What Is Hypothyroidism, and Is It Treatable?

Author:
Dr Khalid Rahman
Updated date:
Aug 18, 2022 9:46 PM EDT

What Is Hypothyroidism?

The inappropriate secretion of TSH (thyroid-stimulating hormone) from the pituitary gland and thyroid gland's dysfunction facilitates the onset of hypothyroidism (Kostoglou-Athanassiou & Ntalles, 2010). Hypothalamus dysfunction leading to inappropriate TRH (thyrotropin-releasing hormone) also increases the risk of hypothyroidism and its clinical complications. Primary hypothyroidism is recognized under the following parameters:

The decrease in FT4 (free T4)
Increase in TSH
Subclinical TSH (i.e., TSH elevation and FT4 normalcy
Direct involvement of thyroid gland

Overt hypothyroidism in many nations reportedly occurs under the impact of salt iodination. Subclinical hypothyroidism in many scenarios remains asymptomatic or devoid of intense symptoms. Contrarily, clinical hypothyroidism leads to the development of intense symptoms that potentially elevate the risk of serious complications, including coma. The development of clinical hypothyroidism from subclinical hypothyroidism occurs under the impact of several conditions, including reproductive complications, neuromuscular symptoms, somatic manifestations, heart failure, and cardiovascular disease. Hypothyroidism also develops among the patients affected by neoplastic diseases under the impact of novel tyrosine kinase inhibitor therapy.

Secondary hypothyroidism is marked by the development of the following manifestations (Kostoglou-Athanassiou & Ntalles, 2010):

Reduction in FT4
Reduced or normal TSH
Direct involvement of hypothalamus/pituitary gland

Thyroid hormone deficiency potentially triggers the development of hypothyroidism and its clinical manifestations (Kostoglou-Athanassiou & Ntalles, 2010). The categorization of hypothyroidism is majorly based on the following parameters:

Congenital hypothyroidism (based on the time of onset)
Acquired hypothyroidism (based on the time of onset)
Primary hypothyroidism (based on endocrine dysfunction level)
Central/secondary hypothyroidism (based on endocrine dysfunction level)
Clinical hypothyroidism
Subclinical/mild hypothyroidism

Causes of Hypothyroidism

Primary hypothyroidism is caused by the following conditions (Kostoglou-Athanassiou & Ntalles, 2010):

Dysgenesis/thyroid agenesis
Drugs
External radiotherapy
Radioactive iodine therapy
Thyroidectomy
Iodine excess or deficiency
Chronic autoimmune thyroiditis

Central/secondary hypothyroidism is caused by the following pituitary conditions:

Personal history of pituitary apoplexy
Personal history of head trauma
Personal history of radiotherapy or pituitary surgery
Pituitary adenomas

The following hypothalamus complications also lead to the development of central/secondary hypothyroidism:

Personal history of radiotherapy or hypothalamic surgery
Personal history of suprasellar tumors

The general or most commonly reported causes of hypothyroidism include the following (Patil, Rehman, & Jialal, 2020):

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Symptoms of Hypothyroidism

The limited production of thyroid hormone inside the human body leads to the development of hypothyroidism. The patients affected with hypothyroidism exhibit a limited level of thyroid hormone in their blood. The deteriorated function of the butterfly-shaped thyroid gland (at the neck’s lower front) potentially reduces the serum level of the thyroid hormone.

Eventually, the reduced concentration of thyroid hormone reaches the body tissues, thereby impacting their energy level. The thyroid hormone assists body physiology by elevating/optimizing the energy level of body organs, including muscles, the heart, and the brain. The sustained deficit of thyroid hormone inside the human body potentially slows down the entirety of bodily processes. This eventually increases the risk of the following symptoms (Mayo Clinic, 2020):

Constipation
Depression
Forgetfulness
Dry skin
Tiredness
Cold feeling
Weight gain
Memory impairment
Reduced heart rate
Thinning of hair
Irregular or heavy menses
Muscle pain/stiffness/tenderness
Swelling/stiffness/pain in joints
Increase in blood cholesterol level
Hoarseness
Puffy face

The atypical symptoms of hypothyroidism substantiate the requirement of the TSH blood test for its diagnosis. Hypothyroidism inherits between generations. Accordingly, individuals with a family history of hypothyroidism experience an elevated risk of developing the disease. The annual testing of TSH is necessarily required to evaluate/rule out the development of hypothyroidism in predisposed individuals.

