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Hypothyroidism develops when the thyroid gland in the neck does not make enough thyroid hormone, resulting in a low thyroid state. Some related conditions to hypothyroidism include chronic thyroiditis or Hashimoto's disease, silent thyroiditis, subacute thyroiditis and neonatal hypothyroidism.

The cause of hypothyroidism is damage to the thyroid gland in the anterior aspect of the neck. The thyroid gland is a small gland, shaped like a butterfly that controls the level of metabolism of the body. Hypothyroidism occurs when the thyroid becomes inflamed and the thyroid cells are damaged. In Hashimoto's thyroiditis, the immune syndrome attacks the thyroid gland and it suffers permanent damage. Hypothyroidism can be a condition that occurs after pregnancy in a condition called "postpartum thyroiditis".

Other causes of low thyroid conditions include birth defects yielding a low thyroid condition, radiation to the neck for other types of cancer, radioactive iodine use in the treatment of an elevated thyroid condition, surgery to remove the thyroid gland or viral illnesses leading to hypothyroidism. Drugs which lead to hypothyroidism include amiodarone, lithium, PTU and methimazole. Brain radiation can contribute to hypothyroidism. Sheehan syndrome is a disease where the pituitary gland is damaged and does not make TSH. It is a more common condition when a woman bleeds heavily in pregnancy or in childbirth.

Risk factors to hypothyroidism are the female gender and being older than age 50. Common symptoms include cold insensitivity, depression, constipation, fatigue, heavy menstrual periods, pale and dry skin, joint or muscle pain, thin, brittle hair and fingernails, weight gain and weakness.

If hypothyroidism is not treated properly, it can lead to hoarseness, decreased taste and smell, thickening of the skin, slow speech, and thinning of the eyebrows.

In order to diagnose hypothyroidism, the doctor might need to do a physical examination, which might show a smaller than normal thyroid gland or sometimes an enlarged thyroid gland. There are coarse facial features, brittle nails, evidence of dry or pale skin that is cold to the touch and swelling of the legs and arms (oedema). The hair becomes thinner and more brittle. An enlarged heart might show up on chest X-ray. There are blood tests often showing an elevated TSH level and a T4 test, which is usually reduced. A T3 test shows lower than normal levels of this hormone as well. Other laboratory testing can reveal an anaemia, an increase in cholesterol levels, an increase in liver enzymes, low sodium and an increased prolactin level.

Treatment involves replacing the thyroid hormone that is not being produced by the thyroid gland. The most commonly used drug is levothyroxine, which is the equivalent of T4. You can also replace the thyroid hormone using T3 or a combination of T4 and T3. The dosage is started low and is worked up so that the TSH level is normalized. A high TSH means a low thyroid condition is going on and a low TSH means that a high thyroid condition is going on. A normal TSH is in the range of 1.5 to 5. Treatment is often lifelong unless you are suffering from viral thyroiditis, which tends to be transient. The medication is taken once per day and hormone levels are checked every two to three months, with the exception of stable conditions, where the hormone level is checked every six months or so.

You should remember to take the hormone replacement therapy every day and you shouldn't stop even if you feel better. If you change brands of thyroid hormone, you should be re-evaluated to make sure the levels of the hormones are normal. If you are on a soy diet or a high fibre diet, then thyroid hormone is absorbed differently. Take your hormone pill an hour before meals and an hour before taking other medications. You shouldn't take thyroid hormone with fiber supplements, calcium, multivitamins, iron supplements, antacids containing aluminium hydroxide, bile acid binders or cholestipol.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here