What can you do if you have hypothyroidism?

This condition is also referred to as hypothyroidism. A healthy thyroid function is essential for the human body, as it plays a central role in many bodily processes. Both an overactive and an underactive thyroid can lead to serious health consequences. In its early stages, hypothyroidism causes barely noticeable symptoms. Over time, however, untreated hypothyroidism can lead to other health problems, such as high cholesterol levels and heart issues (Mayo Clinic, 2022). In this blog, we will inform you about the symptoms and causes of hypothyroidism and the options you can use to improve its function.

Table of Contents

• Functions of the thyroid gland
• The importance of thyroid hormones
• What is the difference between hypothyroidism and hyperthyroidism?
• What symptoms are associated with hypothyroidism?
• Causes of hypothyroidism
• Diagnosis of hypothyroidism
• Treatment of hypothyroidism
• Complications of untreated hypothyroidism
• How can I improve my thyroid function?

Functions of the thyroid gland

The thyroid is a small gland located in the front part of the neck. It is part of the endocrine system, a network of organs that control many important functions in the human body through the production and release of specific hormones. The main function of the thyroid is to regulate metabolism and thus also the production and release of energy in the body. All cells in your body need energy to function. If your thyroid is not working properly, it has a negative impact on your entire body (Cleveland Clinic, 2022).

The importance of thyroid hormones

To understand how hypothyroidism develops, it is important to know the basics about the different thyroid hormones. The amount and release of thyroid hormones are regulated in the brain. The hypothalamus in the brain first releases thyrotropin-releasing hormone (TRH), which stimulates a part of the pituitary gland to release thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid to release thyroxine (T4) and triiodothyronine (T3) (Cleveland Clinic, 2022). The amount of TSH in the blood fluctuates depending on how much T3/T4 is present. To produce thyroid hormones, the thyroid needs iodine, a trace element. Since our bodies cannot produce iodine on their own, it must be consumed through food (primarily iodized table salt) and water. If you have too much or too little iodine in your body, it can affect the production and release of thyroid hormones (IQWiG, 2010). The two most important thyroid hormones are:

• Tetraiodothyronine (Thyroxine / T4): A distinction is made between bound T4, which is attached to proteins in the blood, and free T4 (FT4), which can be converted by the body into the active hormone T3. This process is called deiodination.

• Triiodothyronine (T3): T3 also exists in both bound and free form (FT3) in the body.

Together, T4 and T3 regulate your body's energy consumption and thus affect almost all of your organs. They influence metabolism, respiration, digestion, body temperature, fertility, and brain development (Cleveland Clinic, 2022). The thyroid also produces the hormone calcitonin, which is involved in calcium and bone metabolism (IQWiG, 2010).

What is the difference between hypothyroidism and hyperthyroidism?

While hypothyroidism refers to an underactive thyroid that does not produce enough thyroid hormones, hyperthyroidism is the opposite. In hyperthyroidism, the thyroid is overactive and produces too many thyroid hormones. An overactive thyroid increases the body's metabolism and can lead to symptoms such as weight loss, hand tremors, and a rapid or irregular heartbeat (Mayo Clinic, 2022). In hyperthyroidism, the levels of T3/T4 in the blood are typically high, while TSH levels are low.

What symptoms are associated with hypothyroidism?

The symptoms of hypothyroidism depend on the severity of the condition. The issues develop gradually, often over several years.

• Fatigue and weakness

• Sensitivity to cold

• Dry skin and thinning hair

• Unintended weight gain

• Muscle weakness, pain, and stiffness

• Irregular or heavy menstrual cycles

• Slowed heart rate (bradycardia)

• Depression

Source: Mayo Clinic, 2022

Causes of hypothyroidism

In hypothyroidism, there is a disruption in thyroid hormone production. The causes are divided into primary and secondary causes. Primary hypothyroidism is caused by a condition that directly affects the thyroid so that it cannot produce enough thyroid hormones. Secondary hypothyroidism occurs when the pituitary gland’s ability to produce TSH, which instructs the thyroid to produce thyroid hormones, is impaired (Cleveland Clinic, 2020). Causes of primary hypothyroidism include:

• Autoimmune diseases: The most common cause of hypothyroidism is Hashimoto’s disease. This is an autoimmune disorder in which the body’s immune system attacks and damages the thyroid gland (NIDDK, 2021). The exact reasons for the development of Hashimoto’s are unclear, but genetics appear to play a role.

• Thyroid inflammation (thyroiditis): When the thyroid becomes inflamed, stored hormones may initially be released into the bloodstream, temporarily increasing hormone levels. This is known as thyrotoxicosis. If the inflammation remains untreated, it can lead to hypothyroidism.

• Congenital hypothyroidism: This refers to hypothyroidism that is present at birth.

