Undetected thyroid problem can lead to tiredness, chronic pain and many other symptoms
Muscle cramps, tingling in hands, tiredness, slow thinking, intolerance to cold, and weight gain. These can all be signs that the thyroid gland is not producing enough hormone, which is called hypothyroidism.
As a physician, I see many patients who have had these symptoms for years, and nobody thought to investigate their thyroid function. In this article, I will talk about reasons why the thyroid stops producing hormones, how it is diagnosed and what is the treatment for hypothyroidism.
The thyroid is a gland that attaches to the trachea. It resembles a butterfly. The thyroid produces 3 hormones: calcitonin, Triiodothyronine, also known as T3, and Tetraiodothyronine, or T4.
T3 and T4 exert their effects on almost every cell of our bodies. These two hormones will basically go to all cells of the body and tell them how much energy they need to consume.
When the cells are hit by T3 and T4, they work harder, and this causes them to consume more energy. When there is no T3 and T4, the cells are underperforming and slow.
When the thyroid is overactive, there is too much T3 and T4, the person will feel super energetic, we call this hyperthyroidism. There may be serious consequences, for example, exophthalmos, which is bulging or protruding eyeballs. The eyelids are wide opened and the eyes seem to be popping out.
The most common thyroid dysfunction is hypothyroidism, when it is not producing enough hormones. There are other diseases of the thyroid, for example tumours: benign tumours and cancers, but these are not the focus of this article.
It is estimated that 12% of the world population has some type of thyroid problem. We know that thyroid diseases affect more women than men, and that they become more common with older age.
What are the symptoms of hypothyroidism?
The person will feel tired, lack energy, slow thinking, and depression. It is also common to have muscle cramps, joint pain, numbness, carpal tunnel syndrome, and tingling in hands and feet. Also, intolerance to cold, weight gain, hair loss, dry skin and myxedema, which is a kind of peripheral nonpitting edema. There can also be slowing of heart rate, we call this bradycardia. In women, we see changes in menstrual cycles, and reduced libido.
What causes hypothyroidism?
The most common causes are:
1- Hashimoto’s thyroiditis, an autoimmune disease that results in inflammation of the thyroid gland. This condition is more common in women than in men and often runs in families.
2- Radioactive iodine treatment for hyperthyroidism or toxic multinodular goiter (goy·tr).
3- Congenital hypothyroidism, that is a person is born without a thyroid gland or a poorly functioning one.
4- Surgical removal of the thyroid gland as a treatment for thyroid cancer or hyperthyroidism.
How is hypothyroidism diagnosed?
We usually make the diagnosis of hypothyroidism by ordering a blood test that measures the thyroid-stimulating hormone or TSH. TSH is a hormone produced by the brain, in the hypophysis, also known as pituitary. If the thyroid is not producing enough T3 and T4, then the brain will try to increase the production by releasing more TSH. The TSH is the signal from the brain for the thyroid to produce more T3 and T4. So, we usually measure the TSH first, and if the TSH is elevated, we suspect the thyroid is not working properly.
The normal levels of TSH in the blood will depend on the laboratory and type of test used. Then, we confirm the diagnosis by ordering a blood test to measure the free T4 in the blood.
You may be asking, why don’t we just measure T3 and T4 in the blood instead of measuring the brain hormone called TSH? That is a very good question. That is because sometimes the levels of T4 are normal, but the thyroid is deficient, and it needs a higher amount of TSH to keep producing a normal amount of T4 and T3. We call this subclinical hypothyroidism. The thyroid is at risk of failing. In most cases subclinical hypothyroidism can be monitored without treatment and sometimes the TSH will return to normal on its own.
How is hypothyroidism treated?
Most patients with hypothyroidism need therapy with thyroid hormone replacement for the rest of their lives. They will need to keep monitoring to ensure that the dose of thyroid hormone maintains thyroid function tests in the normal range.
Treatment is in the form of a tablet of thyroid hormones taken once a day. This hormone pill usually contains T4 hormones and is to be taken on an empty stomach and free from other medications. This is important so that other medications do not interfere in T4 absorption from the gut.
This article was written in collaboration with the Thyroid Foundation of Canada. If you are interested, visit their website at https://thyroid.ca/
This article is not intended to give you medical advice. Please talk to your physician or healthcare professional if you have any health issues. If you leave a comment about your own medical condition, I will not be able to provide you medical advice. But, please, leave a comment if you feel that this article has helped you to learn something new.
This article is available as a YouTube video on my channel https://youtu.be/FNOWDb0FXO4
