Introduction

Hypothyroidism is a common condition marked by a deficiency of thyroid hormones. Its diagnosis is mainly
based on biochemical measurements. Thyroid-stimulating hormone (TSH), or thyrotropin, is produced by
the pituitary gland to signal the thyroid to release two essential hormones: thyroxine (T4) and
triiodothyronine (T3). These hormones are crucial for regulating metabolism—the process by which the
body converts food into energy.

Hypothyroidism is categorized into primary and secondary types. Primary hypothyroidism occurs when the
thyroid gland itself fails to produce enough hormones. In contrast, secondary, or central hypothyroidism,
results from issues with the pituitary gland or hypothalamus, while the thyroid functions normally. The
most common cause of hypothyroidism is iodine deficiency. Treatment typically involves thyroid hormone
replacement, as untreated hypothyroidism can lead to increased health risks and mortality.
Hypothyroidism in infants
Hypothyroidism can affect anyone, even infants. Babies born without a functioning thyroid
gland or with an underactive gland may not show symptoms immediately. However, if left
undiagnosed and untreated, symptoms will begin to appear, including:
Feeding difficulties
- Slow growth and poor weight gain
- Jaundice (yellowing of the skin and eyes)
- Constipation
- Low muscle tone
- Dry skin
- Hoarse crying
- Enlarged tongue
- A soft bulge near the belly button
Without treatment, even mild cases of hypothyroidism in infants can result in serious
physical and mental development issues. Early diagnosis is essential to prevent these
complications.

Hypothyroidism in children and teens

Children and teens with hypothyroidism often experience symptoms similar to those in adults, but they
may also face additional challenges, including:

- Stunted growth, resulting in shorter height

- Delayed appearance of permanent teeth

- Delayed onset of puberty

- Slowed cognitive development

These symptoms highlight the importance of early diagnosis and treatment to support healthy growth and
development.
Types:Primary hypothyroidism
Primary hypothyroidism occurs when the thyroid gland is damaged,
reducing its ability to produce the hormones T3 and T4. It accounts for
99% of all hypothyroidism cases, according to a 2019 study. Various
factors can impair thyroid hormone production, including:

- The autoimmune condition Hashimoto’s thyroiditis

- Inflammation of the thyroid (thyroiditis)
- Congenital hypothyroidism
- Surgical removal of part or all of the thyroid
- Radiation treatment affecting the thyroid
- Certain medication side effects

Healthcare professionals diagnose primary hypothyroidism using blood

tests to measure thyroid hormone levels. Typically, individuals with this
condition have low levels of T3 and T4, along with high TSH levels. This
is because, in a healthy response, the pituitary gland increases TSH
when it senses that thyroid hormone levels are insufficient.

Secondary hypothyroidism
Secondary hypothyroidism arises when low thyroid
hormone levels result from problems with the pituitary
gland, which cannot produce enough thyroid-stimulating
hormone (TSH). Since TSH usually signals the thyroid to
release T3 and T4, low TSH leads to a significant drop in
these thyroid hormones. According to a 2017 review,
fewer than 1% of people with hypothyroidism have the
secondary form.

Causes of secondary hypothyroidism include:

- Pituitary tumors
- Sheehan syndrome, a rare condition where pituitary tissue dies due
to childbirth complications
- autoimmune condition attacking pituitary tissue
- Brain damage from radiation therapy
- Side effects from medications like dopamine opioids etc

Healthcare professionals diagnose secondary hypothyroidism through

blood tests, which typically show low levels of TSH, T3, and T4, but
normal levels of TRH.

Tertiary hypothyroidism
Tertiary hypothyroidism is a rare form of hypothyroidism that occurs when the hypothalamus, a part of the
brain responsible for regulating many bodily functions, fails to produce enough thyrotropin-releasing
hormone (TRH). TRH usually signals the pituitary gland to produce thyroid-stimulating hormone (TSH),
which in turn stimulates the thyroid gland to release T3 and T4, the hormones critical for metabolism,
growth, and energy production. In tertiary hypothyroidism, low TRH leads to reduced TSH, which then
results in low levels of T3 and T4.

Causes

- **Tumors in the hypothalamus**: These can interfere with TRH production.

- **Brain injuries or trauma**: Physical damage to the hypothalamus can disrupt hormone regulation.

- **Radiation therapy**: Radiation targeting the brain, often for cancer treatment, can damage
hypothalamic cells.

- **Surgery**: Procedures involving the brain, especially near the hypothalamus, can impair its function.

- **Infections or inflammation**: Conditions like encephalitis or meningitis may lead to hypothalamic

dysfunction.

