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As hypothyroidism doctors refer to a defective hormone production of the thyroid gland. The hormone deficiency slows down all metabolic processes of the body and reduces the efficiency. Thyroid hypofunction is one of the most common metabolic diseases. Women are more likely to suffer from hypothyroidism than men.

In hypothyroidism, the thyroid gland does not produce enough of the two hormones thyroxine (T4) and triiodothyronine (T3). They affect almost all metabolic processes in humans and are thus vital. While mild hypothyroidism usually causes few symptoms, a stronger hormone deficiency slows down almost the entire metabolic activity significantly and causes severe discomfort.

The hormone deficiency in hypothyroidism can be compensated by the usually lifelong taking hormone tablets. Doctors also speak of replacement or replacement therapy. When properly dosed, the quality of life and life expectancy of hypothyroid patients are not limited.

The drug of choice for hypothyroidism therapy is L-thyroxine (levothyroxine): This synthetic hormone acts like the natural thyroid hormone thyroxine (T4) and is partially converted into the thyroid hormone T3 in the body. It must be taken in the morning on an empty stomach.

Treatment with L-thyroxine is started with a low dose and then slowly increased to the individual final dose. Overdose or overdose may cause heart problems or other signs of hyperthyroidism.

The final dose is based on the basal TSH (it should normalize) and the subjective well-being of the patient. Later, usually once a year (more often in infants) is a therapy control by blood test.

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Hypothyroidism is when the thyroid gland does not produce enough thyroid hormones to meet the needs of the body. The thyroid is underactive. The opposite is hyperthyroidism, where the thyroid produces too much thyroid hormone. 2020-03-09 Hypothyroidism
Profiles of Doctors for Hypothyroidism

The symptoms of hypothyroidism can vary greatly depending on how old the person is. However, for example, weight gain and listlessness are typical.

Hypothyroidism usually develops gradually, which is why symptoms often appear late. The treatment of hypothyroidism is always medically (L-thyroxine, levothyroxine) to compensate for the lack of hormones.

What is a hypothyroidism? Thyroid hypofunction (hypothyroidism) means that the body is not sufficiently supplied with the thyroid hormones thyroxine (T4) and triiodothyronine (T3). There are different reasons for this.

Hypothyroidism is one of the most common hormonal diseases. The incidence of hypothyroidism increases with age:

  • 1 out of 5,000 newborns are born with hypothyroidism.
  • About 1 to 2 out of 200 people are affected by hypothyroidism, women more often than men.

Hypothyroidism: Symptoms

In adulthood, hypothyroidism usually develops slowly. At first, the affected person usually notices any or hardly any complaints. Symptoms usually occur only with a stronger underfunction and can be individually different.

However, there are some symptoms typical of hypothyroidism:

  • Performance decline: fatigue and increased need for sleep
  • Apathy
  • Slowdown
  • Difficulty concentrating
  • Lack of interest
  • Sensitivity to cold
  • Anorexia
  • Constipation (constipation)
  • Increased susceptibility to infection
  • Cool, dry, flaky, pale yellow skin
  • Brittle, straw hair
  • Brittle nails
  • Rough, hoarse voice
  • Weight gain (reduced metabolic rate)
  • Slowed heartbeat (bradycardia)
  • Early onset arteriosclerosis (arteriosclerosis) due to elevated cholesterol levels
  • Cycle disorders (in women)
  • Disorders of fertility, libido and virility
  • Weakened muscle reflexes

What Is a Myxedema Coma?

A rare symptom of hypothyroidism is the myxedema coma.

As a result of an increased incorporation of certain substances (protein-sugar-acid compounds) in the subcutaneous fatty tissue, the skin is often doughy distended in people with hypothyroidism (so-called myxedema), especially in the region around the eyes and on the back of the hand. Through myxedema of the vocal cords and tongue, the voice may sound rough and washed out.

A very rare, severe manifestation of myxedema is myxedema coma. It can arise when hypothyroidism is inadequately treated or unrecognized for a long time and there are other factors that weaken the patient (e.g., infection, surgery). Symptoms of myxedema are:

  • Weakness,
  • immobility,
  • low blood pressure (hypotension),
  • greatly lowered body temperature as well
  • a slowed or superficial respiration (hypoventilation).

A myxedema coma is an emergency that needs to be treated in the intensive care unit.

Especially in older people with hypothyroidism, only a few of the symptoms are common. Mild forms of hypothyroidism are therefore often overlooked. Older people should therefore be tested for hypothyroidism if their physical and mental state is not their age or if depression and memory problems occur.

As a result of untreated hypothyroidism, both the physical and mental development of neonates is delayed. In Germany, there is a statutory screening (screening) of all newborns for hypothyroidism. If hypothyroidism is detected, therapy with tablets will follow immediately.

Newborns with hypothyroidism have the following symptoms after birth:

  • They drink little (drinking laziness).
  • They suffer from constipation.
  • They move little (lack of movement).
  • The skin remains yellow longer (so-called Icterus prolongatus, prolonged neonatal ictus).

