Hypothyroidism and Hyponatremia

Hypothyroidism and Hyponatremia – what are they and how are they different?

Hyponatremia is a condition that occurs when sodium levels in our blood drop below a certain level.  Sodium is extremely important for our body for regulating fluid balance, blood pressure, and for normal functioning of the nervous system.  Hyponatremia is also known as ‘water intoxication’ since it can be caused when water intake exceeds the capacity of the body to replace sodium levels.

Hyponatremia is the result of clinical abnormality, while hypothyroidism is a common disease that causes various clinical disorders, including coma, congestive heart failure, hypothermia and electrolyte disturbances. Long-standing severe hypothyroidism, especially in older patients, can cause Myxedema coma. Symptoms of hypothyroidism include extreme bradycardia, hypo-tension and delayed relaxation of deep tendon reflexes amongst many others.

Hyponatremia can be caused by certain medication intake including antidepressants, diuretics, vasopressin, and the sulfonylurea drugs.  It can also affect the mental state of the patient.  When optimum serum sodium levels in the body are altered, it affects blood pressure, heart rate, respiratory rate, and body temperature.

Interesting Questions about Thyroid:

What Are the Main Types of Thyroiditis?

Chronic thyroiditis

Called Hashimoto’s thyroiditis, it is by far the most common form. It begins so slowly that most people don’t know anything is wrong. Over time, the disease destroys thyroid tissue until permanent hypothyroidism results. Some patients with Hashimoto’s have normal thyroid functions (euthyroidism) with a goiter.

Subacute thyroiditis

It’s a less common form, with far fewer cases than in chronic thyroiditis. Often caused by a viral infection, the disease lasts for several months. Subacute thyroiditis is painful, causing a tender, swollen thyroid gland with pain throughout the neck. The pain usually responds to treatment with aspirin or other anti-inflammatory drugs. At first, gland destruction causes the release of stored thyroid hormones, inducing temporary hyperthyroidism. A month or two later, the patient may become hypothyroid, because the thyroid has been damaged and its hormone reserves used up. Most patients return to normal within six to nine months, but the hypothyroidism could be permanent.

Painless thyroiditis

It causes a painless swelling of the thyroid gland. When this disease occurs after pregnancy, it is called postpartum thyroiditis. The course of painless thyroiditis is otherwise similiar to painful subacute thyroiditis.

Acute thyroiditis

A rare disease, is caused by an acute infection. Patients with the disease become very sick and have a high fever. The neck is red, hot, and very tender. Acute thyroiditis is a medical emergency and must be treated with antibiotics and surgery.

What About Thyroid Cancer?

Are all thyroid lumps cancerous? How common is thyroid cancer?

Thyroid lumps (also called nodules) are growths in or on the thyroid gland. They occur in 4%-7% of the population. A thyroid nodule might cause your voice to become hoarse, or it could make breathing or swallowing difficult. However, it usually produces no symptoms and is discovered incidentally by you or your physician

More than 90% of these lumps are benign (not cancerous) and do not need to be removed. Thyroid cancer is found in only about 15,000 people each year and causes about 1,210 deaths per year. The most common form (papillary cancer) moves very slowly, and treatment is almost always successful when the cancer is detected early. A less common form (follicular cancer) also moves relatively slowly. Two less frequent forms of thyroid cancer (undifferentiated, or anaplastic, and medullary) are more serious.

Who can get thyroid cancer?

Anyone can get thyroid cancer. However, one group in particular has a higher risk: people who have had radiation to the head or neck. From the 1920s to the 1960s, x-ray treatments were used for an enlarged thymus gland, inflamed tonsils and adenoids, ringworm, acne, and many other conditions.

At that time, doctors thought the x-rays were safe. About 1 million Americans received the treatment, and some of these people will get thyroid cancer up to 40 or more years after receiving the treatment. We now know that radiation therapy to the head or neck increases the chance of developing thyroid cancer later in life. (Radioactive iodine treatments and x-rays used for testing do not increase the risk of cancer.)

Others at higher risk include a child or elderly person with a lump (nodule) in the thyroid. If a man has a thyroid nodule, it is more likely to be cancerous than if a woman has one.

What are the signs and symptoms of hypothyroidism?

Possible effects of hypothyroidism are:

  • slow heart rate (less than 70 beats per minute)
  • elevated blood pressure
  • feeling slow or tired
  • feeling cold
  • drowsy during the day, even after sleeping all night
  • poor memory
  • difficulty concentrating
  • muscle cramps, numb arms and legs
  • weight gain
  • puffy face, especially under the eyes
  • husky voice
  • thinning hair
  • dry, coarse, flaky, yellowish skin
  • in children, short height
  • constipation
  • heavy menstrual flow
  • milky discharge from the breasts
  • infertility
  • goiter (an abnormal swelling in the neck caused by an enlarged thyroid gland).

Have more questions? Need more answers? Check our Full Thyroid FAQ

Hypothyroidism and Hyponatremia Relationship

Although hyponatremia is known to cause hypothyroidism, scientists have so far failed to identify any clear and concrete relation between hypothyroidism and hyponatremia and thus the mechanism is largely not currently understood.  The main abnormality known to cause hyponatremia is when the Antidiuretic Hormone (ADH) is not controlling the regulation and balancing of blood levels of water correctly.

ADH  is manufactured in the hypothalamus part of the brain.  It’s stored in the posterior pituitary gland and is responsible for controlling water retention on the kidneys.  When it fails to do this correctly, and water levels in the blood get too high, the resulting drop in sodium concentration causes hyponatremia.

Hyponatremia is most commonly observed in hospitalized patients. It needs to be treated on an immediate basis, and this treatment must be adapted to the clinical situation.  Management is critical in order to prevent further complications and harm to the patient.

When sodium levels fall, brain cells swell up causing a cerebral oedema. Unfortunately however the brain, enclosed as it is by the skull, has very little room for expansion and if excessive swelling does occur, it can easily lead to brain damage.

Hyponatremia Symptoms

Important symptoms that can indicate altered sodium levels in the body include:

  • headache,
  • cramps,
  • confusion,
  • weakness

Severe hyponatremia is a life threatening problem if not carefully managed.  Diagnosis is generally via blood and urine tests.  Patients suffering from only mild hyponatremia can usually be cured by simply altering diet and lifestyle.  Patients who suffer from chronic hyponatremia need to take prescribed medicines and therapies to control it along with intravenous fluid and electrolyte replacement.

Donna Morgan

Donna Morgan

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