Hypothyroidism

Hypothyroidism 

Hashimoto’s Disease 

Hashimoto’s disease is a disease of thyroid gland. This condition occurs when your body’s immune system attacks your thyroid gland. The disease is about 5 times more common in women than in men. As a result of Hashimoto’s disease, your thyroid gland often can’t make enough thyroid hormone, which results in hypothyroidism.  

Why does Hashimoto’s Disease occur? 

Normally, your immune system fights infections. It does this by identifying cells that are foreign to your body, like viruses and bacteria. When these foreign cells enter your body, your immune system sends out its own protector cells, as well as substances called antibodies, to attack and damage the foreign cells.  Sometimes your doctor may measure the levels of to these antibodies (thyroid peroxidase antibody and thyroglobulin antibody) to ascertain the diagnosis of Hashimoto’s thyroid disease.  Once the diagnosis is established, further monitoring of these antibody levels does not provide any useful information and should generally be avoided. 

With Hashimoto’s disease, your immune system starts sending protector cells to your thyroid gland because it mistakenly identifies it as a group of foreign cells. This is called an autoimmune condition, which simply means that your immune system is attacking your own cells. 

Goiter 

A goiter is an enlarged thyroid gland. The thyroid may be enlarged because it’s not working properly, or it can be enlarged for other reasons. Although a goiter is usually a reliable sign of a thyroid problem, it doesn’t always need to be treated. 

If you have a goiter, your neck may look as though it has gotten wider or there may be more swelling on one side. Often, there are no symptoms of a goiter. However, when present, some possible signs and symptoms of a goiter are: 

  • Visible enlargement of the neck 
  • Pain in your throat 
  • Hoarseness 
  • Difficulty or discomfort in swallowing 

Why does a Goiter occur? 

A goiter can have several causes: 

  • Hypothyroidism (under activity of the thyroid) 
  • Hyperthyroidism (overactivity of the thyroid) 
  • Thyroid nodules (lumps in the thyroid) 

Treating your Thyroid Disease 

Hashimoto’s Disease 

As a rule, treatment for hypothyroidism due to Hashimoto’s disease should be individualized for each patient. As with all medical conditions, let your doctor know your past health history, and surgeries you have undergone, any medications you have taken in the past and are presently taking. Usually, thyroid hormone replacement therapy is prescribed, and the dose is adjusted based on the blood levels over the next few months. 

Hypothyroidism 

Hypothyroidism is treated with thyroid hormone replacement therapy, which replaces the thyroid hormones that your body cannot produce on its own. Your doctor will most likely prescribe a man-made thyroid hormone replacement such as Synthroid® (levothyroxine sodium tablets, USP).  Other branded versions include Levoxyl®, Tirosint® and Unithroid®. 

It may take several months to adjust your dose of medication, because of the need for testing to make sure your thyroid hormone level is just right. This is necessary to avoid overtreatment of undertreatment. This method of adjusting your dose is called titration. 

After each adjustment in dosage, your TSH level should be measured. When levels reach the normal range, it means the dose of levothyroxine sodium you are taking is the right dose for you. Your doctor will prescribe that dose, which you must take every day. However, because your need for thyroid hormones may change, your doctor will continue to test your thyroid function, usually once or twice a year, and adjust your dose based on your body’s current needs.  Thyroid hormone should be taken on an empty stomach.  You should wait at least 30-45 minutes before eating a meal.  If you are on multivitamins or minerals (such as calcium, potassium, magnesium etc), it is advisable to take these at least 4 hours after you have taken thyroid medicine. 

The main preparations of thyroid hormone are man-made versions of our natural hormone which is called thyroxine (T4).  Normal thyroid gland predominantly synthesize and release T4.  While it is transported through her circulation, most of it is converted into the “active” form of thyroid hormone called T3.  Approximately 10% of thyroid hormone released by the thyroid gland is already converted into T3.  For some patients, taking a small dose of T3 hormone (Cytomel or triiodothyronine) may improve therapeutic response and they may feel better energy with the combination.  Older preparations of the thyroid which were made by grounding up pig thyroid gland are used by some physicians.  These preparations include Armour Thyroid, NP thyroid and Nature-Throid.  These preparations may be associated with a higher risk of heart rhythm problem and required very careful monitoring (see our blog on Armour thyroid). 

The TSH TEST 

The thyroid-stimulating hormone (TSH) test is a simple blood test that measures the amount of thyroid-stimulating hormone in your blood. TSH is produced by your pituitary gland to signal your thyroid to release more or less thyroid hormone. It is the most accurate test of thyroid function in most patients as it indicates brain’s response to the thyroid level. 

If you have a high level of TSH in your blood, it usually means your pituitary (brain) senses that there is not enough thyroid hormone in your blood and it is trying to get the thyroid gland to make more. High TSH levels indicate HYPOthyroidism.  

If you have a low level of TSH, it usually means your pituitary senses that there is too much thyroid hormone in your blood, causing every cell in your body to “speed up.” The pituitary gland then decreases the amount of TSH releases in an attempt to slow down the thyroid to a normal pace (this is a protective mechanism designed by nature to protect your body). Low TSH levels indicate HYPERthyroidism.  

It is important to try and avoid low TSH levels when you are being treated for hypothyroidism.  Persistently low TSH levels increase the risk of dangerous heart rhythm problem called atrial fibrillation which may lead to stroke and congestive heart failure.  It also increases the risk of osteoporosis and bone fractures.  

For further information: www.thyroid.org or www.endocrineweb.com 

This information is for general knowledge & is not a substitute for medical advice from your doctor. 

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