Hypothyroidism

Note: I don't usually write about health/medical topics, but I fear this subject may be neglected too often in people of my age. I'm not a medical professional, although I frequently research health related topics. I also believe that in this age we should be more knowledgable about things that affect us. Resources do exist that enable us to do our homework on most topics and not jump to conclusions prematurely.

As we get old, we experience some declines in general health. Sometimes, as a result, we may simply overlook some issues that can be successfully treated or cured. One of the most interesting, and annoying experiences of women as they age is cold sensitivity. While most would group that symptom with all the other old age ailments, it is really quite significant. Cold sensitivity and unexplained weight gain are two of the symptoms of Hypothyroidism, which is very common in women over 60. Unfortunately primary care physicians don't include that as one of the routine tests. 

What is it?

Hypothyroidism, also called underactive thyroid, is when the thyroid gland doesn’t make enough thyroid hormones to meet your body’s needs. The thyroid is a small gland in the front of your neck. Thyroid hormones control the way the body uses energy, so they affect nearly every organ in your body, even the way your heart beats. Without enough thyroid hormones, many of your body’s functions slow down. 

Who gets it

Women are much more likely than men to develop hypothyroidism. The disease is also more common among people older than age 60.  Between ages 35 and 65, about 13% of women will have an underactive thyroid, and the proportion rises to 20% among those over 65. Because the link between hypothyroidism symptoms and thyroid disease isn't always obvious, especially in older people, many women won't know they have an underactive thyroid — and won't be treated for it. 

How it works

The thyroid releases thyroxine, a hormone that controls many of your bodies functions, and your body in general. It appears that the thyroid is instrumental in converting food into energy and allowing muscles are organs to stay strong. With hypothyroidism your body is simply neglected. For example, it fails to regulate body temperature, hence always feeling cold. Your skin, which is how you sense heat and cold, is also neglected in other ways. Your skin may be drier, and you may experience episodes of psoriasis. You may also notice a decrease in the ability to sweat. Many studies have also shown that wounds may also heal much slower.

When your body fails to adequately convert food into energy, you may also be more tired, and yet insomnia is common as well. The inability to convert food to energy may be the reason unexplained weight gain is so common, even though you may want to eat less; the food is stored in fat cells. This inability results in "slowed-down cells" which burn less energy, so the body produces less heat.

Symptoms

With hypothyroidism, you will have some or more of these symptoms. Symptoms can vary from person to person though it appears the worse it gets the more symptoms you may notice.

The symptoms you are most likely to notice include

Cold Intolerance

One of the functions of the thyroid is to regulate body temperature. With an under-active thyroid, that function may be neglected. Also, with slower metabolism you cells burn less energy and produce less heat.

Dry Skin and slow-healing wounds

Also as a result of slowed metabolism, your skin may be neglected the moisture it needs to function properly. This may result in dry and flaky skin. This can result in slow-healing wounds. There may also be a link to psoriasis. Likewise your  nails may become brittle, hair may thin or become coarse.

Fatigue and Irritability

When your body doesn't convert food into energy as needed, you may be tired most of the time. Irritability is also common, possibly due to fatigue.

Weight gain 

If food isn't converted to food readily, you body must store it. 

Constipation

Slowed down cells may affect every organ in your body. You may not notice a slowed heart rate, or other inadequately functioning organs, but constipation will likely be noticeable. In additon to slower functions,  you lack of energy may also contribute to a slower bowel movements.

Other symptoms may include

  • decreased sweating
  • dry, thinning, coarse hair
  • brittle nails
  • appetite loss, weight gain
  • insomnia or fitful rest
  • depression
  • slowed heart rate (reducing blood flow to other organs)
  • high blood pressure
  • higher LDL and total cholesterol
  • Constipation (due to slower digestion)
  • Muscle and joint pain

Testing

Although you may have many of these symptoms, determining if you have hypothyroidism depends on blood tests. There are two types (levels) of blood tests for hypothyroidism, the TSH and the T3, T4 tests.

TSH (Thyroid stimulating hormone) is the initial test that determines how much the thyroid needs provoking to do its job. The normal range presented on test results is between 0.4 and 4.0. 

TSH levels are determined by ranges (all figures in mU/L—milliunits per liter). Below are the ranges, according to the American Thyroid Association. However, these numbers are not set in stone. Normal ranges can vary by individual, and they can even change over the course of a day. 

  • 0.4: normal
  • 2.5: at risk
  • 4.0: mild hypothyroidism
  • 10.0: hypothyroidism.

Even though your results do not show you have hypothyroidism, if you have the most common symptoms you should go to the next testing phase. At this point you will likely want to start seeing an endocrinologist.

If you have secondary hypothyroidism, TSH may be low or normal and mask secondary hypothyroidism where the pituatary glands doesn't release TSH. 

T3/T4 Testing 

T4 tests for hormone throxine that the thyroid releases. T3 tests for the triiodothyronine released by the thyroid. These two hormones regulate your body’s temperature, metabolism, and heart rate. Both tests have a variant that measures the amount of these hormones that have not yet bound with protein. The most commonly used tests seem to be the Free T4 and Total T3, though other tests may be used depending on the type of hypothyroidism. Not only do these tests determine if you have hypothyroidism, they are also instrumental in determining the treatment.

Treatment

Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism. You'll likely start to feel better soon after you start treatment.

Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage.

Levothyroxine is best taken on an empty stomach at the same time every day. Ideally, you'll take the hormone in the morning and wait an hour before eating or taking other medications. If you take it at bedtime, wait four hours after your last meal or snack. If you miss a dose of levothyroxine, take two pills the next day. 

Risks

While some of symptoms of hypothyroidism may be dismissed as just uncomfortable annoyances, if left untreated hypothyroidism can cause serious health problems. With the slowed heart function, blood flow, and changes in cholesterol, heart failure becomes a serious concern. Although it is rare, untreated hypothyroidism may lead to myxedema coma, an extreme form of hypothyroidism in which the body’s functions slow to the point that it becomes life threatening.

 

Research

https://www.niddk.nih.gov/health-information/diagnostic-tests/thyroid

https://www.endocrineweb.com/conditions/hypothyroidism/hypothyroidism-diagnosis

https://www.health.harvard.edu/diseases-and-conditions/the-lowdown-on-thyroid-slowdown

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

https://www.uptodate.com/contents/hypothyroidism-underactive-thyroid-beyond-the-basics#H12

https://www.uclahealth.org/endocrine-center/hypothyroidism-secondary

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