Hypothyroidism/Myxoedema/Hashimoto’s Disease

Not enough thyroid hormone will make a person sluggish, tired and cold and cause these and other symptoms of conditions known as hypothyroidism, underactive thyroid or myxoedema. Hashimoto’s disease is a type of underactive thyroid disease described as “autoimmune” meaning that the body’s immune system has damaged the thyroid gland. Hashimoto’s disease sometimes occurs after a period of overactive thyroid disease.

“Body” Symptoms of Underactive Thyroid Disease

  1. Sleepiness, exhaustion, lethargy, insomnia.
  2. Low body temperature, cold intolerance, always feeling cold, dressing warmly.
  3. Hair loss, dry hair, dandruff.
  4. Deafness or dulled hearing.
  5. Dry skin, sallow complexion, swollen face, pale lips.
  6. Patchy skin, i.e. varying skin colour not due to exposure to sunlight.
  7. Hoarse voice, slow speech, goitre (swollen neck).
  8. Palpitations, raised cholesterol in the blood.
  9. Menstrual problems, miscarriage, fertility problems, decreased libido.
  10. Weight gain and/or loss of appetite.
  11. Weak and/or painful muscles, stiff joints.
  12. Constipation.
  13. Lumpy red/dark itchy patches on the shins (pretibial myxoedema).
  14. Cold feet, poor circulation.
  15. In the most severe cases, hypothermia and coma.
  16. Some may experience new or worsened food sensitivities or allergies such as hay fever or problems with caffeine or alcohol.

“Mind” Symptoms of Underactive Thyroid Disease

Early stage:- forgetfulness, confusion, difficulty in concentrating, insomnia, depression, feeling low or anxious, inability to cope well with stress or shock.
Later stage:- panic attacks, paranoia, severe depression and/or anxiety and very severe insomnia leading to the possibility of hallucinations especially after stress and/or insomnia.

If a person with an underactive thyroid is not given a thyroid test, they may be misdiagnosed as experiencing depression, anxiety, psychosis or other psychiatric disorder.

Blood Tests and Treatments for Underactive Thyroid Disease – Low T4 Raised TSH

The blood test most commonly used in the UK measures TSH (thyroid stimulating hormone) and T4 (thyroxine). In underactive thyroid disease the thyroxine level is low and the TSH is high. Most GPs in the UK regard a TSH reading of around 0.35 – 5.5 as normal and this is the kind of “normal” range given by most UK labs. Generally people with a TSH over 5.5 would then be given thyroxine.

However recent studies (1998) suggest that a TSH level of over 2.0 international or standard units indicates that the patient is hypothyroid and needs thyroxine. A positive result to a test for antithyroid antibodies would add to the evidence of early hypothyroidism. For someone with underactive symptoms, a TSH of over 2.0 and a positive antibody test thyroxine treatment may be beneficial.

It may also be a good idea to record body temperatures over a few days and take the note along to the doctor’s when requesting a thyroid test as low body temperature, along with other symptoms, is sometimes used as an indicator of a thyroid problem.

Thyroid Hormone Treatments for People with Underactive Thyroid Disease

Thyroxine (T4) is the treatment most commonly prescribed and taken daily by mouth – in most cases, it generally improves and maintains mental and physical health for a hypothyroid person. It is important to consult a doctor regularly for blood tests to check thyroid hormone levels in the blood. It is important to take the correct dose of thyroxine as prescribed by the doctor every day.

It is important for the doctor to know the person’s general health and any medicines they are taking. The dose of thyroxine will usually be increased gradually especially for people with angina.

Some people feel the benefits of thyroxine within a short period of time. Slowly but steadily energy and mental health are resorted or improved in most cases. Once normal blood levels are established it’s important to continue to take the correct dosage of thyroxine and to have a blood test once or twice a year.

Sometimes a person may not benefit from thyroxine (T4) and may need to take a different thyroid hormone called tri-iodothyronine (T3). Recent research suggests that a combination of both T4 and T3 may be beneficial for many people with underactive thyroid disease. There is much written about the use of a combination of T4 and T3 in thyroid books. Some suggest that T3 is particularly important for good brain function. Ask your doctor if you have any questions about this.

It may be advisable for a patient to see an endocrinologist, a doctor specialising in endocrine disorders including thyroid disease.

A doctor may consider it necessary to continue prescribing psychiatric medication along with thyroxine. For most people thyroxine will need to be taken every day for life. On no account should anyone stop either psychiatric medication or thyroxine without consulting their doctor.

On no account should anyone take thyroxine without a blood test, diagnosis and prescription from a doctor. To take thyroxine inappropriately could be dangerous.