Underactivity of thyroid gland

(hypothyroidism)
How a thyroid gland can become underactive
About hypothyroidism
The thyroid gland
Your thyroid is an endocrine gland. This means it secretes hormones into your bloodstream. Hormones are
chemicals produced by your body to help regulate how your cells and organs work. They are sometimes
called chemical messengers.

Your thyroid gland is in your neck, in front of your windpipe. It's about 2cm wide and 4cm high.

The position of the thyroid gland and surrounding structures

Your thyroid gland makes two hormones: thyroxine (also called T4) and triiodothyronine (also called T3).

Together, these hormones regulate your body's growth and metabolism. Your metabolism is how quickly

your body burns energy and how quickly reactions in your body happen. It affects lots of things, including
how much you weigh and how much you sleep.

The production of thyroid hormones is controlled by another hormone called thyroid stimulating hormone
(TSH). This is made by an endocrine gland in your brain called the pituitary gland.

What is hypothyroidism?
Hypothyroidism is when your thyroid is underactive and doesn't produce enough thyroid hormones. Not
having enough thyroid hormones slows down your body's metabolism.

Symptoms of hypothyroidism
Hypothyroidism usually develops gradually. The symptoms are mild, and you may not even notice them at
first. This is called subclinical hypothyroidism.

Hypothyroidism causes a general slowing down of your body's functions. Some of the symptoms include:
 feeling tired and sleeping a lot

 feeling the cold easily

 dry and/or pale skin

 coarse, thinning hair and brittle nails

 sore muscles, slow movements and weakness

 a hoarse or croaky voice

 a change in facial expression

 depression

 problems with memory and concentration

 weight gain

 constipation

 fertility problems and increased risk of miscarriage

 heavy, irregular or prolonged menstrual periods

 a slow heart rate

You may also have swelling of your thyroid gland. This is called a goitre.

If you have some or all of these symptoms, see your GP.

Very rarely, untreated hypothyroidism can lead to coma - called myxoedema coma.

Causes of hypothyroidism
Some people are more likely to develop hypothyroidism than others. Hypothyroidism is more common in
older people, and women are more likely to be affected than men.

Specific causes of hypothyroidism are described below.

Autoimmune thyroiditis
Autoimmune thyroiditis is the most common cause of hypothyroidism in the UK. It's an autoimmune disease.
This means that it's caused by antibodies from your immune system attacking your body. Rather than
attacking foreign bodies such as bacteria or viruses, antibodies destroy your thyroid gland cells. This
prevents your thyroid gland from producing enough thyroid hormones.

Hashimoto's thyroiditis is the most common type of autoimmune hypothyroidism. It can make your thyroid
gland swell up. This may be visible as a lump on your neck (goitre). If you don't have a goitre, the condition
may be called atrophic thyroiditis or primary myxoedema.

Diagnosis of hypothyroidism
Your GP will ask about your symptoms, examine you and you may need to have a blood test.

Hypothyroidism can be diagnosed by monitoring the levels of TSH and thyroid hormones in your blood. A
diagnosis of autoimmune hypothyroidism is usually confirmed by the presence of particular antibodies in
your blood.
Treatment of hypothyroidism
Occasionally, hypothyroidism gets better without treatment. In general, however, the symptoms get
progressively worse if it isn't treated.

Hypothyroidism can be treated with a thyroxine replacement medicine, called levothyroxine. This is taken as
tablets and it can take some time to get the dose right. Usually you will start on a low dose that is gradually
built up every few months. Your GP will adjust your dose according to the results of your blood tests.

Once the correct dose of levothyroxine has been established, you will usually have a thyroid function test
every year to check the levels of your thyroid hormones.

You will usually feel much better once you're taking levothyroxine. Side-effects are unusual because a
missing hormone is simply being replaced. However, if you take too much, you may develop symptoms of an
overactive thyroid, such as anxiety and weight loss.

If you have subclinical hypothyroidism (which means you don't have any symptoms but your thyroid
hormone levels are disrupted) you may not need any treatment at first. Your GP will usually monitor how
your thyroid hormone levels change every few months. If you develop symptoms, your GP will suggest that
you start treatment

Overactive thyroid (hyperthyroidism)

an overactive thyroid (hyperthyroidism), or who would like information about it.

Hyperthyroidism occurs when the thyroid gland is too active and produces excess thyroid hormones. This makes the
body's functions speed up and leads to symptoms such as shaking, weight loss and anxiety.

About hyperthyroidism
Your thyroid is an endocrine gland. This means that it secretes hormones into your bloodstream. Hormones are
chemicals produced by your body to help regulate how your cells and organs work. They are sometimes called
chemical messengers.

