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THE GULF COAST CENTER
ACKNOWLEDGEMENT OF RECEIPT & UNDERSTANDING
OF HYPOTHYROIDISM TRAINING MATERIAL
Full Legal Name: Company Name: I acknowledge that I have received a copy of Training Material on Hypothyroidism, and I acknowledge that I have read and understand its contents. Signature of Individual Signature of Supervisor Please mail completed form to this address after completion: The Gulf Coast Center Attention: Lina Ellis P.O. Box 2490 Galveston, TX 77553-2490 THE GULF COAST CENTER
ACKNOWLEDGEMENT OF RECEIPT & UNDERSTANDING
OF HYPOTHYROIDISM TRAINING MATERIAL
Did you know?
Hypothyroidism is present in 1 out of every 5000 newborns1.
Impairment of thyroid function affects about 2% of adult women and about 0.1% to 0.2% of adult men in North America.2 As many as 25% of patients with hypothyroidism have normal levels of T3.2 Symptoms of thyroid dysfunction can have a significant impact on behavior such as mental confusion and memory problems.3 Hypothyroidism can be associated with depression and its symptoms4,5: • decreased interest in daily activities • concentration difficulties • sleep disturbances • reduced sexual interest Hypothyroidism can be associated with certain heart problems and mild high blood pressure.6 Even mild thyroid failure can have harmful effects.7 What is Hypothyroidism?
The thyroid is a small, butterfly-shaped gland located in the front of the neck, which produces thyroid hormones, or "chemical messengers," that signal cells throughout the body to increase oxygen use. The two key thyroid hormones are L-triiodothyronine (T3)—the more biologically active thyroid hormone—and thyroxine (T ).8 Hypothyroidism occurs when there is an inadequate secretion of thyroid hormones, resulting in a slowing down of the body's metabolism.1,7 While low production of these hormones results in hypothyroidism (an underactive thyroid), high production of these hormones results in hyperthyroidism (an overactive thyroid).1,6 The goals of thyroid hormone replacement therapy are to normalize thyroid hormone levels and to provide symptomatic relief. Although there are several types of thyroid hormone replacement available, not any one type is optimal therapy for everyone. As a result, treatment options may vary from person to person.9 Who Develops Hypothyroidism?
Select a category from the list or scroll down the page.
• Age and Gender
• Genetic Defects • Smoking in Women with Hypothyroidism THE GULF COAST CENTER
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• Risk Factors for Pregnant Women • Other Risk Factors
Age and Gender
Estimates suggest that 1 in 10 Americans, approximately 20 million people, have a thyroid disorder.1 Thyroid disease strikes women more often than men.2 The elderly are the most susceptible to hypothyroidism.3 Underdiagnosis is a risk in the elderly because many of the symptoms of hypothyroidism—dry skin, fatigue, constipation, and memory loss—may be mistaken for signs of aging.4 However, hypothyroidism can affect people of all ages, and 1 out of every 5,000 infants is born without a working thyroid gland.4 Hashimoto's thyroiditis—an inflammation of the thyroid caused by autoimmune factors—is the leading cause of hypothyroidism, affecting about 8% of adults.2 Genetic Defects
Heredity plays a role in both underactive and overactive thyroid; about half of those with
close relatives with chronic autoimmune disease have antibodies—the immune system's
agents for attacking specific proteins—to the thyroid. As many as half of those with Turner's syndrome—one of the most common genetic diseases in women—have hypothyroidism, usually resulting from Hashimoto's thyroiditis.5 Smoking in Women with Hypothyroidism
Smoking is generally regarded as an unhealthy habit for many reasons, and in women with
hypothyroidism, it should likewise be avoided. In a study reported in The New England
Journal of Medicine, women with subclinical hypothyroidism who also smoked had higher total LDL cholesterol levels than nonsmokers. Women with hypothyroidism who smoked also had higher serum cholesterol concentrations and more muscle problems than those who did not smoke.6 It was concluded that smoking impairs both thyroid hormone secretion and thyroid hormone action. Therefore, your smoking status needs to be considered when hypothyroidism is suspected or being medically managed.
