Hypothyroidism is a prevalent condition from which an estimated 10 million Americans suffer. There are also estimates that approximately 10% of women suffer from thyroid hormone deficiency. However, there may be millions more afflicted who do not even know it. The good news is that by recognizing the symptoms and proper diagnosis, you can start treatment and live a happier and healthier life.
Overview of Hypothyroidism
Also known as underactive thyroid disease, hypothyroidism means that your thyroid is not producing enough thyroid hormones. The thyroid gland, located in the front lower part of your neck, releases hormones that affect your entire body, controlling many functions such as metabolism and affecting your skin, brain, muscles, and heart.

This gland produces two hormones: T3 (triiodothyronine) and T4 (thyroxine), which are responsible for things like how effectively you burn calories, as well as your body temperature and heart rate.
You may not notice the symptoms of hypothyroidism at first, or you may brush them off as caused by other things like getting older. Eventually, you may see other signs that are more difficult to ignore. Some of these symptoms include:
  • Puffiness in face
  • Feeling lethargic
  • Hoarseness of voice
  • Dry skin
  • Sensitivity to cold
  • Constipation
  • Impaired memory
  • Goiter (enlarged thyroid gland)
  • Slow heart rate
  • Muscle weakness
  • Thinning hair
  • Muscle aches, stiffness, and tenderness
  • Weight gain
  • Higher cholesterol levels
  • Heavy/irregular periods
  • Joint pain, stiffness, and swelling
While there are some general symptoms that you may notice, there are additional symptoms that you should watch out for in infants and children, such as:
  • Jaundice (yellowing of skin and whites of the eyes)
  • Difficulty breathing
  • Hoarse crying
  • Umbilical hernia
  • Large and protruding tongue
  • Constipation
  • Excessive sleepiness
  • Poor muscle tone
  • Poor mental development
  • Short stature, poor growth
  • Puberty delay
  • Late development of permanent teeth
If you notice these symptoms, and they don’t seem to be improving, it may be time to visit your doctor.

