Hypothyroidism Symptoms: The Great Masquerade

Hypothyroidism Symptoms: The Great Masquerade

Hypothyroidism symptoms are very generalized, vague and occur very gradually.  Often a diagnosis of hypothyroidism is only reached after blood tests for a symptom that may be associated with the possibility of hypothyroidism (a low functioning thyroid gland).  There is a whole constellation of symptoms that fall into this category and some of them will be outlined here.  It is important to remember that in some people there may be no symptoms at all.

The thyroid gland is situated in the neck below the Adam’s apple and should generally not be felt.  In some thyroid conditions there is an enlargement of the gland called a goiter and this may occasionally be the first sign of problems.  The gland is responsible for setting the level of energy utilization in the body, also called the metabolism.  It does this by secreting the thyroid hormones, namely thyroxine (T4) and triiodothyronine (T3).

Hypothyroidism symptoms occur when there are low circulating thyroid hormones, or interference with the activity of thyroid hormones.  Because thyroid hormone levels affect every cell in the body, symptoms are very diverse.

General symptoms include fatigue, cold intolerance and weight gain in the absence of increased appetite.  There may even be a decrease in appetite.  Elevated levels of lipids (fats) including cholesterol in the blood (hyperlipidaemia) may also be a sign of hypothyroidism.  The voice may change, becoming hoarse and there may be generalised aches and pains in the muscles and joints.  One may notice that they are becoming hard of hearing.

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Hypothyroidism Symptoms Affecting The Skin

Hypothyroidism symptoms that affect the skin include dryness and scaling.  The skin may be cold to touch.  The hair is coarse and brittle and there may be noticeable balding.  The complexion is pale, but there may be a flushing of the cheeks.  Sometimes there are discrete white patches on the skin called vitiligo.

Interesting Questions about Thyroid:

Thyroid Hormone Pills

When are thyroid hormone pills used?

Thyroid hormone pills provide the body with the right amount of thyroid hormone when the gland is not able to produce enough by itself. The pills are frequently needed after surgery or radioactive iodine therapy.

Thyroid hormone tablets are the standard treatment for hypothyroidism. While symptoms usually get better within a few months, most patients must take the pills for the rest of their lives. This is especially true for hypothyroidism caused by Hashimoto’s thyroiditis or radioactive iodine treatment.

If the entire thyroid gland has been surgically removed, thyroid hormone tablets replace the body’s own source of the hormone. If only a part of the gland has been removed, the pills may keep the remaining gland from working too hard. This decreases the chance that the thyroid gland will grow back.

How much hormone do I need?

The preferred hormone for treatment is levothyroxine (T4). You should use only the brand-name that your doctor prescribes, since generic brands may not be as reliable. Name-brand levothyroxine pills include Synthroid®, Levoxyl®, Levothroid®, Euthyrox®, and Eltroxin®.

Patients sometimes take more pills than they should, trying to speed up the treatment or lose weight. However, this can lead to hyperthyroidism and long term complications, such as osteoporosis. You should take the pills as your doctor prescribes.

At different times in your life, you may need to take different amounts of thyroid hormone. Therefore, you should see your doctor at least once a year to make sure everything is all right.

® Synthroid is a registered trademark of Knoll Pharmaceuticals.
® Levoxyl is a registered trademark of Jones Medical Industries.
® Levothroid is a registered trademark of Forest Pharmaceuticals.
® Euthyrox is a registered trademark of EM Pharma.
® Eltroxin is a registered trademark of Roberts Pharmaceuticals.

Are thyroid hormone pills needed after treatment for hyperthyroidism?
Many patients treated for hyperthyroidism become hypothyroid. They will need to take thyroid hormone pills for the rest of their lives. In addition, they will need to see their doctor at least once a year.

What is Exophthalmos?

Hyperthyroidism from any cause can make the upper eyelids pull back, but Graves’ disease often causes one or both eyes to bulge out of their sockets. This condition, known as exophthalmos, can cause loss of eye muscle control, double vision, and (rarely) loss of vision. Most cases require no treatment, but some patients may need to see an eye doctor (ophthalmologist) for specialized treatment. This may include steroids, radiation, or surgery.

Surgery (Thyroidectomy)

When is surgery performed?

Surgery (thyroidectomy) is the primary treatment for suspected thyroid cancer and can be used to treat hyperthyroidism. Surgery is used to remove large goiters that make breathing or swallowing difficult. Occasionally, a goiter may be removed for cosmetic reasons.Can you tell me more about cancer surgery?