Risk Factors for Pregnant Women
Women who have hypothyroidism are also at greater risk for autoimmune conditions.1,4 Thyroid dysfunction can have harmful effects on the fetus and the mother during pregnancy.7-11 The NIH (National Institutes of Health) has also established that untreated hypothyroidism during pregnancy can adversely affect the IQ of children.12 Other Risk Factors
Hypothyroidism occasionally occurs with Addison's disease, pernicious anemia, insulin-dependent diabetes, Sjogren's syndrome, and rheumatoid arthritis.5 It is also associated with myasthenia gravis, ovarian failure, sleep apnea, and premature gray hair.1 Physicians should check for hypothyroidism in older people with any of these conditions. THE GULF COAST CENTER
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People with anorexia or bulimia are also at risk for hypothyroidism; in these cases, however, reduced thyroid function may be an adaptation to malnutrition, and, therefore, some experts think only the eating disorder should be treated, not hypothyroidism. Since many drugs affect the thyroid, anyone being treated for a chronic disease, anyone who is taking thyroid medication and requires other drugs, or anyone who is at risk for thyroid disorder and needs to take medications should discuss with their physician the impact of the particular drug on their thyroid. If you believe you may have symptoms of hypothyroidism, see a physician; only a physician should diagnose hypothyroidism. What Are the Signs and Symptoms of Hypothyroidism?
Select from the list of symptoms and phase of hypothyroidism or scroll down the page. • Summary List of Symptoms1 • Early Symptoms • Later Symptoms • Secondary Hypothyroidism • Symptoms in Infants and Children • Subclinical Hypothyroidism Summary List of Symptoms1
In general, the symptoms of hypothyroidism (underactive thyroid)
Weight gain Puffy face Loss or thinning of eyebrows Cold Low sex drive Depression Abdominal bloating Cold hands Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Weight gain Puffy face Loss or thinning of eyebrows Cold Low sex drive Depression Abdominal bloating Cold hands Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Weight gain Puffy face Loss or thinning of eyebrows Cold THE GULF COAST CENTER
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OF HYPOTHYROIDISM TRAINING MATERIAL
Low sex drive Depression Abdominal bloating Cold hands Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Puffy face Loss or thinning of eyebrows Cold intolerance Abdominal bloating Cold hands or feet thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Loss or thinning of eyebrows Cold intolerance Abdominal bloating Cold hands or feet thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Loss or thinning of eyebrows Cold intolerance Abdominal bloating Cold hands or feet thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Cold intolerance Low sex drive Depression Abdominal bloating Cold Dry or thinning hair Joint or muscle pain the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Low sex drive Depression Abdominal bloating Cold hands or feet or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal THE GULF COAST CENTER
ACKNOWLEDGEMENT OF RECEIPT & UNDERSTANDING
OF HYPOTHYROIDISM TRAINING MATERIAL
women may experience heavy periods.2Low sex drive Depression Abdominal bloating Cold hands or feet or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Depression Abdominal bloating Cold hands or feet hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Abdominal bloating Cold hands or feet Dry or thinning hair Joint or Thickening of the skin Thin, brittle fingernails Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or
aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Abdominal bloating Cold hands or feet Dry or thinning hair Joint or Thickening of the skin Thin, brittle fingernails Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or
aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Cold hands or feet Dry or thinning hair Joint or muscle pain of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
THE GULF COAST CENTER
ACKNOWLEDGEMENT OF RECEIPT & UNDERSTANDING
OF HYPOTHYROIDISM TRAINING MATERIAL
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or
aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 As your thyroid hormone levels fall over the following months, the skin becomes rough and dry, hair coarsens, and mental activity—including concentration and memory—may become slightly impaired.2 Depression can develop, and some experts believe that even mild thyroid failure can lead to major depression.3,4 THE GULF COAST CENTER
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Later Symptoms
If hypothyroidism is left untreated, the classic physical changes
characteristic of myxedema can develop—a round, puffy face with a sleepy appearance, dry rough skin, and loss of hair. Other later symptoms include a husky voice and numbness of the arms and legs. Muscle pain, weakness, and carpal tunnel syndrome may occur. Some people experience hearing loss, depression, mental confusion, uneasiness, daytime sleepiness, or memory problems, especially in the elderly. Obstructive sleep apnea, in which tissues in the upper airway collapse at intervals during sleep, thereby
blocking the passage of air, is common. Myxedema coma is a life-
threatening condition caused by long-standing hypothyroidism.2
Summary List of Symptoms1
In general, the symptoms of hypothyroidism (underactive thyroid)
