Guide to Hypothyroidism

Guide to Hypothyroidism

overview

The thyroid produces two different types of hormones, iodothyronine and calcitonin. While calcitonin plays a large role in our body, we will focus on the iodothyronines as they are the main players in thyroid disease. So, what are the iodothyronines and what functions do they perform in the body?

There are two different types of iodothyronines (hereinafter referred to as “thyroid hormones”), namely thyroxine (T4) and triiodothyronine (T3). These two hormones are absolutely essential and necessary for body development, growth and energy metabolism, among other things. Thyroxine (T4) is a so-called “prohormone,” meaning that it has little or no effect on its own and must be converted in the body into the biologically active form triiodothyronine (T3). There are many steps that go into the process of producing these thyroid hormones in the thyroid. It can certainly get confusing and complicated, but the most important parts to understand the process are:

· It is important that the required amounts of iodide are available in the body (iodide is a single ion while iodine is a compound). If there is not the required amount of iodide in the body, it can lead to a lack of hormone production and an enlarged thyroid gland, also known as a goiter.

· It is also important to have the right amount of another hormone known as thyroid stimulating hormone (TSH). TSH is a hormone that signals the thyroid to produce thyroid hormone. TSH comes from the pituitary gland.

• Die Fähigkeit Ihres Körpers, das T4-Hormon in das T3-Hormon umzuwandeln.

The last point in an interesting one. As mentioned in the first paragraph, T4 is a prohormone and is not very active in the body itself. It needs to be converted to the active form T3. Our bodies actually produce MUCH more T4 than T3! In fact, about 60-80% of the thyroid hormones produced by the body are T4 and need to be converted into T3. While our thyroid produces some T3 itself, the vast majority of the T3 that is in our body at any given time has been converted from T4. So it's pretty clear that the conversion of T4 to T3 is extremely important for the proper functioning of our body. Unfortunately, some people have a reduced ability to carry out this conversion and for this reason they require different medications than someone who is able to convert the hormone properly.

So what are the functions of thyroid hormones?

• Sie spielen eine große Rolle bei der Entwicklung des Gehirns und des gesamten Körpers.
• Sie regulieren den Energieverbrauch im Körper und auch, wie Ihr Körper Sauerstoff aufnimmt und verbraucht.
• Sie beeinflussen viele verschiedene Aspekte der Herzfunktion, einschließlich wie hart und wie schnell sie schlägt.
• Sie haben großen Einfluss auf die Stoffwechselprozesse des Körpers, einschließlich der Art und Weise, wie wir unsere Nahrung metabolisieren und wie unser Körper mit Fett und Cholesterin umgeht.

Causes

Thyroid diseases can lead to too much or too little production of thyroid hormones. When a doctor wants to test how your thyroid is working, they usually order what's called a thyroid function test (TFT). Two of the most commonly performed tests measure two things in your body, TSH (thyroid stimulating hormone) and the amount of T4 in your body. There are additional tests as well, but these two are by far the most common. While we don't spend a lot of time discussing TSH, it's important to know that TSH doesn't come from the thyroid itself, but from the pituitary gland. TSH stimulates your thyroid to produce more thyroid hormone.

The most common thyroid disorder is hypothyroidism (low thyroid hormone). Hypothyroidism is actually divided into three separate categories based on the cause of the hypothyroidism.

• Primäre Hypothyreose – Dies tritt bei Menschen auf, die aus verschiedenen Gründen nicht genug Schilddrüsenhormon selbst produzieren können. Die Gründe sind eine Autoimmunerkrankung, die als Hashimoto-Krankheit bekannt ist, und eine unzureichende Jodaufnahme. In Industrieländern der Welt ist eine unzureichende Jodaufnahme äußerst selten. Jod wird am häufigsten zu Speisesalz hinzugefügt (fragen Sie sich jemals, warum Salz üblicherweise als Jodsalz verkauft wird?) Und wir nehmen daher im Allgemeinen ausreichende Mengen auf.
• Sekundäre Hypothyreose – Dies tritt bei Menschen auf, die an einer Krankheit leiden, die TSH (Schilddrüsen-stimulierendes Hormon) beeinträchtigt. Wenn TSH beeinträchtigt ist, erhält Ihre Schilddrüse nicht die Nachricht, genug Schilddrüsenhormon zu produzieren.
• Tertiäre Hypothyreose – Bei diesem Typ produziert Ihr Hypothalmus nicht genug Hormon, das Ihre Hypophyse dazu anregt, TSH freizusetzen.

As we can see, there are many areas where things can go wrong. Aside from primary hypothyroidism, the problem often lies not with the thyroid itself, but with other glands and hormones on the way to producing sufficient thyroid hormones.