• Medical and surgical procedures: In the treatment of other thyroid conditions, such as thyroid nodules (benign thyroid tumors), part or all of the thyroid gland may be removed.

• Radiation therapy to the thyroid: Treatment with radioactive iodine, for example in hyperthyroidism or head and neck tumors, can damage thyroid tissue and cause hypothyroidism.

• Certain medications: Some medications can interfere with the production of thyroid hormones and lead to hypothyroidism. These include certain heart medications and cancer treatments.

• Iodine deficiency: In rare cases, iodine deficiency can contribute to hypothyroidism.

Source: NIDDK,2021

Secondary causes include disorders of the pituitary gland that result in insufficient TSH production to stimulate the thyroid (Mayo Clinic, 2022).

Diagnosis of hypothyroidism

Since thyroid hormones perform essential functions in our bodies, it is important that their levels remain within the normal range, which is considered healthy. To diagnose hypothyroidism, a blood test is performed to determine the level of thyroid hormones in your blood (NHS, 2021). If you have symptoms that you suspect may be related to a thyroid issue, it is important to get tested so that treatment can begin as soon as possible. You can request this from your general practitioner or use a home test from Homed-IQ. The Homed-IQ at-home thyroid test measures free T3, T4, and thyroid-stimulating hormone (TSH) levels in your blood. The blood sample is analyzed by medical professionals in a certified laboratory, and the results are then shared with you. You can print your lab analysis and discuss it with your doctor if necessary.

Treatment of hypothyroidism

Hypothyroidism is a condition that can be well treated. In most cases, the missing hormones are replaced with appropriate medication. A commonly used medication is levothyroxine, which increases the amount of thyroid hormones in the body. Depending on the cause and severity, many people need to take medication for life to maintain a stable hormone balance, but they can still lead a normal and healthy life. In very mild cases, hypothyroidism may even improve on its own (Cleveland Clinic, 2020). In case of uncertainty or doubt, a doctor should always be consulted.

Complications of untreated hypothyroidism

Because thyroid hormones are essential for metabolism, untreated hypothyroidism can lead to elevated low-density lipoprotein cholesterol (LDL) and serious heart problems such as heart failure and heart disease. In addition, a goiter (enlarged thyroid) may develop, which can cause difficulty swallowing and breathing (Mayo Clinic, 2022). Long-term hypothyroidism can also affect fertility and lead to nerve damage (neuropathy) over time. In the context of pregnancy, diagnosing hypothyroidism is especially important. If a pregnant woman has hypothyroidism, it can have serious consequences for the fetus. Thyroid hormones are essential for normal brain development and growth of the fetus (Johns Hopkins, 2023).

How can I improve my thyroid function?

• Know your risk: In order to detect hypothyroidism early, it is important to watch for possible symptoms and get tested if necessary. Women are more often affected by hypothyroidism than men, and the risk increases with age, especially over 60 (NIDDK, 2021).

• Support your energy levels: Many people with hypothyroidism experience fatigue and weakness. Therefore, it can be helpful to support the body with healthy habits. These include drinking enough water, moderate exercise, good sleep, and stress management (NHS, 2021).

• Consume foods that support your thyroid:

  • Iodine: An essential measure for maintaining thyroid health is ensuring an adequate iodine intake. Only then can the thyroid produce hormones. Most people get enough iodine from iodized salt or iodine-enriched foods. Other sources include cheese, cow's milk, eggs, saltwater fish, and soy sauce (Cleveland Clinic, 2022).

  • Vitamin B: Vitamin B12 is also associated with the thyroid. A B12 deficiency is very common in hypothyroidism (about 40%) (Jabbar et al., 2008). Vitamin B12 naturally occurs in animal-based foods, including fish, poultry, eggs, and dairy products (NIH, 2022).

  • Selenium: This nutrient is important for the formation and metabolism of thyroid hormones. Pork, beef, turkey, fish, shellfish, and eggs contain high levels of selenium. Some beans and nuts, such as Brazil nuts, are also rich in selenium (NIH, 2021). Adequate selenium intake is necessary to prevent thyroid disorders (Ventura et al., 2017).

  • Vitamin D: Low levels of vitamin D are associated with autoimmune hypothyroidism. People with Hashimoto’s thyroiditis, an autoimmune thyroid disease, have lower vitamin D levels (Mackawy, 2013). In addition to sunlight, vitamin D can also be obtained through foods like fatty fish (salmon, tuna, mackerel, sardines), beef liver, mushrooms, and egg yolks (Cleveland Clinic, 2022).

• Avoid foods that interact with thyroid medications:
  If you have already been diagnosed with hypothyroidism and are taking medication, some foods can alter the effectiveness of the medication. Avoid taking your thyroid hormones at the same time as walnuts, soy flour, iron supplements or multivitamins containing iron, and calcium supplements (Mayo Clinic, 2021).