Hypothyroidism – in short summary
Hypothyroidism, as the hypofunction of the thyroid gland is called medically, is when fewer thyroid hormones are formed than the organism needed.
Chronic inflammation of the organ is the most common cause.
The symptoms are very diverse as the thyroid affects many bodily functions. Examples: fatigue, weight gain, memory problems, dry skin.
The TSH value, an ultrasound examination and, if necessary, scintigraphy provide information as to whether there is a hypofunction.
To compensate for the hormone deficiency, patients must take L-thyroxine – usually lifelong.
What is a hypothyroidism?
what is hypothyroidism If the thyroid gland produces fewer hormones than the body needs, hyperthyroidism (hypothyroidism) is present
The thyroid is a butterfly-shaped organ that nestles below the larynx to the trachea. The thyroid gland produces the vital thyroid hormone thyroxine (T4) from protein and iodine. The second thyroid hormone triiodothyronine (T3) is produced in the body in the required amount from T4. The thyroid hormones influence not only metabolism but also circulation, growth and mental well-being.
The thyroid hypofunction is – with exceptions – not curable and must, therefore, be treated permanently with medication. But who takes his tablets regularly, but can still lead a normal life.
The cause may be a thyroid disorder itself. Rarely, hypothyroidism is innate, usually resulting from later loss or destruction of intact thyroid tissue, for example, inflammation. It can also lead to hypothyroidism, if the important for hormone formation control centers in the brain, the hypothalamus and the pituitary gland (pituitary gland), not working correctly. Even severe iodine deficiency in the diet may in rare cases lead to hypofunction – usually associated with an enlargement of the thyroid.
The congenital hypothyroidism
A hypofunction may be innate, which is the case in about one in 4,000 newborns. Here, the early detection of outstanding importance. For only by an early treatment permanent damage to the nervous system of the infant, such as mental disabilities, can be avoided. In Germany, therefore, a screening test for early detection is mandatory for all newborns.
The TSH value is determined in a drop of blood dried on filter paper. The sampling usually takes place around the third day of life (often together with the check-up U2). Due to rapid therapy, the full picture of the disease can therefore rarely develop.
Congenital hypothyroid may already be present in the womb or at birth. However, most of the signs are noticeable in the first months of life. Reduced activity and a sedentary lifestyle of the newborn, a drinking weakness, an enlarged tongue and a prolonged neonatal jaundice are typical . If not treated or treated too late, it can lead to developmental disorders of bones (dwarfism) and nervous system (brain). One speaks then of cretinism.
The causes of congenital thyroid hypofunction are:
- The absence of the thyroid gland
- Alteration of the thyroid tissue with loss of function
- Disorders of thyroid hormone production
- Damage to the thyroid during pregnancy in the womb (eg due to severe iodine deficiency, hypothyroidism of the mother or 131-radioiodine therapy)
Inflammation of the thyroid gland: Hashimoto’s and postpartum thyroiditis
In adulthood, chronic thyroiditis is the leading cause of hypothyroidism. This is usually based on an autoimmune disease called Hashimoto’s thyroiditis.
Hashimoto’s thyroiditis is one of the most common autoimmune diseases in humans. Especially affected are women from the 40th to the 50th year of life. The body mistakenly views your own thyroid gland as a foreign tissue and begins to produce antibodies against it. The following chronic inflammation destroys thyroid tissue. After weeks, usually even years, it gradually develops a hypothyroidism with initially only minor, harmless symptoms. The disease is chronic, so it is not curable. However, the symptoms can be completely corrected by the therapy.
A special form of thyroiditis occurs in four to ten percent of all women after childbirth (postpartum thyroiditis). The result is often a temporary hypothyroidism. This inflammation heals in 50 percent of diseased women without lasting consequences again. The remaining 50 percent develop long-term chronic autoimmune thyroiditis with hypothyroidism.
If there is an overactive thyroid or goiter, the medical measures directed against it may unintentionally cause hypothyroidism. These measures include:
- overdosed medications that inhibit the production of thyroid hormones (antithyroid drugs)
- a radioiodine therapy
- he removal of the thyroid or parts of it
- X-ray of the anterior cervical region in cancer
Diseased Control Centers: TRH, TSH
In rare cases, there is a hypofunction, because the parent, regulatory brain regions are affected. Two centers in the brain control the production and distribution of thyroid hormones. One is the hypothalamus with its thyrotropin-releasing hormone (TRH) in the midbrain. TRH promotes the formation and release of TSH. On the other hand, the pituitary gland (pituitary gland) with its thyroid stimulating hormone (TSH), which stimulates the thyroid to produce their hormones and release.
If the pituitary gland (pituitary gland) is the cause of hypothyroidism, it produces too little of the hormone TSH, which stimulates the thyroid gland. The result: The thyroid is not stimulated enough and in turn produces too few hormones. This form is very rare.
Also, the hypothalamus may be disturbed, which triggers a kind of domino effect. Because this brain region produces the messenger TRH. TRH promotes formation and release of TSH. TSH eventually stimulates the thyroid gland to form its own hormones. This form of hypofunction is even rarer.
