Hypothyroidism

Hypothyroidism – short overview

• Common symptoms: Fatigue, weight gain, constipation, depression, freezing
• Important investigations: Blood test for thyroid scores, ultrasound, scintigraphy
• Treatment options: L-thyroxine tablets
• Watch out: Check hormone dose regularly (TSH value), proper treatment during pregnancy is especially important
• Specialist: Internal medicine (endocrinology), gynecology (in pregnant women), family doctor

Thyroid hypofunction: symptoms

In thyroid hypofunction (hypothyroidism) the thyroid gland does not produce enough of the two hormones thyroxine (T4) and triiodothyronine (T3). They affect almost all metabolic processes in humans and are thus vital. While mild hypothyroidism usually causes few symptoms, a stronger hormone deficiency slows down almost the entire metabolic activity significantly and causes severe discomfort.

General symptoms

Common symptoms of hyperthyroidism (Hypothyroidism) include performance and concentration weakness and fatigue. Disturbances of consciousness, sense of orientation and memory and an increased sensitivity to cold are also possible symptoms of hypothyroidism. The reflexes may be slowed down and muscles are more likely to cramp.

Externally, hyperthyroidism can cause signs such as a swollen face with thickened lips and enlarged tongue, swelling around the eye sockets, and slit-like constricted eyelids. The skin may be cool, dry, rough and thickened; sometimes yellowish discoloration occurs (incorporation of the dye carotene!). In addition, hypothyroidism can trigger hair loss and make the hair shaggy and dull. A rough, hoarse voice and possibly a goiter (goiter) are other possible symptoms – they are caused by the pressure of an enlarged thyroid gland on the nerves of the larynx.

In addition, hypothyroidism can cause the following symptoms:

• Depressive mood
• constipation
• Gaining weight without changing dietary habits
• Slowing of the heartbeat (bradycardia), enlargement of the heart, low blood pressure
• Circulatory disorders with abnormal sensations (such as “running ants”)
• Cycle disorders in women
• Limitations of sexual desire (libido), fertility and virility (erectile dysfunction = impotence)

Sometimes, hypothyroidism changes blood levels, such as the amount of hemoglobin and red blood cells. While these parameters may decrease in hypothyroidism, cholesterol levels are often elevated. This can lead to premature arteriosclerosis (arteriosclerosis).

Hashimoto’s thyroiditis – acquired hypothyroidism due to chronic thyroid inflammation – may also be associated with gastric mucosal leakage (chronic atrophic gastritis) and other autoimmune diseases.

Symptoms in the elderly

In older people, hypersensitivity, poor performance or depression are often the only symptoms of hypothyroidism. Not infrequently, such signs are mistakenly interpreted as signs of aging, dementia or depression, and the real cause – the hypothyroidism – remains unrecognized.

Symptoms in babies

Babies with congenital hypothyroidism show a lack of movement, weakened muscle reflexes and lack of drinking right after birth. Intestinal obstruction and prolonged neonatal jaundice may also indicate neonatal hypothyroidism. If the hormone deficiency remains untreated, there will be further growth retardation, delayed mental development and speech development disorders. This severe form of untreated hypothyroidism is called cretinism.

Latent hypothyroidism: symptoms

The listed symptoms such as lack of achievement and concentration, tiredness, etc. apply to a manifest hypothyroidism, ie a hypothyroidism with measurable lack of thyroid hormones and elevated TSH levels. Another picture emerges for latent hypothyroidism: symptoms such as those mentioned above do not occur here or only to a lesser extent. Because with the “hidden” hypothyroidism, the concentration of thyroid hormones is not (yet) lowered, only the TSH value is increased.

Hypothyroidism: causes and risk factors

Superordinate centers in the brain – hypothalamus and pituitary gland – control the production of thyroid hormones: the hypothalamus releases the hormone TRH. It stimulates the pituitary gland to release the hormone TSH. This in turn promotes the production of thyroid hormones.

The causes of hypothyroidism can arise at any of the three levels: through disorders in the function of the thyroid itself, by disturbances of TSH production in the pituitary gland, or by insufficient stimulation of the pituitary gland by the hypothalamus. Physicians distinguish accordingly different forms of hypothyroidism:

Primary hypothyroidism

Primary hypothyroidism is by far the most common form of hypothyroidism. The cause of the disease lies in the thyroid itself. The causes can be innate or occur only in the course of life:

Congenital hypothyroidism

Some children are born without thyroid (athyroidism). In others, the thyroid is abnormally developed (thyroid dysplasia), or there are errors in the production of thyroid hormones. Even if a pregnant woman receives too high a dose of anti-thyroid therapy, the child in the womb may develop hypothyroidism.

Acquired hypothyroidism

Acquired hypothyroidism is, in most cases, the result of chronic thyroid inflammation. This so-called Hashimoto’s thyroiditis is an autoimmune disease: The body forms special antibodies that destroy its own thyroid tissue. It can then no longer produce sufficient levels of thyroid hormones. Why the body makes the antibodies is still unclear.

