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Silent Thyroiditis - What Are The Signs Of It?

MBBS Bachelor of Medicine and Bachelor of Surgery, MD - General Medicine, DM - Endocrinology
Endocrinologist, Hyderabad
Silent Thyroiditis - What Are The Signs Of It?
The thyroid is a small gland that controls metabolism and growth. Silent thyroiditis is a common autoimmune disorder that affects the thyroid gland. It causes an inflammation of the thyroid gland and is characterized by mild symptoms of hyperthyroidism and hypothyroidism. It is known as Silent thyroiditis because this condition is not painful in any way. Silent thyroiditis is also known as lymphocytic thyroiditis or subacute lymphocytic thyroiditis.The cause of this condition is unknown and hence it is not possible to prevent it. This is one of the least common disorders to affect the thyroid gland. However, middle aged women are at the highest risk of suffering from this condition. Other risk factors include a family history of thyroid disorders, certain autoimmune diseases, removal of the adrenal gland or treatment for cancer.

Some of the symptoms of silent thyroiditis are:

Fatigue
Increased sensitivity to heat and cold
Erratic bowel movements
Irregular menstrual periods
Increased appetite
Palpitations
Irritability and nervousness
Unexplained weight loss
Excessive sweating
If you notice such symptoms, you must consult a doctor. To determine a silent thyroiditis diagnosis, a thorough physical examination and a few tests are required. The physical examination focuses on the size of the thyroid gland, heart rate and presence of tumors if any. A blood test will also be required to check thyroid hormone levels such as T3, T4 and TSH levels. Your doctor may also ask for an ultrasound of the thyroid gland and an imaging test to determine iodine radioactive uptake.

Silent thyroiditis has a good prognosis and patients usually recover within one year. The acute phase typically lasts only three months. Most patients do not require any form of treatment for this condition but regular checkups are advised to keep track of the disease. In rare cases, medical treatment may be required. For example, if the patient complains of increased heart palpitations or excessive sweating, beta blockers may be prescribed to lower the heart rate. The patient is advised to get plenty of rest and avoid any stressful situations.

In some cases, silent thyroiditis may lead to permanent hypothyroidism. In such cases, medication may be prescribed to normalize the thyroid hormone levels. In some cases, thyroid hormone replacement therapy may also be advised. Surgery and radioactive iodine treatment are not required to treat silent thyroiditis.

Hypothyroidism - All You Should Know About It!

Diploma in Diabetology, MBBS
Endocrinologist, Mumbai
Hypothyroidism - All You Should Know About It!
Hypothyroidism is a condition in which the thyroid gland is not producing the thyroid hormones adequately. This is a fairly common condition.

What is thyroid gland?

The thyroid gland is a small butterfly-shaped gland located just below Adam s apple. It encircles the windpipe or the trachea. It is about 4 cms in height and weighs about 18 gms. This gland is responsible for the secretion of thyroid hormones. Hormones are chemicals produced by special glands like thyroid, adrenals, ovaries etc. They act as messengers and are carried by the blood to the various target organs.

What are the hormones produced by thyroid gland and what do they do?

The thyroid hormones are of two types T3 (Tri iodo thyronine) and T4 (Thyroxine). These hormones are mainly responsible for the body s metabolism - a process in which food is converted into energy in the cells. They influence growth and development and regulate various bodily functions which are mentioned below:

Heartbeat
Body temperature
Breathing
Body weight
Metabolism of fat
Menstrual cycles in females
Functioning of Nervous system
Digestion
Burning calories etc.
What is Hypothyroidism?

Inadequate production of hormones by the thyroid gland is termed as hypothyroidism. This is also called Underactive thyroid state. Hypothyroidism can make the body s development to slow down and reduces metabolism rates.

What are the causes of Hypothyroidism?

