TSH

Hypothyroidism

Symptoms of Hypothyroidism

Hypothyroidism is a condition in which your thyroid gland does not produce enough thyroid hormones. It refers to a state in which your thyroid hormones production is bellow normal. It is also called under active thyroid or low thyroid, which can slow down many of your body’s functions such as your metabolism and can decrease the cardiac activity. Hypothyroidism affects women more frequently than men.

Furthermore, blood tests are the only way to reliably confirm a diagnosis of hypothyroidism.

Signs and Symptoms of Hypothyroidism

The signs and symptoms of hypothyroidism varies from person to person. It depends upon the deficiency in hormone production by your thyroid gland. In addition, symptoms also depend upon the length of time your body has been without the proper amount of thyroid hormone. 

Many symptoms of hypothyroidism are the same as those of other medical problems, therefore, it can easily be confused for something else. Moreover, the signs and symptoms often develop slowly and you may not notice symptoms for months or even years.

The most common signs and symptoms in Adults

  • Hair Loss
  • Puffy Face (Swollen Face)
  • Feeling cold when other people do not (Cold Sensitivity)
  • Weight Gain
  • Dry Skin
  • Slow heart rate
  • Constipation
  • Irregular Periods in women
  • Tiredness
  • Muscle aches and stiffness
  • Joint Pain
  • Pain, numbness, tingling and general weakness in the hand and wrist (Carpal tunnel syndrome)
  • Feeling more forgetful
  • Depression
  • Loss of interest in sex

If you have one or more of above mentioned symptoms, please contact your doctor, who may refer you to an endocrinologist for diagnosis. They can order a blood test to check if you have hypothyroidism.

Signs and symptoms in Infants

When a baby is born with hypothyroidism, it is called congenital hypothyroidism. Congenital means present from birth. Initially, a newborn baby may have few or no symptoms because, some thyroid hormone from the mother crosses the placenta. Once infants no longer receive thyroid hormone from the mother, symptoms develop slowly. If symptoms do occur, they can include:

  • Yellowing of the skin and whites of the eyes (Jaundice)
  • An enlarged swollen tongue that sticks out
  • A hoarse cry
  • Difficulty breathing
  • Bellybutton that sticks out too far (Umbilical hernia)
  • Feeding problems
  • Cold hands and feet
  • Low body temperature

As the disease progresses, infants are likely to have trouble feeding and may fail to grow and develop normally. They may also have:

  • Poor or slow growth
  • Abnormally low muscle tone (floppy infant)
  • Lethargy (lack of energy, sleeping longer or more often than usual)
  • Constipation
  • Puffy face

Without treatment, baby with congenital hypothyroidism can develop permanent mental disabilities.  Therefore, contact your doctor immediately if your baby has any of the above mentioned symptoms. Please note that these symptoms can be due to other medical problems. 

Signs and symptoms of hypothyroidism in Children and Teens

Symptoms in children and teens are generally the same as adults. However, they may also experience:

  • Poor growth and short stature
  • Delayed mental development
  • Slow reaction time
  • Slower development of permanent teeth
  • Delayed puberty
  • Weight gain

What causes Hypothyroidism?

Hypothyroidism occurs when your thyroid gland fails to produce enough thyroid hormones.

The most common causes are:

  • Hashimoto’s thyroiditis: Hashimoto’s thyroiditis is an autoimmune disorder in which your immune system produces antibodies that attack and destroy your own thyroid gland. As a result, your thyroid gland will not able to make enough thyroid hormone, which leads to the Hypothyroidism. Hashimoto’s thyroiditis is the most common cause of hypothyroidism. (Read more)

  • Inflammation of the Thyroid Gland (Thyroiditis): Thyroiditis is an inflammation of the thyroid gland, usually caused by viral infection, autoimmune attack or after pregnancy. It causes thyroid hormone to leak out of your thyroid gland into the blood. As a result, the leakage increases your thyroid hormone levels, leading to hyperthyroidism.

    Furthermore, the hyperthyroidism may last for many months. After that, your thyroid gland gradually become underactive and the condition may become permanent, this may develop into hypothyroidism.

  • Radiation therapy: Patients with lymphoma, or cancer of the head or neck are treated with radiation therapy. Radiation used for the treatment may damage the cells of the thyroid gland and make it difficult for the thyroid gland to produce hormones. This may lead to hypothyroidism.

