Hyperthyroidism: Causes, Symptoms, types and Treatment

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Hyperthyroidism What is the thyroid?
Hyperthyroidism What is the thyroid?

What is the thyroid?

The thyroid is a gland of the butterfly-shaped endocrine system , located in the front of the neck, above the trachea. Its function is to produce thyroid hormones (T4 and T3).

Through the bloodstream, T4 and T3 reach all the cells of the body in order to control and regulate their metabolism; that is, the rhythm with which the various processes and bodily reactions are carried out. For example, thyroid hormones help the body use and consume energy, maintain the temperature of the body and muscles and organs such as the brain and heart function properly.

What is hypothyroidism?

Hypothyroidism is a dysfunction that causes the thyroid gland not produce enough thyroid hormones, so the body can not continue to function normally and the organic activity decreases or slows down.

Another consequence of the decrease in T3 and T4 – in the case of being a primary hypothyroidism – is a greater secretion of TSH, which is the thyroid stimulating hormone and that occurs in the pituitary gland. In fact, the production of TSH is the body’s way of upregulating or decreasing the production of thyroid hormones and works as the person in charge of an “assembly line”: if the production of these hormones is excessive, TSH Its concentration decreases and the thyroid cells work less in the production of T4 and T3. If, on the contrary, the levels of T4 and T3 decrease, the TSH increases its presence, in order that the performance of the thyroid gland does not decrease.

In this way, the doctor will not take into account only the levels of T4, but also the level of TSH, since, for example, it allows -indirectly- to detect that the thyroid gland is not functioning in the proper limits, even in the case that the levels of T3 and T4 remain stable (as we will see what happens in cases of subclinical hypothyroidism).

Although it has no cure, it is as a rule a disease that is easy to control . Only if it is not diagnosed and left untreated, the symptoms derived from hypothyroidism intensify and, in extreme situations, it can evolve to generalized swelling, heart failure and respiratory failure.

What types are hypothyroidism?

There are two main types of hypothyroidism, depending on whether the problem is in the thyroid gland itself or if it is in the production of thyroid stimulating hormones (TSH, produced in the pituitary gland and TRH, produced in the hypothalamus and which in turn regulates TSH production in the pituitary gland):

Primary hypothyroidism:

it is the most common -represents approximately 95% of cases, according to the Catalan Health Institute (ICS) – and is caused by some damage or alteration in the thyroid. Various diseases, the lack of iodine in food and water, or also their excessive intake, the taking of medication and other conditions can hinder their work or even damage the thyroid hormone-producing cells in the gland itself.

Central hypothyroidism:

represents 5% of cases of hypothyroidism. The lower secretion of thyroid stimulating hormone (TSH) is due to alterations in the pituitary gland (secondary hypothyroidism) or in the hypothalamus (tertiary hypothyroidism).
Occasionally, the so-called subclinical hypothyroidism can be diagnosed , which is a mild failure in the thyroid gland and is defined as the situation that occurs with elevated TSH, but with normal levels of circulating T4. Although previously it was thought that there were no symptoms (hence the term subclinical), at the present time only takes into account the levels of hormones, regardless of whether there are symptoms or not. In these cases, it is usual to maintain an attitude of observation and it is not usually necessary to supplement with external thyroid hormone, but to carry out a periodic follow-up by the doctor, who will decide when it is convenient to start the medication.

Who suffers from hypothyroidism?

According to data from the University Hospital of Navarra, it is a disease that most often affects the female sex, as it is suffered by 2% of adult women, compared to 0.1-0.2% of men. It usually develops after 40 or 50 years, especially when its cause is autoimmune.

What are hypothyroidism causes?