What is hyperthyroidism?
Hyperthyroidism is when your thyroid gland is overactive and produces excess thyroid hormones. This speeds up
your body's metabolism, meaning that organs and processes in your body work faster.

Symptoms of hyperthyroidism
Hyperthyroidism has many different symptoms. In general, the symptoms relate to a speeding up of your body's
metabolism. Symptoms include:

 feeling nervous, irritable or emotional

 tremor (shaking)

 sleeping poorly

 being intolerant of heat and sweating more than usual

 losing weight despite having an increased appetite (although around one in 10 people will gain weight)

 feeling tired

 muscle weakness

 increased heart rate or palpitations

 having infrequent periods or problems getting pregnant

 having more frequent bowel movements or diarrhoea

 shortness of breath, especially when exercising

 loss of hair or finer hair than usual

 swelling of your thyroid gland (goitre)

 swollen/red eyes, or double vision

Causes of hyperthyroidism
Graves' disease
Graves' disease is the most common cause of hyperthyroidism in the UK. It's is an autoimmune disease. This means
that it's caused by antibodies from your immune system attacking your body. In Graves' disease, the antibodies
mimic the activity of TSH, causing your thyroid gland to produce too much thyroid hormone, leading to the symptoms
of hyperthyroidism.

About one in 25 people with Graves' disease also develop thyroid eye disease, called Graves' ophthalmopathy. This
is when the muscles in your eyes and the surrounding tissue swell up, giving your eyes a bulging appearance. Your
eyes may become red and puffy, and, occasionally, it can lead to double vision or limited movement of your eyeball.
Thyroid eye disease doesn't always develop at exactly the same time as Graves' disease. It can occur before or after
it as well.

Graves' disease is most common in women between the ages of 20 and 40. You're more likely to get Graves' disease
if you have close relatives who are affected by it.

Nodular thyroid disease

Small lumps or nodules within your thyroid gland can cause hyperthyroidism, when abnormal thyroid tissue within
these nodules produces too much thyroid hormone. If one nodule forms, this is called toxic solitary adenoma. If more
than one nodule forms, it's called a toxic multinodular goitre.

Diagnosis of hyperthyroidism
Hyperthyroidism can be diagnosed with blood tests that check the levels of your thyroid hormones. The proportions of
the different hormones can also help your doctor to decide what is causing your hyperthyroidism. Sometimes the
presence of certain antibodies (proteins produced by your immune system) is also checked.

If blood tests confirm that you have hyperthyroidism, your doctor will refer you to an endocrinologist (a doctor who
specialises in conditions that affect your hormones). He or she may do more tests to find out the cause of your
hyperthyroidism. Some of these tests are described below.

Treatment of hyperthyroidism
Treatment aims to bring your levels of thyroid hormones down to normal. This state is known as being euthyroid.

Medicines
Your doctor may prescribe anti-thyroid medicines such as carbimazole and propylthiouracil, to reduce the production
of thyroid hormones. However, over time anti-thyroid medicines can lead to hypothyroidism (an underactive thyroid),
so you will need regular blood tests to monitor whether you are taking the correct dose.

Antithyroid medicines are usually prescribed for 12 to 18 months. However, many people need more long-term
treatment.
Alternatively, your doctor may prescribe you medicines called beta-blockers to help control the symptoms of
hyperthyroidism, but these don't treat the underlying problem.

Non-surgical treatments
Radioiodine treatment can be used for most types of hyperthyroidism.

Radioiodine is iodine that has been made radioactive, similar to the iodine used for an iodine uptake scan. You will be
given radioiodine in a tablet or drink form, and it is taken up by your thyroid gland. As the radioactivity builds up it
destroys some of your thyroid tissue. This allows the levels of your thyroid hormones to return to normal.

Surgery
Another treatment option is a thyroidectomy. This is an operation to remove all or part of your thyroid gland. Your
doctor may suggest a thyroidectomy if you haven't responded to other treatments, if you're pregnant and can't take
anti-thyroid medicines or if he or she thinks you may have thyroid cancer. After the surgery, you may need to take
thyroxine replacement medicines every day for the rest of your life.

Treatment for thyroid eye disease

You may need treatment for thyroid eye disease, which can develop if you have Graves' disease. You may need to
use eye drops, wear sunglasses and use extra pillows to raise your head at night to reduce the swelling. Treatments
for more severe eye symptoms include steroid medicines, radiation therapy or surgery. Talk to your doctor for more
advice.