What is it about ?
The thyroid is a small, butterfly-shaped gland that sits at the base of the neck, just below the Adam’s apple.
It produces thyroid hormones (T3 (triiodothyronine) and T4 (thyroxine)). These hormones play an important role at all stages of life. They allow
- normal growth and development,
- the regulation of many processes, including metabolism (they stimulate the metabolism),
- and that the pregnancy is proceeding normally.
When your thyroid is sluggish, it makes too little thyroid hormone (hypothyroidism). It slows down your metabolism.
Most often (in 95% of cases), an underactive thyroid is the consequence of a problem with the thyroid gland itself. It is almost always a autoimmune disease, chronic Hashimoto’s thyroiditis. The problem can also occur after an operation or radiation therapy in the thyroid.
In 5% of cases, the lack of thyroid hormones is linked to a problem with the production of another hormone, TSH (thyroid stimulating hormone). TSH is produced by the pituitary gland, a gland located in the brain. TSH acts on the thyroid: it stimulates the thyroid to produce thyroid hormones.
In some cases, hypothyroidism is only temporary. For example, when the thyroid is inflamed (subacute thyroiditis). In this case, a first phase of accelerated functioning (hyperthyroidism) is followed by a phase of idling. It can also happen in the first year after pregnancy. In addition, certain drugs (lithium, amiodarone) temporarily influence the functioning of the thyroid.
In whom and how often does it occur?
Hypothyroidism is relatively common, and more common than hyperthyroidism. It is estimated that 1 to 2 in 100 people have an underactive thyroid. It is more common in women (2.2%) than in men (0.6%). The risk of developing thyroid problems increases with age.
How to recognize it?
Hypothyroidism can give rise to a variety of complaints and problems. These are often non-specific symptoms and signs, the severity of which varies from person to person.
The characteristic signs that may indicate an underactive thyroid are:
- weight gain,
- tired,
- lack of initiative and depressed mood,
- slowness of motor functions and speech, decreased concentration (especially in the elderly, which is sometimes difficult to distinguish from dementia (beginner)),
- feeling cold,
- constipation,
- slow heart rate,
- skin changes: dry, rough, cold or pale skin, coarse hair and hair loss,
- muscular weaknessmuscle pain and stiffness,
- menstrual cycle disruption, infertility, excess hormone prolactin.
Often the clinical signs and symptoms are not clearly marked, and the disease is difficult to recognize.
How is the diagnosis made?
Your doctor will think about an underactive thyroid when you have symptoms or signs of slowing your metabolism. The risk of a thyroid disorder is higher with a family history or during the first year after pregnancy.
If he thinks of a thyroid problem, the doctor will palpate your thyroid. He will also pay attention to complaints that may arise from a heart (rhythm) problem. A blood test will be taken to measure the amounts of TSH and T4 hormones. Usually an ultrasound is not necessary.
What can you do ?
There is nothing you can do to prevent a thyroid problem.
If your thyroid is sluggish and you need to take medication, it is very important that you take it correctly. You may need to take these drugs for life, depending on where the problem is.
Thyroid hormone treatment is taken once a day: in the morning, on an empty stomach. Some drugs, such as iron and calcium, interfere with the absorption of thyroid hormone. You should therefore take these medicines at least 4 hours after the thyroid hormone begins. If you are taking other medicines, such as hormone replacement therapy during menopause, the dose of thyroid hormone should be increased.
If you have a thyroid problem and would like to be pregnant or are already pregnant, talk to your doctor, as this requires adjusting your treatment.
What can your doctor do?
Hypothyroidism with no obvious cause results in more TSH and less T4 than normal. Treatment and follow-up are usually taken care of by the general practitioner, but for more severe forms of thyroid disease you will be referred to a hormone specialist (endocrinologist).
Treatment involves replacing the thyroid hormone with thyroxine (replacement therapy). The dose of thyroxine and the starting schedule depends on the following:
- body weight,
- age,
- other illnesses or medications,
- severity and duration of the disease,
- (desire for) pregnancy.
Your doctor will take regular blood tests to monitor TSH and T4. At the start of treatment, these blood tests will be scheduled approximately every six weeks. As soon as an adequate maintenance dose is found (i.e. a dose at which symptoms have disappeared and blood values have returned to normal), blood tests can be scheduled once a year, or cases of recurrence of symptoms.
It happens that only TSH has high values, without causing problems. The doctor will follow up with you, but treatment is usually not necessary unless you are pregnant or have very high TSH.
Hypothyroidism that originates in the brain is characterized by normal to slightly low TSH and decreased T4. In this case, your general practitioner will refer you to an endocrinologist for follow-up.
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