Acquired hypothyroidism may also be the result of previous medical treatment. Thus, the therapy of an overactive thyroid (hyperthyroidism) sometimes overshoots the target: Both an irradiation with radioactive iodine and a treatment with drugs for hyperthyroidism can disturb the hormone production so lasting that the hyperfunction becomes a hypofunction.

Thyroid surgery (for example goiter = goiter) can also lead to hypothyroidism if there is not enough healthy thyroid tissue left.

Sometimes iodine deficiency plays a role in the development of acquired hypothyroidism: the thyroid gland needs the trace element to form the thyroid hormones. Anyone who ingests too little iodine with food can develop extreme iodine deficiency and subsequently hypothyroidism.

Secondary hypothyroidism

The cause of hypothyroidism is a secondary hyperthyroidism in the pituitary (pituitary gland): It produces too little TSH, that hormone that stimulates the thyroid hormone production. This may be due to a tumor in the pituitary gland, or its surgical removal or radiation. A craniocerebral trauma can also damage the pituitary gland. Secondary hypothyroidism is rare.

Tertiary hypothyroidism

Even less common is tertiary hypothyroidism, which is due to the hypothalamus. He then produces too little of the hormone TRH, which ultimately regulates the thyroid hormone production on the way through the pituitary gland.

Hypothyroidism – frequency

About one percent of the population suffers from hypofunction of the thyroid gland. About one in 3,500 newborns is born with hypothyroidism. This is called a primary congenital hypothyroidism.

In addition to these patients with overt hypothyroidism, there are still many people who have a so-called latent hypothyroidism: the blood levels of thyroid hormones are normal for them, but the TSH is already elevated. This means that the thyroid only produces sufficient amounts of hormones if it is very strongly stimulated by the pituitary gland. A latent hypothyroidism may later develop into manifest hypothyroidism.

Hypothyroidism: examinations and diagnosis

Hypothyroidism – medical examinations

If you suspect hypothyroidism, the doctor will first ask you about the typical symptoms and then examine you physically. For example, it can feel the texture of your skin, or it can sense the front neck region where the thyroid is located. So he can judge their size and consistency.

Laboratory values ​​of thyroid hormones

Also important is a blood sample. One of the most important blood values ​​for suspecting suspected hypothyroidism is the TSH value. The concentration of this hormone in the blood reveals how much the thyroid needs to be stimulated to produce hormones to produce enough thyroid hormone. In hyperthyroidism, the concentration of TSH in the blood is increased in most cases.

For more information on hormonal thyroid levels, see Thyroid Values.

Further investigations in the context of hypothyroidism help in the search for the cause of your hormone disorder:

• Ultrasound examination: Size and condition of the thyroid can be determined by means of an ultrasound examination. Sometimes the doctor also takes tissue samples (biopsy) for analysis in the laboratory.
• Scintigraphy: In scintigraphy, the doctor examines the thyroid function using radiolabelled substances (radionuclides).
• Antibody detection: In the case of chronic thyroiditis, antibodies against the thyroid tissue can be detected in the blood.

Newborns are tested for hypothyroidism as part of the legally required screening test (U2). To do this, the doctor removes one to two drops of blood from the heel a few days after the birth, drops it on a filter paper and determines the TSH value.

Hypothyroidism: treatment

The hormone deficiency in hypothyroidism can be compensated by the usually lifelong taking hormone tablets. Doctors also speak of replacement or replacement therapy. When properly dosed, the quality of life and life expectancy of hypothyroid patients are not limited.

The drug of choice for hypothyroidism therapy is L-thyroxine (levothyroxine): This synthetic hormone acts like the natural thyroid hormone thyroxine (T4) and is partially converted into the thyroid hormone T3 in the body. It must be taken in the morning on an empty stomach.

Treatment with L-thyroxine is started with a low dose and then slowly increased to the individual final dose. Overdose or overdose may cause heart problems or other signs of hyperthyroidism.

The final dose is based on the basal TSH (it should normalize) and the subjective well-being of the patient. Later, usually once a year (more often in infants) is a therapy control by blood test.

Hypothyroidism: treatment of the elderly

Older patients with hypothyroidism require less L-thyroxine because their natural hormone levels are different from those at younger ages. For example, over-60s typically receive a 30 percent lower levothyroxine dose than younger adults.

Thyroid hypofunction: treatment of pregnant women

In pregnancy, hypothyroidism must be monitored regularly because the body needs more thyroid hormones during this time. Therefore expectant mothers with hypothyroidism will receive an increased dose of L-thyroxine; otherwise, in the worst case, a miscarriage or premature birth is imminent. In premature discontinuation of the tablets, the unborn child can also cause physical and mental damage, because the child’s thyroid gland begins only after the 12th week of pregnancy with the thyroxine synthesis.

Hypothyroidism: treatment of children

Even children with congenital hypothyroidism must take the missing thyroid hormone daily. At the start of taking even within the newborn phase, the children develop mentally normal. However, if the congenital hypothyroidism is recognized and treated only at the age of three to six months, permanent mental damage is to be expected.

