This topic is an over-view of thyroid disease. June was part one addressing hyperthyroidism and an autoimmune condition called Graves’ disease. This month is part two dealing with hypothyroidism. A review: the thyroid is a gland, shaped like a “butterfly,” located in the front of the neck, circling the windpipe (trachea). Your thyroid makes hormones that help control many vital functions of your body, especially controlling your metabolism.
Metabolism is the process when the food you eat is transformed into energy. This energy is used throughout your entire body to keep many of your body’s systems working correctly. When your thyroid doesn’t work properly, it can impact your entire body.
When your thyroid hormone levels are too high or too low, your body can’t work right, which can affect your energy level, mood, and weight. If your body makes too much thyroid hormone, you can develop a condition called hyperthyroidism. If your body makes too little thyroid hormone, it is called hypothyroidism. Both conditions are serious and need to be treated by your healthcare provider.
There are many factors that can create hypothyroidism. These include: (a) Thyroid surgery – the removal of all or part of the thyroid gland can lower the gland’s ability to make thyroid hormones or stop it completely; (b) Radiation therapy – usedto treat cancers of the head and neck can affect the thyroid gland and lead to hypothyroidism; (c) Thyroiditis – happens when the thyroid gland becomes inflamed. This may be due to an infection, or it can result from an autoimmune disorder or another medical condition affecting the thyroid. Thyroiditis can trigger the thyroid to release all of its stored thyroid hormone all at once. That causes a spike in thyroid activity, a condition called hyperthyroidism. Afterward, the thyroid becomes underactive; (d) Medicine – While rare, certain medications could cause hypothyroidism. The most common of these is lithium. Other possibilities include amiodarone/Pacerone (an anti-arrhythmic drug) and some chemotherapy drugs. You may be more at risk for medication-induced hypothyroidism if you already have a genetic predisposition to an autoimmune disease, and; (e) the most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s disease. An autoimmune disease happens when the immune system makes antibodies that attack healthy tissues like the thyroid gland, causing inflammation and, in most cases, eventual destruction of the gland. This reduces the thyroid’s ability to make hormones, affecting 10 – 12 % of the population, with women seven times more at risk than men with most cases occurring in “middle age,” and the disease tends to run in families – but no gene has been found that carries it. To determine if Hashimoto’s disease is the cause of hypothyroidism, your health care provider may order an antibody test.
Physical findings are variable and depend on the extent of the hypothyroidism and other factors, such as age. Examination findings may include the following: (a) puffy face and periorbital edema; (b) cold, dry, pale skin, which may be rough and scaly, edema of hands and feet, most times not “pitting;” (c) thickened and brittle nails – may appear as vertical white ridges on the nails, nail splitting, slow nail growth, and nails lifting up; (d) patchy hair loss or thinning; (e) an irregular pulse and/or palpitations; (f) elevated blood pressure usually “diastolic hypertension.” Blood pressure readings have two numbers – the systolic pressure (the top number) is the pressure in the arteries as the heart beats; the diastolic pressure (the bottom number) is a measurement of the pressure in the arteries as the heart muscle rests; (g) diminished deep tendon reflexes and the classic prolonged relaxation phase, and; (h) macroglossia – enlarged tongue, swelling at the neck area due to an enlarged thyroid (goiter), which may cause pain or trouble swallowing, breathing, or speaking.
Your doctor may prescribe a special diet if you have hypothyroidism. Many people with this condition are lactose intolerant, and dairy products contain lactose and casein. Dairy products can worsen symptoms like fatigue, inflammation, bloating, and gas. These are general guidelines: avoid soya chunks, tofu, soy milk, fried or fatty foods such as butter, mayonnaise, margarine, and other fried foods. Excessively fried food contains fat that can interfere with the body’s ability to absorb thyroid hormone replacement medication. Fats can also impair the thyroid’s ability to produce the hormone thyroxine. Also, fatty foods that are high in calories can be challenging to digest for people who have a slow metabolism. In hypothyroidism, this can lead to excessive weight gain. A high-fiber diet, such as green legumes and whole grains, can interfere with normal digestive system functions and the body’s ability to absorb hypothyroidism medication. Avoid eating a lot of nuts like millets, peanuts, or pine nuts.
Complications of untreated Hashimoto’s disease may include: (a) Goiter – The thyroid gland enlarges-in severe cases, the throat looks as if a tennis ball is lodged under the skin. Occasionally, a large goiter can interfere with breathing or swallowing; b) Emotional problems – low thyroid levels can increase the risk of depression; (c) Heart conditions – low levels of thyroid hormones allow levels of the ‘bad’ cholesterol (low-density lipoprotein or LDL cholesterol) to rise. This can increase the risk of heart disease, including heart attack. In some cases, Hashimoto’s disease causes other cardiac conditions such as heart enlargement or heart failure, and; (d) Myxedema – This severe form of hypothyroidism produces symptoms and signs which may include unnatural sleepiness, extreme sensitivity to cool temperatures, and coma. This condition may be fatal in severe cases, but myxedema is a very rare complication of untreated Hashimoto’s disease.
Treatment usually includes medication with the synthetic thyroid hormone (thyroxine). The doctor will recommend regular blood tests to monitor your thyroid hormone levels to ensure they are within the recommended range. At first, you may need medication. It does not cure the condition but helps maintain normal thyroid hormone levels. The symptoms will return if thyroid medication is stopped. Surgery may be required if the enlarged gland causes pressure symptoms.
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