SparkMD-Frequently Asked Questions about Underactive Thyroid-Hypothyroidism

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Frequently Asked Questions about: Underactive Thyroid - Hypothyroidism
Note: Information provided below is intended as a source of information and a guide. For specific details about your own health, speak to your doctor. Last updated: (4/23/2001) 1. Where is my thyroid gland? 2. What does the thyroid do to keep me healthy? 3. How do I know if I have hypothyroidism? 4. What is the best treatment for my hypothyroidism? 5. How do I know if I am getting enough thyroid hormone? 6. Will I feel better once my thyroid hormone levels are normalized? 7. Why did my thyroid gland stop working? 8. What is a goiter? 9. Will my children inherit my predisposition to have an underactive thyroid? 10. Does my underactive thyroid explain why I can’t lose weight? 11. Will my underactive thyroid ever start up and make normal amounts of thyroid hormone again? 12. Do I have to take pills for the rest of my life?
1. Where is my thyroid gland?
Answer: Your thyroid gland is in your neck just in front of your wind pipe (trachea), that firm tubular structure that you can feel if you touch your neck. The thyroid is shaped like a plump H. You will not be able to feel your own thyroid gland unless it is enlarged, but your doctor should be able to estimate the size and shape of your thyroid by examining your neck.
2. What does the thyroid do to keep me healthy?
Answer: Your thyroid gland doles out just the right amount of thyroid hormone daily to regulate the rate at which the cells in your body work. Once it deviates from this normal pattern and produces too much or too little thyroid hormone we become ill. Problems caused by too much thyroid hormone-hyperthyroidism are discussed above. This section will focus on the consequences of having too little thyroid hormone-hypothyroidism.
3. How do I know if I have hypothyroidism?
Answer: As with hyperthyroidism, there are both Classic and Subtle symptoms of an underactive thyroid. a. Classic symptoms associated with an underactive thyroid include: 1. Fatigue* 2. Slow pulse rate* 3. Dry skin* 4. Constipation* 5. Hair loss* 6. Inability to lose weight 7. Depresssion* 8. Dry cracking nails 9. Decreased sex drive in men and women. 10. Difficulty thinking clearly b. Subtle* symptoms of hypothyroidism are: 1. Impotence* 2. Infertility in men and women 3. Loss of hair on lateral 1/3 of eyebrows 4. Sluggish reflexes Important note: Although symptoms described above are common in men and women with low thyroid hormone levels they are not specific. Other conditions produce similar symptoms. For example *symptoms marked by an asterisk are also common in men and women with Depression.** Only by measuring blood thyroid hormone and TSH levels can you and your doctor know who does and does not have hypothyroidism.
4. What is the best treatment for my hypothyroidism?
Answer: Thyroid hormone pills containing the active thyroid hormone thyroxine are made by many reputable companies and are readily available and relatively inexpensive. Your doctor will most likely start with one dose and then see you again for repeat blood tests to check your thyroid hormone and TSH levels.
5. How do I know if I am getting enough thyroid hormone?
Answer: Your doctor will be guided by the results of the blood tests. If your initial blood tests showed a low thyroxine and high TSH he will give you just enough thyoxine (thyroid hormone) to normalize both thyroxine and TSH levels. The rules are simple and straight forward. a. If both Thyroxine and TSH normalize-stay on same dose b. If thyroxine still low and TSH elevated -increase thyroxine dose. c. If thyroxine high and TSH low-decrease thyroxine dose d. If thyroxine normal but TSH still elevated-increase thyroxine dose.
6. Will I feel better once my thyroid hormone levels are normalized?
*Answer*: Yes. But it is important to have realistic expectations. All of the symptoms caused by hypothyroidism should gradually improve once thyroid hormone and TSH levels are made normal again. Those symptoms that persist after thyroid hormone levels have normalized are due to some factor other than hypothyroidism. This can be troubling especially for those who have anticipated that once they started thyroid hormone therapy, weight would peel off and they would become instantly trim and fit. To achieve those goals they will have to take thyroid hormone and diet and exercise like everyone else.
7. Why did my thyroid gland stop working?
Answer: The most common reason that the thyroid gland stops working is because of an internal reaction within the thyroid that attacks the thyroid hormone secreting cells and prevents them from making their full ration of thyroid hormone the condition is called Hashimoto’s Thyroiditis. In addition other conditions predispose the thyroid to become temporarily or permanently under-performing. Hypothyroidism can occur: a. Immediately following delivery of a healthy child b. After iodine therapy in patients with Hashimoto’s thyroiditis c. Following RAI treatment for hyperthyroidism d. Following radiation of the neck during treatment of Hodgkins Disease or lymphoma. e. After surgical removal of a thyroid cancer or benign goiter.
8. What is a goiter?
Answer: Goiter is a medical term meaning “big thyroid”. Goiters may occur when the thyroid is overactive-thyrotoxic goiter, underactive-hypothyroid goiter or normally functioning-euthyroid goiter.
9. Will my children inherit my predisposition to have an underactive thyroid?
Answer: Yes. Thyroid problems tends to run in families and often women with hypothyroidism will be surprised to discover that their mother or maternal aunt also had an underactive thyroid and required thyroid hormone treatment.
10. Does my underactive thyroid explain why I can’t lose weight?
Answer: One of the enduring myths about the underactive thyroid is that it is responsible for obesity. It is not. The major causes of obesity in humans is increased caloric intake (eating too much) and decreased caloric output (exercising too little). In patients with the most profound degrees of hypothyroidism weight will increase by only a few pounds which can be lost when thyroid hormone levels are normalized.
11. Will my underactive thyroid ever start up and make normal amounts of thyroid hormone again?
Answer: Occasionally hypothyroidism is temporary as is the case in hypothyroidism that develops after a pregnancy. Thyroid hormone treatment may be necessary for a while but some women can try to stop taking their thyroid hormone and wait 6 weeks. Then have thyroid hormone tests. If her thyroid has recovered and thyroid tests are normal stopping treatment makes sense but if tests reveal persistent hypothyroidism continued thyroid hormone treatment is necessary.
12. Do I have to take pills for the rest of my life?
Answer: Hypothyroidism tends to be permanent and with rare exceptions requires lifelong treatment. Used properly, thyroid hormone pills rarely cause side effects. Some medications like iron pills block the absorption of thyroid hormone so we usually advise our patients to take their thyroid pills in the morning and iron pills at night. Our patients ritualize their therapy and usually take their thyroid pill after they brush their teeth in the morning.