Symptoms

- Fatigue and low energy

- Weight gain and cold sensitivity

- Depression and memory issues

- Dry skin and hair loss

- Muscle weakness and joint pain

Diagnosing tertiary hypothyroidism is challenging because it requires differentiating it from primary and
secondary hypothyroidism. Blood tests are commonly used to measure hormone levels:

Sometimes, imaging studies like MRI or CT scans are used to detect structural abnormalities in the
hypothalamus or pituitary gland.

Treatment for tertiary hypothyroidism focuses on restoring normal thyroid hormone levels with hormone
replacement therapy,This therapy is often lifelong and requires regular monitoring to ensure that hormone
levels remain stable. In some cases, treatment for the underlying cause, such as surgery for a tumor, may
also be necessary.

With consistent treatment, people with tertiary hypothyroidism can manage their symptoms and live a
healthy life. However, regular monitoring by healthcare professionals is crucial to ensure that hormone
levels stay balanced and to adjust therapy as needed.

Symptoms
Hypothyroidism has many symptoms that can vary from person to
person. Some common symptoms of hypothyroidism include
1. Fatigue
Fatigue is one of the most common symptomsTrusted Source of
hypothyroidism.Many people with the condition report feeling so
exhausted that they are unable to go about their day as usual.The fatigue
occurs regardless of how much sleep a person gets or how many daytime
naps they take. Treatment for hypothyroidism usually improves people’s
energy levels and functioning.
2. Weight gain
Thyroid hormones help toTrusted Source regulate body weight, food
intake, and the metabolism of fat and sugar. People with low levels of
thyroid hormones can experience weight gain and an increase in body
mass index (BMI).Even mild cases of hypothyroidism may increase the
risk of weight gain and obesity. People with the condition often report
having a puffy face as well as excess weight around the stomach or other
areas of the body.
3. Sore muscles and joints
Hypothyroidism can affectTrusted Source a person’s muscles and joints in
numerous ways, causing:
aches
pains
stiffness
swelling of the joints
tenderness
weakness
Research also suggests a link between thyroid disorders and rheumatoid
arthritis, which is an autoimmune condition that causes painful swelling in
the lining of the joints. Effective treatment for both conditions will help
people manage their symptoms.
4. Mood and memory changes
It is common for individuals with untreated hypothyroidism to experience:
anxiety
depression
apathy, or general lack of interest or feelings of indifference
impaired memory function
less attentiveness and concentration
low moods
slower thinking and speech
These symptoms can occur because the brain requires thyroid hormones
to function correctly. ResearchTrusted Source shows that low levels of
thyroid hormones can cause changes in brain structure and functioning.
These brain changes can reverse once a person begins treatment.
5. Feeling cold
Hypothyroidism can slow down metabolism, leading to a drop in core
body temperature. As such, some people with low levels of thyroid
hormones may feel coldTrusted Source all the time or have a low
tolerance to the cold.This feeling of coldness can persist, even when in a
warm room or during the summer months. People with hypothyroidism
often report having cold hands or feet, although they may feel their whole
body is cold.
These symptoms are not exclusive to hypothyroidism, however.
Circulation problems or anemia can also cause people to feel chilly.
6. Constipation
Digestion is another body function that can slow downTrusted Source due
to hypothyroidism.
Studies report that an underactive thyroid can cause problems with
movement through the gut and the activity of the stomach, small
intestine, and colon.
These digestive changes cause some people to experience constipation..
A person may also have hard stools, difficulty passing stool, or a feeling of
being unable to empty the rectum fully.
7. High cholesterol
Thyroid hormones play a vital role in removing excess cholesterol from
the body via the liver. Low hormone levels mean that the liver struggles
to carry out this function and blood cholesterol levels can increaseTrusted
Source.
Research suggests that up to 13 percentTrusted Source of individuals with
high cholesterol also have an underactive thyroid. As a result, many
experts recommend that doctors routinely test people with high
cholesterol for hypothyroidism.
Treating the thyroid problem may help reduce cholesterol levels, even in
those who do not take cholesterol-lowering drugs.
8. Slow heart rate
People with hypothyroidism may also have a slower heart rate, Low
thyroid levels can affect the heart in other ways too. These effects may
includeTrusted Source:
changes in blood pressure
variations in heart rhythm
less elastic arteries
Bradycardia can cause weakness, dizziness, and breathing problems.
Without treatment, this heart condition may result in serious
complications, such as high or low blood pressure or heart failure.
9. Hair loss
Untreated hormone disorders, including thyroid problems, can contribute
to hair loss. This is because thyroid hormones are essential for the growth
and health of hair follicles. Hypothyroidism may causeTrusted Source hair
loss from the:
scalp
eyebrows
legs
other body parts
People with thyroid problems are also more prone to developing alopecia,
which is an autoimmune condition that causes hair to fall out in patches.
10. Dry skin and weak hair and nails
An underactive thyroid affects the skin in various ways and can cause
symptoms, such asTrusted Source:
dry, coarse skin
paleness
thin, scaly skin
People with hypothyroidism may also develop dry, brittle, and coarse hair
or dull, thin nails that break easily.
These symptoms usually clear up once people begin thyroid hormone
therapy.
11. Goiter
A goiter is an enlargement of the thyroid gland that appears as a swelling
at the base of the neck. Other goiter symptoms include:
a cough
hoarseness
problems swallowing and breathing
Many thyroid problems can resultTrusted Source in a goiter,
including Hashimoto’s thyroiditis, which is an autoimmune condition that
damages the thyroid gland, stopping it producing enough hormones.
Other causes include underactive thyroid and, less commonly in the
United States, iodine deficiency.
12. Menstrual changes
People with an underactive thyroid may experience heavy or irregular
menstrual periods or spotting between periods.
According to the Society of Menstrual Cycle Research, hypothyroidism
causes these problems because it affects other hormones that play a role
in menstruation, such as by:
impairing the degradation of estrogen
reducing the amount of sex hormone-binding globulin

