What is hypothyroidism?

Hypothyroidism is one of the most common metabolic disorders. Women are affected more often than men. In the case of hypothyroidism, the thyroid gland produces fewer hormones than the body needs. This lack of hormones leads to a slowing down of all metabolic processes and thus also to a significant reduction in performance.

The thyroid gland (thyroid gland) is a butterfly-shaped organ located below the larynx, at the front of the neck. The task of the gland is to produce vital thyroid hormones, such as thyroxine (T4) and triiodothyronine (T3). Both hormones influence essential functions in the body. Among other things, cardiovascular system, metabolism, and psyche. The thyroid gland receives the iodine necessary to produce the hormones from food.

Symptoms of hypothyroidism
In most cases, hypothyroidism leads to poor performance, concentration, and fatigue. However, the extent to which these typical symptoms manifest themselves depends on the severity of the hormone deficiency. In the case of only a slight hormone deficiency, the symptoms are correspondingly mild; in the case of severe hypothyroidism, there are clear symptoms. Other possible symptoms include disturbances of consciousness, sense of orientation and memory, and increased sensitivity to cold. In addition, a slowing of reflexes and a tendency to muscle cramps may occur.

Hypothyroidism often manifests itself externally as well. Then there may be a swollen face with thicker lips and an enlarged tongue. Swelling around the eye sockets and thus slit-like narrowed eyelids are also possible. The skin of sufferers is often dry, rough, thickened, and cool. Yellowish discoloration may occur due to the storage of the pigment carotene. Hypothyroidism triggers hair loss in some patients. In addition, the hair may appear saggy and dull. The formation of goiter (goiter) is also seen in some affected individuals. Hypothyroidism can also affect the voice: Sometimes, it becomes rough or hoarse. The voice change is caused by the pressure of the enlarged thyroid gland on the nerves of the larynx.

A gradual, long-lasting course is typical for hypothyroidism. In the beginning, the symptoms tend to be mild, so the disease is usually diagnosed late. Hypothyroidism usually manifests itself with only isolated symptoms in older people, such as increased sensitivity to cold and reduced mental and physical performance. This is often mistaken for the usual age-related changes.

Other possible symptoms of hypothyroidism
Beyond the characteristic symptoms of hypothyroidism, affected individuals may also suffer from the following symptoms:

• Depressed mood
• Weight gain without any changes in dietary habits
• Constipation
• Slowing of the heartbeat (bradycardia), enlargement of the heart, and low blood pressure
• Circulatory disturbances with insensations ("formication")
• Menstrual disorders
• Decrease in libido, fertility, and potency
• Possible change in blood counts: such as decrease in the amount of hemoglobin and red blood cells. Frequently elevated cholesterol levels. This can lead to early hardening of the arteries (atherosclerosis).
• Atrophy of the gastric mucosa (chronic atrophic gastritis) in hypothyroidism due to Hashimoto's thyroiditis.

Symptoms of latent hypothyroidism
Unlike manifest hypothyroidism with measurable deficiency of thyroid hormones and elevated TSH levels, the otherwise typical symptoms of latent hypothyroidism occur only to a lesser extent or not at all. In latent or "hidden" hypothyroidism, the concentration of thyroid hormones is not yet decreased; only the TSH level is increased.

Causes of hypothyroidism
Hypothyroidism can be due to a variety of causes. For example, the function of the thyroid gland may be disturbed or the production of the hormone TSH in the pituitary gland. But insufficient stimulation of the pituitary gland by the hypothalamus is also possible. Hypothalamus and pituitary gland controls the production of thyroid hormones. In this process, the hypothalamus releases the hormone TRH and stimulates the pituitary gland to release the hormone TSH. It promotes the production of thyroid hormones.

According to the different backgrounds that hypothyroidism can have, several forms of the disease are distinguished:

• Primary hypothyroidism
• Secondary hypothyroidism
• Tertiary hypothyroidism

Primary hypothyroidism
It is the most common form of hypothyroidism. The thyroid gland itself triggers primary hypothyroidism. In this case, the disease can be congenital or occur later in life.

Congenital hypothyroidism
One in every 3,500 newborns suffers from congenital hypothyroidism. The cause of this congenital form is either the absence of the thyroid gland (athyreosis), alteration of the thyroid tissue with loss of function, a disorder in the formation of thyroid hormones, or damage to the child's thyroid gland during pregnancy in the womb. This can be caused, for example, by severe iodine deficiency, radioiodine therapy, or hypothyroidism in the mother.

