If the thyroid gland is not making enough of the hormone thyroxine, it results in a condition called hypothyroidism. It is also called an “under-active” thyroid or a “low” thyroid”. For most people with hypothyroidism the thyroid stimulating hormone (TSH) is usually high and the T4/T3 hormones are usually low.
How many people suffer from hypothyroidism?
You may be surprised to hear that hypothyroidism is actually a common condition. Different studies suggest different rates, but around 2-3% of all people around the world have it [R1]. That’s more than 140 million people! This condition is about nine times more common in females than males.
How do you diagnose Hypothyroidism
Doctors diagnose hypothyroidism with a combination of history review, examination findings (such as an enlarged thyroid gland) and blood tests.
Types of hypothyroidism
There are different types and causes of hypothyroidism:
- Autoimmune or Hashimoto’s thyroiditis (most common)
- Iodine deficiency
- Inflammation of the thyroid gland (thyroiditis) which can be due to a viral infection or sometimes following the use of medicines like Lithium or Amiodarone. However, this is rare.
- Defect in the pituitary gland. This is the master endocrine gland just below your brain which controls the thyroid gland.
- Congenital thyroid disease
- Genetic defects in thyroid function, which usually are detected in babies
- Hypothyroidism after removal of the thyroid gland: this occurs after the thyroid gland is removed due to cancer or nodules.
The symptoms of hypothyroidism include:
- Reduced exercise tolerance
- Dry skin
- Weight gain
- Feeling excessively cold or being more sensitive to cold weather
- Swelling of the neck
- Hair loss, including hair of the eyebrows
- Swelling of limbs and face
- Difficulty analyzing things
- Tingling of hands (due to carpal tunnel syndrome)
- Diffuse joint aches
- Slow pulse rate
- Hoarse voice
- For women: heavy periods and sometimes delayed periods
- For children: delayed development
- In the elderly: altered mental state
What medicines are available for hypothyroidism?
- Selenium: Selenium is a natural mineral, just like iron and calcium. It has been shown in many studies to help improve thyroid function.
- Iodine supplementation: all over the world, one of the most common causes of hypothyroidism is lack of iodine in food. Nowadays, this problem is getting better as salt that includes the element iodine (iodised salt) is becoming more widespread around the world.
- Thyroxine (also called Eltroxin, Euthyrox, Synthroid, Thyronorm): this is the T4 hormone in tablet form. It is sold under different trade names around the world. However, all of them contain exactly the same hormone.
- Tri-iodothyronine (also called Cytomel): this is the T3 hormone in tablet form
How do you treat hypothyroidism?
For most people thyroxine is sufficient. However, for this medicine to work properly, you have to take it correctly. This is because there are many things which affect how much of this medicine is absorbed. For best results:
- Take thyroxine on an empty stomach. If you don’t, the food you eat will mix with the medicine and you may not absorb it properly. This will cause a variation in the daily amount of thyroxine you are actually getting. It may seem like a 100 mcg tablet, but if you don’t absorb it properly you may only be getting 80 mcg one day, 70 mcg another day and 90 mcg a third day.
- Take thyroxine with a full glass of water. This is to help you absorb the medicine properly, as a mouthful of water is not enough.
- After taking thyroxine, wait at least 1 hour before you eat any food or drink any liquid (except water). Studies have shown that coffee, milk and other food items affect the absorption of thyroxine.
- If you can’t wait an hour to eat after you take your thyroxine, another option is to take thyroxine at bedtime. The same principles as above apply though. It takes about 3 hours for your stomach to empty after you have eaten a meal. That means that if there is a gap of at least 3 hours between your last meal and when you go to sleep, you can take your thyroxine at bedtime.
- Don’t take iron or calcium tablets along with thyroxine. If you need to take iron or calcium tablets, take them at lunchtime or with your evening meal.
- Don’t skip a dose. If you forget to take your thyroxine one day, take double the dose the next day.