CAUSES
Here are the key causes of hypothyroidism, written more concisely and clearly:

1. **Autoimmune Disease (Hashimoto’s Disease)**: The most common cause of hypothyroidism,

Hashimoto’s disease, occurs when the immune system mistakenly attacks the thyroid gland, reducing its
ability to produce hormones.

2. **Thyroid Surgery**: Removing all or part of the thyroid gland can significantly decrease or completely
stop thyroid hormone production.

3. **Radiation Therapy**: Radiation treatments for cancers of the head and neck can damage the thyroid,
often resulting in hypothyroidism.

4. **Thyroiditis**: This inflammation of the thyroid gland, which can stem from infections, autoimmune
disorders, or other conditions, can cause an initial spike in hormone release (hyperthyroidism), followed by
underactivity.

5. **Medications**: Certain medications, like lithium (used for psychiatric conditions), can affect thyroid
function. It's important to check with healthcare providers about any potential impact on the thyroid.

6. **Congenital Issues**: Some babies are born with a poorly functioning or absent thyroid gland, often
with unclear causes, though some forms are hereditary. Newborn screening helps catch hypothyroidism
early.

7. **Pituitary Gland Disorders**: A rare cause, pituitary disorders, often due to benign tumors, can lead to
low TSH production, affecting the thyroid’s hormone production.

8. **Pregnancy**: Hypothyroidism can develop during or after pregnancy. If untreated, it increases the risk
of complications like miscarriage, preeclampsia, and can affect the developing fetus.

9. **Iodine Deficiency**: The thyroid requires iodine to make hormones. While rare in the U.S. due to
iodized salt, iodine deficiency is a common cause of hypothyroidism globally. Too much iodine can also
worsen hypothyroidism in some cases.

Hypothyroidism can arise from **primary causes** (directly impacting the thyroid) or **secondary
causes** (where the pituitary gland fails to stimulate the thyroid properly). Primary causes are much more
common, with Hashimoto’s disease being the most frequent. Other primary causes include thyroiditis,
treatment for hyperthyroidism, iodine deficiency, and hereditary conditions.

Diagnosis
Diagnosing hypothyroidism can be challenging because its symptoms vary widely and often resemble other
health issues. For this reason, diagnosis relies heavily on blood tests rather than symptoms alone.

The primary test for hypothyroidism measures the level of thyroid-stimulating hormone (TSH) in the blood.
If TSH levels are high, a second test measures T4 (thyroxine). When TSH is high and T4 is low,
hypothyroidism is diagnosed. Sometimes, T3 levels are also measured.

If TSH is elevated but T4 and T3 are within normal ranges, this indicates subclinical hypothyroidism, a mild
form that usually has no noticeable symptoms.

TSH testing is also essential for managing hypothyroidism over time, helping healthcare providers adjust
medication dosages. Certain medications and supplements, like biotin, can affect test results, so it’s
important to inform your healthcare provider about any you’re taking.

Thyroid function tests are the most accurate way to confirm thyroid issues. These tests check TSH and
"free" T4 (FT4) levels. High TSH with low T4 indicates an underactive thyroid. If TSH is high but T4 is normal,
it may suggest a future risk of hypothyroidism, and repeat testing may be advised.

