voice, you could make an appointment with your doctor to check for hypothyroidism. (4) Your doctor can perform various screenings, including: (7)

• ·         A physical exam
• ·         A blood test
• ·         An imaging scan

If these tests show an elevated thyroid-stimulating hormone (TSH) and low levels of thyroid hormones, like free T4, total T3, or free T3, it may be an indication that you have hypothyroidism

What Causes Hypothyroidism? Hashimoto’s Thyroiditis and Other Risk Factors to Know

Anyone can develop hypothyroidism, but you're at higher risk for it if you're a woman older than 60.

Other risk factors for hypothyroidism include:

·         Having a family history of thyroid disease·         Having other autoimmune diseases (such as rheumatoid arthritis, type 1 diabetes, or lupus)·         Taking medication that affects the thyroid·         Having undergone thyroid surgery·         A history of exposure to radiation to your neck or upper chest·         Having been pregnant or delivered a baby within the past six monthsWhat You Should Know About Hashimoto’s Thyroiditis

What causes hypothyroidism?

Common causes of hypothyroidism include:

• An autoimmune disease

Your immune system is designed to protect your body’s cells against invading bacteria and viruses. When unknown bacteria or viruses enter your body, your immune system responds by sending out fighter cells to destroy the foreign cells.

Sometimes, your body confuses normal, healthy cells for invading cells. This is called an autoimmune response. If the autoimmune response isn’t regulated or treated, your immune system can attack healthy tissues. This can cause serious medical issues, including conditions like hypothyroidism.

Hashimoto’s disease is an autoimmune condition and the most common cause of an underactive thyroid. This disease attacks your thyroid gland and causes chronic thyroid inflammation. The inflammation can reduce thyroid function. It’s common to find multiple family members with this same condition. 

Hashimoto's thyroiditis is a condition in which your immune system attacks your thyroid gland, often causing hypothyroidism.

Hashimoto's thyroiditis typically affects middle-aged women, but it can happen in anyone. It affects about 5 in 100 people, and is 8 times more common in women than men. About 10 to 12 percent of the population has the antibodies that cause Hashimoto’s thyroiditis, but not all of these individuals will develop thyroid dysfunction. Currently, the causes of Hashimoto’s thyroiditis are unknown, but experts think they may be due to a combination of genes and an external trigger, like a virus. Doctors can detect the condition by testing your thyroid function. Treatment usually involves thyroid hormone replacement medication.

• Iodine Intake

Your thyroid gland must have correct amounts of the mineral iodine in order to make thyroid hormones.

Consuming too little iodine can lead to hypothyroidism. Too much iodine may also cause or worsen hypothyroidism.

Iodine is found in foods such as seaweed, seafood, and iodized salt.

In some areas of the world, iodine deficiency is common, but it's rare in the United States because most forms of table salt are fortified with the mineral. So iodine levels are not routinely tested in the evaluation for hypothyroidism.

• Thyroidectomy

A thyroidectomy — surgery to remove all or part of your thyroid gland — can slow or stop the production of thyroid hormones and cause hypothyroidism. The operation is fairly common: In 2011, for example, more than 70,000 patients in the United States received a thyroidectomy (the most common cause for surgery was cancer). 

People with thyroid cancer, goiter (an enlarged thyroid), thyroid nodules, or Graves' disease may need to undergo this procedure.

Other Causes of Hypothyroidism: Medication, Therapy, and More

Underactive thyroid may also be caused by:

• Medication Many different types of medication can affect the thyroid gland. Lithium is a common drug that can cause hypothyroidism.

Also, medicines such as radioactive iodine — which is used to treat hyperthyroidism(overactive thyroid) — may impair your thyroid function.

In addition, there are many other drugs that can affect your thyroid gland, such as amiodarone, any chemotherapy category with tyrosine kinase inhibitor and check-point inhibitors, steroids, interferon alpha, and more, Dr. Endo says. Check with your doctor if you are concerned about any medication you are taking.

• Radiation Therapy Radiation for cancers of the head and neck can lead to hypothyroidism.

Congenital Problems:  Sometimes babies are born without a thyroid gland or with a deformed gland, which results in reduced thyroid function.

