Why Am I So Tired All of the Sudden? The Signs and Symptoms of Hypothyroidism when your Thyroid Hormone Output is Low

The thyroid is a small gland located in the front of your neck, just below your voice box, or “Adam’s Apple”. It’s a small gland, but its duties in regulating functions of your body and maintaining your health are tremendous. This all works in quite a mechanical way, but the basic idea is that under control of the pituitary gland, the thyroid takes up iodine from the foods we eat and, in combination with the amino acid Tyrosine, converts it into thyroid hormones. These thyroid hormones are known as triiodothyronine, most commonly referred to as T3; and thyroxine, most commonly referred to as T4. From there, T3 and T4 are distributed throughout the body and regulate our metabolism. An excess or insufficiency of thyroid hormones can lead to many overlapping symptoms and completely throw life as we know it totally off balance.

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When you hear the term hypothyroidism, it sounds pretty scary. All it means is that you have an underactive thyroid. Your thyroid isn’t producing enough of the thyroid hormone thyroxine, to perform the monumental functions it is designed to perform. Your thyroid regulates your metabolish, which in turn regulates many, many bodily functions. When you are experiencing untreated hypothyroid symptoms, you truly feel like your body is giving out. The good news is that it can be easily treated and you can get back to feeling normal again.

Hypothyroidism can be caused by autoimmune disorders like Hashimoto’s thyroiditis, or it can caused by radioactive iodine treatment for hyperthyroidism, where the thyroid is, in essence, killed off. Some people are born without a fully developed, normally function thyroid gland, and some people developed nodules on their thyroid as a result of receiving x-rays when they were younger, before precautions were being taken to guard against radiation damage. Lithium can actually cause temporary hypothyroidism. Whatever the reason, the symptoms are the same. It is a whole body disease, but it comes on quietly and many times over a period of years. Typically, depression is one of the first symptoms of hypothyroidism, but unfortunately, a thyroid test is rarely ordered at this early stage. Many of us who have experienced untreated symptoms feel like we our mind and our body is absolutely falling apart. Your entire body slows down, along with most of its functions, and continues to slow down if left untreated.

• Depression
• Dry, Scaly, Itchy Skin
• Intolerance to Cold Cold Hands and Feet
• Loss of Memory
• Achy joints
• Dry Hair/Scalp
• Hoarseness/Raspy Voice
• Weight Gain with or without a lowered appetite
• Constipation Extreme fatigue
• In women, longer and heavier, or absence of, menstruation
• Dry eyes
• Cracked, brittle fingernails
• Lowered, or absence of, libido
• Lessened ability to pay attention/lowered comprehension
• Lowered heart rate
• Goiter (swelling of the thyroid)
• Muscle weakness/fatigue

It is important to remember that it hypothyroidism symptoms come on slowly--sometimes over a period of years. As your metabolism slow further and further, the symptoms become more plentiful, more bothersome and more pronounced.

Your doctor will feel (palpate) your thyroid to check for any nodules or swelling. He/She will order a simple blood test to check the levels of your thyroid hormones. Many doctors will order a test of your TSH and T4 levels. A TSH test measures your Serum Thyrotropin, which is a thyroid stimulating hormone. TSH is produced by your pituitary gland and is the hormone that prompts your thyroid gland to release T3 and T4. If your TSH level is high and your T4 is low, it is a very good indication that your thyroid is underactive and is not producing enough thyroid hormones to support your metabolism. Most labs consider a TSH of above 6 to be high, however, it is now being recommended that anything above a 3 needs to be taken under consideration--at least for further testing, with anything between a .3 and 3 being considered normal. Many people feel better with a TSH around 1.

There are many other thyroid tests that can be ordered depending on your doctor, but the above are the most common. In addition to a blood test, your doctor may order an ultrasound of your thyroid gland to check for any abnormalities. This is usually done in cases where the doctor feels an abnormality when he palpates the gland at your visit.

Luckily for hypothyroidism victims, it is easily treatable with a daily dose of synthetic thyroid medication like Levothroid or Synthroid. The pill is small, and side effects are EXTREMELY rare. Normally your doctor will start with a low dosage, and then re-test your thyroid levels in 6-8 weeks. If your levels aren't right, he will adjust your dosage and re-test again until your lab results come back normal. The best thing is that as the hormone is re-introduced at the correct levels, your symptoms will begin to correct themselves, even the weight gain! Slowly but surely, you will get back to normal. Remember, though, that current TSH lab values are higher than what the American Association of Endocrinologists has recommended. If you still don't feel right, ask to have your medication adjusted some more, ask to have more tests run. If you can't get your family doctor to listen to what your symptoms are because the lab ranges are what are considered to be normal, ask to be referred to an endocrinologist.

           TEST                                 SHORT NAME                     VALUE

• Serum thyroxine                           T4                             4.6-12 ug/dl
• Free thyroxine fraction                  FT4F                        0.03-0.005%
• Free Thyroxine　                         FT4                           0.7-1.9 ng/dl
• Thyroid hormone binding ratio      THBR                         0.9-1.1
• Free Thyroxine index                   FT4I                              4-11
• Serum Triiodothyronine               T3                               80-180 ng/dl
• Free Triiodothyronine l                FT3                            230-619 pg/d
• Free T3 Index                             FT3I                             80-180
• Radioactive iodine uptake            RAIU                            10-30%
• Serum thyrotropin                       TSH                             0.5-6 uU/ml
• Thyroxine-binding globulin           TBG                              12-20 ug/dl T4 +1.8 ugm
• TRH stimulation test Peak            TSH                                9-30 uIU/ml at 20-30 min
• Serum thyroglobulin l                  Tg                                   0-30 ng/m