Hypothyroidism
Hypothyroidism is a disorder that leads to a lack of thyroid hormone ("sluggish thyroid"). Hypothyroidism is the most common thyroid disease. It occurs more frequently in women than in men, is more common in older people, and may have a familial trait (hit multiple members of the .same family)
What are the symptoms of hypothyroidism?
Hypothyroidism can have various symptoms, since thyroid hormones are important for regulating the operation of virtually all organs and body systems. When levels of thyroid hormones ( T3 and T4 ) become abnormally low for some reason, all body processes become slower. Therefore, the symptoms of hypothyroidism include:
excessive tiredness;
discouragement, or even depression;
slow-witted;
slurred speech;
sensation of extreme cold;
Weight gain (typically around 3 to 5 Kg);
dry skin and fine, brittle hair;
swelling in legs or around the eyes;
little sweating;
constipation and slow digestion;
irregular periods (sometimes excessive bleeding);
infertility;
slow heartbeat (less than 60 beats per minute);
increased cholesterol.
These symptoms are not unique to hypothyroidism. Ie, various other health problems can cause very similar to symptoms of hypothyroidism. Therefore, sometimes the symptoms are attributed to other diseases that may present some similar manifestations, such as anemia, depression and vitamin deficiency, and the diagnosis of hypothyroidism can be made years after the start of the patient's complaints. Fortunately, nowadays doctors know best features of hypothyroidism and make the diagnosis earlier.
What are the causes of hypothyroidism?
In adults, the most common cause of hypothyroidism is a condition called Hashimoto's thyroiditis , or simply Hashimoto's disease . In this disease, the body's defense system (immune system) attacks the thyroid gland and cause damage to this gland, impairing their ability to produce thyroid hormones. Therefore, Hashimoto's disease is part of a group of diseases called autoimmune diseases .
Hypothyroidism can also be caused by medical treatments that reduce the ability to produce thyroid hormone, for example, the use of radioactive iodine (to treat hyperthyroidism, which is the opposite of hypothyroidism) or surgery , with partial or total removal of the thyroid (to treat other problems in this gland). Read more about hyperthyroidism clicking here.
Another cause of hypothyroidism is very rare, is the presence of some disease of the pituitary gland , leading to reduced production of TSH , the hormone that stimulates thyroid function. Some medications can also lead to reduced production or action of thyroid hormones and thus cause hypothyroidism (eg, amiodarone, cough syrups containing iodine, lithium carbonate.)
There are cases also where the thyroid fails to develop properly and the child has thyroid hormone deficiency since birth, is called congenital hypothyroidism , which is usually diagnosed already in the nursery through newborn screening .
What are the consequences of hypothyroidism?
In adults, hypothyroidism (if not handled correctly) leads to a significant reduction in their physical and mental performance, and may cause elevated cholesterol levels, which increase the chance of a heart problem. Furthermore, severe hypothyroidism, untreated, can progress over time to a dramatic situation and at great risk of life, called myxedema coma , which is presented as a reduction in body temperature, loss of consciousness and heart malfunction.
The diagnosis of hypothyroidism is especially important when it is done during pregnancy, since the lack of thyroid hormones can profoundly affect the baby's development, causing mental retardation, and growth retardation. However, these problems for the baby are prevented by early treatment of the mother with thyroid hormone replacement.
How is the diagnosis of hypothyroidism?
Usually the diagnosis is confirmed through a simple blood test. The examinations that help in the diagnosis of hypothyroidism are: the dosage of TSH (which is a hormone produced by the pituitary gland, that stimulates thyroid function), and the dosage of thyroid hormones ( T4 and T3 ).
Classically, the diagnosis of hypothyroidism is made when the patient presents with increased TSH and low T4 in the blood. However, in very mild cases of hypothyroidism, or if this is just the beginning, one can find increased TSH with normal T4. That is, the level of TSH increases before the T4 level falls below normal. This situation, in which the TSH is elevated with normal T4, is called subclinical hypothyroidism . Between the two blood tests, TSH is the most important, since the T4 may vary more than a day to another or from one collection to another, so the doctor will pay more attention to TSH than the T4 make the diagnosis of hypothyroidism.