Rare Disorders Diseases that deposit abnormal substances in the thyroid can affect its ability to function. These diseases may include amyloidosis (a rare disease where amyloid proteins build up in organs like the heart and kidneys), sarcoidosis (a disease that involves the growth of inflammatory cells in the body), or hemochromatosis (the buildup of too much iron in the body).

Pregnancy About 15 percent of pregnant women may experience an increase in the size of their thyroid during pregnancy (returning to normal after). This can be a normal process to increase thyroid hormone production needed to support the pregnancy.

The same antibodies that cause Hashimoto’s thyroiditis can be present in women who become pregnant. In the year following the pregnancy, women with these antibodies can have thyroid dysfunction (either hyperthyroidism or hypothyroidism).

A Pituitary Disorder When the pituitary gland fails to produce enough thyroid-stimulating hormone (TSH), hypothyroidism can occur. Usually this is caused by a tumor in the pituitary. Such tumors typically occur in older adults, and about 10,000 pituitary tumors are diagnosed each year in the United States.

What Is Myxedema, or Advanced Hypothyroidism?

Myxedema is advanced hypothyroidism, and occurs in patients who have had untreated and severe hypothyroidism for a long time.

The condition is rare — one estimate notes the number of historical cases in medical literature hovers only around 300 total — but it can be life-threatening. Researchers estimate that the mortality rate for myxedema is between 20 and 50 percent. (16)

Symptoms of myxedema include:

• ·         Decreased breathing
• ·         Low body temperature
• ·         Low blood pressure
• ·         Loss of consciousness

The Possible Dangers of Living With Hypothyroidism

Endo says some of the major risks of living with hypothyroidism include hypothermia, cognitive impairment, coronary artery disease, and hyperlipidemia (a high concentration of fat, or lipids, in the blood). In addition, she says, patients with hyperlipidemia and coronary artery disease should be especially aware of their hypothyroidism risk.

Other potential long-term complications include decreased lung function, an abnormal enlargement of the thyroid gland, and even coma, when the body’s level of thyroid hormone become extremely low.

Diagnosing hypothyroidism

Two primary tools are used to determine if you have hypothyroidism:

Medical evaluation

Your doctor will complete a thorough physical exam and medical history. They’ll check for physical signs of hypothyroidism, including:

• ·         dry skin
• ·         slowed reflexes
• ·         swelling
• ·         a slower heart rate

In addition, your doctor will ask you to report any symptoms you’ve been experiencing, such as fatigue, depression, constipation, or feeling constantly cold.

If you have a known family history of thyroid conditions, it’s important you tell your doctor during this exam.

Blood tests

Blood tests are the only way to reliably confirm a diagnosis of hypothyroidism.

A thyroid-stimulating hormone (TSH) test measures how much TSH your pituitary gland is creating:

·         If your thyroid isn’t producing enough hormones, the pituitary gland will boost TSH to increase thyroid hormone production.

·         If you have hypothyroidism, your TSH levels are high, as your body is trying to stimulate more thyroid hormone activity.

·         If you have hyperthyroidism, your TSH levels are low, as your body is trying to stop excessive thyroid hormone production.

A thyroxine (T4) level test is also useful in diagnosing hypothyroidism. T4 is one of the hormones directly produced by your thyroid. Used together, T4 and TSH tests help evaluate thyroid function.

Typically, if you have a low level of T4 along with a high level of TSH, you have hypothyroidism. However, there is a spectrum of thyroid disease, and other thyroid function tests may be necessary to properly diagnose your condition.

Treating Hypothyroidism Naturally and With Medication

There are a number of treatments for hypothyroidism, usually involving medication. Some people also use alternative medicines to help them manage their disease.

Common Traditional Medication for Hypothyroidism Treatment

Treatment for hypothyroidism generally involves taking the oral medicine levothyroxine, sold under the brand names Levothroid, Synthroid, and others.

Levothyroxine is a man-made thyroid hormone that works by replacing thyroxine, the hormone your body can no longer make in adequate amounts. It's typically taken daily to reverse symptoms of hypothyroidism.

“Studies after studies show levothyroxine is the best treatment of choice,” Endo explains. She notes that some people are allergic to the generic form of levothyroxine, mostly due to the color dye. In that case, you can use either the levothyroxine 50 microgram (mcg) pills (these don’t have dye in them) or the brand Tirosint, although this is more expensive.

