Name = Hypothyroidism
Thyroxine(T4) normally produced in 20:1 ratio to triiodothyronine(T3)
DiseasesDB = 6558
ICD10 = ICD10|E|03|9|e|00
ICD9 = ICD9|244.9
eMedicineSubj = med
eMedicineTopic = 1145
MeshID = D007037
Hypothyroidism is the disease state in humans and animals caused by insufficient production of
thyroid hormoneby the thyroid gland. Cretinismis a form of hypothyroidism found in infants.
About three percent of the general population is hypothyroid.cite book |author=Jack DeRuiter |title=Thyroid Pathology |year=2002 |pages=30 |url= http://www.auburn.edu/~deruija/endp_thyroidpathol.pdf |format=PDF] Factors such as iodine deficiency or exposure to Iodine-131 (
I-131) can increase that risk. There are a number of causes for hypothyroidism. Historically, and still in many developing countries, iodine deficiencyis the most common cause of hypothyroidism worldwide. In iodine-replete individuals, hypothyroidism is mostly caused by Hashimoto's thyroiditis, or by a lack of the thyroidgland or a deficiency of hormones from either the hypothalamus or the pituitary.
Hypothyroidism can result from
postpartum thyroiditis, a condition that affects about 5% of all women within a year after giving birth. The first phase is typically hyperthyroidism. Then, the thyroid either returns to normal or a woman develops hypothyroidism. Of those women who experience hypothyroidism associated with postpartum thyroiditis, one in five will develop permanent hypothyroidism requiring life-long treatment.
Hypothyroidism can also result from sporadic inheritance, sometimes autosomal recessive.
Hypothyroidism is also a relatively common hormone disease in domestic dogs, with some specific breeds having a definite predisposition. [cite web |author=Brooks W |title=Hypothyroidism in Dogs |url=http://www.veterinarypartner.com/Content.plx?P=A&A=461 |work=The Pet Health Library |date=01/06/2008 |publisher=VetinaryPartner.com |accessdate=2008-02-28]
Temporary hypothyroidism can be due to the
Wolff-Chaikoff effect. A very high intake of iodine can be used to temporarily treat hyperthyroidism, especially in an emergency situation. Although iodine is substrate for thyroid hormones, high levels prompt the thyroid gland to take in less of the iodine that is eaten, reducing hormone production.
Hypothyroidism is often classified by the organ of origin: [cite web |author=Simon H |title=Hypothyroidism |url=http://www.umm.edu/patiented/articles/what_causes_hypothyroidism_000038_2.htm |date=2006-04-19 |publisher=University of Maryland Medical Center |accessdate=2008-02-28] [cite web |author=Department of Pathology |title=Pituitary Gland -- Diseases/Syndromes |url=http://www.pathology.vcu.edu/education/endocrine/endocrine/pituitary/diseases.html |date=
June 13, 2005|publisher=Virginia Commonwealth University (VCU) |accessdate=2008-02-28]
General psychological associations
Hypothyroidism can be caused by lithium-based
mood stabilizers, usually used to treat bipolar disorder(previously known as manic depression).
In addition, patients with hypothyroidism and psychiatric symptoms may be diagnosed with: [cite journal |author=Heinrich TW, Grahm G |title=Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited |journal= |volume=5 |issue=6 |pages=260–266 |year=2003 |pmid=15213796 |doi=]
* atypical depression (which may present as
* bipolar spectrum syndrome (including bipolar I or bipolar II disorder,
cyclothymia, or premenstrual syndrome)
* inattentive ADHD or
sluggish cognitive tempo
In adults, hypothyroidism is associated with the following symptoms:cite book |author=American Thyroid Association (ATA) |title=Hypothyroidism Booklet |year=2003 |pages=6 |url=http://www.thyroid.org/patients/brochures/Hypothyroidism%20_web_booklet.pdf#search=%22hypothyroidism%22 |format=PDF] MedlinePlus|000367|Hypothyroidism — primary — see list of Symptoms] [ [http://health.nytimes.com/health/guides/disease/hypothyroidism/print.html "Hypothyroidism — In-Depth Report." "The New York Times." Copyright 2008] ]
* Poor muscle tone (
Cold intolerance, increased sensitivity to cold
Muscle crampsand joint pain
* Thin, brittle hair
* Dry, itchy skin
Weight gainand water retention. [cite web |title=Hypothyroidism |url=http://www.aace.com/pub/thyroidbrochures/pdfs/Hypothyroidism.pdf |format=PDF |publisher=American Association of Clinical Endocrinologists] [cite journal |author=Yeum CH, Kim SW, Kim NH, Choi KC, Lee J |title=Increased expression of aquaporin water channels in hypothyroid rat kidney |journal=Pharmacol. Res. |volume=46 |issue=1 |pages=85–8 |year=2002 |month=July |pmid=12208125 |doi= |url=]
Bradycardia(low heart rate: less than sixty beats per minute)
* Slowed speech and a
hoarse, breaking voice. Deepening of the voice can also be noticed.