THYROID NORMAL
TSH and normal T4
HYPOTHYROIDISM HOME OR MILD (subclinical)
High TSH, normal T4
HYPOTHYROIDISM INSTALLED (CLINICAL)
high TSH and low T4
Another test that may bring some information is the measurement of antibodies against the thyroid, which are generally increased when the cause of hypothyroidism is Hashimoto's disease. Antibodies can be measured in the laboratory are anti-thyroid peroxidase (or anti-TPO ) and anti-thyroglobulin (or anti-TG ).
How is hypothyroidism treated?
Hypothyroidism is the lack of thyroid hormone. Therefore, treatment is done with the replacement of this hormone in the form of tablets taken orally. The drug of choice is levothyroxine , which is a pharmaceutical form of the hormone T4 . After starting the medication, the patient usually takes about 2 weeks to feel a significant improvement of the symptoms of hypothyroidism (which may be a bit more serious cases).
Levothyroxine should be taken every day, in the morning to play the Normal thyroid function. One important measure is to take it on an empty stomach (at least 30 minutes before breakfast) because food intake along with the medication greatly decreases its absorption by the intestine and thus its effectiveness.
There are several brands of levothyroxine in the Brazilian market, and all are equally effective. However, there may be slight differences in action between one brand and another. So when a person began using a brand of levothyroxine, preferably should continue with the same brand (unless the doctor decides to exchange the medication for some reason). Another important caution with levothyroxine is that it should not be manipulated because the tablets contain very small amounts of thyroid hormone and not always the pharmacies can put the exact amount of the hormone within the capsules.
Most often, people who have hypothyroidism need to do treatment with levothyroxine for the rest of life, but in some cases the thyroid works normally after a few months. If, for some reason, the medication needs to be changed, it is important to check TSH levels with blood tests after changing the medication to ensure that the dose being adequate.
levothyroxine tablets exist with several different doses available in pharmacies (25, 50, 75, 88, 100, 112, 125, 150, 175 and 200 mcg). Adjusting the dose of medication is based on measurements of TSH, which should be maintained if possible within normal values. If doses of levothyroxine are too low for the needs of the patient, this may not feel improvement in symptoms of hypothyroidism or resubmit them. If the doses are too high, the patient may develop hyperthyroidism (too much thyroid hormone), which leads to long-term weakening of the bones, abnormal heart function and cardiac arrhythmias, among other problems. (. Hyperthyroidism Read more about by clicking here)
The need for levothyroxine may fluctuate over time, depending on factors such as other diseases, pregnancy, menopause, and use of other medications. For this reason, it is recommended that patients with hypothyroidism is monitored regularly by a doctor, with TSH tests and adjust the dose of medication if necessary.
So who has hypothyroidism is a sick person for a lifetime?
People with hypothyroidism need to make the right treatment, with daily use of levothyroxine in the most appropriate dose for your situation. If you are using the medication regularly, and thus maintaining TSH levels within the normal range, they can have a healthy, happy and completely normal life.
Nevertheless, if hypothyroidism is not treated properly, it can become a serious problem health, compromising the ability of the person performing their tasks and even pose a life-threatening in extreme cases.
Cases in which a person should do tests to evaluate thyroid?
Not all people need to do blood tests to assess whether the thyroid is functioning properly. The doctor is the one who determines whether or not someone needs to make a TSH, but there are some situations where such assessment is required, such as:
symptoms suggestive of hypothyroidism or hyperthyroidism;
others in the family with thyroid disease;
pregnancy.
Some experts even recommend that all women over 60 years should do at least one test TSH, even in the absence of symptoms, since hypothyroidism is very common in this population, but this is still a controversial subject.
Adapted from text of The Hormone Foundation - www.hormone.org
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