?How common is hypothyroidism?
One in three people has thyroid disease. The majority of people affected by hypothyroidism are women. Women are five to eight times more likely to have hypothyroidism than men. More than half of those with hypothyroidism don’t know they have it. Autoimmune Thyroid Diseases make of 30% of autoaggressive disease and qualified as organ specific. Hashimoto’s thyroiditis, also known as HT or chronic lymphocytic thyroiditis, and Graves’ disease are the most common of the Autoimmune Thyroid Diseases.

Who is more likely to develop hypothyroidism?
Anyone can develop hypothyroidism. However, some people are more likely than others to develop hypothyroidism. Being female and over the age of 50 puts you at a higher risk. With age comes more health problems. People over 60 years of age are more likely to develop hypothyroidism. When close relatives have an autoimmune disease you’re at a higher risk as well. Some other attributes that make you more likely to develop hypothyroidism are being treated with radioactive iodine or other antithyroid drugs and radiation exposure.

Is hypothyroidism during pregnancy a problem?
It is encouraged for pregnant women to be tested for hypothyroidism so that if they are diagnosed, they can take iron supplements to prevent the baby from being born with the same condition. Most doctors will ask those who are pregnant if they have experienced symptoms of hypothyroidism or have had previous issues with the thyroid gland. If an expecting mother does not get tested and treated if diagnosed, the baby would have to start treatment within the first few days and possibly suffer from a severe mental handicap.

What other health problems could I have because of hypothyroidism?
Hypothyroidism is a treatable health condition. However, if gone untreated, hypothyroidism can cause fertility problems as well as problems during pregnancy. Hypothyroidism can cause weight gain, depression, joint pain, fatigue, inflamed thyroid (goiter), and slow thought processes.

What are the symptoms of hypothyroidism?
Hypothyroidism has many potential symptoms that typically take years to develop but fatigue and lethargy are the main symptoms. With a slower metabolism, signs and symptoms will be more obvious. The most common symptoms of hypothyroidism include weight gain, bloated face, dry, pallid, flaky skin. hoarse voice, amplified sensitivity to cold, frail fingernails and hair, constipation, muscle weakness, heavier than usual, or loss of, menstrual period, swollen or stiff joints, stiff, weak, painful muscle aches, and higher than usual blood cholesterol level. Babies born with congenital hypothyroidism don’t typically show signs or symptoms. If symptoms are present they could potentially include jaundice (yellow skin), swollen face, recurrent choking, bulging tongue, under-development – muscle tone, adult teeth, fatigue, and constipation. A person with advanced hypothyroidism, also known as myxedema, will experience decreased breathing, lower body temperature, hypotension (low blood pressure), and unresponsiveness.

What causes hypothyroidism?
Hypothyroidism is caused by cells in the thyroid gland that can’t make enough thyroid hormone. Autoimmune disease, which occurs in the immune system, is caused by the immune system mistaking thyroid gland cells and their enzymes and attack them. Thus, resulting in not enough thyroid cells and enzymes left to make enough thyroid hormone. Some people with thyroid nodules, thyroid cancer, or Graves’ disease may need to have part or all of their thyroid removed. People with part of their gland left may be able to make enough thyroid hormone to keep blood levels normal whereas people who get the whole thyroid removed become hypothyroid. Some medicines such as amiodarone, lithium, interferon alpha, and interleukin-2 can prevent the thyroid gland from being able to make hormone normally. Other things that can cause hypothyroidism are radiation treatment, congenital hypothyroidism, thyroiditis, too much or too little iodine, damage to the pituitary gland, and rare disorders that infiltrate the thyroid.

Hashimoto’s Disease
Definition: An autoimmune disease that results in inflammation of the thyroid gland caused when abnormal blood antibodies and white blood cells infiltrate and attack thyroidal cells
Also known as chronic thyroiditis, struma lymphomatosa, lymphadenoid goiter, chronic lymphocytic thyroiditis, autoimmune thyroiditis
Anatomy/system affected: Endocrine system, glands, immune system, neck
Who is commonly affected: Young or middle-aged women, but it may occur at any age
Causes: Autoimmune in origin; abnormal blood antibodies and white blood cells, called lymphocytes, infiltrate and attack thyroid cells. The combative interplay between the lymphocytes and the thyroid may lead to a complete absence of thyroid cells.

Symptoms: Mild pressure on the thyroid gland, goiter, fatigue, weight gain, cold intolerance, constipation, hair loss

Treatments: Hormone replacement therapy with thyroxine
Causes and Symptoms
Hashimoto’s thyroiditis is a common type of hypothyroidism. The cause and etiology of this disorder are not fully understood; however, it is thought to have an autoimmune origin, in which A family history of thyroid disease is commonly traced.
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Hashimoto’s thyroiditis with lymphoid infiltration. Autoantibodies against thyroid peroxidase and thyroglobulin were elevated. (http://creativecommons.org/licenses/by-sa/3.0)

Thyroiditis
Thyroiditis refers to inflammation of the thyroid gland which includes a group of individual disorders causing thyroid inflammation presented in various ways. Hashimoto’s thyroiditis, the most common cause of hypothyroidism in the U.S. Postpartum thyroiditis which causes high thyroid hormone levels in the blood followed by temporary hypothyroidism is common after delivering a baby. Thyroiditis is found in patients taking the drugs interferon and amiodarone.