If thyroid cancer is suspected, your doctor will recommend surgery. The surgeon usually removes only one lobe of the thyroid, unless cancer is confirmed at surgery. A section of the gland is tested during surgery (frozen section) to tell the surgeon whether it is cancerous (malignant) or not cancerous (benign). If it is malignant, all or most of the thyroid is removed. If the cancer has spread outside of the thyroid, lymph nodes in the neck may also have to be removed. In addition, radioactive iodine therapy may be needed six weeks after surgery to destroy any remaining cancer tissue.

How is the cancer surgery operation done?

The operation is usually performed under general anesthesia and takes about two hours. After surgery, patients may stay in the hospital for up to three days. They may also need to take some time off from work (a week or two for a desk job and three to four weeks for physical labor).

Are there any risks to thyroid surgery?

Thyroid surgery is a safe treatment. However, as with any surgery, there are risks. About 1% of patients develop problems with normal speech caused by damage to nerves leading to the voice box, which lies very close to the thyroid. Occasionally, there may be damage to the parathyroid glands, which control the level of calcium in the blood. If this happens, the patient will need to take calcium and other medicines to prevent future problems. Minor risks of surgery include infection, bleeding, and a scar. The chance of death is very small.

What can be expected with thyroid surgery?

  • Patients will be in the hospital for one to three days.
  • Surgery is usually done under general anesthesia and lasts about two hours.
  • A small cut approximately three to four inches long is made along the natural crease of the neck.
  • After going to the recovery room for a few hours, patients are returned to their rooms. Patients can usually get out of bed, eat, and have visitors the evening of the surgery.
  • It can take up to a year for the scar to heal and the redness to disappear.
  • Because most of the thyroid gland is removed, some patients will have to begin lifelong thyroid hormone replacement.

What are the possible complications of thyroid surgery?

  • The four parathyroid glands located around the thyroid gland can be accidentally damaged causing low calcium levels that can lead to muscle spasms, convulsions, and the formation of cataracts, if untreated.
  • Minor voice changes are not uncommon, but only 1% of those operated on have major voice problems. The nerves from the larynx (voice box) are very near the thyroid gland and sometimes pass through the gland. It is sometimes unavoidable that they are damaged during surgery.
  • As with any surgery, there is the risk of surgical death, bleeding, and infection.

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

Hypothyroidism Symptoms Affecting The Circulatory System

The symptoms involving the blood and heart include anaemia and a slowing of the heart rate (below 60 beats per minute).  This condition is called bradycardia.  One may suffer from chest pains and there may be swelling of the ankles from the heart failing to pump.

Hypothyroidism Symptoms Affecting The Reproductive System

The symptoms relating to the reproductive system include impotence in men.  In women there may be heavy periods.  In both men and women there may be an increase in the level of prolactin in the blood.  This hormone regulates the secretion of milk from the breast and so there may also be inappropriate mild production and leaking.

Psychiatric Hypothyroidism Symptoms

There are some interesting psychiatric symptoms associated with hypothyroidism.  Depression is the commonest symptom and all sufferers need to have their levels checked.  Myxoedema madness is a bizarre condition which involves agitation, delusions, paranoia and even hallucinations.

Hypothyroidism Symptoms Affecting The GI Tract

Hypothyroidism symptoms involving the stomach and intestines include constipation of recent onset.  There may be decreased appetite and weight gain as described above.

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Collect your sample, mail it back in the prepaid envelope, and receive results by email or phone.

Congenital Hypothyroidism

Hypothyroidism symptoms may occur in childhood.  If there are insufficient thyroid hormones from birth, the newborn is said to have congenital hypothyroidism.  The symptoms include slowing of growth and developmental delay.  There is also intellectual disability.  Newborn screening and early treatment with synthetic thyroxine has good results.  In older children there may be delay in puberty.

Occasionally symptoms may be very unusual and present in a variety of ways.  There may be a decreased body temperature below the normal.  There may be fluid accumulations around the heart and lungs.  There may be paralysis of the gut with severe abdominal pain.  Some sufferers may have seizures or even coma.

As can be seen, hypothyroidism symptoms are varied and generalized.  They often present very slowly and sufferers may not notice that they are becoming unwell.  In some there may be no symptoms at all.

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