  • Radioactive Iodine treatment: This treatment is commonly prescribed to people who have hyperthyroidism, to reduce their thyroid hormone production. The Radioactive iodine slowly destroys the cells of your thyroid gland. As a result, your thyroid shrink in size and your levels of thyroid hormone go down permanently. In other words. if you receive Radioactive iodine treatment, your thyroid activity will get slow enough to be considered as hypothyroidism.

  • Thyroid surgery: During surgery, all or part of your thyroid gland is removed by your doctor. This is also known as thyroidectomy. Doctors may remove part or all of the thyroid gland for the treatment of:


    Furthermore, if the whole thyroid is removed, you will definitely become hypothyroid. However, if part of the thyroid gland is removed, the remaining gland may still be able to make enough thyroid hormones.

  • Use of certain medicines: Some medicines can interfere with thyroid hormone production, resulting in hypothyroidism. These include:

    • Heart medicines
    • Mental disorder (psychiatric disorders) medicines
    • Cancer medicines

    Furthermore, the medicines used to treat above mentioned diseases can prevent your thyroid gland from being able to make thyroid hormone normally. Therefore, if you are taking medication, ask your doctor about its effect on your thyroid gland.

  • Less common causes include:

    • Pituitary gland disorder: A problem with the pituitary gland may also cause hypothyroidism, because your pituitary gland release a hormone called Thyroid stimulating hormone (TSH) which tells the thyroid gland how much hormone to make and release.

      If the pituitary gland is damaged due to tumor, radiation, or surgery, it may no longer be able to produce enough Thyroid stimulating hormone (TSH). As a result, the thyroid gland may stop making enough thyroid hormone and can lead to hypothyroidism. This type of hypothyroidism is known as secondary hypothyroidism.

      Please note, Secondary hypothyroidism means decreased activity of the thyroid gland caused by failure of the pituitary gland.

    • Disorder of the hypothalamus: The hypothalamus is a small but an important area of the brain. It is located at the base of the brain, above pituitary gland. The hypothalamus releases a hormone know as thyrotropin-releasing hormone (TRH), which stimulates the pituitary gland to produce a hormone called thyroid-stimulating hormone (TSH). Further, the TSH instructs the thyroid gland to make and release thyroid hormone.

      If the hypothalamus in the brain does not produce enough TRH, this will affect the release of TSH from the pituitary gland. In other words, if a person has too little thyrotropin-releasing hormone (TRH), they will develop hypothyroidism. However, this is an extremely rare form of hypothyroidism, usually occur due to an injury or tumour which destroys the hypothalamus. This condition is known as central hypothyroidism.

    • Congenital hypothyroidism When a baby is born with hypothyroidism, it’s called congenital hypothyroidism. The most common cause of congenital hypothyroidism is failure of the thyroid gland to grow in the baby before birth. At birth, the baby may have no thyroid gland at all, or have an abnormally developed thyroid gland. Why this happens is often unknown, however, in some cases, genetic defects or maternal iodine deficiency may cause this. Furthermore, while some babies may show no signs and symptoms of hypothyroidism, others will be less active or have trouble feeding. It is very important to diagnose and treat the condition as soon as possible.

      If untreated, congenital hypothyroidism can lead to physical and mental growth problems. Therefore, if your baby has congenital hypothyroidism, it is very important that proper treatment is initiated early to prevent it from delaying growth or mental development.

    • Pregnancy: Pregnancy can be a cause of hypothyroidism. Some women develop hypothyroidism during or after pregnancy. If hypothyroidism occurs during or after pregnancy, it is usually due to Hashimoto’s disease. This is an autoimmune disorder in which the immune system mistakenly attacks and damage the thyroid gland. As a result, thyroid gland cannot not make and release enough hormones for body’s need and leads to hypothyroidism.

      If left untreated, hypothyroidism increases the risk of miscarriage, preterm delivery, and a significant rise in blood pressure during late pregnancy. Moreover, it can also seriously affect the developing fetus. Therefore, if you have hypothyroidism, it is important to control your thyroid levels during pregnancy.

