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Thyroid (goiter)
Hypothyroidism (underactive thyroid) and Hashimoto's thyroiditis
Short answer
Hypothyroidism, popularly called an “underactive thyroid,” is a condition in which the thyroid gland cannot make as much hormone as the body needs. In the doctor's observation, in most patients diagnosed with hypothyroidism lately, the cause is autoimmune thyroiditis (Hashimoto's). When hypothyroidism is found for the first time, you should not rush. The additional examinations the doctor requests must be done; otherwise, you may end up needing to take hormones for life for no reason.
Schematic illustration
General information
Symptoms of hypothyroidism
From the doctor's posts
- weight gain (sometimes weight loss), a tendency to put on weight;
- sleepiness, weakness, fatigue, reduced ability to work, forgetfulness;
- poor tolerance of cold;
- hair loss, brittle nails, dry skin;
- constipation; numbness in the hands and feet; swelling (edema) in the body;
- raised blood pressure, a squeezing feeling in the heart, a faster heartbeat;
- discomfort in the neck, a feeling of a foreign object in the throat, a choking feeling, being unable to wear high-necked clothes;
- menstrual irregularities and excess hair growth in women.
According to the doctor's note, an underactive thyroid can sometimes show up through other signs, without these common symptoms.
Types
- Primary forms, related to the gland itself, are the most common: Hashimoto's, iodine deficiency and a lack of some minerals.
- There are also forms related to pituitary and hypothalamic insufficiency.
- Treatment is prescribed individually by an endocrinologist.
Causes of high TSH
A high TSH does not always mean a permanent disease:
- Hypothyroidism — the main cause; the thyroid is underactive.
- Iodine deficiency — still a problem in some regions.
- Autoimmune thyroiditis (Hashimoto's) — the body has antibodies against the thyroid.
- Stress and infection — can cause a temporary rise.
- Some medications — especially psychiatric, heart or cold medications.
- Pregnancy — in some periods it can be slightly higher than normal.
The doctor's note: “If TSH is high, the cause must be investigated, and hormones should not be started in a rush.”
Hashimoto's thyroiditis
- It is an autoimmune disease; often there is no such thing as a “complete cure.”
- Over its course it can cause both hypothyroidism (falling hormone levels) and hyperthyroidism (rising hormone levels). That is why preventive check-ups are advised at intervals set by the endocrinologist, or every 6–12 months.
- In the early stage, symptoms can be very mild: fatigue, weakness, slight intolerance of cold, a mild feeling of fullness in the neck, sleepiness, weight gain, constipation, dry skin, hair loss.
- As the thyroid becomes inflamed, it may enlarge (goiter). This can cause pressure in the neck, a choking sensation, difficulty swallowing and a change in the voice. If the choking sensation gets worse or breathing becomes difficult, be sure to see a doctor.
- To reduce symptoms, symptomatic or replacement treatment is enough in most cases. In a very large goiter, surgery may rarely be needed.
- Older protocols used steroid and immunosuppressant drugs to slow the autoimmune process. Because of the harm–benefit ratio, modern protocols do not include this method. When blood tests show a need, specific treatment is prescribed.
Severe hypothyroidism (myxedema). This is a severe form that is rarely seen today. If adequate treatment is not started in time, it can cause very serious complications and is life-threatening.
Do not confuse it with heart problems. In patients with swelling of the hands and feet, shortness of breath, weakness, a “weak heart,” constipation, weight loss and insomnia, the thyroid must be checked. Otherwise, irreversible conditions (for example, heart failure) can develop.
In the doctor's practice
- Medication is not always prescribed in Hashimoto's. In the early stage, the cause of the symptoms is sometimes a mineral deficiency. In the doctor's words: “In the early stage, it is sometimes possible, with a suitable diet and dietary supplements, to bring thyroid values under control without hormones, and even to keep them under control for a long time. But it is important to remember: only in the early stages. And ongoing monitoring is always important.”
- The benefit of early diagnosis. In autoimmune thyroiditis, early diagnosis is essential for preventing enlargement of the gland, preserving its function and reducing symptoms. In the doctor's words: “An early examination can spare you from early hormone treatment.”
- Clinical observations:
- severe hypothyroidism was found in a patient who had been treated for years for other diagnoses and had never had the thyroid checked (referred by a cardiologist);
- primary hypothyroidism was found in a patient who had received treatment for toxic goiter for a short time 5–6 years ago and did not see a doctor afterward;
- patients with severe hypothyroidism were given information about diet along with treatment.
Q&A
Can Hashimoto's be cured completely?
Hashimoto's is an autoimmune disease, and often there is no such thing as a “complete cure.” In the early stage, values can sometimes be brought under control without hormones, with a suitable diet and dietary supplements. Ongoing monitoring is always important.
If Hashimoto's has been diagnosed, is medication always needed?
No. “In Hashimoto's, we do not always prescribe medication.” The decision depends on the test results, symptoms and stage.
My TSH is high. Should I start taking hormones right away?
No. The cause must be investigated first: stress, infection, some medications and pregnancy can also raise TSH temporarily. “When TSH fluctuates, a hormone drug alone is not enough! The cause must be found, and then the appropriate treatment given.”
Anti-TPO and anti-Tg are high. Is treatment needed?
These markers show that an autoimmune process is going on in the thyroid. If they have come back high once, they are not checked again and again: they establish the diagnosis, but they do not change the course of treatment. If the patient has a coexisting problem or symptoms, treatment is recommended; treatment is not started only because anti-TPO and anti-Tg are high (video).
The doctor’s videos
The videos are in Azerbaijani.