Hypothyroidism - primary Health Article

Symptoms

Early symptoms:

• Weakness
• Fatigue
• Cold intolerance
• Constipation
• Weight gain  
• Depression
• Muscle or joint pain
• Thin brittle fingernails
• Thin, brittle hair
• Paleness

Late symptoms:

• Slow speech
• Dry flaky skin
• Thickening of the skin
• Puffy face, hands, and feet
• Decreased sense of taste and smell
• Thinning of eyebrows
• Hoarseness
• Menstrual disorders

Signs and tests

Physical examination may reveal a smaller than normal gland, though sometimes the gland is normal in size or even enlarged (goiter). Other physical findings include pale, yellow, and dry skin; thin, brittle hair; loss of the edges of the eyebrows; coarse facial features; firm swelling of the arms and legs; and slow muscle relaxation when reflexes are tested. Vital signs may reveal a slow heart rate, low blood pressure, and low temperature.

A chest x-ray sometimes reveals an enlarged heart.

Laboratory tests to determine thyroid function include:

• Free T4 test (low)
• Total T3 or free T3 (low)
• Serum TSH (high)

Additional laboratory abnormalities may include:

• Increased cholesterol levels
• Increased liver enzymes
• Increased serum prolactin
• Low serum sodium
• A complete blood count (CBC) shows anemia

Treatment

The purpose of treatment is to replace the deficient thyroid hormone. Levothyroxine (T4) is the most commonly used medication, but a preparation of T3 is also available. Most people feel their best when TSH is brought into the 1 to 2 mcIU/mL range. People get the lowest dose that is effective in relieving symptoms and normalizing blood tests.

Life-long therapy is needed. Relapses will occur if therapy is interrupted. Medication must be continued even when symptoms go away.

After replacement therapy has begun, report any symptoms of increased thyroid activity (hyperthyroidism), such as restlessness, rapid weight loss, heat intolerance, and sweating.

Myxedema coma is treated by intravenous thyroid replacement and steroid therapy. Supportive therapy (oxygen, assisted ventilation, and fluid replacement) and intensive care nursing may be indicated.