* Dry puffy skin, especially on the face
* Thinning of the outer third of the eyebrows
basal body temperature
Less common symptoms
* Impaired cognitive function (brain fog) and inattentiveness
* A slow heart rate with
ECGchanges including low voltage signals. Diminished cardiac output and decreased contractility.
* Reactive (or post-prandial) hypoglycemiacite journal |author=Hofeldt FD, Dippe S, Forsham PH |title=Diagnosis and classification of reactive hypoglycemia based on hormonal changes in response to oral and intravenous glucose administration |journal=Am. J. Clin. Nutr. |volume=25 |issue=11 |pages=1193–201 |year=1972 |pmid=5086042 |doi= |url=http://www.ajcn.org/cgi/reprint/25/11/1193.pdf |format=PDF]
Pericardial effusions may occur.
* Sluggish reflexes
* Early greying of the hair
Anemiacaused by impaired hemoglobin synthesis (decreased EPO levels), impaired intestinal iron and folateabsorption or B12 deficiency from pernicious anemia
Shortness of breathwith a shallow and slow respiratory pattern.
* Impaired ventilatory responses to
* Increased need for sleep
Irritabilityand mood instability
* Yellowing of the skin due to impaired conversion of
beta-caroteneto vitamin A
* Impaired renal function with decreased GFR.
* Thin, fragile or absent cuticles
Elevated serum cholesterol
* Acute psychosis (
myxedema madness) is a rare presentation of hypothyroidism
* Decreased sense of taste and smell (late, less common symptoms)
* Puffy face, hands and feet (late, less common symptoms)
* Premature wrinkling on the face
Hypothyroidism in pediatric patients was previously classified as "
Cretinism", and can cause the following symptoms:
mental retardationif present at birth, and untreated.
The severity of hypothyroidism varies widely. Some have few overt symptoms, others with moderate symptoms can be mistaken for having other diseases and states. Advanced hypothyroidism may cause severe complications including cardiovascular and psychiatric
To diagnose primary hypothyroidism, many doctors simply measure the amount of
Thyroid-stimulating hormone(TSH) being produced by the pituitary gland. High levels of TSH indicate that the thyroid is not producing sufficient levels of Thyroid hormone(mainly as thyroxine(T4) and smaller amounts of triiodothyronine (T3)). However, measuring just TSH fails to diagnose secondary and tertiary forms of hypothyroidism, thus leading to the following suggested blood testing if the TSH is normal and hypothyroidism is still suspected:
* free triiodothyronine (fT3)
* free levothyroxine (fT4)
* total T3
* total T4
Additionally, the following measurements may be needed:
* 24 hour urine free T3;Baisier W. Hertoghe J. Eeckhaut W. Thyroid insufficiency. Is TSH the only diagnostic tool? J Nutr Environ ed. 2000;10:105–113. [http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002"Thyroid insufficiency. Is TSH the only diagnostic tool?"] ]
antibodies— for evidence of autoimmune diseases that may be damaging the thyroid gland;
* serum cholesterol — which may be elevated in hypothyroidism;
* prolactin — as a widely available test of pituitary function;
* testing for anemia, including
Hypothyroidism is treated with the levorotatory forms of
thyroxine(L-T4) and triiodothyronine(L-T3). Both synthetic and animal-derived thyroid tablets are available and can be prescribed for patients in need of additional thyroid hormone. Thyroid hormone is taken daily, and doctors can monitor blood levels to help assure proper dosing. There are several different treatment protocols in thyroid replacement therapy:
;T4 Only: This treatment involves supplementation of levothyroxine alone, in a synthetic form. It is currently the standard treatment in mainstream medicine.cite journal |author=American Association of Clinical Endocrinologists |title=Medical Guidelines For Clinical Practice For The Evaluation And Treatment Of Hyperthyroidism And Hypothyroidism |journal=Endocrine Practice |volume=8 |issue=6 |year=2002 |month=November/December |pages=457–469 |url=http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf |format=PDF]
;T4 and T3 in Combination: This treatment protocol involves administering both synthetic L-T4 and L-T3 simultaneously in combination.cite journal |author=Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange AJ |title=Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism |journal=N. Engl. J. Med. |volume=340 |issue=6 |pages=424–9 |year=1999 |month=February |pmid=9971866 |doi= |url=http://content.nejm.org/cgi/content/full/340/6/424]
;Desiccated Thyroid Extract:
Desiccated thyroid extractis an animal based thyroid extract, most commonly from a porcine source. It is also a combination therapy, containing natural forms of L-T4 and L-T3.cite journal |author=Baisier, W.V.; Hertoghe, J.; Eeckhaut, W. |title= Thyroid Insufficiency. Is Thyroxine the Only Valuable Drug? |journal=Journal of Nutritional and Environmental Medicine |volume=11 |issue=3 |year=2001 |month=September|pages=159–66 |url= |doi=10.1080/13590840120083376 — [http://www.ingentaconnect.com/content/routledg/cjne/2001/00000011/00000003/art00002 Abstract] ]
The current standard treatment in thyroid therapy is levothyroxine only, and the American Association of Clinical Endocrinologists (AACE) states that desiccated thyroid hormone, combinations of thyroid hormone, or triiodothyronine should not generally be used for replacement therapy. Nevertheless, there exists some controversy about whether this treatment protocol is optimal, and recent studies have given conflicting results.
