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Hypothyroidism

Myxedema; Adult hypothyroidism; Underactive thyroid; Goiter - hypothyroidism; Thyroiditis - hypothyroidism; Thyroid hormone - hypothyroidism

Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid.

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Endocrine glands
Hypothyroidism
Brain-thyroid link
Primary and secondary hypothyroidism

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Causes

The thyroid gland is an important organ of the endocrine system. It is located at the front of the neck, just above where your collarbones meet. The thyroid makes hormones that control the way every cell in the body uses energy. This process is called metabolism.

Hypothyroidism is more common in women and people over age 50.

The most common cause of hypothyroidism is thyroiditis. Swelling and inflammation damage the thyroid gland's cells.

Causes of this problem include:

Other causes of hypothyroidism include:

Symptoms

Early symptoms:

Late symptoms, if untreated:

Exams and Tests

The health care provider will do a physical exam and may find that your thyroid gland is enlarged. Sometimes, the gland is normal size or smaller-than-normal. The exam may also reveal:

Blood tests are also ordered to measure your thyroid hormones TSH and T4.

You may also have tests to check:

Treatment

Treatment is aimed at replacing the thyroid hormone you are lacking.

Levothyroxine is the most commonly used medicine:

When starting you on your medicine, your doctor may check your hormone levels every 2 to 3 months. After that, your thyroid hormone levels should be monitored at least once every year.

When you are taking thyroid medicine, be aware of the following:

While you are taking thyroid replacement therapy, tell your doctor if you have any symptoms that suggest your dose is too high, such as:

Outlook (Prognosis)

In most cases, thyroid hormone level becomes normal with proper treatment. You will likely take a thyroid hormone medicine for the rest of your life.

Possible Complications

Myxedema coma, the most severe form of hypothyroidism, is rare. It occurs when thyroid hormone levels get very low. It can be caused by an infection, illness, exposure to cold, or certain medicines in people with untreated hypothyroidism.

Myxedema coma is a medical emergency that must be treated in the hospital. Some people may need oxygen, breathing assistance (ventilator), fluid replacement, and intensive-care nursing.

Symptoms and signs of myxedema coma include:

People with untreated hypothyroidism are at increased risk of:

When to Contact a Medical Professional

Call your provider if you have symptoms of hypothyroidism.

If you are being treated for hypothyroidism, call your doctor if:

Related Information

Metabolism
Free T4 test
T3 test
Hypothalamus
Overweight
X-ray
Low blood sugar
Endoscopic thoracic sympathectomy
Iontophoresis
Thyroid gland removal - discharge

References

Brent GA, Weetman AP. Hypothyroidism and thyroiditis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier; 2016:chap 13.

Ferri FF. Hypothyroidism. In: Ferri FF, ed. Ferri's Clinical Advisor 2019. Philadelphia, PA: Elsevier; 2019:761-762.

Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028. PMID: 23246686 www.ncbi.nlm.nih.gov/pubmed/23246686.

Jonklaas J, Bianco AC, Bauer AJ, et al; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid associationtask force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-1751. PMID: 25266247 www.ncbi.nlm.nih.gov/pubmed/25266247.

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Review Date: 6/14/2018  

Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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