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Hypothyroidism

Brief Overview: Hypothyroidism is a chronic endocrine disorder characterized by insufficient production of thyroid hormones (T4 and T3), leading to a slowing of metabolic processes throughout the body. It is most commonly caused by autoimmune thyroid disease (Hashimoto’s thyroiditis) but may also result from thyroid surgery, radiation, medications, or iodine imbalance. Management focuses on thyroid hormone replacement, symptom control, and long-term monitoring.

Prevalence: According to NIDDK, “Nearly 5 out of 100 Americans ages 12 years and older have hypothyroidism, although most cases are mild or have few obvious symptoms.”

Etiology: According to NIDDK, “Hypothyroidism has several causes, including

  • Hashimoto’s disease
  • thyroiditis, or inflammationof the thyroid
  • congenital hypothyroidism, or hypothyroidism that is present at birth
  • surgical removal of part or all of the thyroid
  • radiation treatment of the thyroid
  • some medicines

Less often, hypothyroidism is caused by too much or too little iodine in the diet NIH external link or by disorders of the pituitary gland or hypothalamus NIH external link.1 Iodine deficiency, however, is extremely rare in the United States.”

Risk Factors:

  • Female sex
  • Family history of thyroid disease
  • Personal history of autoimmune disease
  • Pregnancy or postpartum period
  • Older age
  • Iodine imbalance
  • Neck radiation or thyroid surgery
  • Certain medications

Commonly Associated Conditions:

  • Hashimoto’s thyroiditis
  • Hyperlipidemia
  • Depression and anxiety
  • Cognitive slowing or memory complaints
  • Infertility and menstrual irregularities
  • Cardiovascular disease
  • Other autoimmune disorders (e.g., type 1 diabetes, celiac disease)

Common Medications:

Treatment is aimed at replacing deficient thyroid hormone.

  • Levothyroxine (T4) – first-line and most commonly prescribed
  • Liothyronine (T3) – rarely used; specialist-directed
  • Combination T4/T3 therapy – Armour Thyroid
  • Medication counseling points:
    • Taken once daily on an empty stomach (typically morning) with water. Wait 30-60 minutes before eating, drinking, or taking other medications.
    • Avoid taking with calcium, iron, or fiber supplements within 4 hours
    • Dose adjustments based on TSH monitoring
    • Lifelong therapy is often required

Common Labs, Imaging, and Tests:

  • TSH, serum free T4, T3
  • Thyroid antibodies
  • Lipid panel, CBC, CMP may be indicated
  • Thyroid ultrasound, CT
  • Thyroid uptake scan

Common Symptoms: Symptoms may be gradual and nonspecific, including:

  • Fatigue and low energy
  • Cold intolerance
  • Weight gain
  • Constipation
  • Dry skin and hair thinning
  • Depression or “brain fog”
  • Bradycardia
  • Menstrual irregularities
  • Voice hoarseness

Common Treatments:

  • Thyroid hormone replacement therapy (see ‘Medication’ above)
  • Regular laboratory monitoring (TSH-guided dosing)
  • Management of associated conditions (e.g., hyperlipidemia, depression)
  • Patient education regarding medication adherence
  • Endocrinology referral for complex or refractory cases

Physical Findings:

  • Often subtle or normal early in disease
  • Bradycardia
  • Dry, cool skin
  • Periorbital puffiness
  • Weight gain
  • Goiter (in some cases)
  • Delayed deep tendon reflexes

Potential Complications and Contraindications:

  • Potential complications:
    • Cardiovascular disease
    • Hyperlipidemia
    • Infertility or pregnancy complications
    • Cognitive impairment
    • Myxedema coma (rare, life-threatening)
  • Contraindications / cautions:
    • Overtreatment may cause hyperthyroidism, arrhythmias, or bone loss
    • Caution in elderly patients and those with coronary artery disease
    • Drug interactions affecting absorption (antacids, supplements, PPIs)

General Health and Lifestyle Guidance:

  • Take thyroid medication consistently at the same time each day
  • Maintain regular follow-up and lab testing
  • Avoid excessive iodine intake
  • Encourage balanced nutrition and physical activity
  • Monitor for symptom changes
  • Reinforce lifelong nature of treatment

Suggested Questions to Ask Patients:

  1. Have you noticed changes in energy, weight, or cold tolerance?
  2. Are you taking your thyroid medication every day as prescribed?
  3. Any missed doses or difficulty with timing?
  4. Have you experienced palpitations, anxiety, or insomnia?
  5. When was your last thyroid blood test?
  6. Are you taking supplements that may interfere with absorption?
  7. Any new symptoms affecting daily activities?

Suggested Talking Points:

  • Hypothyroidism slows many body systems but is very treatable.
  • Thyroid medication replaces what your body can’t make enough of.
  • Consistency in medication timing is essential for good control.
  • Blood tests help ensure the dose is just right.
  • Most people feel significantly better once levels are stable.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.