Two recent studies comparing synthetic T4 versus synthetic T4 + T3 have shown "clear improvements in both cognition and mood" from combination therapy. cite journal |author=Robertas Bunevicius, Arthur J. Prange Jr. |title=Mental improvement after replacement therapy with thyroxine plus triiodothyronine: relationship to cause of hypothyroidism |journal=The International Journal of Neuropsychopharmacology |volume=3 |issue=2 |pages=167-174 |year=2000 |month=June |pmid= |doi=doi:10.1017/S1461145700001826 |url=http://journals.cambridge.org/action/displayAbstract?aid=52289] . Another study comparing synthetic T4 and
desiccated thyroid extractshowed marked improvements in virtually all symptom categories when certain patients were switched from synthetic T4 to desiccated thyroid extract.
However other studies have shown no improvement in mood or mental abilities for those on combination therapy, and possibly impaired well-being from subclinical hyperthyroidism.cite journal |author=Siegmund W, Spieker K, Weike AI, "et al" |title=Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14 : 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism |journal=Clin. Endocrinol. (Oxf) |volume=60 |issue=6 |pages=750–7 |year=2004 |month=June |pmid=15163340 |doi=10.1111/j.1365-2265.2004.02050.x |url=] And, a 2007 metaanalysis of the nine controlled studies so far published found no significant difference in the effect on psychiatric symptoms.cite journal |author=Joffe RT, Brimacombe M, Levitt AJ, Stagnaro-Green A |title=Treatment of clinical hypothyroidism with thyroxine and triiodothyronine: a literature review and metaanalysis |journal=Psychosomatics |volume=48 |issue=5 |pages=379–84 |year=2007 |pmid=17878495 |doi=10.1176/appi.psy.48.5.379 |url=]
There is also concern among some practitioners about the use of T3 due to its short half life. T3 when used on its own as a treatment results in wide fluctuations across the course of a day in the thyroid hormone levels, and with combined T3/T4 therapy there continues to be wide variation throughout each day.cite journal |author=Saravanan P, Siddique H, Simmons DJ, Greenwood R, Dayan CM |title=Twenty-four hour hormone profiles of TSH, Free T3 and free T4 in hypothyroid patients on combined T3/T4 therapy |journal=Exp. Clin. Endocrinol. Diabetes |volume=115 |issue=4 |pages=261–7 |year=2007 |month=April |pmid=17479444 |doi=10.1055/s-2007-973071 |url=]
Subclinical hypothyroidism occurs when thyrotropin (TSH) levels are elevated but thyroxine (T4) and triiodothyronine (T3) levels are normal.cite book |author=Jack DeRuiter |title=Endocrine Module (PYPP 5260) |chapter=Thyroid pathology |chapterurl=http://www.auburn.edu/~deruija/endp_thyroidpathol.pdf |format=PDF |year=2002 |pages=pp30 |publisher=Auburn University School of Pharmacy] In primary hypothyroidism, TSH levels are high and T4 and T3 levels are low. Endocrinologists are puzzled because TSH usually increases when T4 and T3 levels drop. TSH prompts the thyroid gland to make more hormone. Endocrinologists are unsure how subclinical hypothyroidism affects cellular metabolic rates (and ultimately the body's organs) because the levels of the active hormones are adequate. Some have proposed treating subclinical hypothyroidism with levothyroxine, the typical treatment for overt hypothyroidism, but the benefits and the risks are unclear. Reference ranges have been debated as well. The American Association of Clinical Endocrinologists (ACEE) supports a narrower TSH range, especially when the person has clinical signs of thyroid disease. This reference range may reduce the risks of goiter, thyroid nodules, thyroid cancer, and overt hypothyroidism, but remains controversial. [cite web |title=Subclinical Thyroid Disease |url=http://www.aace.com/pub/positionstatements/subclinical.php |work=Guidelines & Position Statements |date=
