Hypothyroidism (Underactive Thyroid) Treatment in Delhi, India

Hypothyroidism is a medical condition characterised by an underactive thyroid gland, which is a small butterfly-shaped gland located in the front of the neck. The thyroid gland plays a crucial role in regulating various metabolic processes in the body by producing thyroid hormones, primarily triiodothyronine (T3) and thyroxine (T4). These hormones are essential for the proper functioning of cells and organs, affecting metabolism, energy production, and overall growth and development.

In hypothyroidism, the thyroid gland doesn't produce enough thyroid hormones, leading to a slowdown in the body's metabolic processes, which in turn affects various body functions. It may also lead to high cholesterol or heart problems, if not treated.

Hypothyroidism can have various causes, and it often results from a disruption in the normal functioning of the thyroid gland. The most common causes include:

• Hashimoto's: It is an autoimmune disease and one of the most common causes of hypothyroidism. It occurs when the immune system mistakenly attacks and damages the thyroid gland, leading to inflammation and a gradual decline in thyroid function.
• Iodine Deficiency: Iodine is an essential mineral required for the production of thyroid hormones. A lack of iodine in the diet can lead to hypothyroidism, although iodine deficiency is rare in regions where iodine is adequately present in the diet.
• Surgical Removal of the Thyroid Gland: In some cases, the thyroid gland may be partially or completely removed due to thyroid cancer, large goitres, or other thyroid disorders. This surgical intervention can result in hypothyroidism, necessitating thyroid hormone replacement therapy.
• Radiation Therapy: Radiation treatment, particularly to the head and neck region, can damage the thyroid gland and lead to hypothyroidism. This is more commonly seen in individuals who have received radiation therapy for certain cancers.
• Certain Medications: Some medications, such as lithium (used for bipolar disorder), amiodarone (used for heart arrhythmias), and certain antithyroid drugs, can interfere with thyroid function and cause hypothyroidism.
• Congenital Hypothyroidism: Some individuals are born with an underactive thyroid gland due to a congenital disorder. This condition, if not detected and treated early, can lead to developmental issues and intellectual disabilities.
• Pituitary Gland Dysfunction: The pituitary gland, located in the brain, produces thyroid-stimulating hormone (TSH), which stimulates the thyroid gland to produce thyroid hormones. If there is a problem with the pituitary gland, such as a tumour or dysfunction, it can result in decreased TSH production and subsequently lead to hypothyroidism.
• Inflammation of the Thyroid Gland (Thyroiditis): This can disrupt its normal function and lead to hypothyroidism. Other than autoimmunity, it can be caused by infections and viral illness.
  
  It's important to note that the specific cause of hypothyroidism can vary among individuals, and in some cases, the exact cause may not be easily identified. If someone experiences symptoms of hypothyroidism, it is crucial to consult with a healthcare professional for proper diagnosis and appropriate management.

While anyone can develop hypothyroidism, certain factors make some individuals more susceptible. Here's a closer look at the key risk factors:

Demographic factors

• Women: They are more prone than men, especially after age 60.
• Age: Increased risk after 50, with women experiencing a particularly sharp rise around menopause.
• Family history: those with a close relative with autoimmune diseases or hypothyroidism are at a higher risk.

Medical factors

• Autoimmune diseases: Conditions like type 1 diabetes, lupus, or rheumatoid arthritis increase the risk.
• Thyroid gland damage: Prior surgery, radiation therapy, or thyroiditis can leave the gland vulnerable.
• Iodine deficiency: It was an important cause in India, but is almost eradicated. Rare in developed countries, but still a risk factor in some regions.
• Pituitary gland issues: If the pituitary gland malfunctioning affects thyroid hormone production.
• Certain medications: Drugs like lithium or amiodarone can interfere with thyroid function.

Other factors

• Pregnancy and postpartum: Up to 5% of women experience thyroiditis after childbirth, increasing hypothyroidism risk.
• Stress: While the link isn't definitive, chronic stress might influence thyroid function in some individuals.
• Environmental factors: Exposure to certain toxins or heavy metals may play a role, although research is ongoing.

It's important to note that having one or more risk factors does not necessarily mean an individual will develop hypothyroidism. Regular monitoring, awareness of symptoms, and appropriate medical evaluation are crucial for early detection and management of thyroid disorders.

Hypothyroidism, an underactive thyroid gland, can manifest in a variety of ways. Here's a breakdown of the most common symptoms.

