What Causes Hypothyroidism, Its Signs and Symptoms, and Ways to Manage the Condition
Hypothyroidism is a common thyroid disorder that affects millions of people worldwide. Symptoms like difficulty losing weight, hair loss, dull skin, brain fog, and many others can make it difficult to perform daily activities. However, there are ways to manage the condition to improve your life. In this article, you’ll learn more about hypothyroidism, what causes the condition, and its symptoms.
The thyroid is a small gland located in the middle of your neck that plays a significant role in how your body functions. This endocrine gland produces hormones that regulate metabolism, body temperature, and growth. However, the thyroid is also one of the most sensitive glands affected by environmental factors, medication, nutrient deficiencies, and hormonal fluctuations. A damaged thyroid can lead to hypothyroidism, a common thyroid disorder that affects multiple systems throughout the body.
The thyroid’s role in your body
When we talk about hypothyroidism, it’s important to first understand the thyroid and its functions.
The thyroid is a butterfly-shaped endocrine gland located at the front of the neck. It wraps around the windpipe (trachea) and sits at approximately the throat level where a bowtie would be worn. The gland has two lobes (the "wings" of the butterfly) connected by a thin strip of tissue called the isthmus.
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The pituitary gland at the base of the brain controls the thyroid through the thyroid-stimulating hormone (TSH). Normally, the thyroid produces thyroid hormones triiodothyronine (T3) and thyroxine (T4). Thyroid hormones, together with estrogen, progesterone, testosterone, cortisol, and other hormones, regulate various body processes. Temperature, weight and metabolism, growth and development of the human body, heart rate, menstrual cycle, and many other processes are regulated by the thyroid.
However, for various reasons, such as the body’s cells attacking the thyroid tissue or other hormones blocking T3 and T4, the gland can stop working properly, causing a condition called hypothyroidism.
What is hypothyroidism?
Hypothyroidism, or underactive thyroid, is an endocrine condition that happens when the thyroid doesn’t produce enough thyroid hormones. Approximately 5% of the general population have some form of hypothyroidism. The condition has four types, but not all of them present significant symptoms. Many people might have an underactive thyroid but don't recognize the symptoms and seek treatment.
Because the thyroid is mainly linked to the way the body uses energy, the main symptoms of the condition are usually a lack of energy and weight gain, as the body can't efficiently convert calories into energy. Hypothyroidism can’t be cured, but it can be managed with certain lifestyle changes and thyroid hormonal replacement therapy.
Types of hypothyroidism
Primary hypothyroidism
Primary hypothyroidism is the most common form (99% of cases) of the condition. It’s mainly caused by an autoimmune condition called Hashimoto's disease. Hashimoto's disease develops when the body's immune system attacks thyroid tissue and gradually destroys the thyroid's ability to produce hormones.
Common signs you might have Hashimoto's:
- High TSH, low T4 levels
- Gradual onset of symptoms
- More common in women
- Often accompanied by other autoimmune conditions
It might take years for Hashimoto's disease to develop, as it usually starts with mild symptoms. That’s why many people only seek help when the disease progresses. Eventually, it can lead to complete thyroid failure if untreated.
Secondary hypothyroidism
Secondary hypothyroidism, also called central hypothyroidism is caused by pituitary gland dysfunction. Secondary hypothyroidism can be more difficult to diagnose, as it often starts suddenly from pituitary tumors, radiation treatment, head trauma, surgery, or inflammation. A common sign of secondary hypothyroidism is low or normal TSH with low T4 levels.
Congenital hypothyroidism
This type of hypothyroidism is present at birth or develops shortly after. The condition affects approximately 1 in 2,000–4,000 newborns. It’s usually caused by thyroid gland absence or underdevelopment, genetic mutations, thyroid hormone synthesis defects, or iodine deficiency. In this case, the newborn must receive medication and be regularly monitored.
Subclinical hypothyroidism
Subclinical hypothyroidism is considered the mildest form of the condition. It manifests through slightly elevated TSH levels, while T4 levels remain normal. Many people with subclinical hypothyroidism don't experience any symptoms, but it can progress to overt hypothyroidism eventually.
What causes hypothyroidism?
Hypothyroidism is a complex condition that can develop at any stage of a person’s life. Many different factors influence the thyroid gland. Therefore, even the healthiest people might develop the condition at some point in their lives.
The most common causes of hypothyroidism
Autoimmune disorders
Conditions like Hashimoto's thyroiditis, type 1 diabetes, rheumatoid arthritis, lupus, and celiac disease can increase your risk of developing thyroid issues. In such cases, your own defense system attacks healthy thyroid tissue. As the tissue gradually dies, the gland is unable to produce sufficient thyroid hormones, leading to hypothyroidism. Autoimmune disorders often have a genetic component.
Medical treatments
The thyroid gland is sensitive to various medical treatments, especially cancer treatments. If you recently received radiation therapy to the neck and chest, it can damage thyroid cells.
Another cause of hypothyroidism is surgery where the thyroid is partially or totally removed (thyroidectomy). Usually, such surgery is performed due to neck injuries or to remove cancerous thyroid tissue. Pregnancy-related causes like postpartum thyroiditis or pregnancy-induced hormonal changes can also damage the gland.
Medications
Some drugs interfere with the body’s natural hormones and metabolism which in turn can affect the thyroid. The most common culprits are lithium (a psychiatric medication), amiodarone (a heart medication), some cancer medications like interferon alpha, and certain antidepressants.