What Are the Risk Factors of Hypothyroidism?

Some of the significant risk factors of hypothyroidism include the following:

Pregnancy or postpartum complications
History of partial thyroidectomy
Radiation therapy to upper chest and neck
Anti-thyroid therapy
Autoimmune diseases, including celiac disease and type-1 diabetes mellitus
Family history of thyroid complications
Age greater than 60 years
Female gender

How Is Hypothyroidism Tracked or Diagnosed?

No well-defined characteristic symptoms/clinical manifestations of hypothyroidism have been reported so far in the medical literature (American Thyroid Association, 2020). Sometimes, hypothyroidism symptoms remain undiagnosed or unexplored due to other co-morbidities and their clinical manifestations. The physicians, therefore, require careful observation of the clinical history and symptoms of the patients suspected of hypothyroidism. They require observing the following points while recording the personal/family history of the suspected patients:

The family history of thyroid disease
Medication history based on thalidomide, interleukin-2, interferon-alpha, lithium, and amiodarone
Personal history of radiation therapy for neck cancer
Personal history of thyroid surgery
Health-related changes leading to a reported slow-down in the body’s physiological processes

The physical assessment should effectively evaluate/rule out the following attributes:

Reduction in heart rate
Decreased reflexes
Swelling over the thyroid gland
Dry skin

The following lab tests help in diagnosing hypothyroidism in the suspected patients:

TSH level indicates the body’s overall T4 (thyroid hormone) demand. The elevated TSH level in blood reveals the body’s increased requirement for producing T4. Accordingly, the TSH test helps in tracking T4 level elevation in the context of diagnosing hypothyroidism.
Thyroxine binding globulin attaches a major portion of T4 while disallowing its transport into the body tissues. The unattached T4 (constituting 1–2 percent of the entire T4) enters into the body tissues to support their normal physiology. The tests including free T4 index and free T4 help in evaluating the serum concentration of unaffixed T4 in the human body.

Are There Any Complications?

Hypothyroidism, if left untreated, results in the development of the following complications:

Birth defects
Infertility
Myxedema
Peripheral neuropathy
Mental health complications
Cardiac problems
Goiter

How Is It Treated?

Hypothyroidism cannot be cured; however, regular maintenance of T4 and TSH levels is possible through dietary interventions, exercise, and medication. The functional disruption of the thyroid appears reversible in individuals affected with viral thyroiditis. Pregnancy-induced hypothyroidism also reverses with time.

T4 replacement therapy is an approved intervention for normalizing the level of thyroid hormone in hypothyroid patients. The administration of synthetic thyroxine pills helps to overcome free T4 deficiency in hypothyroid patients. However, synthetic thyroxine is not recommended for patients affected by life-threatening hypothyroidism or severe myxedema.

Some hypothyroid patients who do not benefit from thyroxine alone require the co-administration of Cytomel® (T3) to enhance their therapeutic outcomes. Hypothyroid patients require modifying their thyroxine dosage based on their clinical manifestations under medical supervision.

What Are the Risks Associated With Synthetic Thyroxine?

The excessive administration of synthetic thyroxine increases the risk of the following symptoms (American Thyroid Association, 2020):

Skipping/racing heart
Shortness of breath
Muscle weakness
Exercising difficulty
Feel of hotness and shakiness
Nervousness
Appetite elevation
Sleeping difficulty
Fatigue

Is It Possible to Prevent or Control Hypothyroidism?

The primary prevention of hypothyroidism is based on reducing the risk factors among healthy individuals. The secondary prevention of hypothyroidism is based on occult disease screening (Cooper & Ridgway, 2002). However, tertiary prevention is based on reducing the risk of thyroid hormone overdose and iatrogenic disease. The optimal medical care for hypothyroid patients is highly needed to effectively reduce the risks of severity enhancement of their disease condition (Azizi et al., 2018). Some of the significant measures for reducing the risk of autoimmune hypothyroidism are mentioned below (Laurberg et al., 2013).