Early symptoms

• Fatigue and tiredness: Feeling constantly drained and lacking energy, even after adequate sleep.
• Sensitivity to cold: Feeling colder than usual, despite others being comfortable.
• Constipation: Difficulty with bowel movements, which can become less frequent and harder to pass.
• Dry skin and hair: Dry, itchy skin and brittle, thinning hair are common indicators.
• Weight gain: Unexplained weight gain despite unchanged diet and exercise habits.
• Muscle aches and weakness: Generalised muscle pains, cramps, and overall feeling of weakness.
• Irregular or heavy periods: Changes in menstrual cycle regularity or increased blood flow can occur.
• Depression and mood swings: Low mood, feelings of sadness and irritability, and difficulty concentrating.

Late symptoms

• Slowed heart rate: A resting heart rate that is noticeably slower than usual.
• Puffy face and eyes: Swelling around the face and eyes due to fluid retention.
• Hoarseness and voice changes: A deeper, raspier voice is a potential symptom.
• Thinning eyebrows: Gradual loss of eyebrow hair, particularly the outer edges.
• Cold intolerance: Extreme sensitivity to cold temperatures, even indoors.
• Memory problems and brain fog: Difficulty focusing, forgetfulness, and mental sluggishness.
• Hearing loss: Decreased ability to hear, particularly high-pitched sounds.
• Anaemia: Low red blood cell count, leading to fatigue and pale skin

Diagnosing hypothyroidism involves a combination of clinical assessment, medical history review, and laboratory tests to evaluate thyroid function. Here are the key steps in the diagnosis of hypothyroidism.

Clinical Evaluation

• Medical history: Medical history including family history.
• Physical examination: Physical examination, include checking for signs such as dry skin, hair changes, goitre (enlarged thyroid), and reflexes.

Blood tests (thyroid function tests)

After the clinical evaluation, individuals need to undergo one or more of the following blood tests.

• TSH test: Elevated TSH levels are typically indicative of hypothyroidism. TSH is produced by the pituitary gland and stimulates the thyroid to produce more thyroid hormones.
• T4 (Thyroxine) test: Total or free thyroxine levels may be measured to assess the amount of active thyroid hormone in the blood.
• T3 (Triiodothyronine) test: Though less commonly measured, T3 levels may also be assessed.

• Antithyroid antibodies: In cases where autoimmune thyroiditis (Hashimoto's thyroiditis) is suspected, blood tests may be conducted to detect antithyroid antibodies, such as anti-thyroid peroxidase (anti-TPO) antibodies.

Imaging studies (if needed)

An ultrasound of the thyroid may be performed to assess the size, structure, and any abnormalities of the thyroid gland.

Additional testing (if needed)

A radioactive iodine uptake test may be done in certain cases to evaluate how the thyroid gland takes up iodine, helping to determine the cause of the dysfunction.

Once a diagnosis of hypothyroidism is confirmed, the healthcare provider will work with the individual to develop an appropriate treatment plan.

When it comes to treatment managing hypothyroidism, the underactive thyroid, several options exist, each aiming to restore hormonal balance and alleviate symptoms. 

Hormone Replacement Therapy (HRT)

The mainstay of hypothyroidism treatment is HRT, typically involving a daily dose of levothyroxine (synthetic T4). This medication replaces the missing thyroid hormone, regulating your metabolism and alleviating symptoms like fatigue, brain fog, and weight gain. Our experienced endocrinologists will carefully tailor your dosage based on regular blood tests and your individual needs, ensuring optimal hormone levels and treatment effectiveness.

Dietary and lifestyle modifications

Although lifestyle does not have a major impact on thyroid function, healthy lifestyle choices can significantly enhance your treatment journey and overall well-being. Here are some key areas to focus on:

• Balanced diet: Prioritise nutrient-rich foods like fruits, vegetables, whole grains, and lean protein to provide your body with the building blocks it needs for optimal thyroid function.
• Regular exercise: Aim for moderate activity most days of the week. Walking, swimming, or yoga can boost your energy levels, improve mood, and strengthen your overall health.
• Stress management: Chronic stress can exacerbate hypothyroidism symptoms. Techniques like meditation, deep breathing, or spending time in nature can help you manage stress and find inner peace.
• Adequate sleep: Aim for 7-8 hours of quality sleep each night. Adequate sleep supports hormone regulation and promotes overall well-being.

Additional support (in specific cases)

• Iron supplementation: Hypothyroidism can sometimes be associated with iron deficiency, necessitating additional iron intake.
• Selenium supplementation: This trace mineral plays a role in thyroid hormone metabolism, and supplementation might be beneficial in some cases.
• Addressing comorbidities: Managing conditions like high blood pressure or depression can further enhance overall well-being.

Hypothyroidism, marked by fatigue and a slowed metabolism, may seem mild but can have serious consequences if left untreated or severe. Recognizing and understanding possible complications is essential for proactive management.