    • Iodine deficiency: Your thyroid gland needs iodine to make thyroid hormone. However, your body does not make iodine, therefore, you need to get it through your diet. Further, keeping thyroid hormone production in balance requires the right amount of iodine in the diet. Please note, too little iodine can lead to hypothyroidism and too much iodine can worsen hypothyroidism in people who already have the condition. Therefore, talk to your doctor about how much iodine you need.

      Moreover, lack of iodine in the diet is the most common cause of hypothyroidism in many developing countries. Food sources of iodine include:
      • Iodized salt
      • Seafood
      • Eggs
      • Dairy products

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    Diagnosis of Hypothyroidism

    It is very important that hypothyroidism is diagnosed as soon as possible. Therefore, if you have signs or symptoms, contact your doctor immediately for complete diagnosis. Further, there are two methods used to determine whether you have hypothyroidism:

    • Physical examination: Your doctor will ask you questions about your medical history and perform a physical examination. In physical exam, your doctor will check your thyroid gland and look for physical signs of hypothyroidism such as dry skin, slower heart rate, swelling in neck and weight gain.

      Moreover, your doctor will also ask you about any symptoms you have been experiencing, such as fatigue, constipation, or constantly feeling cold etc.

      However, the diagnosis of hypothyroidism cannot be based on symptoms alone because many of its symptoms are the same as those of other diseases.
    • Blood Tests: Blood tests are the only way to confirm the diagnosis of hypothyroidism. Therefore, your doctor will order blood tests to check your hormone levels. These may include:

      • Thyroid-stimulating hormone (TSH) test: This is the most important and sensitive test to diagnose hypothyroidism. This test measures how much TSH your pituitary gland is producing. If the TSH level is above normal, you may have hypothyroidism.

      • Thyroxine (T4) tests: This test is also useful. T4 is one of the main hormones produced by the thyroid gland. If your T4 level is below normal, it usually means you have hypothyroidism.

      Together, T4 and TSH tests can help diagnose the thyroid function. If your TSH level is elevated and the T4 level is low, it means you have hypothyroidism. However, if your TSH is elevated but the T4 is normal, this is called subclinical hypothyroidism. It is believed to be an early stage of hypothyroidism.

      In addition to the above, your doctor may also recommend additional blood tests such as T3 and thyroid autoantibody tests to confirm the diagnosis or find out the cause of hypothyroidism.

Treatment of Hypothyroidism

Hypothyroidism cannot be cured. But the good news is that hypothyroidism is usually quite easy to treat. It is usually treated by taking the oral medicine called levothyroxine.

Levothyroxine is a synthetic (man-made) thyroid hormone thyroxine (T4). Its pills contain hormone exactly like the thyroxine (T4), which your own thyroid gland can no longer make. This oral medicine is typically taken daily to restore adequate hormone levels in your body and reversing the symptoms of hypothyroidism. Your doctor may recommend taking this medicine in the morning before eating each day.

Furthermore, your doctor will give you a blood test to check your TSH levels about 6 to 8 weeks after you start taking levothyroxine. Your dosage can be adjusted by your doctor depending upon the results of your blood test. Once your TSH levels are stable and the correct dose is identified, your doctor may recommend blood test only once every 6 months.

Treatment with levothyroxine is usually continued for the rest of your life, but your doctor may adjust your dose over time. Please note, never increase or decrease the dose of levothyroxine without first consulting your doctor. Taking too much dose can cause serious problems, such as:

  • Appetite increases
  • Inability to sleep (Insomnia)
  • Heart palpitations (Skipping heartbeat)
  • Shakiness
  • Nervousness

Diet in Hypothyroidism

If we talk about diet plan for hypothyroidism, then there are certainly many do’s and dont’s. However, the diet cannot cure or prevent hypothyroidism. It can only help to manage the symptoms. Moreover, some foods may improve certain symptoms, while others may make them worse or interfere with treatment.

