The Many Faces of Hypothyroidism

A tiny gland in your neck, the thyroid is responsible for regulating your metabolism, hormones, and heartbeat. Key to accomplishing those all-important tasks is producing just the right amount of thyroid hormone (TH). If your thyroid gland does not produce enough TH—a condition known as hypothyroidism or underactive thyroid—your body will not function at its best and different processes, such as your metabolism, may slow down. 

The most common cause of hypothyroidism in the U.S. is an autoimmune disorder called Hashimoto's thyroiditis, where the body's immune system attacks the thyroid gland. Other known causes include iodine deficiency, surgical removal of the thyroid gland, radiation treatment, and certain medications.

Regardless of the cause, when TH levels are too low, the body’s processes start to slow down and you may experience a range of symptoms—although some people report no symptoms at all. When they do appear, symptoms tend to vary from person to person and commonly include:

• Fatigue
• Weight gain
• Hair loss
• Brain fog
• Trouble tolerating cold
• Joint and muscle pain
• Constipation
• Dry skin or dry, thinning hair
• Heavy or irregular menstrual periods or fertility problems
• Slowed heart rate
• Depression

Diagnosing hypothyroidism typically involves a simple blood test to measure the levels of thyroid-stimulating hormone (TSH) and TH. If TSH levels are high and TH levels are low, it indicates hypothyroidism.

While there is no cure for hypothyroidism, it can be managed with medication. The standard treatment is levothyroxine, a synthetic form of TH. In order to work, this medication MUST be taken first thing in the morning on an empty stomach and you need to wait 30 minute before you take any other medication or to eat or drink anything. 

In most cases, levothyroxine effectively manages the condition for most patients, but others may continue to experience persistent symptoms despite achieving normal TSH and TH levels. It may take some trial and error to find the right dose of medication for each individual.

Even once your levels are stable, you’ll need to continue taking medication for the remainder of your life and to monitor yourself for symptoms. You also need to alert all of your healthcare providers of any changes to your health, weight, and of any new medications you may be taking or have stopped taking.

Even if you’re one of the lucky diagnosed individuals with no symptoms of hypothyroidism, it’s important to stay on any prescribed medications. Because your thyroid affects so many systems in your body, untreated hypothyroidism can cause widespread harm. Common complications include:

• High cholesterol
• Fertility issues
• Heart disease
• Goiter
• Kidney disease
• Decreased lung function
• Nerve damage (peripheral neuropathy)
• Challenges with mental and emotional health, including depression

In extremely rare cases in which an individual has severe, untreated hypothyroidism for an extended period of time, a myxedema crisis or coma may occur.

If you suspect that you are suffering from hypothyroidism, speak to a doctor as soon as possible; especially if your symptoms persist or become more severe over time.

Carolyn Goodwin, FNP, is a member of the endocrinology care team at Southwestern Vermont Health Care.