Underactive thyroid or ‘hypothyroidism’

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By Dr Helen Webberley
MBChB MRCGP MFSRH | GMC no. 3657058

Please note that this service does not aim to replace advice given to you by your own doctor, it is meant to supplement your health knowledge and awareness. It is not ever to be used in the case of a medical emergency.
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About Underactive thyroid or ‘hypothyroidism’

The thyroid is a small gland that is situated in the front of the lower neck. It is made up of 2 lobes that straddle the wind pipe and are joined by a central ‘isthmus’. The cells of the thyroid gland produce a very important hormone called thyroxine.

Thyroxine is essential for maintaining our metabolic balance and growth and having too little (or too much) can have a catastrophic impact on how we feel and may even be fatal. The amount of thyroxine produced by the thyroid gland is controlled by tiny concentrations of a chemical called ‘thyroid stimulating hormone’ or TSH that are released by the pituitary gland in the brain, into the blood stream.

When the TSH hits the thyroid, thyroxine is released. The commonest cause of underactive thyroid is resistance of the thyroid gland to TSH. When this happens, the pituitary gland churns out more and more TSH to try and stimulate the gland into cooperating! This is why the first blood tests to become abnormal in hypothyroidism, are elevated levels of TSH, closely followed by a decline in the circulating thyroxine levels (T4 or T3).

This ‘resistance’ can occur for several reasons, autoimmune disease (where the body’s own natural defences are directed at the thyroid cells, known as Hashimoto’s thyroidiitis), a very specific viral infection which causes painful swelling of the thyroid gland (De Quervain’s thyroiditis), certain drugs, or just general wear and tear! Just occasionally hypothyroidism can be caused by a failure of the pituitary gland to produce TSH (in which case the circulating TSH levels are low). This is fortunately rare.

The main symptoms of hypothyroidism as you might expect, are due to a general slowing of our metabolism and reduced growth rate. They include;

  • tiredness and lethargy
  • slow pulse rate
  • weight gain
  • coarsening of facial features
  • anaemia
  • absent periods in women
  • poor growth in children (the medical jargon for severely hypothyroid children was unfortunately called ‘cretinism’ – a condition that is thankfully rare!)

The treatment (as with all the glandular failures) is easy. Just replace the hormone! Thyroxine is likely to be started at a low level by your doctor, and is slowly increased depending on your blood test

Written by Dr M J Webberley, Consultant Gastroenterologist, September 2015

FAQ

What is the menopause?
When the ovaries shut down at the end of the reproductive life, they stop producing eggs and they also stop producing the female hormones. This lack of oestrogen and progesterone can cause problems.
Symptoms of the menopause.
  • hot flushes
  • night sweats
  • vaginal dryness
  • loss of libido (sex drive)
  • stress incontinence (leaking urine when you cough or sneeze)
  • bone thinning – which can lead to osteoporosis and fractures
Ways of Taking HRT
  • cream – applied to the vaginal area
  • tablets – which can be taken by mouth
  • a patch that you stick on your skin
  • an implant – under local anaesthetic, small pellets of oestrogen are inserted under the skin of your tummy, buttock or thigh
  • oestrogen gel – which is applied to the skin and absorbed
Who Should Have HRT?
  • All women under 50 who have gone through the menopause should be encouraged to use HRT.
  • In women under 60 suffering with the symptoms of the menopause, the benefits of HRT usually outweigh the risks.
  • The upper age limit should be based on symptoms and not set at an arbitrary level. If the symptoms persist then again the benefits usually outweigh the risks.
Who Can't Take HRT?
You may not be able to take HRT if you have:

  • a history of breast cancer, ovarian cancer or womb cancer
  • a history of blood clots
  • a history of heart disease or stroke
  • untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
  • liver disease
  • abnormal bleeding down below that has not been investigated
Potential Side Effects of HRT
  • fluid retention
  • bloating
  • breast tenderness or swelling
  • headaches
  • indigestion
  • depression
How Can I Get HRT?
Sometimes GPs can be scared to prescribe HRT. If you would like to discuss whether HRT would be suitable for you then contact Dr Webberley and discuss your case in person.

Medication

Medicine Name

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Medicine Name

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Medicine Name

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Blood Tests

Blood Test Name

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Blood Test Name

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