What to Eat
  • Cheese, Milk, Yogurt.
  • Fish, Tuna, Shrimp, Oysters, Crab
  • Eggs, Meat, Chicken, Turkey, Ham
  • Brown Rice, Oatmeal, Quinoa etc.
  • Berries, Apples, Peaches, Grapes, Citrus fruits Pineapple, Bananas etc.
  • Greens, Asparagus, Carrots, Peppers, Spinach, Mushrooms etc.
  • Potatoes, Peas, Butternut squash etc.
  • Almonds, Cashews, Pumpkin seeds, Natural peanut butter etc.
  • Dairy Products
  • Non caffeinated Beverages
  • Selenium rich food
What to avoid
  • Soy Foods, Tofu.
  • Cabbage, Broccoli, Cauliflower, Turnip.
  • Gluten, found in Bread and Pasta.
  • Fatty foods such as Butter, Mayonnaise, Fatty cuts of meat and Fried foods.
  • Alcohol.
  • Processed Foods in Packages.
  • Foods and beverages high in added sugar.

Do not try any new diets without talking to your doctor first. It is important to always have a conversation with your doctor or a registered dietician before starting a new diet, especially if you have hypothyroidism.

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Thyroid Gland

Thyroid Gland Image
Location of Thyroid Gland

Thyroid is a small gland (about 2 inches long) which has the shape like a butterfly that lies in the front of your neck. It has two sides called lobes, located either side of your windpipe. Further, these two lobes of the gland are connected by a small tissue called the isthmus.

Thyroid is a vital hormone gland which plays a major role in metabolism, growth, development, temperature, weight and heart rate of the human body by constantly releasing a steady amount of thyroid hormones (T3 and T4) into the bloodstream. Also, during infancy and childhood, adequate thyroid hormone is crucial for brain development.

How the Thyroid Gland Works

Thyroid gland produces two type of hormones T3 and T4 by absorbing iodine from the food you eat. These hormones controls the body’s metabolism and are necessary for all the cells in your body to work normally. In other words, thyroid hormones regulates the speed with which your body cells work.

If too much of the hormones are released by the thyroid gland, then your body cells work faster than normal, and you have hyperthyroidism. On the other hand, if too little of the thyroid hormones are produced, then cells and organs of your body slow down, and you have hypothyroidism. Therefore, it is important that T3 and T4 levels are neither too high nor too low in your body. 

The two thyroid hormones are:

  • T3 – Triiodothyronine: This hormone contains three atoms of iodine and is often called T3.
  • T4 – Thyroxine: This hormone contains four atoms of iodine and is often called T4.

How Thyroid Gland produce hormones as needed?

To produce the right amount of hormones, the thyroid gland needs the help of pituitary gland. The pituitary gland produces a hormone called thyroid-stimulating hormone (TSH) which tells the thyroid gland how much hormones (T3 and T4) to produce.

Moreover, the pituitary gland monitors and controls the amount of thyroid hormones in your bloodstream:

  • When T3 and T4 levels are low in your body then pituitary gland makes more TSH to tell the thyroid to produce more thyroid hormones.
  • When T3 and T4 levels are high pituitary gland makes less TSH.

Please note, TSH levels that are too high or too low can indicate your thyroid is not working properly.

Thyroid disease

  • Hypothyroidism: It is a condition in which thyroid gland does not produce enough thyroid hormones. It is also called under active thyroid or low thyroid, which can slow down the metabolism rate of your body and can decrease the cardiac activity. (read more)
  • Hyperthyroidism: It is a condition in which thyroid gland produces too much hormones. It is also called overactive thyroid. Hyperthyroidism can accelerate the metabolism rate of your body. As a result, it can cause weight loss and irregular heart activity. (read more)
  • Goiter: A Goiter is an abnormal enlargement of thyroid gland. It indicates a condition, in which thyroid grows abnormally. Goiter commonly develops as a result of iodine deficiency or due to thyroid problem. (read more)
  • Graves’ Disease: It is an autoimmune disorder that cause an over active thyroid gland and results in an over production of thyroid hormones (Hyperthyroidism). In this disease, your immune system creates antibodies known as thyroid-stimulating immunoglobulins (TSI). These antibodies then attach to healthy thyroid cells and can cause your thyroid to create too much thyroid hormone. (read more)
  • Hashimoto’s Disease: Hashimoto’s Disease in an autoimmune disorder in which the immune system mistakenly attacks the thyroid gland. This can lead to hypothyroidism, a condition in which thyroid does not make enough hormones for body’s need. (read more)
  • Thyroid Nodules: The term thyroid nodule refers to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. It can be solid or filled with fluid. Most thyroid nodules aren’t serious and don’t cause symptoms. Only a small percentage of thyroid nodules are cancerous. (read more)
  • Thyroid Cancer: It is a disease in which malignant (cancer) cells form in the tissues of the thyroid gland. The malignant cells begin multiplying in your thyroid and, once there are enough of them, they form a tumor. If it’s caught early, then thyroid cancer is one of the most treatable forms of cancer. (read more)