Children whose thyroid hypofunction is not treated may develop the following symptoms:

  • Short stature with short stature
  • Disturbed speech ability
  • Delayed puberty
  • Degraded intelligence
  • Hardness of hearing
  • Speech disorder
  • Extremely rare: cretinism

Hypothyroidism: Causes

Thyroid hypofunction (hypothyroidism) can have many causes:

  • If the function of the thyroid itself is disturbed, it is called primary hypothyroidism. It is by far the most common form of hypothyroidism.
  • In rare secondary hypothyroidism, the pituitary gland (pituitary gland) - the control center of many glands - releases too few hormones, so the thyroid is not stimulated.
  • Extremely rare is the function of the so-called hypothalamus disturbed. The hypothalamus is part of the diencephalon and controls the pituitary gland as a superior center. The scientific term for hypothyroidism, which is caused by disorders in the hypothalamus, is tertiary hypothyroidism.

Primary hypothyroidism

If a thyroid defect results in hypothyroidism, it is a primary hypothyroidism. The cause then lies in the organ itself.

Such hyperthyroidism may be innate, for example if the thyroid gland is completely absent or too small. Congenital hypothyroidism can also occur if the iodine utilization is disturbed by a gene defect. That is, the body has enough iodine available, but it can not incorporate it into the thyroid hormones.

Significantly more often, however, the hypothyroidism is acquired in the course of life. The cause of this is usually a loss or destruction of originally functional thyroid tissue, for example according to:

  • Inflammation of the thyroid (thyroiditis), especially as a result of an autoimmune disease (Hashimoto's thyroiditis), in which the body directs its antibodies against the tissue of the thyroid and destroys it.
  • Thyroid surgery e.g. due to hyperthyroidism (hyperthyroidism).
  • Irradiation of the thyroid gland.
  • Taking certain medications (such as antithyroid drugs).
  • Radioiodine therapy.

Radioiodine therapy is used to treat hyperthyroidism. Radioactive radiation destroys excess hormone-producing tissue. In some cases, this leads to hypothyroidism.

Hypothyroidism may in rare cases be due to an extreme deficiency of the vital (essential) trace element iodine. This is favored by the fact that in Germany some regions are iodine deficient areas.

Secondary hypothyroidism

Secondary hypothyroidism occurs when, due to disorders of the pituitary gland (pituitary gland), for example, by tumors, a thyroid gland with thyroid stimulating hormone (TSH) is absent. The thyroid itself is completely intact. This form of hypothyroidism is very rare.

Tertiary hypothyroidism

Tertiary hypothyroidism is a hypothalamic disorder that does not produce enough thyrotropin releasing hormone (TRH). This breaks the control loop between the brain and the thyroid and does not stimulate the thyroid gland to produce thyroid hormones.

Possible causes are plant defects, tumors or inflammations. This form of hypothyroidism is very rare.

Hypothyroidism: Diagnosis

In congenital thyroid hypofunction (hypothyroidism), the diagnosis is usually made very early today due to a legal provision: For each newborn between the third and fifth day of life, the thyroid function (so-called neonatal screening) is examined. The concentration of certain thyroid hormones is determined with the help of a few drops of blood taken from the heel. This investigation also occurs when older children, adolescents or adults are suspected of having hypothyroidism.

  • A normal TSH value excludes thyroid disorders, an elevated level confirms hypothyroidism.
  • A low level of free thyroxine confirms hypothyroidism.

Thyroid scores also provide an indication of what form of hypothyroidism is present.

Since a certain form of thyroiditis, the so-called Hashimoto's thyroiditis, often causes a hypofunction of the thyroid, a blood sample should be examined for the presence of specific antibodies. They arise in the context of this autoimmune disease and are called TPO antibodies and thyroglobulin antibodies. They attack healthy endogenous tissue, which then loses its function.

Ultrasound examination (sonography) can also be used to check the condition of the thyroid gland and to determine if, for example, there are any nodules. However, statements about the functional efficiency of the thyroid can not be made in this way.

Hypothyroidism: Course

When thyroid hypofunction (hypothyroidism) is treated with the necessary thyroid hormones, one can usually expect an uncomplicated course: performance or lifetime are in no way limited.


If a child's hypothyroidism is treated with medication in time, it will not endanger the baby's development. Congenital hypothyroidism, however, can lead to complications untreated: Children with untreated congenital hypothyroidism remain mentally and show a developmental disorder (so-called cretinism).

Typical long-term consequences of childhood hypothyroidism include:

  • speech disorders
  • growth arrears (reduced body size)
  • maturation residue (bone and tooth age)
  • mental and psychological retardation (children are lagging behind in development)
  • hardness of hearing
  • speech disorders

Inadequately treated or unrecognized hypothyroidism can in rare cases lead to the so-called myxedema coma, which is characterized by

  • Weakness,
  • immobility,
  • low blood pressure,
  • low temperature as well
  • characterized by slow or superficial respiration (hypoventilation).