Weight gain Puffy face Loss or thinning of eyebrows Cold Low sex drive Depression Abdominal bloating Cold hands Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Weight gain Puffy face Loss or thinning of eyebrows Cold Low sex drive Depression Abdominal bloating Cold hands Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Weight gain Puffy face Loss or thinning of eyebrows Cold Low sex drive Depression Abdominal bloating Cold hands Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Puffy face Loss or thinning of eyebrows Cold intolerance Abdominal bloating Cold hands or feet thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; THE GULF COAST CENTER
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muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Loss or thinning of eyebrows Cold intolerance Abdominal bloating Cold hands or feet thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Loss or thinning of eyebrows Cold intolerance Abdominal bloating Cold hands or feet thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Cold intolerance Low sex drive Depression Abdominal bloating Cold Dry or thinning hair Joint or muscle pain the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Low sex drive Depression Abdominal bloating Cold hands or feet or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Low sex drive Depression Abdominal bloating Cold hands or feet or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Depression Abdominal bloating Cold hands or feet hair Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; THE GULF COAST CENTER
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muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Abdominal bloating Cold hands or feet Dry or thinning hair Joint or Thickening of the skin Thin, brittle fingernails Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or
aging. They begin to feel chronically tired and overly sensitive to cold;
muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Abdominal bloating Cold hands or feet Dry or thinning hair Joint or Thickening of the skin Thin, brittle fingernails Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or
aging. They begin to feel chronically tired and overly sensitive to cold;
muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Cold hands or feet Dry or thinning hair Joint or muscle pain of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Dry or thinning hair Joint or muscle pain Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Joint or muscle pain Thickening of the skin Thin, brittle Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or THE GULF COAST CENTER
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aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Thickening of the skin Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Thin, brittle fingernails Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 Early Symptoms
Early Symptoms
Many people attribute the early symptoms of hypothyroidism to stress or aging. They begin
to feel chronically tired and overly sensitive to cold; muscle and joint aches often develop; modest weight gain is common even though appetite diminishes; constipation is often a problem.2 Premenopausal women may experience heavy periods.2 As your thyroid hormone levels fall over the following months, the skin becomes rough and dry, hair coarsens, and mental activity—including concentration and memory—may become slightly impaired.2 Depression can develop, and some experts believe that even mild thyroid failure can lead to major depression.3,4 Later Symptoms
If hypothyroidism is left untreated, the classic physical changes characteristic of myxedema
can develop—a round, puffy face with a sleepy appearance, dry rough skin, and loss of hair. Other later symptoms include a husky voice and numbness of the arms and legs. Muscle pain, weakness, and carpal tunnel syndrome may occur. Some people experience hearing loss, depression, mental confusion, uneasiness, daytime sleepiness, or memory problems, especially in the elderly. Obstructive sleep apnea, in which tissues in the upper airway collapse at intervals during sleep, thereby blocking the passage of air, is common. Myxedema coma is a life-threatening condition caused by long-standing hypothyroidism.2 Secondary Hypothyroidism
Secondary hypothyroidism is not common. It is caused by an abnormality of the pituitary gland and deficient TRH secretion.2 Symptoms in Infants and Children
All newborns are now screened for hypothyroidism in order to help prevent retardation,
which can occur if the disorder is not detected early. Some early symptoms that develop in children who are not treated include feeding problems, constipation, hoarseness, and THE GULF COAST CENTER
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sleepiness. Later, babies may have protruding abdomens, rough, dry skin, and delayed teething. If they do not receive proper treatment in time, they may be extremely short for their age, have a puffy, bloated appearance, or have below-normal intelligence. Therefore, a child who appears to be growing abnormally slowly should be examined for hypothyroidism.5 Subclinical Hypothyroidism
Subclinical hypothyroidism, or subclinical thyroid dysfunction, is characterized by a mildly
elevated TSH level with normal serum T and T 3. It is called subclinical because this condition is recognized before symptoms are detected.6 Symptoms in adults, particularly those over age 50, usually develop so slowly that hypothyroidism is often first diagnosed in blood tests. If you believe you may have symptoms of hypothyroidism, see a physician; only a physician should diagnose you with hypothyroidism. THE GULF COAST CENTER
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DIAGNOSIS
How Does a Doctor Determine You Need Thyroid Hormones?
