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Hypothyroidism


Alternative Names:

Myxedema; Adult hypothyroidism

Symptoms:

Early symptoms:

Late symptoms, if untreated:

  • Decreased taste and smell
  • Hoarseness
  • Puffy face, hands, and feet
  • Slow speech
  • Thickening of the skin
  • Thinning of eyebrows
Exams and Tests:

The health care provider will do a physical exam and find that your thyroid gland is enlarged. Sometimes, the gland is normal size or smaller-than-normal. The exam may also reveal:

  • Brittle nails
  • Coarse features of the face
  • Pale or dry skin, which may be cool to the touch
  • Swelling of the arms and legs
  • Thin and brittle hair

Blood tests are also ordered to measure your thyroid hormones TSH and T4.   

You may also have tests to check:

Treatment:

Treatment is aimed at replacing the thyroid hormone that you are lacking.

Levothyroxine is the most commonly used medicine:

  • You will be prescribed the lowest dose possible that relieves your symptoms and brings your blood hormone levels back to normal.
  • If you have heart disease or you are older, your doctor may start you on a very small dose.
  • Most people with an underactive thyroid will need to take this medicine for life.

When starting your medicine, your doctor may check your hormone levels every 2 to 3 months. After that, your thyroid hormone levels should be monitored at least once every year.

When you are taking thyroid medicine, be aware of the following:

  • Do not stop taking the medicine when you feel better. Continue taking it exactly as your doctor prescribed.
  • If you change brands of thyroid medicine, let your doctor know. Your levels may need to be checked.
  • What you eat can change the way your body absorbs thyroid medicine. Talk with your doctor if you are eating a lot of soy products or are on a high-fiber diet.
  • Thyroid medicine works best on an empty stomach and when taken 1 hour before any other medications. Ask your doctor is you should take your medicine at bedtime. Studies have found that taking it at bedtime may allow your body to absorb the medicine better than taking it in the daytime.
  • Wait at least 4 hours after taking thyroid hormone before you take fiber supplements, calcium, iron, multivitamins, aluminum hydroxide antacids, colestipol, or medicines that bind bile acids.

While you are taking thyroid replacement therapy, tell your doctor if you have any symptoms that suggest your dose is too high, such as:

  • Palpitations
  • Rapid weight loss
  • Restlessness or shakiness
  • Sweating
Outlook (Prognosis):

In most cases, thyroid hormone levels return to normal with proper treatment. You will likely take a thyroid hormone medicine for the rest of your life.

Possible Complications:

Myxedema coma, the most severe form of hypothyroidism, is rare. It occurs when thyroid hormone levels get very low. It can be caused by an infection, illness, exposure to cold, or certain medicines in people with untreated hypothyroidism.

Myxedema coma is a medical emergency that must be treated in the hospital. Some patients may need oxygen, breathing assistance (ventilator), fluid replacement and intensive-care nursing.

Symptoms and signs of myxedema coma include:

People with untreated hypothyroidism are at increased risk of:

  • InfectionInfertility, miscarriage, giving birth to a baby with birth defects
  • Heart disease because of higher levels of LDL ("bad") cholesterol
  • Heart failure
When to Contact a Medical Professional:

Call your health care provider if you have symptoms of hypothyroidism (or myxedema).

If you are being treated for hypothyroidism, call your doctor if:

  • You develop chest pain or rapid heartbeat
  • You have an infection
  • Your symptoms get worse or do not improve with treatment
  • You develop new symptoms
References:

Brent GA, Davies TF. Hypothyroidism and thyroiditis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, et al. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 13.

Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 22;12:1200-1235.

Kim M, Ladenson P. Thyroid. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 233.


Review Date: 6/7/2013
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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