Centres of Excellence -> Endocrinology and Diabetes -> Hypothyroidism

Hypothyroidism (underactive thyroid)

What is hypothyroidism?

Hypothyroidism is a functional form of thyroid dysfunction characterized by a reduced level of thyroid hormones T4 and/or T3. Women are more often affected.

What are the causes of hypothyroidism?

The most common cause of hypothyroidism in our part of the world is Hashimoto's disease, followed by the use of certain medications, the condition after removal of the thyroid gland or the use of radioiodine treatment and excessive iodine intake (excess iodine interferes with the synthesis of thyroid hormones!). Other etiological factors include irradiation of the head and neck, congenital thyroid deficiency and acute and subacute inflammation of the thyroid gland.

Changes within the hypothalamus and pituitary gland can also cause hypothyroidism. The causes of congenital hypothyroidism are changes in genes such as TPO, TSHR, PAX8, FOXE1, SLC26A4 and AIRE. The condition in which we find elevated TSH values, with still normal values of T4 and T3 hormones, is called subclinical (latent) hypothyroidism. Only about 20% of patients show clinically serious symptoms, while the rest have mild or moderate symptoms or are without them, which delays timely diagnosis and treatment.

What are the symptoms of hypothyroidism?

Some of the most common complaints are chronic fatigue, general weaknes, lethargy, general physical and mental slowness, drowsiness, enlargement of the thyroid gland, difficulties with concentrtion, forgetfulness, decreased appetite, weight gain, puffy face, hoarse voice, yellowish skin color, body chills, stool constipation, dry and scaly skin, cracked nails, hair loss, swelling of body parts and menstrual cycle disorder.

Extreme and untimely detected cases are presented by extremely slow heart rate, heart rhythm disorders, fluid in the chest or abdomen, anemia and swelling of the body. Myxedema coma is an extremely severe form of hypothyroidism that is characterized by low body temperature with extreme hypothermia, slowed breathing and heart rate, fluid in the chest and/or abdomen, generalized swelling of the body with the development of heart failure and death.

Diagnostics and treatment

The diagnosis is made by specialist and ultrasound examination, laboratory evaluation of TSH and thyroid hormone, sometimes with the evaluation of antibodies, while thyroid scintigraphy is rarely necessary.

The principle of treatment of hypothyroidism includes replacement treatment with thyroid hormones (T4, and sometimes T3). There are several types of drugs on the market today for the treatment of hypothyroidism.

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