Hipotiroidismo ATA

H YP O T H Y R O I D I S M
A BOOKLET FOR PATIENTS AND THEIR FAMILIES
A publication of the American Thyroid

Association (ATA)
www.thyroid.o
rg
C O P YR IG H T 2013 A ME R I C A N T HYR O I D A S SOC I

ATION
American Thyroid Association Hypothyroidism
THE AMERICAN T HYROID A SSOCIATION ( ATA)

The American Thyroid Association (ATA) is the leading organization devoted to thyroid
biology and to the prevention and treatment of thyroid disease through excellence in
research, clinical care, education, and public health.
La Asociacin Americana de la Tiroides (ATA) es la principal organizacin dedicada a la biologa de la tiroides y para
la prevencin y tratamiento de la enfermedad de la tiroides a travs de la excelencia en la investigacin, la atencin
clnica, la educacin y la salud pblica.
AGRADECIMIENTOS
The ATA gratefully acknowledges the current and past members of the ATA Clinical Affairs
Committee and the ATA Patient Education & Advocacy Committee as contributors and
authors to this booklet; all educational information for patients and the public posted on the
ATA website www.thyroid.org; as well as articles and updates disseminated through Friends
of the ATA and the Clinical Thyroidology for Patients.
El ATA agradece a los miembros actuales y anteriores del Comit de Asuntos Clnicos ATA y
el Comit de Educacin y Defensa ATA Paciente como colaboradores y autores de este libro;
toda la informacin educativa para los pacientes y el pblico en el sitio web de ATA
www.thyroid.org; as como artculos y actualizaciones difundida a travs de Amigos de la
ATA y la tiroidologa Clnicos para pacientes.
ATA PATIENT RESOURCES