Treatment of latent hypothyroidism

In case of latent hypothyroidism, treatment with L-thyroxine (in low dosage) is also usually initiated. This should reduce the risk of early arteriosclerosis and infertility.

Hypothyroidism: homeopathy

Especially in chronic diseases such as hypothyroidism many patients hope for help outside of conventional medicine. But can a hypothyroidism be treated homeopathically? Basically, in diseases that require substitution therapy, homeopathy reaches its limits.

However, homeopathy can be used concomitantly with conventional medical hypothyroidism therapy. For example, in hypothyroidism with slowed metabolism, obesity and freezing despite normal room or outside temperature Graphites D12 is recommended. An experienced therapist can advise patients as to which homeopathic remedies may also support conventional medical thyroid hypofunction treatment.

Hypothyroidism: prevention

The most common cause of hypothyroidism is autoimmune disease (Hashimoto’s thyroiditis). In this disease, the body’s immune system is directed against its own thyroid gland. As a rule, this cause of hypothyroidism can not be prevented.

It is different with the iodine deficiency caused hypothyroidism. Watch out for a iodine-rich diet. Use iodized table salt and eat fish regularly. Many species of fish naturally contain abundant iodine. You can read more about iodine-rich nutrition in the article “Hypothyroidism – Nutrition”.

Tips for the diet

If you have hypothyroidism, there are some important things to consider about your diet. Because the hormone tablets are not compatible with all foods. Calcium-rich foods, for example, block the uptake of L-thyroxine from the intestine and thus alter the hormone level in the blood. Other foods or drinks may interact with the drug.

If there is still residual thyroid function – and this is so for many patients at least for a while – you should be careful to take enough iodine with your food. Sufficient iodine intake is also an important prevention of thyroid enlargement, the so-called iodine deficiency goiter.

How to prevent with the right diet of hypothyroidism, which foods are particularly rich in iodine and what you should consider in a treated hypothyroidism, read in the article thyroid hypofunction – nutrition.

Weight loss in hypothyroidism

People with hypothyroidism often have a weight problem. This is because their metabolism is slower due to the lack of thyroid hormones than in healthy people.

This reduces the so-called basal metabolism, that is, the amount of energy that the body needs at rest for the maintenance of bodily functions (e.g., body temperature, circulation, digestion). In addition, in hypothyroidism more water is stored in the tissue.

Nevertheless, it is also possible for a thyroid function to lose weight. The most important key to this is the drug treatment with thyroid hormones. But also the right balance of calorie intake and calorie consumption is important.

What you should pay special attention to, see the article thyroid subfunction – losing weight.

Hypothyroidism: disease course and prognosis

Thyroid hypofunction can be treated effectively by taking hormone tablets (substituted hypothyroidism). This treatment usually has to be continued for life. Patients who follow the therapy exactly can lead a completely normal life. They are not limited in their performance and life expectancy. Even a pregnancy is quite possible for women with hypothyroidism.

The situation is different for years of untreated hypothyroidism. Consequences such as elevated cholesterol, arteriosclerosis and infertility are not uncommon.

Desire to have children with hypothyroidism

Impaired thyroid function is a common cause of unmet desire for children. About one in ten couples is childless for this reason. Because the hormones of the thyroid have multiple effects on the metabolism and thus on the gonads and sexual function. In women, thyroid malfunction can interfere with egg maturation and the menstrual cycle, among other things.

There must be no fully developed hypothyroidism with a detectable hormone deficiency. Studies have shown that even a latent hypothyroidism complicates the pregnancy, in which only an elevated TSH value is detectable.

What your doctor can investigate in connection with the thyroid gland, if you can not get pregnant, and what treatments there are, see the article thyroid under-function – desire for children

Prognosis in children with congenital hypothyroidism

If the doctor detects congenital hypothyroidism right after birth and treats it, the children develop normally. If therapy is initiated too late, only dwarfism can be positively influenced. The by a Hypothyroidism However, brain damage and mental development disorders remain.

Additional information

Book recommendations:

• Successfully treat hypothyroidism: ways out of the depression, weight in balance. No more tired, tired and pale! (Dr. Andrea Flemmer, 2017)

• Thyroid under-function, hashimoto and hormones. The step-by-step guide to better treatment: Thyroid Principles Book (Irene Gronegger, 2015)

Guideline:

• S2k Guideline “Diagnosis, Therapy and Follow-Up of Primary Congenital Hypothyroidism” of the German Society for Paediatrics and Adolescent Medicine and the German Society of Endocrinology (as of February 2011, under revision)

Support Groups:

Thyroid League Germany e.V.
Johanniter GmbH, Waldkrankenhaus
Waldstr. 73, 53177 Bonn

http://www.schilddruesenliga.de/

Network pituitary and adrenal diseases e.V.
Waldstr. 53, 90763 Fuerth

http://www.glandula-online.de