Nutrition
The nutrients you consume daily can influence the state of your thyroid. Severe iodine deficiency or excessive iodine intake can cause thyroid dysfunction. Selenium, vitamin D, and severe vitamin B12 deficiencies often lead to hypothyroidism.
Other factors
Environmental factors like endocrine disruptors in your surroundings, can cause the thyroid to shut down. Exposure to radiation, heavy metals, industrial chemicals, and certain pesticides puts your thyroid at risk.
Genetic factors also play a role in the likelihood of developing hypothyroidism. Inherited thyroid disorders, a family history of autoimmune diseases, and certain genetic mutations can increase the risks of an underactive thyroid.
Who’s more prone to hypothyroidism?
Generally speaking, women and people over 60 are more prone to hypothyroidism. Regular hormonal fluctuations that women experience during their reproductive years and later on during menopause make them more susceptible to the condition. Another reason why women are more likely to develop hypothyroidism is that they have a more active immune system, which can lead to Hashimoto's disease. Additionally, people with other autoimmune conditions, Down syndrome, and Turner syndrome are at a higher risk of developing hypothyroidism.
Signs and symptoms of hypothyroidism
Hypothyroidism is a complex condition that can affect many bodily processes. It’s worth pointing out that not everyone experiences the symptoms, and some symptoms might be mistaken for burnout or aging. It’s important to regularly check your hormone levels to identify the condition before it progresses.
Here are the signs of hypothyroidism:
- Physical changes like weight gain, water retention, swelling, and bloating might signal an underactive thyroid. You might also notice your skin becoming duller and drier, and your hair falling out more than normal. For some people, their skin might become pale and yellowish.
- Energy and muscle function symptoms include persistent fatigue, where you might feel exhausted after doing simple tasks around the house or at work, muscle weakness, aches and stiffness, joint pain, and reduced exercise tolerance.
- Mental and emotional changes can manifest as declining cognitive function, brain fog, memory problems, difficulty concentrating, slower thinking, and reduced attention span. Many people with hypothyroidism also experience mental health problems such as depression, anxiety, mood swings, irritability, and lack of motivation.
- Reproductive and hormonal issues, like irregular or heavy periods, difficulty getting pregnant, decreased libido, increased risk of miscarriage, pregnancy complications, and postpartum issues, are also common signs of hypothyroidism.
Hypothyroidism also affects your metabolism and digestive system. You might experience constipation, digest food more slowly, feel bloated, lack appetite, and struggle to lose weight. Many people with hypothyroidism also have a slower heart rate, higher cholesterol levels, increased blood pressure, and poor circulation.
Is hypothyroidism curable?
No, hypothyroidism isn’t curable, but it’s very manageable, and in many cases, people who have it lead completely normal lives.
How to manage hypothyroidism
Hypothyroidism is treated medically and with lifestyle changes. Your doctor might prescribe hormone replacement therapy with synthetic thyroid hormones like levothyroxine. In fact, because of so many hypothyroidism cases around the world, levothyroxine (LT4) is one of the most prescribed medications worldwide. While on HRT, you should regularly have blood tests every 6-12 months, track your symptoms, and attend regular medication reviews.
However, medical treatment might not be as effective without lifestyle changes. For best results, you should improve your diet, exercise regimen, and stress management.
Follow a hypothyroidism-friendly diet
A hypothyroidism-friendly diet includes iodine-rich foods like seaweed and fish, selenium (Brazil nuts, red meat, eggs), zinc (meat, seafood, legumes), and iron (lean meats, spinach). However, it’s recommended to limit or avoid processed and high-sugar foods and large amounts of soy products and cruciferous vegetables, as they can inhibit iodine transport and absorption.
Find the right exercise routine
Regular physical activity is just as important when dealing with an underactive thyroid as diet and medication. As mentioned previously, hypothyroidism happens when the thyroid can’t properly manage energy levels. This, in turn, can cause more calories to be stored as fat tissue, further aggravating the condition. Moving and exercising can help the body use the energy you get from food better and speed up metabolism.
Start slowly and gradually increase intensity. Many people with hypothyroidism find slow exercises to be more effective than strenuous activities. You can try a mix of cardio and strength training, walking, swimming, yoga, or weight training. Muscle mass is crucial for managing hypothyroidism because muscle is an active tissue that consumes a lot of energy on its own, which helps improve metabolism.
Manage stress
The thyroid works hand in hand with the adrenal glands, which produce adrenaline and stress hormones. When there are too many stress hormones in your bloodstream, they might further slow down your metabolism and cause the thyroid to react. People with hypothyroidism might notice that during times of high stress, they feel even more fatigued than usual and gain weight.
Try to find ways to manage short-term stress with techniques like meditation, deep breathing exercises, yoga, and a regular sleep schedule. For long-term stress reduction, try mental health support such as therapy, support groups, and regular social interactions.
Clean up your environment
The thyroid gland is sensitive to environmental toxins, also known as endocrine disruptors. Most of these toxins hide in your environment, such as food, water, clothing, and cookware. Depending on your location and exposure risk, you might want to install water and air filters, switch to organic produce, replace plastic cookware with wood, metal, and glass, and wear clothing made from natural fabrics.
Living a healthy and happy life with hypothyroidism
Hearing that you have an incurable condition is difficult to accept. At times, you might feel like you’re fighting windmills. But don’t get discouraged. Hypothyroidism is complex, but many people live completely healthy and happy lives with the condition. You only need to find what works best for you in terms of medication, diet, and exercise.
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