Hypothyroidism can be caused by a number of factors:

Hashimoto's thyroiditis: This is the commonest cause. This is an autoimmune disorder (normally body s defence system fight against external infections. In autoimmune disorder the defence system attacks the healthy cells of the body by mistake). In Hashimoto s thyroiditis the immune system/defence system produces antibodies that attack the thyroid gland and destroy it.
Iodine deficiency in diet. For the production of thyroid hormones iodine is very important. The body does not produce iodine normally, so it needs to be supplemented from outside. Iodine is mainly present in the food we eat. It is mainly present in shellfish, salt-water fish, eggs, dairy products. If a person does not eat iodine rich foods, he may end up with iodine deficiency leading to hypothyroidism. Currently, this causative factor is on the decline due to government initiative of table salt with iodine.
Surgery: Surgery to remove thyroid gland (for e.g. thyroid cancer treatment, overactive thyroid etc.)
Radiation to the neck (to treat cancer in the neck area): The thyroid gland cells are damaged due to the radiation.
Treatment with radioactive iodine: This treatment is used for managing hyperthyroidism/overactive thyroid, where the thyroid gland produces excessive thyroid hormones. One of the treatment modalities is by radioactive iodine. Sometimes this radiotherapy destroys normal functioning cells which lead to hypothyroidism.
Certain medicines: Certain medicines used to treat heart conditions, cancer, psychiatric conditions etc. for e.g. amiodarone, lithium, interleukin-2, interferon-alpha.
Pregnancy: Pregnancy (the reason is unclear but it has been noticed that the thyroid may get inflamed after delivery this is called Postpartum thyroiditis.
Damage to the pituitary gland: Pituitary gland is a gland which is present in the brain. It produces a hormone called TSH (Thyroxine-Stimulating hormone).The TSH tells the thyroid gland how much thyroid hormone it should make. If the levels of thyroid hormone in the blood are low, then the TSH will stimulate the thyroid gland to produce more Thyroid hormone.
Hypothalamus disorders: This is an organ in the brain. This produces a hormone called TRH (Thyrotropin Releasing Hormone) which acts on the Pituitary gland to secrete TSH. So any disorder of Pituitary gland will indirectly effect the production and secretion of Thyroid hormones. These are very rare disorders.
Congenital thyroid defects: Some babies are born with thyroid problems. This is due to the thyroid not being developed normally during pregnancy. Sometimes the thyroid gland does not function normal. This can be identified by screening for thyroid disorders in the first week after delivery. This is usually by a blood test using a small drop of blood from the baby s heel.
What are the different types of hypothyroidism?

One classification is based on whether the defect is with the thyroid gland or not:

Primary hypothyroidism: The problem is in the thyroid gland itself and thus there is reduced production /secretion of thyroid hormones.
Secondary hypothyroidism: Here the problem is with the Pituitary gland or the Hypothalamus. This results in abnormal production of TSH or TRH, which indirectly leads to less production and secretion of thyroid hormones.
Another classification is based on the symptoms and levels of the thyroid hormones and TSH:

Overt hypothyroidism: Here the patient is having the symptoms. Further the T3/T4 are low and TSH is high
Subclinical hypothyroidism: Here patient may or may not have symptoms. The T3/T4 levels are normal but TSH is high. In this situation the patient is at an increased risk of developing overt hypothyroidism in the future especially if he has Thyroid peroxidase antibodies on testing.
Who are at risk of developing Hypothyroidism?

Women have a higher risk of suffering from hypothyroidism than men.
Older people are at increased risk.
People suffering from other autoimmune diseases like Coeliac disease, Type-1 Diabetes Mellitus, Vitiligo, Pernicious anemia, Multiple sclerosis, Rheumatoid arthritis, Addison s disease etc.
People with psychiatric conditions such as bipolar disorder
People with Chromosomal abnormalities like Down syndrome, Turners syndrome also have a high risk of suffering from hypothyroidism.
What are the symptoms of hypothyroidism?

Symptoms vary from person to person. They may also mimic other conditions and hence be difficult to diagnose. Symptoms may also develop very slowly over a span of moths-years. Some of the characteristic symptoms of this disease are:

Depression
Constipation
Hair loss
Dry hair
Dryness of the skin
Tiredness
Body pains
Fluid retention in the body
Irregular menstrual cycles
Increased sensitivity to cold
Reduced heart rate
Increase in size of the thyroid gland called Goitre. This is due to constant stimulation of the thyroid gland by TSH.
Weight gain
Carpal tunnel syndrome
Hoarse voice
Infertility
Loss of libido/sex drive
Confusion or memory problems especially in the elderly
What are the symptoms to look for in a baby if you suspect hypothyroidism?