Levothyroxine may lower your cholesterol levels and help you return to a normal weight. The medicine causes very few side effects and is relatively inexpensive, with an average retail price of $16.73. (17) The generic form of the drug is covered by most Medicare and insurance plans.

Treatment with levothyroxine is usually continued for the rest of your life, but your doctor may adjust your dose over time.

How to Help Treat Hypothyroidism With Alternative Medicine

Some people with hypothyroidism choose to supplement their treatment with alternative medicines, often to help with symptoms like fatigue, weight gain, stress, and mental fog. Treatments can include yoga, meditation, hypnosis, vitamins, or special diets.

One small study of 20 female patients with hypothyroidism found that yoga helped patients manage their symptoms.

While people with thyroid disease are often careful to eat a diet low in iodine (which can worsen hypothyroidism once a patient has it), or to take Vitamin D or calcium supplementation, no diet or nutrient can cure thyroid disease.

And many experts stress that while these complementary and alternative therapies can supplement traditional treatment, they cannot replace it.

Alternative treatment for hypothyroidism

Animal extracts that contain thyroid hormone are available. These extracts come from the thyroid glands of pigs. They contain both T4 and triiodothyronine (T3).

If you take levothyroxine, you’re only receiving T4. But that’s all you need because your body is capable of producing T3 from the synthetic T4.

These alterative animal extracts are often unreliable in dosing and haven’t been shown in studies to be better than levothyroxine. For these reasons, they aren’t routinely recommended.

Hypothyroidism Treatments That Don’t Work

One treatment that medical doctors do not recommend? Natural dessicated thyroid products (either porcine or bovine products). The most common is the pig thyroid extract called Armour. Because the components of the pig’s thyroid hormone are very different from that of a human being, medical professionals recommend against using this agent, Endo says. These are most often prescribed by naturopathic doctors.

What Is the Best Diet and Lifestyle for Managing Hypothyroidism?

There's no medical evidence that any particular diet will improve the functioning of your thyroid gland, despite anecdotal claims seen online and elsewhere.

If you're taking thyroid hormone replacement for hypothyroidism, you may want to avoid consuming certain foods within a few hours of taking your thyroid medication. Some foods, like calcium, iron, and multivitamins, may block absorption of the thyroid hormone, and so should be taken four hours apart from levothyroxine, Endo says.

Foods to limit with hypothyroidism:

• ·         Soybean flour and cottonseed meal
• ·         Iron and calcium supplements
• ·         Antacids containing aluminum or magnesium
• ·         Some ulcer or cholesterol-lowering drugs
• ·         Walnuts

Overall, it is most important for people with hypothyroidism to eat a well-balanced diet, rather than try to consume any particular food group, Endo says.

Aging Well With Hypothyroidism

In patients older than 60, hypothyroidism becomes very common and increases with age. In fact, up to 1 in 4 patients in nursing homes may have undiagnosed hypothyroidism, according to the American Thyroid Association.

Symptoms may include:

• ·         Memory loss
• ·         Weight gain
• ·         Fatigue
• ·         Dry skin
• ·         Constipation

Since symptoms may mimic normal aging, it’s important for a doctor to make an assessment and decide on a possible course of treatment, such as thyroid hormone replacement.Doses of hormone treatment must be increased slowly, to prevent too much stress on other body systems, like the heart and central nervous system. (24)

Surprisingly, some studies have found that slightly elevated TSH levels could contribute to an extended lifespan. These individuals had a slightly higher TSH with a normal T4 level, called subclinical hypothyroidism. People over age 65 with hypothyroidism should be treated, but they should also discuss the TSH treatment goal (a higher normal TSH goal may be better). Still, hypothyroidism in older adults should be treated, primarily to relieve symptoms and prevent myxedema

Dietary recommendations for people with hypothyroidis

As a general rule, people with hypothyroidism don’t have a specific diet they should follow. However, here are some recommendations to keep in mind:

here are some highly nutrient foods that play as an active role in hypothyroidism diet declining process.

Coconut oil, Seaweed, Garlic, Cayenne pepper, Ginger, Pistachio nuts, Fennel, Ginseng, Sesame, etc. are some highly nutritious foods that kills the effect of under active thyroid gland and improves your hypothyroidism diet.