Typically, symptoms of hypothyroidism start out mild and tend to progress the longer it goes untreated. The most common effects of hypothyroidism are:

• Ermüden
• Fühlen Sie sich kalt oder gekühlt
• Gewichtszunahme
• Verstopfung
• Spröde und leicht zu brechende Nägel
• Haarausfall
• Trockene und juckende Haut
• Gelenkschmerzen
• Sprachänderungen
• Schlechter Appetit
• Verlangsamung der normalen Herzfrequenz

As we can see, there are MANY possible physical manifestations of low thyroid hormone. People generally describe the symptoms as “blah” overall.

If hypothyroidism is left untreated and continues to worsen, some serious problems can occur, including:

• Koma
• Herzinfarkt
• Vergrößerte Schilddrüse (bekannt als Kropf)

Medication

There are many different medications that can be used to replace low levels of thyroid hormone in the body. The three most common are listed below:

• Levothyroxin (Mehrere Markennamen einschließlich Synthroid, Levothroid und Unithroid)
• Liothyronin (Markenname Cytomel)
• Dess

Thyroid (Multiple brand names including Armor Thyroid and Nature-Throid)

We will discuss each of these medications in detail.

Levothyroxine

Levothyroxine is by far the most commonly prescribed medication for thyroid replacement therapy. Levothyroxine is a synthetic preparation of the T4 thyroid hormone and, as mentioned in the previous sections, must be converted into the active T3 hormone in the body. Why is the most commonly prescribed thyroid replacement drug T4 as opposed to the already active T3? This is a fair question, especially since many people cannot or do not have the ability to make T3 from T4 compromised. The answer to the question is that it has consistent potency at every dose (since it is manufactured synthetically, the variability in strength from tablet to tablet is extremely low) and that it has predictable absorption/long duration of action. It is usually dosed only once daily. Levothyroxine is also the most cost-effective thyroid replacement drug.

It is extremely important to take this medication (and all thyroid medications) at the same time each day. The most common recommendation is to take your dose first thing in the morning, when you wake up with a full glass of water and should not eat or take any other medications for at least 30 minutes. This recommendation is here because the dosages of thyroid hormone are low! The typical human dose is 112 micrograms. That's 1/1000 of 112 milligrams and 1/1000000 of 112 grams! We are talking about an extremely small dosage here. A small change in absorption can greatly affect how your medication affects you. Typically, after starting your thyroid medication, you will have a follow-up appointment with your doctor in 6-8 weeks to determine whether you need a dose change.

Liothyronine

Liothyronine, also known as Cytomel, is a synthetic T3 hormone. The advantage of liothyronine is that it does not need to be converted like levothyroxine to become active. This is certainly a positive feature for patients with a limited ability to convert T4 to T3. Liothyronine also has a slightly quicker onset than levothyroxine. With all of these positive aspects, one might wonder why liothyronine is not the most popular thyroid replacement drug. First, liothyronine is more expensive than levothyroxine. Second, due in part to the more rapid onset of action, a risk of cardiotoxicity has been associated in the past. Due to the quicker onset of action, the T3 level in your body may be too high for a short time, which can cause problems. While it is predominantly administered once daily, in some people it may need to be administered twice daily because it does not have the long duration of action that levothyroxine does. Regarding taking liothyronine, it should be taken in the same manner as levothyroxine, first thing in the morning.

Desiccated thyroid

Desiccated thyroid goes by many names, but is most commonly sold as Armor Thyroid. A desiccated thyroid is an animal thyroid (most commonly a pig) that has been cleaned, pulverized, dried, and then formed into a variety of dosage forms. There are two main characteristics of desiccated thyroid that differ from the other medications. First, and perhaps most importantly, it is a natural medication and contains the natural thyroid hormones. It is not synthetic like the other medications. Second, the desiccated thyroid contains BOTH T4 and T3. There has been and probably always will be controversy over the use of desiccated thyroid. Some positive attributes include the fact that it is natural, contains both T4 and T3 (although studies are inconclusive as to whether this has any benefit), and a good supply of anecdotal evidence. The main negative of this form of thyroid is the fact that the dose can vary from tablet to tablet. Due to the manufacturing process, it is much more difficult to obtain accurate dosages every time compared to the synthetic versions of Thyroid. Thyroid desiccation can also be difficult for doctors to dose and very often the dosage is increased until patients' symptoms improve. Many practitioners like to rely on hard lab values ​​instead of tracking symptoms. Desiccated thyroid is not typically recommended as first-line treatment by many medical organizations.

Inspired by Arthur Percy