July 11, 2007|publisher=The American Association of Clinical Endocrinologists |accessdate=2008-06-08] There is always the risk of overtreatment and hyperthyroidism. Some studies have suggested that subclinical hypothyroidism does not need to be treated. A meta-analysisby the Cochrane Collaborationfound no benefit of thyroid hormone replacement except "some parameters of lipid profiles and left ventricular function".cite journal |author=Villar H, Saconato H, Valente O, Atallah A |title=Thyroid hormone replacement for subclinical hypothyroidism |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD003419 |year=2007 |pmid=17636722 |doi=10.1002/14651858.CD003419.pub2] A more recent metanalysis looking into whether subclinical hypothyroidism may increase the risk of cardiovascular disease, as has been previously suggested, [cite journal |author=Biondi B, Palmieri EA, Lombardi G, Fazio S |title=Effects of subclinical thyroid dysfunction on the heart |journal=Ann. Intern. Med. |volume=137 |issue=11 |pages=904–14 |year=2002 |month=December |pmid=12458990 |doi= |url=] found a possible modest increase and suggested further studies be undertaken with coronary heart disease as a end point "before current recommendations are updated". [cite journal |author=Ochs N, Auer R, Bauer DC, "et al" |title=Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality |journal=Ann. Intern. Med. |volume=148 |issue=11 |pages=832–45 |year=2008 |month=June |pmid=18490668 |doi= |url=http://www.annals.org/cgi/content/full/148/11/832]
* [http://www.hormone.org/public/thyroid.cfm Thyroid Section] of
The Hormone Foundation
* [http://www.thyroidscience.com/ Thyroid Science journal]
* [http://www.endo-society.org The Endocrine Society]
* [http://www.aace.com/ American Association of Clinical Endocrinologists]
* [http://thyroidfoundation.org/ American Foundation of Thyroid Patients]
* [http://www.allthyroid.org/ Thyroid Foundation of America]
* [http://www.thyroid.org.au/ Thyroid Australia]
* [http://www.icarecafe.com/?page_id=1107&group_id=6/ icarecafe Hypothyroid Patient Group]
* [http://www.ahsta.com Alternative Health Solutions for Thyroid Autoimmunity]
* [http://www.elaine-moore.com Elaine Moore Graves' and Autoimmune Disease Education]
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Look at other dictionaries:
hypothyroidism — [hī΄pōthī′roid iz΄əm] n. 1. deficient activity of the thyroid gland 2. the disorder resulting from this, characterized by a retarded rate of metabolism and resulting sluggishness, puffiness, etc … English World dictionary
hypothyroidism — hypothyroid, adj. /huy peuh thuy roy diz euhm/, n. Pathol. 1. deficient activity of the thyroid gland. 2. the condition produced by a deficiency of thyroid secretion, resulting in goiter, myxedema, and, in children, cretinism. [1900 05; HYPO +… … Universalium
hypothyroidism — noun Etymology: International Scientific Vocabulary Date: 1905 deficient activity of the thyroid gland; also a resultant bodily condition characterized by lowered metabolic rate and general loss of vigor … New Collegiate Dictionary
hypothyroidism — noun /ˌhaɪpəˈθaɪrɔɪˌdɪzəm/ The disease state caused by insufficient production of thyroid hormone by the thyroid gland … Wiktionary
hypothyroidism — Diminished production of thyroid hormone, leading to clinical manifestations of thyroid insufficiency, including low metabolic rate, tendency to weight gain, somnolence and sometimes myxedema. SYN: athyrea … Medical dictionary
hypothyroidism — n. underactivity of the thyroid gland (Medicine) … English contemporary dictionary
hypothyroidism — [ˌhʌɪpəʊ θʌɪrɔɪdɪz(ə)m] noun Medicine abnormally low activity of the thyroid gland, resulting in retardation of growth and mental development. Derivatives hypothyroid noun & adjective … English new terms dictionary
hypothyroidism — hy·po·thyroidism … English syllables
hypothyroidism — n. subnormal activity of the thyroid gland. If present at birth and untreated it leads to cretinism. In adult life it causes mental and physical slowing, undue sensitivity to cold, slowing of the pulse, weight gain, and coarsening of the skin… … The new mediacal dictionary
hypothyroidism — hy•po•thy•roid•ism [[t]ˌhaɪ pəˈθaɪ rɔɪˌdɪz əm[/t]] n. 1) pat deficient activity of the thyroid gland 2) pat the condition produced by a deficiency of thyroid secretion, resulting in goiter, myxedema, and, in children, cretinism • Etymology:… … From formal English to slang