After you have discussed your symptoms with your doctor and hypothyroidism is suspected, a TSH (thyroid stimulating hormone) test, and possibly others, may be ordered. When a physician receives a laboratory report, the report slip will state normal ranges for TSH and possibly for other specific hormones. The TSH measurement is of fundamental importance since it reflects the sufficiency of the brain's supply of thyroid hormone. A normal range TSH indicates that the hypothalamus senses a normal amount of thyroid hormone and is stimulating the thyroid to continue making and releasing thyroid hormone at the same rate. An elevated TSH level signals the central nervous system's insufficiency of thyroid hormone, while a reduced TSH level indicates that the central nervous system senses increased amounts of thyroid hormone.
Blood Tests1
If you take thyroid supplement medication on the day of your blood test, you should wait
until after the blood has been drawn so as to avoid any test interference. Once the blood has been drawn, you may take that day's dose and return to your regular dosing schedule. There are many blood tests used to diagnose and monitor patients with thyroid conditions. No single lab test is considered 100% accurate in determining thyroid disease, but a combination of two or more tests may help to determine if there is a problem with the thyroid gland or the pituitary gland. The Thyroid Stimulating Hormone (TSH) and Free Thyroxine Index (FT I) are the two blood tests most commonly used to diagnose patients with hypothyroidism and to monitor their progress while using a thyroid medication.1 However, in many situations, it is necessary to perform other tests as well. Several hormones, their relationship to one another, and the respective tests used to measure the hormone levels are described below: Thyroid Stimulating Hormone (TSH)1: TSH, also referred to as thyrotropin, is released
by the pituitary gland in response to TRH stimulation. Just as the name implies, TSH
stimulates the thyroid gland to produce more thyroid hormone for the body. In summary, a
low level of circulating thyroid hormone results in a release of TRH, which stimulates TSH production, and finally an increased production of thyroid hormones by the thyroid gland. TSH measurement may help the physician to determine if the problem is primary (thyroid gland) or secondary (pituitary gland) hypothyroidism. TSH measurement may also be used, in conjunction with other tests, to determine whether the dose of thyroid supplementation medication needs to be adjusted. For example, if the TSH level is high, an increase in thyroid supplement dose may be needed. Total T Immunoassay (Total T , T RIA, thyroxine, or T )1: This test is used to
determine the total amount of T in the blood, representing both the bound (to proteins) and unbound portions of T . The majority of T in the blood is bound to protein and therefore has no activity. The amount of free versus bound T can be measured with a separate test. Free Thyroxine Index (FT I)1: This test is used to determine the amount of free
(unbound) T in the blood. It is important to look at the amount of free T since this is the portion of thyroid hormone available to become active in the body. THE GULF COAST CENTER
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Total T3 Immunoassay (Total T3, T3RIA, L-triiodothyronine, or T3)1: This test is used
to determine the total amount (both bound and unbound portions) of T3—the more potent and active form of the two thyroid hormones—in the blood. Like T , if the hormone is bound to protein, it is considered inactive. This test is most often used in the diagnosis of different types of hyperthyroidism, such as Graves' disease. In hypothyroidism, these levels may often remain within the normal range. Free T3: It is believed that the minute amount of free hormone (the amount not bound by
proteins in the circulation) may be the amount that is responsible for the biological activity of thyroid hormones at the cellular level (0.02% for Free T versus 0.2% for Free T Measuring the Free T3 value involves either two-test index methods, physical separation methods that isolate free from protein-bound hormone, or immunoassay methods. Your physician may have a preference for which Free T3 test to use. The normal values for the thyroid blood tests may vary with different laboratories. It is always important to compare your results with the normal values provided by your laboratory. It is also important to pay particular attention to the units of measure (ie, µg/dL versus mmol/L) to be sure you are comparing similar entities. The following are average normal values1: Results in
Results in
Normal Value Hypothyroidism Hyperthyroidism
0.3 – 5.0µU/mL Thyroid Stimulating Hormone 0.3 – 5.0 mU/L 5 – 11µg/dL or Total T Immunoassay 64 – 142 nmol/L 95 – 190 ng/dL Total T3 Immunoassay 1.5 – 2.9 nmol/L Wide Range of Variation
Within the range of normal for thyroid hormone concentration, there is a rather wide degree
of variation from individual to individual.3
When a patient has symptoms suggestive of hypothyroidism but is shown to have lower normal values of thyroid hormone, a physician may start a trial of thyroid hormone therapy, hoping to increase these lower normal thyroid hormone values to upper normal values. If there is a sustained favorable response without any evidence of clinical hyperthyroidism, long-term replacement therapy may be justified. THE GULF COAST CENTER
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TREATMENTS
Hypothyroidism is traditionally treated with thyroid hormone replacement therapy (either synthetic or natural). Thyroid replacement therapy could include taking levothyroxine (T4), liothyronine (T3), or a combination product that contains both T4 and T3. All of these treatments work in the body like thyroxine, the human hormone that is normally produced by the thyroid gland, and subsequently converted to T3, the active hormone. Forest Pharmaceuticals, Inc. offers two combination (T4/T3) products, and one levothyroxine product to help treat hypothyroidism: Armour™ Thyroid (Thyroid Tablets, USP), Thyrolar® (liotrix tablets, USP), and Levothroid® (levothyroxine sodium tablets, USP). Armour Thyroid is the leading combination therapy (T4/T3 ) product available for the
treatment of hypothyroidism. It is a natural preparation derived from porcine thyroid
glands.
