Hypothyroidism: how it manifests and how it should be addressed

Hypothyroidism is a deficiency of thyroid hormones. These hormones have very diverse and important functions: they regulate every function of our body, acting on all organs and systems (cardiac, respiratory, digestive, nervous, etc.). It is one of the most common consultations in Endocrinology, being the majority of patients women, and can occur at any age.

Why hypothyroidism occurs

It is a failure of the thyroid gland, located in front of the trachea at the level of the neck (primary hypothyroidism). In some cases it can also be a failure at the level of the thyroid regulatory center, located in the central nervous system, specifically in the hypothalamic-pituitary axis (secondary hypothyroidism).

The vast majority of cases are due to a problem in the patient’s immune system that mistakenly attacks the thyroid gland producing inflammation and progressive tissue destruction (autoimmune thyroiditis).

Another second major cause is iodine deficiency. This happens mostly in undeveloped countries. Endocrinology specialists want to make the population aware of the importance of this mineral, especially in at-risk populations such as children, pregnant women and infants.

Likewise, and less frequently, hypothyroidism can appear after thyroid surgery, after viral infections or due to the side effects of drugs.

The existence of “endocrine disruptors” or polluting environmental substances that can cause glandular diseases, including hypothyroidism, is currently being investigated.

Factors leading to thyroid gland dysfunction and hypothyroidism

In cases of autoimmune hypothyroidism there is a clear genetic predisposition. There are also external factors that precipitate it, such as stress (either physical, e.g. after an infection, or emotional) or hormonal changes (e.g. puberty or pregnancy). In consultation it is common to receive patients with the disorder who are suffering or have just come out of a highly stressful period in their lives. There is also talk of dietary factors involved, of the relationship with the state of the intestinal bacterial flora and of the vitamin-mineral deficiency that may contribute to the process.

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These are new concepts that are probably involved, although it is too early for there to be evidence.

What are the symptoms of hypothyroidism?

The most common symptoms of hypothyroidism are: progressive onset of fatigue, drowsiness, apathy, feeling cold, dry skin, memory lapses, slow mental performance and swelling with possible weight gain.

Obviously, these are very non-specific symptoms, so the presence of these symptoms does not mean that the patient suffers from hypothyroidism. It could be any other disorder that may cause them, such as a depressive condition, for example.

The specialists in Endocrinology comment that the great majority of people who come for consultation due to tiredness and weight gain, think they have hypothyroidism when in fact it is an unbalanced diet and lack of physical activity. Only in some cases is there really hypothyroidism, so the diagnosis must be made by a professional and must be supported by complementary explorations (analysis and/or ultrasound).

Treatment options for hypothyroidism

The treatment of hypothyroidism varies depending on the case. In the mildest cases, analytical follow-up and periodic observation will be sufficient.

When the body is no longer able to compensate for the hormone deficiency on its own, this function is replaced by giving the same hormones from outside, in the form of tablets (usually synthetic levothyroxine). The treatment is simple, easy to follow and has no side effects beyond those we can cause when the dose administered is not correct.

It is also important to check the patient’s diet, the possible lack of vitamins or minerals and to rule out the presence of other associated diseases. In this way, the physical and emotional well-being of the patient can be ensured at each visit.