Acquired hypothyroidism
Hypothyroidism acquired during life can also have several causes. Very often, the condition develops due to inflammation of the thyroid gland (thyroiditis). A common form of thyroiditis is the so-called Hashimoto's thyroiditis. In this autoimmune disease, the body mistakenly sees its thyroid gland as a foreign body, producing antibodies against the tissue. This is gradually destroyed by chronic thyroiditis. The loss of originally functional thyroid tissue due to Hashimoto's thyroiditis is by far the most common cause of hypothyroidism. Women over the age of 40 are particularly affected.

After childbirth, about four percent of women suffer from postpartum thyroiditis. In this particular form of thyroiditis, temporary hypothyroidism occurs after childbirth. Usually, this heals without consequences.

Hypothyroidism can also occur after medical treatments or medical interventions on the thyroid gland - usually due to hyperthyroidism. For example, sometimes radiation with radioactive iodine or therapy with drugs for hyperthyroidism (overactive thyroid) leads to such a lasting disruption of hormone production that hypothyroidism occurs. Likewise, surgery on the thyroid gland, for example, in the case of goiter, can trigger hypothyroidism. But also, iodine deficiency is more often decisive in developing hypothyroidism. Hypothyroidism can develop if too little iodine is taken in with the diet and if there is a severe iodine deficiency.

Secondary hypothyroidism
Secondary hypothyroidism rarely occurs. In this case, the pituitary gland produces too little TSH, which stimulates the thyroid gland to produce hormones. Possible causes may be a tumor in the pituitary gland, radiation to the pituitary gland, or its surgical removal. A traumatic brain injury may have also damaged the pituitary gland.

Tertiary hypothyroidism
Tertiary hypothyroidism occurs even more rarely than the secondary form of the disease. In this case, the hypothalamus produces too little of the hormone TRH. This controls thyroid hormone production via the pituitary gland.

Hypothyroidism - Diagnosis
The patient should give the attending physician a comprehensive description of their complaints and previous medical history. A physical examination follows this medical history. If hypothyroidism is suspected, the physician will, among other things, examine the condition of the skin and palpate the anterior neck region to assess the size and consistency of the thyroid gland.

Crucial to the diagnosis is the blood test. The concentration of thyroid hormones and the TSH value is particularly relevant. The TSH concentration is usually elevated if there is an underactive thyroid gland. In the case of thyroiditis, such as Hashimoto's thyroiditis, specific thyroid antibodies can often be detected.

Further examinations may often be necessary. One of these is sonography. With the help of ultrasound, the size and structure of the thyroid gland can be assessed. In some cases, the doctor also takes a small tissue sample of the thyroid (fine needle biopsy) for subsequent examination under the microscope. Scintigraphy may also be indicated. It is used to check thyroid function by measuring iodine accumulation in the thyroid gland. A radioactively labeled substance is injected into the patient's vein during this examination. If the thyroid gland is underactive, it absorbs little or no labeled substances.

Every newborn is tested for hypothyroidism as part of the screening examination. A few days after birth, one to two drops of blood are taken from the baby's heel. The TSH level is then determined.

Hypothyroidism - Treatment
After diagnosing hypothyroidism, patients usually receive the missing thyroid hormone in tablet form for the rest of their lives. The hormone deficiency can thus be compensated. This is referred to as replacement or substitution therapy. If the dosage is optimally adapted to individual needs, neither quality of life nor life expectancy are restricted. Hypothyroidism is treated with levothyroxine's artificial thyroid hormone (L-thyroxine, L-T4). It acts like the natural thyroid hormone thyroxine (T4) and is partially converted by the organism into the thyroid hormone T3. Patients take the tablets in the morning on an empty stomach.

Therapy begins with a low dose and is gradually increased, accompanied by regular blood tests until the desired dose is reached. This medication adjustment is essential as part of the therapy because life-threatening cardiac arrhythmias and angina pectoris attacks can occur if the thyroid hormone is administered too high or too quickly. The dosage of the final dose is based on the basal TSH value, which should normalize, and subjective well-being. This is usually followed by annual blood tests for monitoring, with shorter intervals in newborns.

Latent hypothyroidism is usually also treated with L-thyroxine. However, the dose is generally lower than in the manifest form of the disease. The aim here is to reduce the risks of early arteriosclerosis and infertility.

Hypothyroidism - diet
Since the hormone tablets used to treat hypothyroidism are not compatible with all foods, patients must pay attention to several things in their diet. For example, calcium-rich beverages such as milk and certain fruit juices or foods made from dairy products block the absorption of L-thyroxine from the intestines, altering the hormone level in the blood. Drug interaction is also possible with other foods and beverages. Patients should seek advice on this from their physician. - If the thyroid gland still has a residual function, it is crucial to consume sufficient iodine in the diet. This can help prevent thyroid enlargement, known as goiter. Foods particularly rich in iodine include sea fish such as salmon, cod and plaice, seafood, and seaweed. The use of iodized table salt is also helpful in preventing hypothyroidism.

