Symptoms and Treatment Options for Hypothyroidism

Hypothyroidism is a common endocrine disorder where the thyroid gland fails to produce sufficient thyroid hormones (primarily thyroxine [T4] and triiodothyronine [T3]). These hormones regulate metabolism, growth, and development, so their deficiency leads to systemic symptoms.

Symptoms of Hypothyroidism 

Symptoms develop gradually and may include:  

General Symptoms  

- Fatigue, sluggishness  

- Weight gain (despite reduced appetite)  

- Cold intolerance  

Skin & Hair Changes 

- Dry, coarse skin  

- Brittle nails  

- Thinning hair or hair loss  

- Puffy face (myxedema)  

Neuromuscular Symptoms  

- Muscle weakness, cramps  

- Joint pain/stiffness  

- Slow reflexes  

- Depression, memory impairment  

Cardiovascular & Respiratory  

- Bradycardia (slow heart rate)  

- Elevated cholesterol  

- Shortness of breath (due to pleural effusion in severe cases)  

Reproductive & Endocrine 

- Heavy or irregular menstrual periods  

- Infertility  

- Goiter (enlarged thyroid, if due to iodine deficiency or Hashimoto’s)  

Severe Cases (Myxedema Coma – Rare but Life-Threatening)  

- Hypothermia  

- Altered mental status  

- Respiratory failure  

Causes of Hypothyroidism 

1. Autoimmune (Hashimoto’s thyroiditis) – Most common cause (antibodies attack the thyroid).  

2. Iatrogenic – Post-thyroidectomy or radioactive iodine therapy.  

3. Medications – Lithium, amiodarone, interferon.  

4. Iodine deficiency (rare in developed countries).  

5. Pituitary/hypothalamic disorders (secondary hypothyroidism).  

Diagnosis  

- Blood tests:  

  - High TSH (primary hypothyroidism)  

  - Low free T4 

  - Anti-TPO antibodies (if Hashimoto’s is suspected)  

- Imaging: Thyroid ultrasound (if nodules or goiter present).  

Treatment Options  

1. Levothyroxine (Synthetic T4) – First-Line Therapy 

- Dosing: Started at 1.6 mcg/kg/day (adjusted based on age, weight, and cardiac risk).  

- Monitoring: TSH checked every 6-8 weeks until stable, then annually.  

- Key Points 

  - Take on an empty stomach (30-60 mins before food).  

  - Avoid calcium/iron supplements within 4 hours (they impair absorption).  

2. Liothyronine (T3) – Rarely Used

- Reserved for cases where T4-to-T3 conversion is impaired (controversial).  

3. Desiccated Thyroid Extract (Armour Thyroid) – Not Preferred  

- Contains both T4 and T3 but lacks consistent dosing; not recommended by most guidelines.  

4. Lifestyle & Dietary Considerations

- Adequate iodine intake (but avoid excess).  

- Manage weight, exercise, and monitor lipids.  

Emergency Treatment (Myxedema Coma)  

- IV levothyroxine + glucocorticoids (if adrenal insufficiency is suspected).  

- Supportive care (warming, ventilatory support).  

Prognosis 

- Most patients respond well to levothyroxine and lead normal lives.  

- Lifelong treatment is usually required, with periodic TSH monitoring.