These ingredients are highly nutritious which improves our metabolic rate. Also a sufficient level of iodine in food regulates our body temperature and helps the patient in reducing their weight.

Eat a balanced diet

Your thyroid needs adequate amounts of iodine in order to fully function. You don’t need to take an iodine supplement in order for that to happen. A balanced diet of whole grains, beans, lean proteins, and colorful fruits and vegetables should provide enough iodine.

Monitor soy intake

Soy may hinder the absorption of thyroid hormones. If you drink or eat too many soy products, you may not be able to properly absorb your medication. This can be especially important in infants needing treatment for hypothyroidism who also drink soy formula.

Soy is found in:

·         tofu

·         vegan cheese and meat products

·         soy milk

·         soybeans

·         soy sauce

You need steady doses of the medication to achieve even levels of thyroid hormone in your blood. Avoid eating or drinking soy-based foods for at least two hours before and after you take your medication.

Be smart with fiber

Like soy, fiber may interfere with hormone absorption. Too much dietary fiber may prevent your body from getting the hormones it needs. Fiber is important, so don’t avoid it entirely. Instead, avoid taking your medicine within several hours of eating high-fiber foods.

Don’t take thyroid medicine with other supplements

If you take supplements or medications in addition to thyroid medicine, try to take these medicines at different times. Other medications can interfere with absorption, so it’s best to take your thyroid medicine on an empty stomach and without other medicines or foods.

Living with hypothyroidism: Things to consider

Even if you’re undergoing treatment, you may deal with long-lasting issues or complications because of the condition. There are ways to lessen the effect of hypothyroidism on your quality of life:

Develop fatigue coping strategies

Despite taking medication, you may still experience fatigue from time to time. It’s important you get quality sleep each night, eat a diet rich in fruits and vegetables, and consider the use of stress-relieving mechanisms, like meditation and yoga, to help you combat low energy levels.

Talk it out

Having a chronic medical condition can be difficult, especially if it’s accompanied by other health concerns. Find people you can openly express your feelings and experiences to. This can be a therapist, close friend, or family member, or a support group of other people living with this condition.

Many hospitals sponsor meetings for people with conditions like hypothyroidism. Ask for a recommendation from your hospital’s education office, and attend a meeting. You may be able to connect with people who understand exactly what you’re experiencing and can offer a guiding hand.

Monitor for other health conditions

There is a link between other autoimmune diseases and hypothyroidism.

Hypothyroidism often goes along with other conditions like:

·         celiac disease

·         diabetes

·         rheumatoid arthritis

·         lupus

·         adrenal gland disorders

·         pituitary problems

·         obstructive sleep apnea

Hypothyroidism and depression

When levels of thyroid hormones are low, your body’s natural functions slow down and lag. This creates a variety of symptoms, including fatigue, weight gain, even depression.

Some people with hypothyroidism may only experience mood difficulties. This can make diagnosing hypothyroidism difficult. Instead of only treating the brain, doctors should also consider testing for and treating an underactive thyroid.

Depression and hypothyroidism share several symptoms. These include:

·         difficulty concentrating

·         weight gain

·         fatigue

·         depressed mood

·         reduced desire and satisfaction

·         sleep difficulties

The two conditions also have symptoms that may distinguish them from one another. For hypothyroidism, problems such as dry skin, constipation, high cholesterol, and hair loss are common. For depression alone, these conditions wouldn’t be expected.

Depression is often a diagnosis made based on symptoms and medical history. Low thyroid function is diagnosed with a physical exam and blood tests. To see if there’s a link between your depression and your thyroid function, your doctor can order these tests for a definitive diagnosis.

If your depression is caused only by hypothyroidism, correcting the hypothyroidism should treat the depression. If it doesn’t, your doctor may prescribe medications for both conditions. They’ll slowly adjust your doses until your depression and hypothyroidism come under control.

Hypothyroidism and anxiety

While hypothyroidism has long been associated with depression, a recent study indicates it may be associated with anxiety, too. Researchers recently evaluated 100 patients between the ages of 18 and 45 with a known history of hypothyroidism. Using an anxiety questionnaire, they found that nearly 60 percent of people with hypothyroidism met the criteria for some form of anxiety.

The research to date has consisted of small studies. Larger and more focused studies on anxiety may help determine if a true connection exists between hypothyroidism and anxiety. It’s important for you and your doctor to discuss all your symptoms when being evaluated for thyroid conditions.