Smoking cessation
Optimization of dietary iodine
Alcohol intake moderation

The regular assessment of TSH and FT4 is highly required during levothyroxine therapy to check the disease intensity. Some hypothyroid patients experience a persistently elevated TSH level based on the following factors (Chakera et al., 2012):

Thyroid hormone resistance
The activity of heterophil antibodies and their impact on laboratory assay
Autoimmune gastritis/celiac disease
Malabsorption
Consumption of levothyroxine with diet
Concomitant drug interactions
Reduced medication compliance
Inappropriate dosage of levothyroxine

Hypothyroid patients require controlling the above-mentioned factors to reduce the risk of their TSH elevation. Some of the commonly practiced hypothyroidism management measures include the following (Medical News Today, 2020).

Utilization of iodine supplements
Consumption of prenatal vitamins and iodized salt during pregnancy
Administration of vitamin D
Administration of probiotics

Can Hypothyroidism Be Treated With Herbs?

The below-mentioned herbs prove advantageous in treating the clinical manifestations of hypothyroidism or sub-clinical hypothyroidism in research settings (Metro, et al., 2018, Sinadinos & Herbalist, n.d.). However, you should consult with your primary healthcare provider before starting any treatments.

Aloe barbadensis miller juice
Astringents
Demulcents
Female hormone optimizing herbs
Immune system modulating herbs
Lymphatic herbs
Circulatory system stimulating herbs
Hepatics
Adrenal herbal tonics
Adaptogen herbs
Iodine rich seaweeds
Withania somnifera
Centella asiatica
Eleutherococcus senticosis
Panax quinquefolium
Panax ginseng
Glycyrrhiza glabra
Glycyrrhiza uralensis
Aralia californica
Oplopanax horridum
Codenopsis pilosula
Ganoderma sinensis
Schisandra chinensis
Rehmannia glutinosa
Berberis
Silybum marianum
Curcuma longa
Rumex crispus
Zanthoxylum americanum
Zingiber officinale
Ginkgo biloba
Crataegus oxycantha
Asclepias Asperula
Ceanothus americanus
Galium aparine
Phytolacca Americana
Phytolacca decandra
Vitex agnus-castus
Cimicifuga racemose
Angelica sinensis
Brassica nigra
Sinapis alba

References

American Thyroid Association. (2020). Hypothyroidism. Retrieved from https://www.thyroid.org/hypothyroidism/

Azizi, F., Mehran, L., Hosseinpanah , F., Delshad, H., & Amouzegar, A. (2018). Secondary and Tertiary Preventions of Thyroid Disease. Endocrine Research, 124-140. doi:10.1080/07435800.2018.1424720

Chakera, A. J., Pearce , S. H., & Vaida, B. (2012). Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Design, Development, and Therapy, 1-11. doi:10.2147/DDDT.S12894

Cooper, D. S., & Ridgway, E. C. (2002). Thoughts on Prevention of Thyroid Disease in the United States. Thyroid, 925-929. doi:10.1089/105072502761016566

Kostoglou-Athanassiou, I., & Ntalles, K. (2010). Hypothyroidism - new aspects of an old disease. Hippokratia, 14(2), 82-87. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895281/

Laurberg, P., Andersen, S., Pedersen, I. B., Knudsen, N., & Carlé, A. (2013). Prevention of Autoimmune Hypothyroidism by Modifying Iodine Intake and the Use of Tobacco and Alcohol Is Manoeuvring Between Scylla and Charybdis. Hormones, 30-38. doi:10.1007/BF03401284

Mayo Clinic. (2020). Hypothyroidism (underactive thyroid). Retrieved from https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284

Medical News Today. (2020). What is hypothyroidism? Retrieved from https://www.medicalnewstoday.com/articles/163729

Metro , D., Cernaro, V., Papa, M., & Benvengac, S. (2018). Marked improvement of thyroid function and autoimmunity by Aloe barbadensis miller juice in patients with subclinical hypothyroidism. Journal of Clinical and Translational Endocrinology, 18-25. doi:10.1016/j.jcte.2018.01.003

Patil, N., Rehman, A., & Jialal, I. (2020). Hypothyroidism. In StatPearls. Treasure Island (Florida): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519536/

Sinadinos, C., & Herbalist, C. (n.d.). Herbal Therapeutic Treatments for Hypothyroidism. Retrieved from https://www.americanherbalistsguild.com/sites/default/files/sinadinos_christa_-_herbal_support_for_hypothyroidism.pdf

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.