Hypothyroidism and Hashimoto's Disease

Hypothyroidism, or an underactive thyroid gland, is the most common thyroid disorder.  With this condition, the thyroid gland is unable to release enough thyroid hormone into the blood.

The diminished level of thyroid hormone decreases your metabolism and affects your entire body by slowing down many of its functions. Left untreated, hypothyroidism can raise your cholesterol levels and increase your risk for heart attack or stroke.

Although people of any age can develop hypothyroidism, it is more common in older adults, particularly women over the age of 60.

Hashimoto's disease—also known as Hashimoto's thyroiditis or chronic lymphocytic thyroiditis—is the most common cause of hypothyroidism in the United States. Hashimoto's disease, an immune disorder, occurs when one's own body makes antibodies to attack and destroy the thyroid cells. The resulting inflammation impairs the thyroid's ability to supply sufficient hormones and leads to hypothyroidism.

In addition to Hashimoto's disease, other common causes of hypothyroidism include surgery to remove the thyroid gland, radioactive iodine therapy for hyperthyroidism, and external-beam radiation therapy for certain types of cancer.

Whatever the origin, the symptoms of hypothyroidism can be slow to manifest and difficult to understand. Consequently, they are sometimes mistaken for other conditions, such as depression. Some of the most common signs include:  

  • Fatigue
  • Increased sensitivity and intolerance to cold
  • Depressed mood or feelings of sadness
  • Overall decreased levels of energy
  • Unexplained weight gain
  • Dry or rough skin
  • Puffy and swollen face
  • Constipation
  • Muscle weakness or cramps
  • Increased or irregular menstrual flow
  • Pain, stiffness or swelling in the joints
  • Impaired memory or difficulty thinking clearly
  • Slowed heart rate
  • Elevated blood cholesterol levels

Those with Hashimoto's disease may also develop a goiter and subsequent bulging neck.  

Diagnosis and Treatment

Your doctor will take a complete history and physical, and then order simple blood tests to check your levels of both thyroid hormones and the thyroid-stimulating hormones produced by the pituitary gland. High amounts of the latter indicate that your body is trying to correct the problem of not having enough thyroid hormone.

Once diagnosed, treatment for hypothyroidism is very straightforward. Because the goal is to restore your circulating thyroid hormones back to normal levels, your doctor will prescribe an oral synthetic thyroid hormone replacement.  These drugs, which are known to have very few risks or side effects, ultimately reverse the symptoms of the illness.   

Our team will then meet with you regularly to monitor your progress and test your blood to make sure that your medication dosage remains therapeutic. A patient usually maintains this treatment regimen for the rest of his or her life.

In the case of Hashimoto's, this approach usually alleviates the goiter condition, when present. However, if the goiter does not improve and is causing other problems—such as pain or difficulty swallowing, breathing or speaking—surgery to remove it may be required.

Diabetes, Hormones & Metabolism (Endocrinology)