Heart Issues

• Enlarged heart: Over time, low thyroid hormone levels can weaken the heart muscle, leading to an enlarged heart and potentially heart failure.
• Abnormal heart rhythms: Hypothyroidism can also disrupt heart rhythm, causing conditions like arrhythmias and palpitations.
• High cholesterol: Lowered metabolism associated with hypothyroidism can lead to higher cholesterol levels, further increasing the risk of heart disease.

Neurological problems

• Cognitive decline: Memory issues, brain fog, and even depression can occur if severe hypothyroidism goes untreated.
• Carpal tunnel syndrome: Compression of the nerves in the wrist, causing pain and numbness, can be a complication of hypothyroidism.
• Peripheral neuropathy: Damage to nerves in the hands and feet, resulting in tingling, numbness, and weakness, can also be associated with the condition.

Other potential associations / complications

• Goitre: This refers to an enlarged thyroid gland, often noticeable as a swelling in the neck. While not always harmful, it can be unsightly and uncomfortable.
• Infertility: Hypothyroidism can disrupt menstrual cycles and ovulation, making it harder to conceive.
• Birth defects: In rare cases, severe untreated hypothyroidism during pregnancy can increase the risk of birth defects in the baby.
• Myxedema coma: This is a life-threatening emergency state caused by extremely low thyroid hormone levels, requiring immediate medical attention.

Q. What is subclinical hypothyroidism?

Subclinical hypothyroidism is a milder form of hypothyroidism where thyroid hormone levels are slightly elevated, but symptoms may be absent or subtle. It is often diagnosed through blood tests measuring thyroid hormone levels.

Q. What's the difference between hypothyroidism and hyperthyroidism?

Hypothyroidism is characterised by an underactive thyroid, leading to reduced thyroid hormone levels and symptoms like fatigue and weight gain. Hyperthyroidism, on the other hand, results from an overactive thyroid, causing elevated thyroid hormone levels and symptoms such as weight loss and increased heart rate.

Q. What causes hypothyroidism in pregnancy?

Pregnancy-related hypothyroidism can be caused by autoimmune thyroiditis (Hashimoto's thyroiditis), iodine deficiency, or inflammation of the thyroid gland. Proper management during pregnancy is crucial to prevent complications.

Q. Can hypothyroidism cause erectile dysfunction?

Hypothyroidism can contribute to sexual dysfunction, including erectile dysfunction, due to its impact on overall metabolic function and hormonal balance. Effective management of hypothyroidism may improve such symptoms.

Q. Can hypothyroidism lead to weight gain?

Yes, hypothyroidism can lead to weight gain due to a slowed metabolism. However, not everyone with hypothyroidism will experience significant weight gain. Usual weight gain is not more than 2-3 Kg.

Q. Can hypothyroidism be prevented?

In some cases, hypothyroidism can be prevented by addressing underlying causes such as iodine deficiency. However, in many instances, especially those related to autoimmune conditions, prevention may not be possible.

Q. Can hypothyroidism go away on Its own?

In most cases, hypothyroidism is a lifelong condition that requires ongoing management with medication. While some cases of subclinical hypothyroidism may resolve spontaneously, clinical hypothyroidism usually requires treatment.

Q. What Is the outlook/prognosis for hypothyroidism?

With proper diagnosis and management, the outlook for hypothyroidism is generally favourable. Medication, lifestyle adjustments, and regular monitoring can help individuals lead normal, healthy lives. Compliance with prescribed treatments is key to managing symptoms effectively.

Q. Is it possible to have hypothyroidism with normal TSH?

Yes, it is possible. While most people with hypothyroidism have elevated TSH levels due to an underactive thyroid, some individuals may still have normal TSH levels. This occurs as the body increases TSH production to stimulate the thyroid despite insufficient hormone release.

Q. Why is it advised not to skip doses or stop taking Levothyroxine, even if symptoms of hypothyroidism improve?

Skipping doses or discontinuing Levothyroxine can lead to a decline in thyroid hormone levels, causing the return of hypothyroidism symptoms. Consistent medication use is essential for maintaining thyroid function.

Q. In the event of missing a dose of Levothyroxine, what is the recommended course of action to maintain treatment effectiveness?

If a dose is missed, taking two pills the next day is generally advised. However, it's essential to consult with a healthcare provider for personalised guidance based on individual circumstances.

Q. Are there any potential side effects associated with Levothyroxine, and how can they be minimised while ensuring the medication's effectiveness?

Potential side effects of levothyroxine may include insomnia, palpitations, or weight changes. These can be minimised by adhering to prescribed dosages, regular monitoring, and promptly communicating any concerns with a healthcare provider for adjustments if needed.

Reviewed By Dr. Ambrish Mithal, Chairman & Head - Endocrinology & Diabetes on 26 Aug 2024