Hypothyroidism, the great decelerator

With an estimated one percent (1%) of the Canadian population affected, hypothyroidism is far from being a rare condition. Are you familiar with this hormonal disturbance?

With an estimated one percent (1%) of the Canadian population affected, hypothyroidism is far from being a rare condition. Are you familiar with this hormonal disturbance?

The thyroid: A primer

The thyroid is a small butterfly-shaped gland located at the base of the neck, in front of the Adam’s apple. It produces vital hormones that are involved in every aspect of metabolism.

Iodine is essential to the production of thyroid hormones. This trace element is naturally present in seafood and in plants cultivated in iodine-rich soil. In industrialized countries, the fact that iodine is mandatorily added to table salt means that we no longer see severe cases of hypothyroidism associated with an iodine deficiency. However, iodine deficiency is still common in developing countries, manifesting in the population as goiter or cretinism, a condition characterized by stunted overall development in children.

The thyroid gland produces two main hormones, namely thyroxine (T4) and triiodothyronine (T3). These hormones maintain the speed at which the body burns fat and sugar, help control our body temperature, influence the heart rate and help regulate the production of protein.

When there is an over-production of thyroid hormones, the body “overheats” – for example, the person might suffer from insomnia, become irritable and lose weight. This is what we call hyperthyroidism.

Conversely, hypothyroidism occurs when the thyroid does not produce enough thyroid hormones, resulting in a slowed-down metabolism.

At first, symptoms of hypothyroidism can be so subtle or vague that individuals may attribute them to the fact that they’re getting older or are a little overworked. However, as the metabolism slows down, certain signs and symptoms become more obvious. Here are the most common:

- Fatigue
- Sluggishness
- Increased sensitivity to cold
- Constipation
- Pale, dry skin
- Brittle nails and hair
- Puffy face
- Hoarse voice
- Unexplained weight gain
- Muscle weakness, aches, or stiffness
- Pain, stiffness or swelling in your joints
- Depression
- Memory problems

There are numerous possible causes of hypothyroidism, such as having an autoimmune disease, being treated for hyperthyroidism, having undergone radiotherapy for a cancer located in the head or neck, having had thyroid surgery, or taking certain types of medication.

The good news is that hypothyroidism is very easy to diagnose and treat!

When should you see a doctor?

It is recommended that you see your family doctor if you feel tired for no clear reason and have other signs or symptoms of hypothyroidism, such as pale skin, a puffy face, constipation or a hoarse voice.

To assist your doctor and help him or her answer your questions during the consultation, here is what you can prepare ahead of time:
- A list of your symptoms, even if they don’t seem related to the problem that led you to see the doctor
- A list of personal information, including your level of stress and any recent changes in your life
- A list of the medication, vitamins and supplements you are taking
- The questions you would like to ask the doctor

A blood test is required to diagnose hypothyroidism.

What is the treatment for hypothyroidism?

The typical treatment for hypothyroidism is to take one tablet per day of replacement thyroid hormones, usually levothyroxine. Levothyroxine is generally available in the form of small tablets, the most common brand being Synthroid®.

After one or two weeks of treatment, the individual normally notices an increased energy level. The body takes a few weeks to reach a new equilibrium. Another blood test is usually taken about six weeks after the treatment onset, to check whether the dose is suitable. The test measures the level of a substance called TSH. If the level is too high, this is a sign that the body requires a higher dose of thyroid hormones.

Levothyroxine does not generally cause any adverse effects if it is administered at the right dose. Since hypothyroidism is a chronic disease, it requires a lifelong treatment; otherwise the symptoms will gradually reappear. Since the appropriate dose must be carefully adjusted to the individual’s needs, an annual follow-up is required.

Some medications, supplements and even foods can interact with the body’s ability to absorb levothyroxine. Your pharmacist will ensure there are no interactions between levothyroxine and other medication you may be taking, and will advise you as to the best time to take it. Also consult your pharmacist before taking over-the-counter drugs, because some may be contraindicated in persons taking levothyroxine.