In this case, immediate intensive medical help is necessary.

Hypothyroidism: Treatment

Hypothyroidism is treated with medications that contain the necessary thyroid hormones. Among other things, the iodine-containing thyroid hormones T3 and T4 stimulate cell metabolism and are necessary for normal body growth. An active ingredient commonly used in treatment of hypothyroidism is levothyroxine (L-thyroxine).

The actually effective hormone is triiodothyronine - it is formed in the blood from L-thyroxine by an iodine atom is split off from this.

If there is a congenital hypothyroidism, the missing hormones must be replaced immediately, so that the development of the brain and other organs is not impaired. Thanks to the newborn screening, doctors recognize the congenital forms of hypothyroidism today in the first days after birth, so that the treatment can start immediately. Those affected must take the hormones regularly for life.

Adults with severe (manifest) hypothyroidism must regularly and permanently take thyroid hormones in order to achieve sufficient concentration.

Treatment with thyroid hormones usually begins with a low dose, which is then slowly increased. Hormone status should be checked periodically using a blood test to adjust the dose if necessary. Side effects do not occur with correct dosage.

Treatment of a myxedema coma

If hypothyroidism is not treated, it can rarely result in a so-called myxedema coma. Then intensive care assistance is necessary. It includes:

  • Respiratory Equipment,
  • the intake of steroid hormones (glucocorticoids),
  • a glucose infusion,
  • the regulation of the electrolyte and water balance,
  • the administration of levothyroxine (L-thyroxine) and
  • if necessary, a reheating.

Hypothyroidism: Prevention

It is not possible to prevent hypothyroidism, nor to heal it. All you can do is keep the symptoms at bay using the treatment.

If severe iodine deficiency causes hypothyroidism, you can improve iodine intake by consistently using iodized table salts. It is also recommended to eat sea fish twice a week as sea fish contains a lot of iodine. To cover the daily needs safely, you can take in addition to Jodräparate in consultation with your doctor.

But beware: During pregnancy and lactation, other guidelines for the iodine requirement apply!

Latest News in Hypothyroidism

Type 1 diabetes doubles the likelihood of an underactive thyroid


People often develop type 1 diabetes as well as an underactive thyroid, Hashimoto's thyroiditis, which can be associated with psychological and cognitive problems.

People with type 1 diabetes are twice as likely to have an underactive thyroid (hypothyroidism) than people without diabetes. Because the thyroid gland does not produce enough hormones, the metabolism is slowed down and performance is reduced. Women are affected more often than men. One possible cause is Hashimoto's thyroiditis, an autoimmune disease in which the thyroid is permanently inflamed because the body makes antibodies against the thyroid.

The course of the disease is insidious: sometimes the hypofunction does not develop until months or even years after the antibodies against the thyroid gland are first detectable in the blood. Only when the concentrations of the thyroid hormones T3 (triiodothyronine) and T4 (thyroxine) are reduced does manifest hypothyroidism exist. This is often the time when the diagnosis is first made. The therapy consists of a lifelong intake of the artificially produced hormone L-thyroxine, with which the symptoms can be treated very well.

An underactive function can therefore cause attention disorders, concentration and memory problems as well as depressive moods and anxiety disorders. "People with type 1 diabetes are not only at high risk for Hashimoto's thyroiditis, they are also at risk from mental illness," warns Professor Dr. med. Karsten Müssig, chief physician at the Clinic for Internal Medicine and Gastroenterology at the Franziskus-Hospital Harderberg.

Imaging methods suggest that these impairments are associated with circulatory disorders in certain areas of the brain. "It is possible that the psychological and cognitive problems associated with Hashimoto's thyroiditis are caused by changes in the immune system and in the neurotransmitter balance," adds Müssig.

A current study published by Alexander Eckert from the Institute for Epidemiology and Medical Biometry at the University of Ulm with his colleagues in 2020 in the Journal of Diabetes extends this approach. Using a large group of subjects between the ages of 11 and 25, the scientists investigated whether mental illnesses are more common in young people with type 1 diabetes and Hashimoto's thyroiditis than in people with type 1 diabetes without Hashimoto's thyroiditis. "People with type 1 diabetes and Hashimoto's thyroiditis who had to be treated with L-thyroxine suffered significantly more often from psychological complaints than those who had thyroid autoantibodies but did not yet need any drug therapy," reports Professor Dr. med. Monika Kellerer, chairwoman of the DDG.

On the occasion of Thyroid Week from April 26th to 30th, 2021, the DDG would like to clarify and draw attention to the connection between type 1 diabetes, Hashimoto's thyroiditis and psychological and cognitive problems. "Doctors always have to watch out for mental and cognitive impairments in people with type 1 diabetes and Hashimoto's thyroiditis. Doctors should also think about Hashimoto's thyroiditis in people with type 1 diabetes and, for example, depression," warns the professor Kellerer, specialist in internal medicine, diabetology and endocrinology and medical director at the Marienhospital in Stuttgart.

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