Infants suffering from congenital hypothyroidism may show no symptoms or exhibit signs of excessive drowsiness, cold hands, cold feet, constipation, hoarse cry, poor growth or absent growth, poor appetite, bloating of abdomen, puffiness of face, swollen tongue, persistent jaundice.

How to diagnose hypothyroidism?

Blood tests:

TSH: This hormone is made in the pituitary gland and it stimulates the thyroid gland to produce thyroxine. If the thyroxine levels are low in the blood, the pituitary gland produces and secretes more TSH into the blood to act on the thyroid gland to produce more thyroxine. A raised TSH level indicates hypothyroidism. Other tests are not usually necessary unless a rare cause of hypothyroidism.
T4: A low level of thyroxine indicates hypothyroidism.
T3: these levels are generally not needed to diagnose hypothyroidism
Anti-Thyroid peroxidase antibodies (anti-TPO antibodies) or Anti- thyroglobulin antibodies are present in 90-95% of patient with autoimmune thyroiditis.
Other blood tests include Creatinine Kinase, Serum Lipids, Complete blood picture etc.
Ultrasound of the neck is done if the patient presents with a thyroid swelling.
What is the treatment of hypothyroidism?

Overt hypothyroidism is treated by synthetic Thyroxin hormone which should be taken every day on an empty stomach at least 30 45 minutes before breakfast. The treatment is continued for the rest of the patient s life. Regular thyroid function tests are done once every 8 weeks-12 weeks to adjust the dose of the thyroxine in the initial period of diagnosis. Once the thyroxine dose is stabilised, the tests can be done even once a year. This treatment is quite effective.

Sub-clinical hypothyroidism is only treated if the patient is a woman and is contemplating pregnancy, in patients with symptoms or if the TSH is quite high.

What are the side-effects of thyroxine medication?

There are few side effects if any. Most people tolerate these medications quite well. An important consideration before starting medication is to check if the patient has chest pain/angina. These people are started on the least available dose. If these patients are started on a higher dose they notice a worsening of their angina pains.

Side effects mainly occur if the thyroxine dose is high which leads to hyperthyroidism. The symptoms of this could be palpitations 9increased heart beat), weight loss, profuse sweating, anxiety, irritability etc.

There are some tablets which increase with thyroxine tablets. These include carbamazepine, iron supplements, calcium supplements, rifampicin, phenytoin, warfarin etc.

What are the complications of hypothyroidism?

If untreated hypothyroidism can lead to:

Heart problems like heart attack due to increased levels of bad cholesterol like LDL, or heart failure due to fluid retention
Obesity
Infertility
Joint pains
Depression
A pregnant woman with hypothyroidism is at increased risk of giving birth to a baby with congenital hypothyroidism, also known as cretinism. Further, the woman may have pregnancy related complications like pre-eclampsia, premature delivery, low birth weight baby, anemia, post-partum haemorrhage (bleeding after delivery) etc.
Myxoedema is another complication where the patient has extremely low levels of thyroid hormone. The body temperature drops drastically making the person lose consciousness or go into a coma.

Know The Relation Between Hypothyroidism And Pregnancy!

MS - Obstetrics and Gynaecology
Gynaecologist, Jaipur
Know The Relation Between Hypothyroidism And Pregnancy!
The human body works as directed by the various hormones released by the endocrine system. These hormones are essential for coordination of various body functions. From the height a person achieves to the metabolic reactions in the body to the reproductive cycle to the stress levels a person can handle, all are hormone controlled.

Pregnancy is another critical, complicated phase that a woman goes through. It is one of the most awaited phases in a woman s life; however, it is not very simple either. The above-noted hormones play a major role in this pregnancy, as the baby is dependent on the mother for its initial supply of hormones until it can start producing its own hormones. If the baby does not receive the require amounts, there could be various detrimental effects during development and post birth.