Levothroid is a synthetic treatment containing the hormone levothyroxine (T4). It is both
gluten-free and lactose-free. It treats hypothyroidism by replacing or supplementing the T4
that is normally produced by the thyroid.
Thyrolar is the only synthetic product combining L-triiodothyronine (T3) and levothyroxine
sodium (T4 ) indicated for the treatment of hypothyroidism. This product is for patients who
seek combination therapy in a synthetic form.
GLOSSARY
Addison's disease-a disease of the adrenal glands characterized by low blood pressure,
weight loss, anorexia, and weakness; without replacement hormonal therapy, it is usually
Autoimmune disease-condition in which the body's immune system reacts against one's
own tissues or organs
Carpal tunnel syndrome-a condition in the wrist due to biomechanical factors, causing
pain and burning or tingling in the fingers and hands
Hashimoto's thyroiditis-chronic inflammation of the thyroid caused by the immune
system reacting against its own tissues Hyperthyroidism-excess production of thyroid hormone due to abnormal thyroid gland
function, nodules, or excessive thyroid function
Hypothalamus-lying below the thalamus, it is the part of the brain that regulates
autonomic activities such as body temperature and certain metabolic processes
Hypothyroidism-deficiency of thyroid activity
THE GULF COAST CENTER
ACKNOWLEDGEMENT OF RECEIPT & UNDERSTANDING
OF HYPOTHYROIDISM TRAINING MATERIAL
LDL-(low density lipoprotein)-"bad cholesterol"; the higher the LDL levels in the blood, the
higher the risk for coronary artery disease
L-triiodothyronine (T3)-a key thyroid hormone that is the more biologically active
Myasthenia gravis-a disease usually affecting the muscles of the eyes, face, lips, tongue,
throat, or neck, causing a muscle weakness, disability, and fatigue
Myxedema-a condition characterized by swelling of the skin and other tissues, particularly
around the eyes and cheeks, caused by extreme deficiency of thyroid hormone
Obstructive sleep apnea-a sudden stopping of the normal breathing while sleeping
Pernicious anemia-reduction in red blood cells generally occurring in later adult life due to
the inability to absorb B12 from the gastrointestinal tract
Rheumatoid arthritis-a chronic disease characterized by stiffness and inflammation of the
joints, loss of mobility, weakness, and deformity
Secondary hypothyroidism-a deficiency of pituitary TSH secretion resulting from
insufficient thyroid releasing hormone secretion
Subclinical hypothyroidism-a mildly elevated TSH level with normal T3 and T levels and
either no symptoms or very minor symptoms of hypothyroidism Thyrotoxicosis-a toxic condition resulting from excessive amounts of thyroid hormones in
the body, as that occurring in hyperthyroidism Thyroxine (T )-an iodine-containing hormone produced by the thyroid gland to regulate
metabolism; also made synthetically for treatment of thyroid disorders TSH (thyroid stimulating hormone)-thyrotropin; a pituitary hormone that promotes the
growth of the thyroid gland and stimulates hormonal secretion of the thyroid gland
Turner's syndrome-complete or partial absence of one of the two X chromosomes in the
female, usually causing sterility and other signs

Source: http://gulfcoastcenter.org/userfiles/file/Provider-contract-forms-trainings/HYPOTHYROIDISM-STUDY-GUIDE-AND-ACKNOWLEDGEMENT-FORM.pdf