Causes of Hypothyroidism
There are several causes of hypothyroidism, including:
Hashimoto’s Disease
Hashimoto’s disease is an autoimmune condition and the leading cause of hypothyroidism. An autoimmune condition is one where the fighter cells that are supposed to kill invading bacteria and viruses end up attacking healthy cells. In this particular autoimmune disease, the fighter cells attack the thyroid gland and lead to chronic inflammation in the thyroid. This condition is also commonly found in other family members.
Congenital Hypothyroidism
A baby can be born with hypothyroidism. Sometimes babies are born with a partially formed thyroid or no thyroid. A child may also have an ectopic thyroid, meaning that the thyroid (or part of it) is not in the right place. There are also cases where the thyroid or its enzymes are simply not functioning properly.
Surgical Removal of the Thyroid or Part of It
Various conditions, such as Graves’ disease, thyroid cancer, or thyroid nodules, will require surgery to remove part or all of your thyroid. Without the full thyroid, your body cannot produce the right amount of thyroid hormones to keep your body functioning as healthily as possible.
Radiation Therapy
Sometimes people with nodular goiter, thyroid nodules, or Graves’ disease are treated with radioactive iodine. The purpose of this is to destroy the thyroid gland. However, other conditions like cancers in the neck or head, Hodgkin’s disease, or lymphoma are also treated with radiation and may cause patients to lose some or all of their thyroid function.
Medications, including lithium, amiodarone, and interferon-alpha, can also cause hypothyroidism by interfering with the natural production of the thyroid hormones. Iodine and antithyroid medicines prescribed for hyperthyroidism could lower thyroid hormone production more than necessary, causing hypothyroidism.
Pituitary Gland Problems
The pituitary gland is responsible for creating the thyroid-stimulating hormone (TSH), instructing your thyroid how much of the hormone it needs to make and release. In rare cases, a problem can occur within the pituitary gland that negatively affects the production of TSH.
In some cases, women can develop hypothyroidism while they are pregnant or postpartum. Typically, this is because they produce antibodies against their thyroid glands. If left untreated during the pregnancy, this can increase a woman’s risk of miscarriage, preeclampsia, and premature labor/delivery. It may also lead to serious issues with a developing fetus.
Iodine Deficiency
Iodine is a mineral that the thyroid needs to function correctly. Iodine is a trace mineral that can be found in plants grown in iodine-rich soil, iodized salt, seaweed, and seafood. For the most part, iodine deficiency is not an issue in the United States but can be problematic in other countries.
Complications with Untreated Hypothyroidism
Unfortunately, there can be numerous complications caused by untreated hypothyroidism.
Heart Problems
Hypothyroidism can be linked to an increased risk of heart failure and heart disease and can result from the high levels of the “bad” cholesterol that frequently occurs in people with underactive thyroid.
A goiter develops when the thyroid gland becomes enlarged because there is constant stimulation to release necessary hormones. It may not cause any discomfort, but you will notice that it is enlarged, and you may have difficulty breathing and swallowing.
Hypothyroidism can have an impact on your fertility, because low levels of the thyroid hormone may potentially interfere with ovulation. Hashimoto’s disease can also affect your fertility, as may other causes of hypothyroidism.
Myxedema is a rare condition, but one that can be life-threatening. It can be caused by undiagnosed hypothyroidism. Symptoms of this condition can appear as an intense sensitivity to cold and drowsiness. As this condition continues to go undiagnosed, it may lead to significant lethargy and unconsciousness and ultimately trigger myxedema coma due to stress, infection, or sedatives. If you think you have this condition, see a doctor right away.
Birth Defects
If hypothyroidism is undiagnosed throughout pregnancy, there is an increased risk of congenital disabilities. There is also a higher risk of severe developmental and intellectual problems.
Peripheral Neuropathy
In the long term, undiagnosed hypothyroidism can damage your peripheral nerves. These nerves are responsible for carrying important information from the brain/spinal cord through the rest of your body and can lead to tingling, numbness, and pain in the affected areas.
Mental Health Issues
Hypothyroidism can also lead to mental health issues and slowed mental functioning. You may notice depression that increases in severity until you are diagnosed and treated for hypothyroidism.
After taking a medical history, the doctor will do a physical exam to check for an enlarged thyroid gland and other changes like drier skin, slower heart rate, reflexes, and swelling. They will then do some blood tests to diagnose hypothyroidism. The TSH test is one of the most important diagnostic tests and will measure the amount of TSH in blood. TSH is released from the pituitary gland to signal the thyroid gland to produce T4. An abnormally high amount of TSH means that the thyroid is not producing enough T4.
There is also a T4 test. This hormone can be attached to thyroxine-binding globulin when it is in the bloodstream. These bound hormones are unable to get into the body’s cells. This test measures how much of the unbound/free T4 is in the blood and available for distribution.
If you are diagnosed with hypothyroidism, there are several treatments that can help alleviate the symptoms and allow you to live a healthier, happier life. Typically, people with hypothyroidism are prescribed levothyroxine, which is a synthetic thyroid hormone. The dosage will likely be adjusted as needed throughout your treatment. Your physician will test your blood to ensure that the levels are where they need to be and will adjust medication accordingly. There may be some supplements, medications, and foods that will affect your ability to absorb levothyroxine. If you eat large amounts of products that contain soy or are on a high-fiber diet, you should talk to your doctor. You should also mention to your doctor if you are taking other medications, including:
  • Calcium supplements
  • Iron supplements or multivitamins containing iron
  • Aluminum hydroxide (some antacids contain this)
Levothyroxine is most effective when taken daily at the same time, on an empty stomach. Ideally, this hormone should be taken first thing in the morning. You should wait an hour before you eat or take other medications. If you do choose to take this medicine at bedtime, you need to wait four hours after your last meal or snack.
Although hypothyroidism is a lifelong condition, it does not mean you cannot live a full and happy life. The medicines will be adjusted as needed, and you will be monitored to make sure that the dosage is always correct for you. By getting treatment, your life will be significantly improved, allowing you to live every day to the fullest.

Posted on 11/27/2019

Disclaimer: No content on this site should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
  1. Hypothyroidism: Overview, Causes, and Symptoms. EndocrineWeb. https://www.endocrineweb.com/conditions/thyroid/hypothyroidism-too-little-thyroid-hormone. Accessed November 27, 2019
  2. Hypothyroidism - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284. Accessed November 27, 2019.
  3. Hypothyroidism (Underactive Thyroid). WebMD. https://www.webmd.com/women/hypothyroidism-underactive-thyroid-symptoms-causes-treatments#1. Accessed November 27, 2019.
  4. Everything You Need to Know About Hypothyroidism. Healthline. https://www.healthline.com/health/hypothyroidism/symptoms-treatments-more#causes. Accessed November 27, 2019.
  5. Hypothyroidism (Underactive). American Thyroid Association. https://www.thyroid.org/hypothyroidism. Accessed November 27, 2019.
  6. How Doctors Diagnose Hypothyroidism. EndocrineWeb. https://www.endocrineweb.com/conditions/hypothyroidism/how-doctors-diagnose-hypothyroidism. Accessed November 27, 2019.
  7. Thyroid Function Tests. American Thyroid Association. https://www.thyroid.org/thyroid-function-tests. Accessed November 27, 2019.
  8. Hypothyroidism - Diagnosis and treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289. Accessed November 27, 2019.