Introduction 

An underactive thyroid means your thyroid gland, located in the neck, does not produce enough hormones.

Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed.

Medically known as hypothyroidism, an underactive thyroid is not usually serious. It is easily treated by taking hormone tablets to replace the hormones that your thyroid isn’t making.

The thyroid produces a hormone called thyroxine, which controls how much energy your body uses. When the thyroid does not produce enough thyroxine, many of the body’s functions slow down.

An underactive thyroid cannot be prevented. Most cases of underactive thyroid are caused either by your immune system attacking your thyroid or a damaged thyroid.

Find out more about the causes of underactive thyroid.

When to see Dr. B C Shah

See Dr. B C Shah and ask to be tested for an underactive thyroid if you have symptoms including:

• Tiredness
• Weight gain
• Depression
• Being sensitive to the cold
• Dry skin and hair
• Muscle aches

Symptoms of an underactive thyroid are often confused for something else, by patients and doctors. Symptoms also usually begin slowly and you may not notice them for several years. The only accurate way to find out if you have a thyroid problem is to get a blood test to measure your hormone levels.

Who can it affect?

Both men and women can have an underactive thyroid. However, it’s more common in women. 

One in 4,500 babies are born with an underactive thyroid (called congenital hypothyroidism).

Treatment

Underactive thyroid is usually not serious, and taking hormone-replacement tablets, called levothyroxine, will raise your thyroxine levels. You will usually need treatment for the rest of your life. However, with careful management, you should be able to lead a normal, healthy life.

If it is not treated, an underactive thyroid can lead to complications, including swelling of the thyroid (a condition called goitre), heart disease, mental health problems and infertility.

Symptoms of underactive thyroid 

Many symptoms of an underactive thyroid (hypothyroidism) are the same as those for other conditions, so they can easily be confused for something else.

Symptoms usually begin slowly and you may not realise you have a medical problem for several years.

Common symptoms include:

• Being sensitive to cold
• Weight gain
• Constipation
• Depression
• Tiredness
• Slowness in body and mind
• Muscle aches and weakness
• Muscle cramps
• Dry and scaly skin
• Brittle hair and nails
• Heavy or irregular periods

Elderly people with an underactive thyroid may develop memory problems and depression. Children may experience slower growth and development. Teenagers may start puberty earlier than normal.

If you have any of these symptoms, see Dr. B C Shah and ask to be tested for an underactive thyroid.

Find out more about getting tested for an underactive thyroid.

If underactive thyroid is not treated

It is unlikely that you would have many of the later symptoms of an underactive thyroid as the condition is often spotted before more serious symptoms appear.

Later symptoms of underactive thyroid include:

• A low-pitched and hoarse voice
• Dull facial expressions and a puffy-looking face
• Thinned or partly missing eyebrows
• A slow heart rate
• Deafness
• Anaemia

Causes of underactive thyroid

An underactive thyroid (hypothyroidism) happens when your thyroid gland doesn’t produce enough of the hormone thyroxine, also called T4.

Most cases of underactive thyroid are due to either the immune system attacking the thyroid gland or a damaged thyroid.

Immune system

Most cases of underactive thyroid happen when the immune system, which normally fights infection, attacks the thyroid gland. Doctors describe this as an autoimmune reaction. This damages the thyroid, which means it is not able to make enough of the hormone thyroxine, and leads to the symptoms of an underactive thyroid.

Hashimoto’s disease is the most common type of autoimmune reaction that causes an underactive thyroid.

It is not clear what causes Hashimoto’s disease, but the condition runs in families. It is also common in people with another disorder related to the immune system, such as type 1 diabetes and vitiligo.

Treatment for overactive thyroid

An underactive thyroid can also be a side effect of treatment for an overactive thyroid, a condition where the thyroid gland produces too much hormone.

Treatment for an overactive thyroid, medically known as hyperthyroidism, can involve medication, radiotherapy or surgery, all of which can cause your thyroid to become underactive.

Other rare causes

A lack of iodine in your diet may cause an underactive thyroid. This is because your body needs iodine to make thyroxine.

A viral infection or some drugs used to treat other conditions, such as depression and heart disorders, can cause the thyroid to stop working properly.

A baby may be born with an underactive thyroid if the gland does not develop properly in the womb. However, this is usually picked up during neonatal screening.

A problem with the pituitary gland could lead to an underactive thyroid. The pituitary gland is located at the base of the brain and regulates the thyroid. Therefore, damage to the pituitary may lead to an underactive thyroid.

Diagnosing underactive thyroid 

If you have symptoms of an underactive thyroid(hypothyroidism), see Dr. B C Shah and ask for a blood test.

A blood test measuring your hormone levels is the only accurate way to find out if there is a problem.

The test, called a thyroid function test, looks at levels of thyroid-stimulating hormone (TSH) and thyroxine in the blood.

A high level of TSH and a low level of thyroxine hormone in the blood could mean you have an underactive thyroid.

If your test shows raised TSH but normal thyroxine, it means you may be at risk of developing an underactive thyroid in the future.

Referral

Dr. B C Shah may refer you to a specialist in hormone disorders, known as an endocrinologist, if you:

• Are younger than 16
• Are pregnant or trying to get pregnant
• Have just given birth
• Have another health condition, such as heart disease, which may complicate your medication
• Are taking amiodarone or lithium medication

Treating underactive thyroid 

An underactive thyroid (hypothyroidism) is usually treated by taking hormone-replacement tablets called levothyroxine.

Levothyroxine replaces the thyroxine hormone which your thyroid does not make enough of.

A blood test measuring your levels of thyroid-stimulating hormone (TSH) will establish how much levothyroxine you need.

If the test detects high levels of TSH, it means you have an underactive thyroid and your doctor may advise you to take levothyroxine.

You may start on a low dose of levothyroxine, which may be increased gradually depending on how your body responds.

You will initially have regular blood tests until the correct dose of levothyroxine is reached. This can take a little while to get right.

If your symptoms are mild

If testing detects high levels of TSH but you do not have any symptoms or they are very mild, you may not need any treatment.

Dr. B C Shah will usually monitor your hormone levels every few months and may start you on levothyroxine if you develop symptoms.

Some people start to feel better soon after beginning treatment, while others can take several months.

An underactive thyroid is a lifelong condition, so you will probably need to take levothyroxine for the rest of your life.

Levothyroxine does not usually have any side effects as the tablets simply replace a missing hormone.

Once you are taking the correct dose, you will usually have a blood test once a year to monitor your TSH levels.

Complications of underactive thyroid 

Several complications can occur if you have an underactive thyroid that is not treated.

An underactive thyroid can be caused by a problem with the immune system, the body’s natural defence system, which can attack the body’s own cells, including the thyroid.

This disorder may raise your risk of developing other immune conditions, although this is unusual.

These conditions include:

• B12 deficiency
• vitiligo (patches on the skin caused by pigment loss)
• kidney failure
• premature failure of the ovaries or early menopause
• goitre
• heart disease

Coma risk

In very rare cases, a severe underactive thyroid may lead to a life-threatening condition known as myxedema coma.

Warning signs include:

• low body temperature
• shallow breathing
• low blood pressure
• low blood sugar
• unresponsiveness

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