Hypothyroidism can be produced by several causes:

  • Autoimmune diseases: the most common is a condition called Hashimoto’s thyroiditis. It causes the immune system, which protects the body against foreign infections, to confuse the thyroid cells and their enzymes with invading agents and attack them. Another autoimmune disease that can cause hypothyroidism is atrophic thyroiditis.
  • Thyroiditis: an illness caused by a problem in the immune system or by a viral infection, which causes inflammation of the thyroid and, consequently, that the thyroid hormones are released suddenly. This causes hyperthyroidism of short duration, which then gives way to hypothyroidism.
  • Congenital hypothyroidism (from birth): although it is not usual, it is the most frequent endocrine alteration in newborns. Its causes are: iodine deficiency and, in those places with enough iodine, the most common is to be born without a thyroid gland or to be formed only partially or in an incorrect place.
  • Transient, among which are thyroiditis after childbirth, silent thyroiditis and subacute de Quervain thyroiditis. Some women develop hypothyroidism during or after pregnancy because their body produces antibodies that attack the thyroid gland. Therefore, they require special control and surveillance by the endocrinologist for the proper development of pregnancy.
  • Certain medications: for example, amiodarone, lithium, interferon alfa, and interleukin-2 may trigger hypothyroidism, but usually only in those with a genetic predisposition. Also some antitussive and expectorant syrups, iodinated contrasts and some antiseptics may precipitate it.
  • Problems or inflammation of the pituitary gland (hypophysis): a disorder in this gland prevents it from producing enough TSH hormone.
  • Excess or lack of iodine: iodine is a mineral used by the body to produce thyroid hormones. For this reason, and although it is important to include iodized salt in our diet, it should be taken in moderation.
  • Partial or total surgical removal of the thyroid gland: this intervention may be necessary in case of thyroid nodules, thyroid cancer or Graves disease.
  • Radioactive treatment: it can be radioactive iodine – administered to treat diseases such as those mentioned in the previous point – or radiation – used as a treatment for Hodgkin’s disease, lymphoma or cancers of the head or neck.
  • Diseases that occur with the appearance of substance deposits in the thyroid and prevent it from performing its function correctly, such as, for example, amyloidosis and sarcoidosis.

What symptoms produces hypothyroidism?

The symptoms of hypothyroidism usually appear little by little and tend to develop progressively. Among the most common are:

  • Apathy, indifference or, sometimes, depression.
  • Weight gain: because the cells burn less energy.
  • Dry skin and hair, with fragile and brittle hair and nails.
  • Finding “bad” cholesterol levels in a general analytic.
  • Tiredness and / or drowsiness
  • Less ability to concentrate , memory failures and forgetfulness.
  • Greater sensitivity to cold.
  • Hoarse voice and swollen face.
  • Constipation.
  • Pain and / or muscle cramps.
  • Rigidity or swelling in the joints.
  • In women, menstrual disorders.

All these symptoms can go unnoticed for a while since they are nonspecific, that is, they can be common to other pathologies and are often a reflection of a “slowing down” of the functioning of the organism.

How is hypothyroidism treated?

Although it is a chronic disease, hypothyroidism is controllable with lifelong medication.

The pharmacological treatment is based on the substitution of the T4 hormone that the thyroid is no longer able to produce, by synthetic thyroxine (T4) through the taking of a daily dose. This treatment is the most important pillar so that the different organs and apparatuses continue performing their functions, stimulated by the thyroid hormone that, in this case, instead of occurring in our interior, is administered in the form of medication. In this way, hormone levels are regulated and the metabolism returns to normal. Likewise, cholesterol is reduced and, if there has been an increase in weight, it is usually reversed.

It is a permanent treatment – which must be periodically checked by a doctor – but which allows the person with hypothyroidism to lead a completely normal life in most cases.

To keep thyroid hormone levels stable, it is important to never skip the daily intake of the medication. The doctor should also be informed in case of ingesting drugs or supplements that may interfere with the body’s ability to assimilate thyroxine, such as soy or fiber ingested in large quantities, iron or calcium supplements or aluminum hydroxide that, for example, it is found in some antacids.

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