Symptoms of Hypothyroidism

Fatigue

Weakness

Weight gain or increased difficulty losing weight

Coarse, dry hair

Dry, rough pale skin

Hair loss

Cold intolerance (can't tolerate the cold like those around you)

Muscle cramps and frequent muscle aches

Constipation

Depression

Irritability

Memory loss

Abnormal menstrual cycles

Decreased libido

SOUNDS LIKE ME! except for the cold intolerance and I don't think I'm losing hair...Or maybe my hair is so thick I just don't notice...

But then of course, I bet many illnesses have similar symptoms.

Diagnosis and treatment

Oh, if only it were this simple all the time! Although the majority of individuals with hypothyroidism will be easy to diagnose with these simple blood tests, many millions will have this disease in mild to moderate forms which are more difficult to diagnose. The solution for these people is more complex and this is due to several factors. First we must realize that not all patients with hypothyroidism are the same. There are many degrees of this disease from very severe to very mild. Additionally, and very importantly, we cannot always predict just how bad (or good) an individual patient will feel just by examining his/her thyroid hormone levels. In other words, some patients with very "mild" deviations in their thyroid laboratory test results will feel just fine while others will be quite symptomatic. The degree of thyroid hormone abnormalities often, but NOT ALWAYS will correlate with the degree of symptoms. It is important for both you and your physician to keep this in mind since the goal is not necessarily to make the lab tests go into the normal range, but to make you feel better as well! We must also keep in mind that even the "normal" thyroid hormone levels in the blood have a fairly large range, so even if a patient is in the "normal" range, it may not be the normal level for them.

For the majority of patients with hypothyroidism, taking some form of thyroid hormone replacement (synthetic or natural, pill or liquid, etc) will make the "thyroid function tests" return to the normal range, AND, this is accompanied by a general improvement in symptoms making the patient feel better. This does not happen to all individuals, however, and for these patients it is very important to find an endocrinologist who will listen and be sympathetic. (We aim to help you find this type of doctor.) Because most patients will be improved (or made completely better) when sufficient thyroid hormone is provided on a daily basis to make the hormone levels in the blood come into the normal range, physicians will often will rely on test results to determine when a patient is on the appropriate dose and therefore doing well. Remember, these tests have a wide normal range. Find a doctor who helps make you FEEL better, not just make your labs better because once given this diagnosis, you are likely to carry it for a long, long time. There is more than one drug, there is more than one lab test, and there is a "just right" doctor for everybody.

Treatment of Hypothyroidism

Hypothyroidism is usually quite easy to treat (for most people)! The easiest and most effective treatment is simply taking a thyroid hormone pill (Levothyroxine) once a day, preferably in the morning. This medication is a pure synthetic form of T4 which is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes. It comes in multiple strengths, which means that an appropriate dosage can almost always be found for each patient. The dosage should be re-evaluated and possibly adjusted monthly until the proper level is established. The dose should then be re-evaluated at least annually. If you are on this medication, make sure your physician knows it so he/she can check the levels at least yearly. Note: Just like we discussed above, however, this simple approach does not hold true for everybody. Occasionally the correct dosage is a bit difficult to pin-point and therefore you may need an exam and blood tests more frequently. Also, some patients just don't do well on some thyroid medications and will be quite happy on another. For these reasons you should not be shy in discussing with your doctor your blood hormone tests, symptoms, how you feel, and the type of medicine you are taking. The goal is to make you feel better, make your body last longer, slow the risk of heart disease and osteoporosis...in addition to making your blood levels normal! Sometimes that's easy, when its not, you need a physician who is willing to spend the time with you that you deserve while you explore different dosages other types of medications (or alternative diagnoses).

Some patients will notice a slight reduction in symptoms within 1 to 2 weeks, but the full metabolic response to thyroid hormone therapy is often delayed for a month or two before the patient feels completely normal. It is important that the correct amount of thyroid hormone is used. Not enough and the patient may have continued fatigue or some of the other symptoms of hypothyroidism. Too high a dose could cause symptoms of nervousness, palpitations or insomnia typical of hyperthyroidism. Some recent studies have suggested that too much thyroid hormone may cause increased calcium loss from bone increasing the patient's risk for osteoporosis. For patients with heart conditions or diseases, an optimal thyroid dose is particularly important. Even a slight excess may increase the patient's risk for heart attack or worsen angina. Some physicians feel that more frequent dose checks and blood hormone levels are appropriate in these patients.

After about one month of treatment, hormone levels are measured in the blood to establish whether the dose of thyroid hormone which the patient is taking is appropriate. We don't want too much given or subtle symptoms of hyperthyroidism could ensue, and too little would not alleviate the symptoms completely. Often blood samples are also checked to see if there are antibodies against the thyroid, a sign of autoimmune thyroiditis. Remember, this is the most common cause of hypothyroidism. Once treatment for hypothyroidism has been started, it typically will continue for the patient's life. Therefore, it is of great importance that the diagnosis be firmly established and you have a good relationship with a physician you like and trust.

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