Hypothyroidism

1. What is hypothyroidism (under functioning of thyroid)?

Hypothyroidism means that the thyroid gland can't make enough thyroid hormone to keep the body running normally.

2. What causes hypothyroidism?

Most cases of hypothyroidism are caused by a condition called Hashimoto's thyroiditis, in which a patient's immune system attacks and destroys the thyroid. Iodine deficiency used to be a common cause in India but after iodized salt became widely available has now become rare. It can also be caused by treatment of hyperthyroidism or by certain medications, and it may be present from birth.

3. How do I suspect hypothyroidism?

Common complaints include fatigue and lethargy, cold sensitivity, dry skin and lifeless hair, impaired concentration and memory, increased weight, puffiness and constipation. Patients may also fairly often experience a hoarse voice, tingling of the hands, heavy or delayed menstrual periods, deafness and joint aches. In childhood there may be delayed development and puberty. Some patients have a swelling in the front of the neck due to thyroid enlargement (a goiter).

4. Can I have hypothyroidism even if I don’t have any of above mentioned symptoms?

Yes. Many patients have relatively few of the classical signs or symptoms just listed. In fact, nowadays most patients often are diagnosed at an early stage of disease, due to increased awareness and improved testing

5. How is the diagnosis of hypothyroidism made?

Your doctor will be able to get a good assessment of your thyroid gland activity by taking a history of your symptoms and by a physical examination. However to confirm the diagnosis, it is necessary to get laboratory tests that measure thyroid function test (TFT; serum T4 and TSH levels).

6. Is hypothyroidism a lifelong disorder?
In majority of cases, hypothyroidism is indeed lifelong disorder. It may be temporary in a few conditions (eg., ingestion of certain drugs or after thyroiditis).

7. How is hypothyroidism treated?
Treatment is referred to as ‘Replacement’ treatment i.e., the deficient thyroid hormone is replaced externally in tablet form with synthetic thyroxine (T4). Thyroxine (T4) is the major hormone produced by the thyroid gland and pure synthetic T4, taken once daily by mouth, successfully treats the symptoms of hypothyroidism in most patients. The current common branded forms of synthetic T4 in India are Thyronorm, Eltroxin, Thyrox, Thyroup, Thyrofit,Thyobuild, Lethyrox, Thyrocheck etc. Because of variations in the potency of T4 made by different manufacturers, including generic preparations, it is best to stay on T4 from a single manufacturer whenever possible.

8. Does the treatment have any side effects?
The treatment replaces the natural hormone which is deficient with synthetic hormones in tablet form which is safe, if you take the right dose as advised by your doctor. Under-treatment will cause inadequate replacement of the deficient hormone and hence symptoms persist. On the other hand, over-treatment may cause irritability, tremors, fast and irregular heart beats. It is important to take adequate dose of thyroid hormone regularly as prescribed by your doctor.

9. How soon after starting treatment will symptoms disappear?
Certain symptoms like puffiness and weight generally improve in a couple of weeks. Thereafter, improvement in appetite and constipation occur. Some symptoms like hoarseness of voice, changes in hair and skin may require several months to disappear.

10. Does the diet have to be changed?
Diet need not be changed. On the other hand, if you are suffering from some other diseases like diabetes or high blood pressure, appropriate modification of diet may be needed kindly consult your doctor / qualified dietician for this purpose.

11. Can hypothyroid patients lead a normal married life?
Hypothyroid patients who are properly treated can lead a normal sex life. Hypothyroid women in particular who are properly treated can have regular menstrual cycles, normal conception, pregnancy and delivery. There is no excessive risk of defects in newborn. The offspring of a hypothyroid individual need not necessarily have thyroid disorder. 

12. What happens if a hypothyroid patient becomes pregnant?
The dose of thyroxine has to be adjusted during the period of pregnancy. Most patients require increase in dose. However the dosage adjustment should only be done by your doctor. As soon as you miss a menstrual cycle get the pregnancy confirmed and contact your Endocrinologist as early as possible.

13. What if I am on other medication?
If you are already taking any medication for some other disease, please inform you doctor about the same and get the necessary advice.