Hypothyroidism

Endocrine glands

Hypothyroidism

Brain-thyroid link

Thyroid gland

Definition:
Hypothyroidism is a condition in which the thyroid gland fails to produce enough thyroid
hormone.
Alternative Names:
Myxedema; Adult hypothyroidism
Causes, incidence, and risk factors:
The thyroid gland, located in the front of the neck just below the larynx, secretes hormones that
control metabolism. These hormones are thyroxine (T4) and triiodothyronine (T3).
The secretion of T3 and T4 is controlled by the pituitary gland and the hypothalamus, which is
part of the brain. Thyroid disorders may result not only from defects in the thyroid gland itself,
but also from abnormalities of the pituitary or hypothalamus.
Hypothyroidism, or underactivity of the thyroid gland, may cause a variety of symptoms and
may affect all body functions. The body's normal rate of functioning slows, causing mental and
physical sluggishness. The symptoms may vary from mild to severe, with the most severe form
called myxedema, which is a medical emergency.
The most common cause of hypothyroidism is Hashimoto's thyroiditis, a disease of the thyroid
gland where the body's immune system attacks the gland. Failure of the pituitary gland to secrete
a hormone to stimulate the thyroid gland (secondary hypothyroidism) is a less common cause of
hypothyroidism. Other causes include congenital defects, surgical removal of the thyroid gland,
irradiation of the gland, or inflammatory conditions.
Risk factors include age over 50 years, female gender, obesity, thyroid surgery, and exposure of
the neck to X-ray or radiation treatments.
Symptoms:
Early symptoms:

weakness
fatigue

cold intolerance

constipation

weight gain (unintentional)

depression

joint or muscle pain

thin, brittle fingernails

thin and brittle hair

paleness

Late symptoms:

slow speech
dry flaky skin

thickening of the skin

puffy face, hands and feet

decreased taste and smell

thinning of eyebrows

hoarseness

abnormal menstrual periods

Additional symptoms that may be associated with this disease:

overall swelling
muscle spasms (cramps)

muscle pain

muscle atrophy

uncoordinated movement

absent menstruation

joint stiffness

dry hair

hair loss

facial swelling

drowsiness

appetite loss

ankle, feet, and leg swelling

short stature

separated sutures

delayed formation or absence of teeth

Signs and tests:
A physical examination reveals delayed relaxation of muscles during tests of reflexes. Pale,
yellow skin; loss of the outer edge of the eyebrows; thin and brittle hair; coarse facial features;
brittle nails; firm swelling of the arms and legs; and mental slowing may be noted. Vital signs
may reveal slow heart rate, low blood pressure, and low temperature.

A chest X-ray may reveal an enlarged heart.

Laboratory tests to determine thyroid function include:

T4 test (low)
serum TSH (high in primary hypothyroidism, low or low-normal in secondary
hypothyroidism)

Additional laboratory abnormalities may include:

increased cholesterol levels

increased liver enzymes

increased serum prolactin

low serum sodium

a complete blood count (CBC) that shows anemia

Treatment:
The purpose of treatment is to replace the deficient thyroid hormone. Levothyroxine is the most
commonly used medication. The lowest dose effective in relieving symptoms and normalizing
the TSH is used. Life-long therapy is needed. Medication must be continued even when
symptoms subside. Thyroid hormone levels should be monitored yearly after a stable dose of
medication is determined.

After replacement therapy has begun, report any symptoms of increased thyroid activity
(hyperthyroidism) such as restlessness, rapid weight loss, and sweating.
Myxedema coma is a medical emergency that occurs when the body's level of thyroid hormones
becomes extremely low. It is treated with intravenous thyroid replacement and steroid therapy.
Supportive therapy of oxygen, assisted ventilation, fluid replacement, and intensive-care nursing
may be indicated.

Expectations (prognosis):
With treatment, return to the normal state is usual. Life-long medication is needed. Myxedema
coma can result in death.
Complications:
Myxedema coma, the most severe form of hypothyroidism, is rare. It may be caused by an
infection, illness, exposure to cold, or certain medications in an individual with untreated
hypothyroidism. Symptoms and signs of myxedema coma include unresponsiveness, decreased
breathing, low blood pressure, low blood sugar, and below normal temperature.
Other complications are heart disease, increased risk of infection, infertility, and miscarriage.
Calling your health care provider:
Call your health care provider if signs of hypothyroidism (or myxedema) are present.
Call your health care provider if chest pain or rapid heart beat occur, infection occurs, symptoms
worsen or do not improve with treatment, or new symptoms develop.
Prevention:
There is no prevention for hypothyroidism; however, screening tests in newborns can detect
congenital hypothyroidism.
Review Date: 4/19/2004
Reviewed By: Nancy J. Rennert, M.D., Endocrinology, Yale University School of Medicine, New
Haven, CT. Review provided by VeriMed Healthcare Network.