Characteristic of hypothyroidism is its creeping, long-lasting course. Above all, it causes only minor complaints at the beginning and is therefore often recognized late. In older people, usually only single symptoms, such as an increased sensitivity to cold as well as a reduced physical and mental performance noticeable – which is often confused with normal, age-related changes.
The lack of thyroid hormones affects a variety of body organs, on our nervous system and on our psyche.
Typical symptoms of hypothyroidism include:
- sensitivity to cold
- Fatigue increased need for sleep, listlessness, apathy
- Slowed reflexes
- Memory weakness, depressive moods
- Weight gain and elevated lipid levels (especially cholesterol, especially LDL cholesterol may be increased)
- Muscle weakness, muscle stiffness
- Cool and pale dry skin
- Myxedema: doughy swelling of the subcutaneous connective tissue, especially on the arms and legs and on the face. Affected people seem “bloated”.
- Brittle, brittle hair, increased hair loss
- Brittle nails
Heisere, deep voice, slow, slurred speech
- Chronic constipation
- Possibly a goiter (goiter)
- Fluid accumulation in the eyelids (eyelid edema)
- Irregular menstrual bleeding in women, unfulfilled desire for children or reduced fertility
- Reduction of sexual pleasure and potency in men
- With severe, long-standing and untreated hypothyroidism, slower heartbeat, decreased and especially increased diastolic blood pressure (second blood pressure) may occur. The coronary arteries can calcify and heart muscle weakness or pericardial effusion may occur
Diagnosis: recognize hypothyroidism
Often the doctor gets first clues through the descriptions of the patient, which lead him to suspect a diagnosis. Because some symptoms, such as tiredness, are not clear at first but can occur in many diseases and in otherwise healthy individuals, it is important to consider under-functioning at all. In order to confirm a corresponding assumption, the following measures are possible:
Blood tests: TSH value
At the beginning of the diagnosis is the determination of the laboratory value TSH, which can give important indications for thyroid dysfunction. If the gland tissue is underactive, the TSH value is increased. If, on the other hand, there is a regulatory disturbance in the area of the pituitary gland or the hypothalamus, the TSH values are too low.
The standard range of the TSH value is between 0.4 and 4.0 milliUnits per liter (mU / l).
The thyroid hormone levels may be determined at the same time or subsequently. They are in a subfunction below or just within the normal range (compensated hypothyroidism). In addition, in the case of Hashimoto’s thyroiditis, it is usually possible to detect certain antibodies in the blood – against thyroglobulin (Tg antibodies) and thyroxine peroxidase (TPO antibodies).
Therapy: take L-thyroxine
The aim is to compensate for the hormone deficiency and thus eliminate or at least alleviate the symptoms. Because the hypofunction results from a deficiency of thyroid hormones, these hormones are also added to the body in tablet form. With a few exceptions, this treatment must be life-long and uninterrupted. In the case of iodine deficiency as a trigger, additional iodine can be administered. In Germany, hypothyroidism is virtually non-existent due to severe iodine deficiency.
When the intake of thyroid hormones is attached, depends on various factors. For example, it plays a role in how old the patient is, whether a woman is pregnant and whether comorbidities exist. Depending on these and other influences, the doctor and patient must develop a customized therapy.
The tablets are taken with synthetically produced thyroxine (T4), which is identical to the T4 produced in the thyroid gland. L-thyroxine should not be taken with other medicines. The level of the required T4 dose is mostly determined by a “creeping therapy”, especially in older patients or longer existing subfunction. This means: It starts with a lower concentration and this is – accompanied by blood tests – continuously increased to a sufficient level. The reason for this procedure: Symptoms of hyperthyroidism, such as cardiac arrhythmias, may be too high and too rapid a dose of T4 .
Although a tablet therapy must be life-long. But those affected can lead a completely normal life if taken correctly. Check-ups take place about once a month at the beginning of treatment. If blood or hormone levels, in particular the TSH value, have returned to normal, the control rhythm is changed to half-yearly, later on annually.
The second thyroid hormone T3 is produced in the body from T4 in the required amount. Only in exceptional cases, namely, when certain enzyme defects or hormone-forming disorders due to chronic liver disease,
When is it recommended to take iodine?
In Germany, the iodine supply is sufficient, so that a hypothyroidism is almost never based on an iodine deficiency. An additional iodine intake in autoimmune diseases of the thyroid with hypothyroidism is not useful. Only in pregnancy and lactation is an additional iodine intake recommended for women with hypothyroidism. Affected mothers talk best with their gynecologist to find out about the appropriate dosage.
Proper diet and weight loss for thyroid problems
There are no specific nutritional recommendations for people with hypothyroidism. Rather, the general tips apply: By maintaining a balanced diet and exercise sufficient body weight in the normal range or lose weight. The focus is first to normalize thyroid levels. A weight loss, if appropriate, should be done afterward.
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