What is Hypothyroidism?

Hypothyroidism is the state which is caused when the thyroid gland

produces an insufficient amount of thyroid hormone. The thyroid is
one of the larger hormonal glands in the body. It is located in the neck
and is responsible for the production of hormones which regulate the
metabolism in the body and affect the growth and rate of function of
many other systems in the body.

Who Suffers?

Women, in all age groups, are more likely than men to suffer from
subclinical hypothyroidism. Up until the age of 60 about 8 percent of
women and only 4 percent of men carry the condition. Though after
the age of 60, the numbers about double for both age groups with 15
percent of women compared to 8 percent of men carrying the
condition.

It is especially important for women who think they may have the
condition to be treated accurately. As Elizabeth Vliet, M.D., points out
in her bestselling book Screaming to be Heard: Hormonal
Connections Women Suspect… and Doctors Ignore, it is common
that women concerned about the condition are told their thyroid is
functioning normally, when in fact, the full set of thyroid tests were
never completed.

Causes of subclinical hypothyroidism

One reason for the increase rates of subclinical hypothyroidism in

older people may be a direct result of the causes of the condition.
Hypothyroidism eventually occurs in up to 25 percent of all individuals
treated with surgery or antithyroid drugs. And although thyroid failure
is most common after radioactive iodine treatments, these are not the
only causes of the condition. Other causes may include:

• Treated Graves Disease

• Head and neck surgery
• Iodine deficiency
• Medications, including lithium, iodine and Cordarone
These are the most common, but not all of the possible causes of
hypothyroidism. It is important to be tested for the condition if any of
these causes are met.

Cause
About three percent of the general population is hypothyroid.[ Factors
such as iodine deficiency or exposure to Iodine-131 (I-131) can
increase that risk. There are a number of causes for
hypothyroidism. Iodine deficiency is the most common cause of
hypothyroidism worldwide. In iodine-replete individuals
hypothyroidism is generally caused by Hashimoto's thyroiditis, or
otherwise as a result of either an absent thyroid gland or a deficiency
in stimulating hormones from the hypothalamus or pituitary.
Hypothyroidism can result from postpartum thyroiditis, a condition
that affects about 5% of all women within a year of giving birth. The
first phase is typically hyperthyroidism; the thyroid then either returns
to normal, or a woman develops hypothyroidism. Of those women
who experience hypothyroidism associated with postpartum
thyroiditis, one in five will develop permanent hypothyroidism
requiring life-long treatment.
Hypothyroidism can also result from sporadic inheritance,
sometimes autosomal recessive
Hypothyroidism is also a relatively common disease in domestic
dogs, with some specific breeds having a definite predisposition.
Temporary hypothyroidism can be due to the Wolff-Chaikoff effect. A
very high intake of iodine can be used to temporarily treat
hypothyroidism, especially in an emergency situation. Although iodine
is substrate for thyroid hormones, high levels prompt the thyroid
gland to take in less of the iodine that is eaten, reducing hormone
production.
Hypothyroidism is often classified by association with the indicated
organ dysfunction (see below):
Question of Treatment of Subclinical Hypothyroidism

There is debate among medical doctors as to whether subclinical

hypothyroidism needs to be treated at all. Some doctors argue that it
is not necessary to treat patients with the condition. But most doctors
agree that treatment is the best option. Subclinical hypothyroidism, if
left untreated can begin to manifest symptoms of full-fledged
hypothyroidism, in which more urgent action would be necessary.
Early treatment of the condition can also prevent the growth of a
goiter and may help to eliminate symptoms.

Risks of Not Treating Subclinical Hypothyroidism

If left untreated, the risks of subclinical hypothyroidism can result in

the increase other, more dangerous conditions. These increased
risks include:

• Heart attack
• Atherosclerosis
• Elevated cholesterol and high triglycerides
• Depression anxiety and panic attacks
• Miscarriage
• Developmental problems in new born infants

Treatment of Subclinical Hypothyroidism

Treatment of subclinical hypothyroidism is similar to the treatment of

hypothyroidism. In both instances, the synthetic hormone
levothyroxine is administered to the patient. Levothyroxine is a
synthetic form of thyroxine, the hormone produced in the thyroid.
When administered the hormone is metabolized much slower than
the naturally occurring thyroid hormone resulting in a more balanced
thyroid activity. The drug is generally administered daily and about
one hour before a patience meal to maximize is absorption and
effectiveness. Patients with subclinical hypothyroidism are treated
with a much lower dosage of the synthetic compound than those with
full-fledged hypothyroidism.
Incidence rate

We aimed to evaluate the risk factors for the development of

definitive thyroid failure, to analyze the natural course of subclinical
hypothyroidism and to quantify the incidence rate of overt
hypothyroidism in elderly patients.

Two hundred and fourteen patients (186 women and 28 men) over
age 60 years with subclinical hypothyroidism and no previous history
of thyroid disease were prospectively studied. Subjects were followed
up for 6–72 months (mean, 31.7 months) with repeated
determinations of TSH and free T4. Fifty-eight patients (27.10%)
developed overt hypothyroidism, and 81 (37.85%) showed
normalization of their TSH values. The incidence rate of overt
hypothyroidism was 9.91 cases per 100 patient-years in the whole
population, and 1.76, 19.67, and 73.47 cases per 100 patient-years in
subjects with initial TSH values between 6.0–8.9, 9.0–13.9, and 14.0–
18.9 mU/l, respectively.

Kaplan–Meier analysis showed that the development of definitive

thyroid hypofunction was significantly related to the presence of
symptoms of hypothyroidism, goitre, positive thyroid antibodies
(P<0.05), and mainly low normal free T4 (P<0.01) and high TSH
(P<0.001) concentrations at baseline. A stepwise multivariate Cox
regression analysis showed that the only significant factor for
progression to overt hypothyroidism was serum TSH concentration

Previous studies only documented the prevalence of goiter based on

clinical examination. There appeared to be an increase in the
prevalence of goiter during this six-year period, with the initial rate in
1987 of 3.7% to 6.7% in 1993 (Phil. F&F, 2001). In the latter data, the
highest prevalence rate was seen in pregnant women aged 13 to 20
years at 27.4%. This study will be the first national survey in the
Philippines on the prevalence of thyroid disorder based on thyroid
function tests.