Hypothyroidism: Diagnosis and Treatment of Symptoms and Management of Stomach Problems

Since the hormones T3 and T4 regulate energy metabolism, typical symptoms of hypothyroidism are often nonspecific and develop gradually. Common symptoms include extreme fatigue, difficulty concentrating, and a depressed mood. Physically, hypothyroidism often manifests as dry skin, brittle hair, and a slowed heart rate. Constipation and increased sensitivity to cold are also classic signs of hypothyroidism. Many of these symptoms are often mistakenly interpreted as normal signs of aging, particularly in older adults, which is why it’s important to take a closer look at the symptoms.

There are various reasons why hormone production decreases. Primary hypothyroidism is the most common form of hypothyroidism, in which the problem lies directly within the gland itself. The most common cause here is Hashimoto’s thyroiditis, an autoimmune disease that triggers chronic inflammation of the thyroid gland. Another cause of hypothyroidism can be an extreme iodine deficiency, since iodine is the most important building block for the production of thyroid hormones. Less common is central hypothyroidism, in which the pituitary gland or the hypothalamus (secondary or tertiary hypothyroidism) does not release enough regulatory hormones. Acquired hypothyroidism can also develop following radioiodine therapy or treatment for hyperthyroidism.

Possible causes of primary hypothyroidism include:

• autoimmune inflammatory processes that destroy thyroid tissue (for example, Hashimoto’s thyroiditis)
• loss of thyroid tissue due to thyroid surgery, radioiodine therapy for thyroid disorders, or radiation therapy to the head and neck region
• Severe iodine deficiency
• Severe iodine excess
• Possible selenium deficiency

Taking certain medications can also contribute to the development of primary hypothyroidism. 

These include:

• Thyrostatic agents for hyperthyroidism
• Cytokines used to treat multiple sclerosis, asthma, rheumatoid arthritis, and in cancer therapy
• Lithium for bipolar disorder
• Amiodarone for cardiac arrhythmias

The following symptoms usually occur in connection with hypothyroidism:

• Constant fatigue
• Lack of motivation
• Depression
• Difficulty concentrating and memory problems
• Constant feeling of being cold
• Low body temperature
• Slow heart rate
• Edema (swelling of the face and limbs due to fluid retention in the tissues)
• Joint pain
• Muscle weakness
• Loss of appetite, constipation, nausea
• Noticeable weight gain
• Dry, itchy skin
• Myxedema—a doughy thickening of the skin
• Brittle nails, hair loss
• Menstrual irregularities in women, libido problems, reduced fertility

A combination of symptoms from several symptom groups indicates hypothyroidism. False positive or negative (self-)diagnoses are easily made. A blood test provides clarity.

Hypothyroidism may or may not be accompanied by noticeable changes in the thyroid gland:

• Enlarged thyroid gland (goiter)—especially in cases of iodine deficiency and congenital hypothyroidism
• Enlarged thyroid gland – in cases of thyroid destruction, for example due to autoimmune inflammatory processes

Constant fatigue is one of the symptoms that can occur with hypothyroidism © pix4U | AdobeStock

Diagnosis and treatment usually begin with a detailed consultation with the patient. However, laboratory testing is essential for a definitive diagnosis of hypothyroidism. An elevated TSH level in the blood is the first indication that the pituitary gland is trying to stimulate the sluggish thyroid gland. In cases of overt hypothyroidism, the levels of the free hormones T3 and T4 (triiodothyronine and thyroxine) are also reduced. Subclinical hypothyroidism is present when the TSH level is elevated but the T3 and T4 hormone levels are still within the normal range. To determine the cause of hypothyroidism, the doctor may also perform ultrasound examinations or test for specific antibodies.

Treatment for hypothyroidism is very straightforward today. Since the body cannot produce sufficient amounts of the hormone on its own, it is replaced with a synthetic version. The drug of choice is usually L-thyroxine, a synthetic thyroid hormone that corresponds to the body’s own T4. The goal of treating hypothyroidism is to bring the TSH level back into the reference range. The dose is adjusted individually. It is important to take the medication regularly in the morning on an empty stomach to ensure optimal absorption. With properly adjusted therapy, patients can live completely symptom-free.

Monitoring hormone levels is particularly important in cases of hypothyroidism during pregnancy. In the first few weeks, the unborn child is completely dependent on the mother’s hormone production. A deficiency in thyroid hormones can jeopardize the child’s physical and mental development. Therefore, pregnant women who already have hypothyroidism often need to increase their dose early on. Subclinical hypothyroidism is also usually treated consistently during this time to prevent complications.

Latent hypothyroidism (or latent thyroid insufficiency) is a mild form of hypothyroidism. In this condition, the body is still able to produce sufficient hormones but requires extremely strong stimulation from TSH to do so. Whether medication is advisable at this stage depends on the patient’s individual symptoms and factors such as the desire to have children or cardiovascular risks. Experienced endocrinologists provide individualized advice on this matter.

Untreated hypothyroidism can cause serious health problems in the long term. In addition to significantly impairing overall well-being, it can lead to elevated blood lipid levels and thus an increased risk of atherosclerosis. In extreme cases—which are very rare today—completely neglected hypothyroidism can lead to myxedema coma. Therefore, it is important to see a doctor at the first signs of hypothyroidism.

Can hypothyroidism be prevented? Depending on the cause, this is only possible to a limited extent. Since iodine deficiency is a major cause of hypothyroidism worldwide, ensuring an adequate intake of iodine through diet—such as by eating ocean fish or using iodized table salt—is advisable. However, a balanced diet alone cannot prevent an autoimmune disease such as Hashimoto’s. If there is a family history of the condition, regular thyroid check-ups are advisable. You can also find information on surgical procedures in the section on thyroid surgery.