Feeling depressed or forgetful?  How about being tired all of the time or notice your hair falling out?  Are you gaining weight for no reason?  I was just two years ago.  Luckily I went to my doctor with these symptoms and he ran some blood tests.  Guess what?  I had hypothyroidism.  Believe it or not – approximately 59 million Americans have this mysterious and often undiagnosed disease.  In fact, more people are affected by hypothyroid symptoms than diabetes, yet it is far less recognized or understood.  Hypothyroidism is more common than you would believe, and millions of people are currently hypothyroid and don’t know it.  What is it?  Very simply, the disease is an underactive thyroid.  Unfortunately, the common warning signs are often dismissed as stress, depression, aging, lifestyle, female problems or “all in the patient’s head”.  Even when diagnosed, hypothyroidism is frequently treated improperly, preventing millions from living and feeling well.

          The thyroid produces hormones that influence every organ, tissue and cell in the body.  The hormones also control heart rate, body weight, body temperature, energy level, muscle strength and menstrual regularity.  The thyroid is a small, butterfly-shaped gland located in the front of the neck that produces hormones, notably thyroxine (T4) and triiodothyronine (T3), which stimulate vital processes in every part of the body.  These thyroid hormones have a major impact on growth, the use of energy and oxygen, heat production, fertility, the use of vitamins, proteins, carbohydrates, fats, electrolytes and water, and immune regulation in the intestine.  Further, they can also alter the actions of other hormones and drugs.  The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body’s metabolism.  Since the main purpose is to “run the body’s metabolism,” it is understandable that people with this condition will have symptoms associated with a slow metabolism.    

          A diagnosis of hypothyroidism can be suspected in patients with fatigue, cold intolerance, constipation and dry, flaky skin.  Several other symptoms one could exhibit include hair loss, early graying of hair, menstrual irregularities, infertility, difficulty swallowing, an enlarged thyroid gland and erectile dysfunction (in men).  As the disease becomes more severe, there may be puffiness around the eyes, a slowing of the heart rate, a drop in body temperature and heart failure.  In its most profound form, severe hypothyroidism may lead to a life-threatening coma (myxedema coma).  Symptoms of this disorder include a severe drop in body temperature (hypothermia), delirium, reduced lung function, slow heart rate, constipation, urine retention, seizures, stupor, fluid build-up and finally coma.  It is uncommon, but may develop in untreated patients subjected to severe stress, such as infection, surgery or extreme cold.  Certain drugs (such as sedatives, painkillers, narcotics, amiodarone and lithium) may increase the risk as well.  Emergency treatment is required.  Mortality rates are high (30 – 60%) with the highest risks in older patients and those with persistent hypothermia or heart problems.

          Quite often doctors believe a patient’s symptoms are related to something else and many are left undiagnosed with hypothyroidism.  This mysterious disorder requires a blood test to confirm the diagnosis.  First, an elevated TSH (thyrotropin) level should be noted and thyroxine (T4) level determined.  Other thyroid tests are often run and may be helpful.  Measuring cholesterol levels is also important.  In addition, doctors should consider the age of the patient, the presence of other medical problems that may benefit from thyroid replacement treatment (such as heart failure or depression) and the presence of other medical problems that thyroid replacement therapy may worsen (such as osteoporosis).  Patients with overt hypothyroidism, indicated by clear symptoms and blood tests that show high TSH (generally 10 mU/L and above) and low thyroxine (T4) levels, must have thyroid replacement therapy.  Ideally, synthetic T4 replacement should be taken in the morning, 30 minutes before eating.  Other medications containing iron or antacids should be avoided, because they interfere with absorption.

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