Congenital hypothyroidism
A child born with congenital hypothyroidism (CH) has developmental disabilities with little or no chance of improvement and, unless immediately treated with thyroid hormones, may also be physically disabled or dwarfed, with the bone ends not growing or maturing normally. The typical infant with CH can show a variety of symptoms: low body temperature, poor appetite, decreased activity, flabbiness, low pulse rate, delayed union of bones of the skull, feeding difficulties even to the point of choking and cyanosis (turning blue from lack of oxygen), and thickened, off-color skin.

Also known as Infantile hypothyroidism, cretinism
Anatomy or system affected: Endocrine system, musculoskeletal system, neck, nervous system
Definition: Retardation of mental and physical growth arising from prenatal or neonatal hypothyroidism.

Causes: Thyroid disorder
Symptoms: Developmental disabilities, low body temperature, poor appetite, decreased activity, flabbiness, low pulse rate, delayed union of skull bones, feeding difficulties, off-color skin
Treatments: Thyroid replacement therapy from birth
No treatment is available for the brain damage that has taken place but, thyroid replacement therapy from birth, using either natural or synthetic hormones, will avert most physical effects, but the intellectual disability is irreversible.

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This 6 week old female presented with symptoms of jaundice, which was proven to be due to hypothyroidism. By Dr. Hudson Public domain, via Wikimedia Commons.

Surgical removal of part or all of the thyroid
Surgical removal of part or all of the thyroid could include:
An open thyroid biopsy – rarely used operation; a nodule is excised directly;
A hemithyroidectomy or thyroid lobectomy – where one lobe (one half) of the thyroid is removed;

An isthmusectomy – removal of just the bridge of thyroid tissue between the two lobes; used specifically for small tumors that are located in the isthmus.

A total or near-total thyroidectomy is the removal of all or most of the thyroid tissue.

Radiation treatment of the thyroid
In order for the thyroid gland to produce hormones that regulate the body’s energy and metabolism, the thyroid gland needs iodine. The thyroid gland cannot distinguish between stable (regular) iodine and radioactive iodine and will absorb whatever it can result in radiation treatment of the thyroid.

After thyroid cancer surgery, thyroid hormone needs to replace the function of the removed thyroid gland and keep small or residual amounts of thyroid cancer cells from growing. Thyroid hormone suppression therapy is another important part of thyroid cancer treatment and stops the growth of microscopic thyroid cancer cells or residual thyroid cancer.

Medicines
MIND-BODY MEDICINES-These are based on a belief that the mind is able to affect your body
Yoga
Meditation
Hypnosis
BIOLOGICALLY-BASED PRACTICES-These include things most often found in nature and includes dietary supplements and herbal products. For patients with thyroid cancer or thyroid disease, a special diet that includes foods that contain iodine is recommended. Iodine in liquid or supplement form is not recommended. Patients will commonly be recommended to take Vitamin D or calcium supplements.

Vitamins
Herbs
Special Diets

MANIPULATIVE AND BODY-BASED PRACTICES-These are based on working with the body and are thought to have underlying benefits for the mind as well.

Massage
Chiropraxy
ENERGY MEDICINE-Energy medicine invokes the belief that the body has energy fields that can be manipulated for healing and wellness.

Reiki
Tai Chi
WHOLE MEDICAL SYSTEMS-These systems include beliefs and approaches to healing and wellness that come from all of the world and from many cultures.
Naturopathy
Homeopathy
Chinese medicine
Vodun/Expiritism
Ayurvedic medicine
How do doctors diagnose hypothyroidism?
Doctors will take a blood sample to detect levels of TSH and follow up with a test of thyroxine, also known as T-4, levels. If the level of TSH is above average and the level of T-4 is below average, it means that the hypothalamus and pituitary gland are attempting to compensate for the under activity of the thyroid by stimulating it with more TSH. Patients who do not experience symptoms are encouraged to be screened periodically to see if levels of TSH are high even if T-4 levels are normal.

How is hypothyroidism treated?
To restore normal body function, the patient will need to take a synthetic thyroid hormone called levothyroxine, also known as Levoxyl or Synthroid. After several weeks on levothyroxine, weight gain symptoms are reduced if not reversed. Since hypothyroidism cannot be cured, doctors stress the importance that patients continue treatment throughout their lives. The doctors will increment the dosage as indicated by periodic checks of TSH levels which also help the body while it adjusts to the increase in metabolism.

What should I eat or avoid eating if I have hypothyroidism?
Hypothyroidism can only be prevented if it is caused by a lack of iodine in the diet, in which case people need to ensure their diet contains sufficient levels of iodine. Examples and the amount of iodine that it contains that you should eat if you have hypothyroidism are:
Iodized salt – 3,000 micrograms per 100 grams
Seafood – 66 micrograms per 100 grams
Meat – 32 micrograms per 100 grams
Eggs – 26 micrograms per 100 grams
Dairy – 13 micrograms per 100 grams
Bread/cereals – 10 micrograms per 100 grams
Fruits – 4 micrograms per 100 grams

Hawthorne RM. J. PD. Congenital hypothyroidism. Magill’s Medical Guide (Online Edition). 2013. https://proxy01.nwacc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true;db=ers;AN=86194015;site=eds-live. Accessed November 12, 2018.

Hypothyroidism. American Thyroid Association. https://www.thyroid.org/hypothyroidism/. Accessed November 13, 2018.
Leschek E, Cooper DS. Hashimoto’s disease. womenshealth.gov. https://www.womenshealth.gov/a-z-topics/hashimotos-disease. Published October 18, 2018. Accessed November 13, 2018.
What Is Hypothyroidism? What Causes Hypothyroidism? Medical News Today (England). https://proxy01.nwacc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsnbk&AN=140188A9A6387838&site=eds-live. Published September 11, 2009. Accessed November 12, 2018.

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