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Thyroid Tests

Doctors use thyroid tests to check how well your thyroid gland is working. Thyroid tests also help your doctor to diagnose and find the cause of thyroid diseases such as:

  • Hypothyroidism
  • Hyperthyroidism
  • Goiter
  • Graves’ Disease
  • Thyroiditis
  • Hashimoto’s Disease
  • Thyroid Nodules
  • Thyroid Cancer

Tests for Thyroid include:

  1. Physical Examination
  2. Blood tests
  3. Imaging tests

Physical Examination: Your doctor will ask you questions about your medical history and perform a physical examination. Your doctor will check your neck to see whether the thyroid gland is enlarged or has thyroid nodules. Depending on the results of the physical examination, your doctor may also do other tests, such as Blood Tests and Imaging Tests.

Blood Tests: To know how well your thyroid gland is functioning, your doctor usually measure the levels of thyroid hormones in your blood. Your doctor may order one or more blood tests to check the levels of thyroid hormones in your blood.

Further, blood tests are done by taking blood from a vein in your arm. Blood Tests may include:

  • Thyroid stimulating hormone (TSH) test: TSH is a hormone produced and released into the bloodstream by the pituitary gland (a pea-sized structure) which is located at the base of your brain. TSH tells your thyroid gland how much T4 and T3 to make.

    Doctors usually check the amount of TSH in your blood first. Because, a high TSH level means you have hypothyroidism. This means that your thyroid gland is not making enough thyroid hormone. However, a low TSH level means you have hyperthyroidism. This means that your thyroid is making too much thyroid hormone.

    Therefore, the level of TSH (thyroid-stimulating hormone) in your blood is the best indicator of your thyroid function.

  • Triiodothyronine (T3) test: T3 test help doctors to diagnose hyperthyroidism or to show the severity of hyperthyroidism.

  • Free Triiodothyronine (FT3) test

  • Thyroxine (T4) test: T4 is one of the main thyroid hormones. A high level T4 in your blood usually means you have hyperthyroidism. However, a low level of T4 in your blood may mean you have hypothyroidism.

  • Free thyroxine (FT4) test

Additional Blood Test: In addition to above mentioned blood tests, your doctor may also order Thyroid Antibody Tests.

  • Thyroid Antibody Test: This test measures the level of thyroid antibodies in your blood. Thyroid antibodies are made when your immune system mistakenly attacks the healthy cells of your thyroid gland. This is known as an autoimmune disorder. Moreover, the presence of thyroid antibodies in your blood suggests that the cause of thyroid disease is an autoimmune disorder, such as Hashimoto’s disease or Graves’ disease. There are three major types of thyroid antibodies:
    • Thyroid peroxidase antibodies (TPO): These antibodies can be a sign of Hashimoto’s disease or Graves’ disease.
    • Thyroglobulin antibodies (Tg): These antibodies can also be an indication of Hashimoto disease. Most people with Hashimoto disease have raised levels of both Tg and TPO antibodies.
    • Thyroid stimulating hormone (TSH) receptor: These antibodies can be a sign of Grave’s disease.
    • Thyroid peroxidase antibodies (TPO): These antibodies can be a sign of Hashimoto’s disease or Graves’ disease.
    • Thyroglobulin antibodies (Tg): These antibodies can also be an indication of Hashimoto disease. Most people with Hashimoto disease have raised levels of both Tg and TPO antibodies.
    • Thyroid stimulating hormone (TSH) receptor: These antibodies can be a sign of Grave’s disease.
    • Thyroid peroxidase antibodies (TPO): These antibodies can be a sign of Hashimoto’s disease or Graves’ disease.
    • Thyroglobulin antibodies (Tg): These antibodies can also be an indication of Hashimoto disease. Most people with Hashimoto disease have raised levels of both Tg and TPO antibodies.
    • Thyroid stimulating hormone (TSH) receptor: These antibodies can be a sign of Grave’s disease.
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