Hypothyroidism or an underactive thyroid is extremely common in women and there are multiple theories about how hypothyroidism can affect a woman s chances of getting pregnant. While the correlation between hypothyroidism and pregnancy are quite well researched, a strong connection stating hypothyroid women being not able to be pregnant is yet to be proven.

The following are some correlations between hypothyroidism and pregnancy.

Increased chance of miscarriage: Women with reduced thyroid functions have double the chances of having a miscarriage. Women suffering from thyroid are at a risk of recurrent miscarriages during the first trimester. The chances of miscarriages during the second trimester are also about 40% higher in hypothyroid women. These women are also at a risk of:

Premature labour
Low birth weight
Increased chances of stillbirth
Maternal anemia
Postpartum hemorrhage
Developmental defects and/or delays in the newborn
Placental abruption
High blood pressure
One of the reasons identified for infertility in women is hypothyroidism. This range varies from 1% to 40% and so remains to be proven still. In addition, the hypothyroid mother will have a set of symptoms to live through, which may be further complicated given the pregnancy. Thyroid replacement should be religiously done and monitored to ensure TSH levels are at the optimal required levels (2.5 to 3 mIU/L) during the entire duration of pregnancy.

If you have the following, be sure to go through a comprehensive thyroid screening before and during pregnancy.

Family history of thyroid
History of thyroid dysfunction or goitre or thyroid antibodies
Clinical signs and symptoms suggestive of hypothyroidism
History of repeated miscarriages
History of head and neck radiation
Family/personal history of autoimmune disorders
While it still remains to be proven that hypothyroidism per se can stop a woman from being pregnant, there are definitely effects of hypothyroidism on the developing child and the mother. A comprehensive screening and close monitoring through pregnancy are extremely essential.

I got to know I have hypothyroid 16.64 in 2016. I started taking thyronorm and now I am using 62.5 mg. I did tsh test in sept 2018 and result is 1.3 which is normal. Then I did tsh test last week and it is .4 which is normal too. But my query is whether I can continue taking 62.5 mg tablet or I need to contact doctor immediately to see that the tsh level should not come down. Any risk if it comes down from normal range.

MBBS, CCEBDM, Diploma in Diabetology, Diploma in Clinical Nutrition & Dietetics, Cetificate Course In Thyroid Disorders Management (CCMTD)
Endocrinologist, Dharwad
I got to know I have hypothyroid 16.64 in 2016. I started taking thyronorm and now I am using 62.5 mg.
I did tsh test...
lybrate-user ji, thanks for the query. Madam when one is on adequate dose of levothyroxine, tsh is maintained with in the normal range. Even though the range is 0.5 to 4.5 or up to 5 mu/l, maintaining tsh around 3 to 4 is good enough. Only tsh goes below 0.1 mu/l then it is considered as going to wards hyperthyroidism. So please keep checking tsh once every 3 to 4 months and see that it is with in normal limits. If any major change occurs then better to consult the doctor. Or it is also good to consult routinely once a quarter. Thanks.
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I am suffering from hypothyroidism. First, tsh was 10. Doctor suggested thryzyte 50mscg after that it was 6 tsh. Then 4.45 now again it's 5.24. What should I do? As thyrxite 50 banned I am using .thyronorm 50 mcg. From today. What to do. Should I go for homoeopath treatment? Why my tsh has increased. And my weight also increased day by day and 75 kg. 165 cm.is that ok to take thyronorm 50 instead of thought.

BHMS
Homeopath, Chennai
I am suffering from hypothyroidism. First, tsh was 10. Doctor suggested thryzyte 50mscg after that it was 6 tsh. Then...
Hypothyroidism is a condition in which the thyroid gland is under active and does not produce sufficient amounts of thyroid hormones required in the body. The most cause of hypothyroidism is Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an auto immune disorder in which the antibodies are produced by the immune system against its own tissue, which in turn attacks the thyroid gland resulting in hypothyroidism.Severe Iodine defficiency can also lead to hypothyroidism . Natural Homeopathic remedies for hypothyroidism are highly effective and especially useful for people who want to avoid the side effects of prescription drugs. Top Homeopathic Remedies for Hypothyroidism Calcarea carb , Sepia ,Lycopodium, Graphites and Nux Vomica are the leading homeopathic remedies for hypothyroidism The normal range of TSH levels is 0.4 to 4.0 milli-international units per liter. You can easily take an online consultation for further treatment guidance and permanent cure without any side effects Medicines will reach you via courier services
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Hi, It s been five months that I was diagnosed with hypothyroid. My tsh was 72 and within 60 days it came down to tsh 2. How long will it take for me to get cured with homeopathy?