Homeopathy for hypothyroidism
Hypothyroidism (underactive thyroid gland) cannot be treated casually by homeopathy. However, the symptoms of the disease can often be alleviated with homeopathic remedies. The orthodox medical treatment can thus be accompanied in a supportive manner. The following homeopathic remedies can reduce the symptoms in many cases (selection):

Fucus vesiculosus: For hypothyroidism and goiter.
Thyreoidinum: For water retention in the subcutis (myxedema). Patients often have a hoarse voice, especially when the edema occurs on the hands and feet and the tongue or mucous membrane of the throat.
Graphites: For hypothyroidism with obesity and frequent freezing.
Acupuncture for hypothyroidism
If hypothyroidism was caused, for example, by an autoimmune disease (such as Hashimoto's thyroiditis), acupuncture could often support conventional medical treatment. An experienced acupuncturist will align the therapy with the fine needles to the patient's symptoms. As a rule, ten appointments are scheduled for acupuncture treatment. The aim is to have a balancing effect on the immune disorder but also to alleviate the patient's specific symptoms.

Hypothyroidism is the elderly
In older people, the symptoms of hypothyroidism present themselves somewhat differently than usual. Often, only complaints such as sensitivity to cold, poor performance, or depression appear. The symptoms are then often attributed to other causes. Signs of aging, dementia, or depression are often suspected. Therefore, the actual disease of hypothyroidism remains undetected for a long time. In treating hypothyroidism, older patients require a smaller amount of L-thyroxine than younger ones because the natural hormone levels change with age. People older than 60 receive a 30 percent lower dose of levothyroxine than younger people.

Hypothyroidism in babies
Babies with congenital hypothyroidism suffer from a lack of movement, weakened muscle reflexes, and reluctance to drink. Neonatal hypothyroidism may also be indicated by intestinal blockage and prolonged neonatal jaundice. The disease leads to growth retardation, impaired mental development, and speech development disorders if left untreated. If this form of untreated hypothyroidism occurs, it is referred to as cretinism. If diagnosis or treatment is delayed, for example, until the child is three to six months old, permanent mental damage is expected.

Hypothyroidism in pregnant women
It is vital to have hypothyroidism checked regularly by a doctor during pregnancy. Since the body then needs more thyroid hormones, expectant mothers with hypothyroidism receive an increased dose of L-thyroxine. If the tablets are not taken, there is a risk of miscarriage or premature birth in the worst case. Sudden discontinuation of the drug can damage the unborn child both physically and mentally because the child's thyroid gland does not begin synthesizing thyroxine until the twelfth week of pregnancy.

FAQ about hypothyroidism

What can be done about hypothyroidism?
Those suffering from hypothyroidism usually have to take the missing thyroid hormone for the rest of their lives to balance their hormone levels. Patients receive the synthetic thyroid hormone levothyroxine in tablet form. A balanced diet and sufficient exercise are also important. The aim is to keep body weight within the normal range or lose weight. The most important goal, however, is to normalize thyroid levels. If weight loss is the goal, this should only be a second step.

How dangerous is hypothyroidism?
With the permanent use of artificial thyroid hormones, patients can usually lead a completely everyday life. Pregnancy is also possible with hypothyroidism. However, if the disease goes untreated for years, there is a risk of elevated cholesterol levels, arteriosclerosis (hardening of the arteries), and infertility. If hypothyroidism in newborns is not treated or is treated too late, physical and mental development is impaired. These include deformities of the skeletal system, short stature, speech disorders, hearing loss, and obesity.

How can hypothyroidism be prevented?
It is not always possible to prevent hypothyroidism. For example, if the cause of hypothyroidism is Hashimoto's thyroiditis, an autoimmune disease, it cannot be prevented. On the other hand, if hypothyroidism was triggered by iodine deficiency, it is possible to ensure an iodine-rich diet in the future. It is best to use only iodized table salt and regularly eat sea fish such as salmon or cod and algae or seafood.

Why is it difficult to get pregnant with hypothyroidism?
Thyroid hormones affect metabolism and, therefore, gonads and sexual function. If a woman suffers from hypothyroidism, this can disrupt egg maturation and the menstrual cycle. Even latent hypothyroidism with an elevated TSH level is enough to make pregnancy difficult. However, the deficiency of thyroid hormones can be compensated by taking hormone tablets daily. This, with sufficient replacement therapy, allows even women with hypothyroidism to become pregnant.

How often does hypothyroidism occur?
In the United States, about five percent of the population suffers from hypothyroidism. One in 3,500 newborns is born with so-called primary congenital hypothyroidism. In addition, many people also suffer from latent hypothyroidism. In this case, the blood levels of thyroid hormones are normal, but the TSH level is already elevated. Latent hypothyroidism can later become manifest hypothyroidism. Read more about health here