Hypothyroidism (Underactive Thyroid)

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What is hypothyroidism (underactive thyroid)?

Hypothyroidism, known as an underactive thyroid, is a medical condition where your thyroid gland (crucial in regulating your body’s metabolism) cannot produce enough thyroid hormones to meet your body's needs. Thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3) control how your cells utilise energy from the food you consume.

When you have hypothyroidism, the insufficient production of these hormones can slow down various bodily functions. Hypothyroidism can affect people of all ages, and its symptoms vary from mild to severe, impacting your energy levels, weight, mood, and overall well-being. Proper diagnosis and treatment can help manage this condition effectively and restore thyroid hormone levels.

What causes hypothyroidism (underactive thyroid)?

Hypothyroidism, or an underactive thyroid, occurs when your thyroid gland does not produce enough thyroid hormones. Some causes of hypothyroidism include: 

  • Hashimoto’s thyroiditis: the most common cause of hypothyroidism is an autoimmune condition known as Hashimoto's thyroiditis. In this condition, your immune system mistakenly attacks the thyroid gland, leading to inflammation and reduced thyroid function.
  • Thyroid surgery or neck-area radiation: thyroid surgery or neck-area radiation can inadvertently damage or remove part of the thyroid gland, reducing hormone production. 
  • Medications: certain medications, like lithium or amiodarone, are linked to hypothyroidism as a side effect. 
  • Iodine deficiency: in regions with low dietary iodine, iodine deficiency can hinder thyroid hormone production. 
  • Pituitary gland issues: these issues can reduce thyroid-stimulating hormone (TSH) production, which is essential for thyroid hormone production. 
  • Genetics: congenital hypothyroidism occurs in some babies due to genetic factors or foetal developmental issues. Early screening in newborns helps diagnose congenital hypothyroidism for timely intervention.

What are the symptoms of hypothyroidism (underactive thyroid)?

Symptoms of hypothyroidism include: 

  • Fatigue
  • Weight gain
  • Cold sensitivity
  • Dry skin
  • Brittle hair and nails
  • Muscles aches
  • Constipation
  • Memory fog
  • Swelling
  • Depression
  • Menstrual changes

If you suspect you have symptoms of hypothyroidism or are concerned about your thyroid health, consult with an endocrinologist for a proper evaluation and diagnosis.

hypothyroidism symptoms
Hypothyroidism is characterised by various symptoms such as weight gain, fatigue, dry skin, etc.

Is hypothyroidism (underactive thyroid) painful?

Generally, hypothyroidism itself is not associated with intense pain. However, it can cause various symptoms that may cause some level of discomfort. Muscle aches and joint pain can be part of the condition, which may lead to a general sense of discomfort. 

Additionally, individuals with hypothyroidism may experience headaches and, in rare cases, nerve-related pain. It is essential to note that pain or discomfort depends on your tolerance to pain, and the severity of these symptoms varies between individuals.

Who is at risk of hypothyroidism (underactive thyroid) in Singapore?

Hypothyroidism can affect anyone, but certain factors may increase the risk of developing an underactive thyroid in Singapore. Risk factors of hypothyroidism include:

  • Gender: women are more prone to hypothyroidism than men.
  • Age: hypothyroidism tends to increase with age (developing more commonly in individuals over the age of 60
  • Genetics: genetics can play a role in thyroid conditions, and if you have a family history of thyroid disorders, your risk may be slightly higher than others.
  • Autoimmune disorders: certain autoimmune diseases can contribute to hypothyroidism as the immune system mistakenly attacks the thyroid glands. 
  • Iodine intake: another factor that can lead to hypothyroidism is an individual’s iodine intake. Although Singapore has a well-regulated iodised salt supply, excessive or deficient iodine intake can still impact your thyroid function.
  • Radiation exposure: past radiation therapy or radiation exposure to your neck area increases the risk of thyroid problems by up to 50%.
  • Medications: some medications, such as lithium or amiodarone, may affect your thyroid function and lead to hypothyroidism.
thyroid treatment
Seeking immediate medical attention helps to prevent your condition from worsening and affecting your bodily functions.

How is hypothyroidism (underactive thyroid) diagnosed?

Diagnosing hypothyroidism typically involves a combination of the following:

  • Medical history assessment: your endocrinologist will begin by discussing your symptoms, family history, and any risk factors you may have, allowing them to gain valuable insights.
  • Physical examination: during the physical exam, your endocrinologist will check for signs of an underactive thyroid, such as a swollen thyroid gland. 
  • Laboratory tests: laboratory tests are vital in confirming hypothyroidism. These tests measure levels of thyroid-stimulating hormone (TSH) and thyroxine (T4). Elevated TSH and decreased T4 levels are indicative of hypothyroidism. Additional thyroid antibody tests may be considered to determine the underlying cause, especially if autoimmune factors are suspected.

These tests help your endocrinologist establish a precise diagnosis and develop an appropriate treatment plan tailored to your needs.

What are the treatment options for hypothyroidism (underactive thyroid) in Singapore?

In Singapore, the treatment options for hypothyroidism are highly effective and readily available. The primary approach is hormone replacement therapy.

Here is what you can expect:

  • Levothyroxine medication: the most common and effective treatment involves taking a synthetic thyroid hormone called levothyroxine. It is crucial to take this medication as directed, typically on an empty stomach in the morning, to ensure optimal absorption.
  • Regular monitoring: after starting levothyroxine, you will be required to attend regular check-ups to monitor your thyroid hormone levels. Your endocrinologist may adjust your medication to achieve the right balance of hormones in your body.
  • Lifestyle management: this includes a balanced diet, regular exercise, and managing stress. It can help you feel your best and support thyroid function.
  • Dietary considerations: it is essential to be mindful of dietary factors, especially if you have specific dietary restrictions. In Singapore, where iodised salt is widely available, iodine deficiency is rare. However, certain foods, known as goitrogens, can interfere with thyroid function if consumed excessively.
  • Follow-up care: continuous follow-up with your endocrinologist is essential to ensure effective treatment. They will assess your progress, adjust medication as needed, and address any concerns or questions you may have.

Hypothyroidism is a manageable condition, and with the proper treatment and ongoing care, you can lead a healthy and fulfilling life.

If you are suffering from a thyroid disorder, have a family history of thyroid disorders, or are concerned about developing thyroid cancer, schedule an appointment with ACE Surgery and Endoscopy for a detailed examination and individualised treatment plan.

Frequently Asked Questions

What are the risks of untreated hypothyroidism (underactive thyroid)?

Untreated hypothyroidism can lead to various health risks, including heart problems, depression, infertility, and a life-threatening condition called myxedema coma. Proper treatment is essential to prevent your condition from worsening.

Is hypothyroidism (underactive thyroid) common in Singapore?

Hypothyroidism is relatively common in Singapore, and its prevalence may be influenced by factors such as age, gender, family history, and iodine intake.

Can hypothyroidism (underactive thyroid) be cured?

Generally, hypothyroidism is managed rather than cured. Treatment for hypothyroidism involves thyroid hormone replacement, allowing you to lead a normal life with ongoing medication.

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Reyaz Moiz

Dr Reyaz Singaporewalla
Senior Consultant Endocrine and General Surgeon

MBBS (Bom), MS (Surg), DNB (Surg), FRCS (Edin), MMed (Singapore), FRCSEd.