Hypothyroidism and pregnancy

Hypothyroidism affects your entire body. Your thyroid is responsible for many of your body’s daily functions, including metabolism, heartbeat, and temperature control. When your body doesn’t produce enough thyroid hormone, all of these functions can slow.

Women who have hypothyroidism and wish to become pregnant face a particular set of challenges. Low thyroid function or uncontrolled hypothyroidism during pregnancy can cause:

·         anemia

·         miscarriage

·         preeclampsia

·         stillbirth

·         low birth weight

·         brain development problems

·         birth defects

Women with thyroid problems can and very often do have healthy pregnancies. If you have hypothyroidism and are pregnant, it’s important to keep the following in mind during the time you’re expecting:

Stay current on medicine

Continue to take your medication as prescribed. It’s common to have frequent testing so your doctor can make any necessary adjustments to your thyroid medication as your pregnancy progresses.

Talk to your doctor about testing

Women can develop hypothyroidism while they’re pregnant. This occurs in three to five out of every 1,000 pregnancies. Some doctors routinely check thyroid levels during pregnancy to monitor for low thyroid hormone levels. If the levels are lower than they should be, your doctor may suggest treatment.

Some women who never had thyroid problems before they were pregnant may develop them after having a baby. This is called postpartum thyroiditis. In about 80 percent of women, the condition resolves after a year, and medication is no longer required. Approximately 20 percent of women who have this diagnosis will go on to require long-term therapy.

Eat well

Your body needs more nutrients, vitamins, and minerals while you’re pregnant. Eating a well-balanced diet and taking multivitamins while you’re pregnant can help maintain a healthy pregnancy.

Hypothyroidism and weight loss

Your thyroid gland creates hormones that are responsible for a large number of bodily functions. These functions include using energy, controlling body temperature, keeping organs functioning, and regulating metabolism.

When thyroid hormone levels are low, research shows that people are more likely to gain weight. That’s likely because their body doesn’t burn energy as efficiently as a body with a healthier thyroid. The amount of weight gain isn’t very high, however. Most people will gain somewhere between 5 and 10 pounds.

Once you’re treated for this condition, you may lose any weight that you’ve gained. If treatment doesn’t help eliminate the extra weight, you should be able to lose weight with a change in diet and an increase in exercise. That’s because once your thyroid levels are restored, your ability to manage your weight returns to normal.

Hypothyroidism and weight gain

When your thyroid doesn’t function as well as it should, many of your body’s functions slow down. This includes the rate at which you use energy, or metabolic rate.

If your thyroid gland doesn’t function properly, your resting or basal metabolic rate may be low. For that reason, an underactive thyroid is commonly associated with weight gain. The more severe the condition is, the greater your weight gain is likely to be.

Properly treating the condition can help you lose any weight you gained while your thyroid levels were uncontrolled. However, it’s important to know that’s not always the case. Symptoms of underactive thyroid, including weight gain, develop over a long period of time.

It’s not uncommon for people with low thyroid hormone to lose no weight once they find treatment for the condition. That doesn’t mean the condition isn’t being properly treated. Instead, the weight gain may be the result of lifestyle rather than low hormone levels.

If you’ve been diagnosed with hypothyroidism and are treating the condition but don’t see a change in your weight, you can still lose weight. Work with your doctor, registered dietitian, or personal trainer to develop a focused healthy-eating plan and exercise strategy that can help you lose weight.

There are some key points that enhance the role of hypothyroidism diet.. They are as follows:-

1.    Have your meal at short intervals, not once completely for making the best hypothyroidism diet..

2.    At least 10-12 glasses of water on a daily basis are required for maintaining water content in your body along with hypothyroidism diet.

3.    Daily workout of minimum 30 minutes is proved to be the top most key point in hypothyroidism diet.

4.    After having every meal, go for 15 minutes’ walk on a recurrent basis.

5.    Plain salad with no salt should be added in hypothyroidism diet chart.

6.    Avoidance of fried foods plays a key role in reducing your body weight and digestive issues.

7.    Inclusion of fresh fruits and vegetables in your diet make you feel free from several health issues.

8.    Conserved foods should be avoided from the hypothyroidism diet chart..