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|What Is Hypothyroidism?
Hypothyroidism is the most common type of thyroid disease and currently affects about 1.5 million Americans. The incident rate is much higher in women than in men. It is a condition where the thyroid gland (picture) does not produce enough hormones to keep the body's metabolism running at a normal rate. As a result, the whole body slows down leading to weight gain, tiredness, constipation, infertility and a tendency to feel the cold. Fortunately most women are diagnosed long before serious health problems develop and it is usually managed with oral pills. However some studies show that up to 50 percent of cases of depression are caused by an undiagnosed thyroid condition. Furthermore women with subclinical hypothyroidism (the stage of the disease before symptoms are noticed or diagnosed) are almost twice as likely as healthy women to have blocked arteries (atherosclerosis) and are twice a likely to have heart attacks. Screening for hypothyroidism is particularly recommended for pregnant women because it can cause serious pregnancy complications such miscarriage, preeclampsia and mental retardation of their baby.
Symptoms develop slowly and may not be noticeable for years. In fact they are often put down to other issues such as stress, aging or early menopause symptoms. The most common signs are:
Iodine deficiency is the most common cause of hypothyroidism in poor countries, but in the West most table salt or other staple food products have been iodized, so this is not a factor (see causes of thyroid disease). The two most common causes in the United States are:
Hypothyroidism can easily be detected with a thorough physical examination and blood tests. The doctor will take a full medical history asking about any previous exposure to radiation and if you have taken any medications linked to causing the condition. He will check the size of your thyroid and look for signs of inflammation. He will also check your skin and nails for signs of dryness and your arms and legs for any swelling. Next he will order some thyroid tests, usually a TSH and T4 blood test. These are highly sensitive and accurate tests which should give a clear diagnosis either way. If the results are positive, the doctor may order an antibody test. This will check to see if your condition is caused by an autoimmune disorder like Hashimoto's disease.
For most people, treatment is simple. If their hypothyroidism is caused by the removal of their thyroid or Hashimoto's disease, treatment involves taking daily thyroid-hormone replacement pills. Levothyroxine is the most commonly prescribed drug. In elderly patients, particularly those with heart disease, doctors start by prescribing the lowest possible dose and raise it until their TSH levels return to a normal range. Doctors tend to start younger patients on the full dose immediately. There has been some debate in the medical community as to what constitutes a 'normal' TSH range. Traditionally it has been considered 0.5 to 5 mU/ml. However many doctors dispute this and insist the range is much narrower and should be considered 0.5 to 2.5 mU/ml. Some doctors use the wider range, some the narrow range. If you are being given medication and don't feel it is working, ask your doctor to test your TSH level. If it is between 3 and 5, ask him to increase your dosage (he may be working on the older 0.5-5 range). After changing dosage you need to wait 4 to 6 weeks before testing your TSH levels, it takes this time to impact the lab tests.
In most cases medications return your thyroid levels to normal, but they only stay that way as long as you keep taking the meds. So in answer to the question: Yes, more than likely you will need to keep taking your pills for life. However, there is an exception. Up to 25 percent of patients with autoimmune hypothyroidism (such as Hashimoto’s) can return to normal thyroid function after a number of years of treatment. This is because the antibodies that caused the problem in the first place might disappear from their system over time. If you have autoimmune hypothyroidism and you have been taking meds for several years, talk to your doctor about stopping treatment for 4 to 6 weeks, and then check your TSH levels. You might be one of the lucky ones! However, never stop taking your pills without your doctor's consent.
Most cases of hypothyroidism in the United States are caused by Hashimoto's disease, and there is no known way to prevent this disease. The best thing you can do is screen for thyroid problems every 5 years after the age of 35. That way, at least you can catch the condition in it's earliest stage when it is least likely to cause any complications.
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