Hypothyroidism is when the thyroid gland does not produce enough thyroid hormones to meet the needs of the body. The thyroid is underactive.
The opposite is hyperthyroidism, where the thyroid produces too much thyroid hormone. However, the link between hyperthyroidism and hypothyroidism is complex, and one can lead to the other, in certain circumstances.
Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Worldwide, environmental iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism, but in areas of iodine sufficiency, Hashimoto’s disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure.
The thyroid gland is found in the front of the neck below the larynx, or voice box, and has two lobes, one on each side of the windpipe. It is an endocrine gland, made up of special cells that make hormones.
Hormones are chemical messengers that relay information to the organs and tissues of the body, controlling processes such as metabolism, growth, and mood. The production of thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland.
This, in turn, is regulated by the hypothalamus, a region of the brain. TSH ensures that enough thyroid hormones are made to meet the needs of the body. Treatment for hypothyroidism focuses on supplementing the thyroid hormone.
Iodine and Nutrition
Iodine is an element that is needed for the production of thyroid hormone. The body does not make iodine, so it is an essential part of your diet. If you do not have enough iodine in your body, you cannot make enough thyroid hormone.
Iodine deficiency in pregnancy is a worldwide problem and has become a global public health concern since it is identified as the leading cause of preventable brain damage in newborns and infants due to inadequate intake by mothers and infants.
Major international efforts are being made to help reduce the problem, mainly through the use of iodized salt and supplements. Iodine deficiency disorder is a serious public health threat for 2 billion people worldwide.
It is the leading cause of mental development disorders in young children, from cretinism to more subtle degrees of impaired cognitive development which can lead to poor school performance and reduced work capacity in hundreds of millions of children. It is implicated in still-birth, miscarriage, physical impairment and thyroid dysfunction.
Maintaining adequate iodine intake is important for most people, but those with autoimmune thyroid disease can be particularly sensitive to the effects of iodine, meaning that it can trigger or worsen hypothyroidism.
Symptoms of Hypothyroidism
Symptoms vary a great deal between inpiduals, and they are shared by other conditions. Thyroid hormones affect multiple organ systems, so the symptoms of hypothyroidism are wide-ranging and perse.
Symptoms of hypothyroidism commonly include but are not limited to fatigue, weight gain, cold intolerance, slowed heart rate, movements, and speech, joint and muscle pain, cramps, and weakness, constipation, dry skin, thin, brittle hair or fingernails, decreased sweating, heavy periods, or menorrhagia, weakness, high cholesterol, puffy face, feet, and hands, insomnia, balance and co-ordination issues, loss of libido, recurrent urinary and respiratory tract infections, anemia and depression.
If left untreated, the following symptoms can manifest hoarseness, puffiness in the face, thinned or missing eyebrows, slow heart rate and hearing loss.
Hypothyroidism develops slowly. Symptoms may go unnoticed for a long time, and they may be vague and general.
Hypothyroidism in Infants
Although hypothyroidism most often affects middle-aged and older women, anyone can develop the condition, including infants. Congenital hypothyroidism occurs when a newborn infant is born without the ability to make normal amounts of thyroid hormone.
The condition occurs in about 1 in 4,000 children, is most often permanent and treatment is lifelong. Initially, babies born without a thyroid gland or with a gland that doesn't work properly may have few signs and symptoms.
When newborns do have problems with hypothyroidism, the problems may include yellowing of the skin and whites of the eyes (jaundice).
In most cases, this occurs when a baby's liver can't metabolize a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells.
Hypothyroid infants usually have a large, protruding tongue, difficulty breathing, hoarse crying, an umbilical hernia. As the disease progresses, infants are likely to have trouble feeding and may fail to grow and develop normally. They may also have constipation, poor muscle tone, and excessive sleepiness.
Thyroid hormone is important for your baby's brain development as well as growth; therefore, untreated congenital hypothyroidism can lead to intellectual disabilities and growth failure. However, because there is excellent treatment available, with early diagnosis and treatment, your baby is likely to lead a normal, healthy life.
Hypothyroidism in Children and Teens
In general, children and teens who develop hypothyroidism have the same signs and symptoms as adults do, but they may also experience poor growth, resulting in short stature, delayed development of permanent teeth, delayed puberty, and poor mental development.
Hypothyroidism During Pregnancy
Women with hypothyroidism have decreased fertility; even if they conceive, the risk of abortion is increased, and the risk of gestational hypertension, anemia, and postpartum hemorrhage is increased.
The risk of these complications is greater in women with overt, rather than subclinical hypothyroidism. Increased demands on metabolism during pregnancy results in increased demands on the thyroid.
In one study, 85 percent of women who are pregnant and taking thyroid hormone replacement needed an additional intake of 47 percent on average, during pregnancy.
If hypothyroidism occurs during pregnancy, it is usually due to Hashimoto’s thyroiditis. This condition affects between 3 and 5 out of every 1,000 women during pregnancy.
Uncontrolled hypothyroidism increases the risk of miscarriage, preterm delivery, and a rise in blood pressure during late pregnancy. It can also affect brain development and growth rates.
Prevention of Hypothyroidism
People who may have a higher risk of thyroid problems, for example, women during pregnancy, should check with their doctor about the need for additional iodine.
Screening is not recommended for those who do not have symptoms unless they have risk factors like a history of autoimmune disease, previous radiation treatment to the head or neck, a goiter, a family history of thyroid problems, and the use of medications known to affect thyroid function.
Diet can affect the way in which the body absorbs thyroid medication. There is no evidence that a particular diet will prevent hypothyroidism, and there is no way to prevent hypothyroidism unless you live in a region with low iodine levels in the diet, for example, some parts of Southeast Asia and Africa.
Those with autoimmune Hashimoto’s may benefit from following a gluten-free diet. Research suggests a link between celiac disease and autoimmune thyroid disease, and both have inflammatory components. Avoiding gluten may help in nonceliac autoimmune diseases, but it is important to speak to a doctor first before cutting out foods that contain gluten.
Other foods and nutrients may be hazardous, especially if consumed in large quantities. These include soya, as it can affect thyroxine absorption. Iodine, found in seaweeds, and in supplements, including some multivitamins. Iron supplements, as they can affect thyroxine absorption.
Cruciferous vegetables, such as cauliflower, and cabbage may contribute to a goiter, but only in very large amounts. Consuming additional iodine can interfere with the balance involved in treatment. If hyperthyroidism develops, iodine can be hazardous.
Iodine is needed for the production of the thyroid hormones, but the level must be balanced. Too much or too little iodine can lead to hypothyroidism or hyperthyroidism.
During pregnancy, iodine requirements increase. Using iodized salt in the diet and taking prenatal vitamins can maintain the required levels of iodine.
For those with autoimmune and inflammatory thyroid conditions, supplements such as turmeric and omega-3s may help to improve inflammation. Turmeric can be helpful in reducing whole-body inflammation, healing the gut, as well as detoxifying from heavy metals, in those with autoimmunity and Hashimoto’s.
Selenium: people with some types of thyroid problems may benefit from taking selenium, but this should only be used after discussing it with a doctor.
Vitamin D: a deficiency has been linked with the severity of disease in Hashimoto’s. Supplementation may be necessary to reach beneficial vitamin D blood levels above 50 ng / dL.
Probiotics are defined as live microorganisms with various health benefits. Some people with hypothyroidism may have changes in the small intestine, where bacteria from the colon spread into the small intestine where they are not normally located, known as small intestine bacterial overgrowth (SIBO).
By Dr Magdy Badran , Consultant Ped Immunology
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