BHMS & MD, MCAH
Homeopath, Vijayawada
Hi, It s been five months that I was diagnosed with hypothyroid. My tsh was 72 and within 60 days it came down to tsh...
Dear lybrate-user glad to knwo your tsh value reached normal range. Though tsh reached normal range, thyroid being hormonal disturbance it has to be moniterd every 3 months for 1 year and to be under medication, because the hormonal fluctuation may arise, but once if after monitering it for 1 year and reports present normal range of tsh, and as awhole if you have no problems and everything is alright then that is sign of it got cured. Then after you can keep a check after 3-6 months gap.
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Blood examination report: haemoglobin is 6.4 ultra sensitive thyroid stimulating: 2.76uiu/ml. (0.30 - 5.50) {euthyroid. =0.30 - 5.50} hypothyroid = > 5.50 hyperthyroid=> 0.15} borderline = 0.16 - 0.29}

C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
Your blood report shows anemia and nothing else. If you have any other doubts, different tests suitable for your doubt need to be done.
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Hello Sir, Whether thyroxine is to be taken long life in hypothyroidism. Since I am taking 100 mg tablet for the last 15 years.

MBA (Healthcare & Hospital Administration), MBA (Healthcare), PG Diploma in Cosmatology and PG Diploma in advanced skin & Laser
Homeopath, Vapi
Hello Sir, Whether thyroxine is to be taken long life in hypothyroidism. Since I am taking 100 mg tablet for the last...
It depends on your report and your recovery. If your reports are going to normal then tapper the dose of medicine. But you don't do it your own. Consult your nearby doctor. Repeat the thyroid report every 3 months. It will give a clear idea to you.
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Hello Sir, I am 34 years female suffering from hypothyroid past 5 years. I am taking 50 mcg daily and my tsh level is normal. Can I stop this or it will be life long. Is there any side effects? Please suggest to me.

BHMS
Homeopath, Chennai
Hello Sir, I am 34 years female suffering from hypothyroid past 5 years. I am taking 50 mcg daily and my tsh level is...
Hypothyroidism is a condition in which the thyroid gland is under active and does not produce sufficient amounts of thyroid hormones required in the body. The most cause of hypothyroidism is Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an auto immune disorder in which the antibodies are produced by the immune system against its own tissue, which in turn attacks the thyroid gland resulting in hypothyroidism.Severe Iodine defficiency can also lead to hypothyroidism . Natural Homeopathic remedies for hypothyroidism are highly effective and especially useful for people who want to avoid the side effects of prescription drugs. Top Homeopathic Remedies for Hypothyroidism Calcarea carb , Sepia ,Lycopodium, Graphites and Nux Vomica are the leading homeopathic remedies for hypothyroidism The normal range of TSH levels is 0.4 to 4.0 milli-international units per liter. You can easily take an online consultation for further treatment guidance and permanent cure without any side effects Medicines will reach you via courier services
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I am hypothyroid patient I am doing regular exercise and walking and feeling better, I also loose some weight thankfully. But I want to ask here that my tsh level is detected 0.109 as I am taking 100 mcg tablet also in the morning. This much tsh level is ok or not and how much mcg tablet should I go for now 75 or 50 mcg. Thanks in advance.

MD - Homeopathy, BHMS
Homeopath, Thane
I am hypothyroid patient I am doing regular exercise and walking and feeling better, I also loose some weight thankfu...
What was your previous level of tsh? If that has reduced to 0.109 then your thyroxine dose should be reduced from 100 mcg. Normal tsh value is (0.4miu - 4.0miu).consult your doctor nearest doctor for further assistance.
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