Hypothyroidism: What It Means for You
You're feeling sluggish, tired, cold, achy and constipated. Your voice is hoarse, and your face is puffy. And you're gaining weight but losing hair. What's going on? You could have a failing thyroid gland, no longer producing enough hormones for your body to function properly. While hypothyroidism, or underactive thyroid, has several possible causes, it's most commonly an autoimmune disease. The good news: Once you get your diagnosis and medication dosage straight, treatment is often as simple as a taking a single daily pill. Here's what you need to know:
About your thyroid: The butterfly-shaped thyroid gland, located in the front base of your neck, is part of your endocrine system. It produces thyroid hormones -- T3 and T4 -- which affect metabolism and play a role in body temperature; heart, brain and muscle function; skin and hair dryness; and weight, cholesterol levels and menstruation.
Thyroid hormone works by: The pituitary gland in the brain produces thyroid-stimulating hormone, or TSH. "It's helpful to think of the pituitary as acting as a thermostat," says Dr. Anne Cappola, an endocrinologist and associate professor of medicine at the Perelman School of Medicine at University of Pennsylvania. "When [the pituitary] senses there's too little thyroid hormone around, it makes hormone to stimulate the thyroid to make more, to bring it back up into balance."
Who's most likely affected: Women are more likely to have autoimmune conditions, such as lupus and rheumatoid arthritis, so they're also more vulnerable to hypothyroidism. Hypothyroidism affects men, too. Because it's often a slow, progressive condition, middle-aged and older adults are more likely to have reduced thyroid function to the point of causing symptoms.
Other causes are: Thyroid surgery, radiation therapy and certain medications can contribute to hypothyroidism. Pituitary gland failure to make enough TSH is another possibility. Congenital disease can cause some babies to be born with a missing or damaged thyroid gland. You can find out if your state tests newborns for hypothyroidism. (Most states do.)
You may have low thyroid if: "There isn't a single, specific symptom to point to and say, 'That's hypothyroidism,'" says Cappola, who helped write the American Thyroid Association's guidelines for managing hypothyroidism. Fatigue and tiredness are common symptoms. Weight gain is another, she says, although not as big a component as people think. "If you ask people who's tired, who's gaining weight, who's constipated -- that's a lot of people," she says. "So thank goodness we actually have a test for it."
The gold-standard blood test is: "TSH is the pituitary hormone that's used to diagnose hypothyroidism most of the time," says Dr. Lewis Blevins Jr., an endocrinologist and clinical professor of neurological surgery and medicine, and medical director of the California Center for Pituitary Disorders at University of California--San Francisco. "If you have a thyroid-failure situation, usually your TSH is going to be elevated. And your T3 and T4 levels are going to be low-normal or frankly low."
Replacement therapy means: Thyroid hormone replacement -- specifically, T4 -- is the standard therapy for true hypothyroidism with significant symptoms. One of the most commonly prescribed medicines, levothyroxine, is the generic form. Synthroid and Levoxyl are brand-name versions. You only need to take a pill once daily, and it's considered very safe at the right dose. "The side effects that you get from thyroid hormone replacement are exclusively due to too strong or too weak a dose," Cappola says. The rare exception, she says, is if people react to dyes contained in some of the pills.
Before your start thyroid medicine: Make sure you have the right diagnosis. Your doctor should investigate underlying causes of low thyroid and confirm abnormal blood levels with a repeat laboratory test. If uncertainty continues, an endocrinologist can provide a second opinion. "I'm shocked at the number of people I've found in my career that really didn't need thyroid hormones," Blevins says. "It's a pet peeve of mine that too many people are treated when they don't necessarily need to be."
Tweaking your dose: "Thyroid hormone is not going to be an overnight sensation," Blevins says. Instead, you'll gradually feel better as your dose is adjusted to the right level. You can't rush this titration process, he says. You'll need blood testing six to eight weeks after starting the drug and at about six weeks after a dose adjustment, until your circulating hormone levels fall within a good range. Once your dose is settled and you're doing well, you should follow up with yearly rechecks.
Ask your doctor: For new patients, Blevins says, "It this temporary or permanent?" and "What's the cause?" are good first questions. Next are: "How are we going to treat it" and "What's the follow-up going to be like?" It's important to discuss the best time of day to take thyroid medicine, whether with meals or an empty stomach, and which other medications or supplements you take could interfere with treatment. Pregnant women should talk to their doctors about how to manage medication.
People frequently ask Cappola: "Is there anything I could have done to prevent this?" The answer is no, she says. "There was nothing anyone could have done to stop it; nothing they did to precipitate it. I think that reassures people." Also often-asked: "Is there a way I can get my thyroid back?" Unfortunately, she says, by the time obvious symptoms and abnormal test results arise, a large portion of the thyroid has been destroyed, and it's reached a tipping point.
If standard therapy isn't enough: Not everyone responds to T4 replacement alone. That's how it was for medical software professional Jacqueline Horwitz, 63, a project manager at Boston Children's Hospital. Already suffering from chronic fatigue syndrome and fibromyalgia, she was diagnosed with hypothyroidism in 2001. "I was tired all the time," she says. "I was cold. I had a lot of aches and pains. I just couldn't live my life." She didn't feel any better with levothyroxine.
"So I started to educate myself," says Horwitz, who has a graduate degree in health policy. As she learned that replacing T3 hormone, along with taking T4, helps certain patients, she found a new endocrinologist who prescribed T3. In her case, the combination worked. "After months and months of trying to get help for this, I finally felt better," she says. Almost 15 years later, Horwitz is now taking generic levothyroxine, plus Cytomel for T3 replacement, and she feels fine.
Your long-term outlook is: Basically, with treatment, you go about your life as before, with no restrictions. "The evidence would suggest that people who are put on thyroid hormone have the same longevity as people who don't [have the condition]," Cappola says.
Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.