Additional tests, like triiodothyronine (T3) and thyroid antibody tests, are less common but may be used to
rule out autoimmune thyroid conditions such as Hashimoto’s thyroiditis when suspected.
Treatment for hypothyroidism mainly focuses on restoring thyroid hormone levels to normal. The primary
method is thyroid hormone replacement therapy, which compensates for the underproduction of
hormones by the thyroid gland. Here’s an overview of the most common treatments:

### 1. **Hormone Replacement Therapy (Levothyroxine)**

- **Levothyroxine**, a synthetic form of thyroxine (T4), is the most widely used treatment for
hypothyroidism. It is designed to mimic the natural T4 hormone produced by the thyroid gland and is
usually taken as a daily pill.

- **How It Works**: The body naturally converts T4 into the active T3 hormone as needed, so
supplementing with T4 alone is generally sufficient for most people.

- **Dosage and Adjustments**: The dosage of levothyroxine is individualized based on blood test results,
primarily TSH levels. Over time, adjustments are often necessary, especially in certain situations such as
pregnancy, aging, or changes in weight.

- **Monitoring**: Regular TSH tests are used to monitor the treatment's effectiveness and ensure that
the hormone levels remain within a healthy range. This helps prevent either over-treatment (leading to
hyperthyroidism symptoms) or under-treatment.

### 2. **Combination Therapy (T4 and T3)**

- Some patients may benefit from a combination of **levothyroxine (T4) and liothyronine (T3)**,
especially if they do not respond well to T4 alone. This is less common, as most people’s bodies can
naturally convert T4 to T3 as needed.

- **Combination therapy** is generally used only under specific circumstances, as T3 is more potent and
acts more quickly than T4. Excessive T3 can lead to symptoms of hyperthyroidism, such as rapid heartbeat
and nervousness.

- **Research and Caution**: While combination therapy may help certain patients feel better, it’s still a
topic of research, as balancing the two hormones can be challenging.

### 3. **Natural Desiccated Thyroid (NDT)**

- **Natural desiccated thyroid (NDT)** is an alternative treatment derived from the thyroid glands of pigs
and contains a mix of both T4 and T3.

- **Considerations**: Some people prefer NDT for its natural origin, but the hormone levels in these
medications can vary slightly, making precise dosing more challenging. NDT is less commonly prescribed
due to these inconsistencies, though some patients report better symptom relief.

- **Monitoring**: Like synthetic options, NDT requires close monitoring with blood tests to ensure that
hormone levels remain balanced.

### 4. **Addressing Underlying Causes**

 - If hypothyroidism results from an underlying condition, such as **Hashimoto's thyroiditis** or
**pituitary gland dysfunction**, treating the underlying condition is also important. For instance, if a
pituitary tumor affects hormone production, surgery or radiation may be considered.

- **Iodine Deficiency**: In rare cases where iodine deficiency causes hypothyroidism, increasing iodine
intake can help. However, this is more relevant in areas with low dietary iodine, as iodine deficiency is
uncommon in many parts of the world due to iodized salt.

### 5. **Lifestyle and Dietary Adjustments**

- While hormone therapy is the main treatment, certain lifestyle changes may help manage symptoms.
For example:

- **Diet**: Some people may benefit from eating a well-balanced diet rich in nutrients that support
thyroid health, like selenium and zinc.

- **Avoiding Certain Foods**: Large quantities of goitrogenic foods (like soy, cabbage, and broccoli) can
interfere with thyroid function in some people, though these typically need not be eliminated unless
advised by a healthcare provider.

- **Avoiding Certain Supplements and Medications**: Supplements, such as iron or calcium, and
medications that interfere with thyroid hormone absorption should be taken at different times from thyroid
medication.

### 6. **Regular Follow-Up and Monitoring**

- Because hypothyroidism is typically a lifelong condition, regular follow-up appointments are essential.
These visits ensure that TSH levels stay within the target range and allow healthcare providers to make
adjustments to treatment as needed.

- **Special Considerations**: Life stages such as pregnancy, aging, and changes in weight can affect
hormone needs. Pregnant individuals with hypothyroidism often require higher doses of thyroid hormone,
as adequate levels are essential for fetal development.

### Prognosis and Quality of Life

- With appropriate treatment, most people with hypothyroidism can lead a normal, healthy life. However,
they need to remain consistent with medication and regular monitoring.

- Untreated hypothyroidism, by contrast, can lead to serious complications, such as heart problems,
mental health issues, infertility, and myxedema coma (a rare but life-threatening condition).

### Conclusion

Hypothyroidism is primarily managed with hormone replacement therapy, especially levothyroxine, which
is effective, safe, and easy to use. Regular monitoring and, if needed, adjustments ensure that hormone
levels stay balanced and symptoms remain controlled.
CASE STUDY
https://www.healthline.com/health/hypothyroidism/symptoms-treatments-more#diet

https://pubmed.ncbi.nlm.nih.gov/22191793/

https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2019.00177/full

https://my.clevelandclinic.org/health/diseases/12120-hypothyroidism

https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289;