ATA RECURSOS DEL PACIENTE
The ATA patient resources are designed to provide up-to-date information for thyroid
patients, their families and other interested public communities. The ATA is dedicated to
serving as an educational resource for the public by supporting thyroid research and
promoting the prevention, treatment and cure of thyroid-related diseases and thyroid cancer.
The information contained in or made available through the ATA Website www.thyroid.org
is not intended to replace the services of a trained health professional or to be a substitute for
medical advice of physicians. The user should consult a physician in all matters relating to
his or her health, and particularly in respect to any symptoms that may require diagnosis or
medical attention.
The American Thyroid Association makes no representations or warranties with respect to
any information offered or provided within or through the ATA Website regarding treatment,
action, or application of medication. Neither the ATA nor any of its Affiliates will be liable
for any direct, indirect, consequential, special, exemplary, or other damages arising
therefrom.
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Los recursos de los pacientes ATA estn diseados para proporcionar hasta al da la informacin para pacientes de la
tiroides, sus familias y otras comunidades pblicas interesadas. El ATA se dedica a servir como un recurso educativo
para el pblico mediante el apoyo a la investigacin de la tiroides y la promocin de la prevencin, el tratamiento y la
cura de las enfermedades relacionadas con la tiroides y cncer de tiroides.
La informacin contenida en o disponible a travs del Sitio Web www.thyroid.org ATA no est destinado a reemplazar
los servicios de un profesional de salud capacitado o para ser un sustituto de consejo mdico de los mdicos. El
usuario debe consultar a un mdico en todos los asuntos relacionados con su salud, y en particular con respecto a los
sntomas que pueden requerir diagnstico o atencin mdica.
La Asociacin Americana de la Tiroides no hace representaciones o garantas con respecto a cualquier informacin
ofrecidos o prestados en oa travs del sitio web de ATA en cuanto al tratamiento, la accin, o la aplicacin del
medicamento. Ni la ATA ni ninguna de sus filiales sern responsables de los daos directos, indirectos, consecuentes,
especiales, ejemplares, o de otro tipo derivados del mismo.
AMER IC A N T H YR OI D A SS OC IA T
I ON
6066 Leesburg Pike, Suite 550
Falls Church, VA 22041
www.thyroid.org
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TABLA DE CONTENIDOS
La Asociacin Americana de la Tiroides (ATA) ...................................................... 2
Agradecimientos..................................................................................................................... 2
Recursos para el paciente
ATA............................................................................................................. 2
American Thyroid Association ............................................... .................................................. 2
hipotiroidismo.......................................................................................................................... 4
Cul es elthyroid?................................................................................................................. 4
Qu eshypothyroidism?......................................................................................................... 4
Quin puede
desarrollarhypothyroidism?......................................................................................... 4
Los factores que contribuyen al riesgo de desarrollar hipotiroidismo: ........................................5
Los sntomas.................................................................................................................................5
Las caractersticas comunes de hipotiroidismo ................................................ 6
Causas......................................................................................................................................... 7
prevencin................................................................................................................................... 9
Diagnosis..................................................................................................................................... 9
Los cambios en cmo se siente............................................................................... 9
Historial mdico y familiar..................................................................................................... 9
examen fsico.......................................................................................................................... 9
Los anlisis de sangre de TSH y T4.................................................................. 10
Maneras que el hipotiroidismo no se puede diagnosticar ................................................ 11
tratamiento.................................................................................................................................12
Tiroxina (T4)replacement.................................................................................................. 12
Quin debe tratarte............................................................................................................ 12
Factores de dosis de tiroxina......................................................................................................12
Si queda embarazada..................................................................................................... 16
Consideraciones de tratamiento..................................................................................................16
Seguimiento...............................................................................................................................18
Repita la sangretests.................................................................................................................. 18
Variacin normal de los niveles de TSH .................................................................... 19
Asegrese de seguimiento con su mdico si .... .................................................. .....................19
Si el hipotiroidismo no se trata o si se interrumpe el tratamiento ......................................... 20
bebs ychildren............................................................................................................ 20
El hipotiroidismo causado por la deficiencia de yodo .............................................. 20
Personas de todas las edades........................................................................................ 20
Hipotiroidismo severo (mixedema) ............................................. .................................... 20
Mantener a otras personas informadas .............................................................. 21
Dgale a sufamily..................................................................................................................... 21
Cuntele a sus otros mdicos y farmacutico ................................................ 21
Asociacin entre usted y su mdico ............................................ ...................................... 21
Sus necesidades emocionales.............................................................................................. 22
Vivir conhypothyroidism...................................................................................................... 22
Muchas preguntas sobre hipotiroidismo quedan misterios ............................................ ...... 22
Trminos mdicos en este folleto................ .................................................. ... 23
Para saber ms............................................................................................................................ 25
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HIPOTIROIDISMO
QU ES LATIROIDES?
The thyroid is a butterfly-shaped endocrine gland usually located in the lower front of the
neck below the larynx (the voice box). The thyroid's job is to make thyroid hormones, which
are secreted into the blood and then carried to every tissue in the body. Thyroid hormone
helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs
working as they should. The main hormone made by the thyroid is thyroxine, also called T4
because it contains four iodine molecules. Small amounts of another and more potent
thyroid hormone containing three iodine molecules, triiodothyronine (T3) are also made by
the thyroid gland. However, most of the T3 in the blood is made from T4 in other body
tissues.
Thyroid hormones control the way every tissue in your body uses energy. They are essential
to help each cell in your bodys tissue and organs work right. For example, thyroid hormone
controls the bodys temperature, heart rate, blood pressure, and the rate at which food is
turned into energy (metabolism).
La tiroides es una glndula endocrina en forma de mariposa que generalmente se encuentra en la parte frontal inferior
del cuello debajo de la laringe (caja de la voz). El trabajo de la tiroides es para producir hormonas tiroideas, que son
secretadas a la sangre y luego llevaron a todos los tejidos del cuerpo. La hormona tiroidea ayuda a que el uso de la
energa del cuerpo, mantener el calor y mantener el cerebro, el corazn, los msculos y otros rganos que trabajan
como deberan. La hormona principal hecho por la tiroides es la tiroxina, tambin llamado T4, ya que contiene cuatro
molculas de yodo. Pequeas cantidades de otros y ms potente hormona tiroidea que contiene tres molculas de
yodo, triyodotironina (T3) tambin se hacen por la glndula tiroides. Sin embargo, la mayor parte de la T3 en la sangre
est hecho de T4 en otros tejidos del cuerpo.
Las hormonas tiroideas controlan la forma en todos los tejidos en el cuerpo utiliza la energa. Son esenciales para
ayudar a cada clula en el tejido de su cuerpo y los rganos funcionan bien. Por ejemplo, la hormona tiroidea controla
la temperatura del cuerpo, el ritmo cardaco, la presin arterial y el ritmo al que la comida se convierte en energa
(metabolismo).
QU ES EL HIPOTIROIDISMO?
Hypothyroidism is a kind of thyroid disease. If you have hypothyroidism that means you
have an underactive thyroid ("hypo-" means "under" or "below normal"). In people with
hypothyroidism, the thyroid does not make enough thyroid hormone to keep the body
running normally. Common causes of hypothyroidism are autoimmune disease, surgical
removal of the thyroid, and radiation treatment.
Low thyroid hormone levels cause the body's functions to slow down, leading to general
symptoms like dry skin, fatigue, loss of energy, and memory problems. Hypothyroidism
is diagnosed by a simple blood test for thyroid-stimulating hormone (TSH).
Hypothyroidism is treated by replacing the missing thyroid hormone with synthetic
thyroxine pills, which the person must take every day for life. With daily treatment, most
patients recover completely.
El hipotiroidismo es una especie de enfermedad de la tiroides. Si usted tiene
hipotiroidismo, que significa que tiene una tiroides poco activa ("hipo" significa "bajo" o
"debajo de lo normal"). En las personas con hipotiroidismo, la tiroides no produce
suficiente hormona tiroidea para mantener el cuerpo funcionando normalmente. Las
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causas comunes de hipotiroidismo son la enfermedad autoinmune, la extirpacin
quirrgica de la glndula tiroides, y el tratamiento de radiacin.
Los niveles bajos de hormonas tiroideas causan las funciones del cuerpo para reducir la
velocidad, lo que lleva a los sntomas generales como la piel seca, fatiga, prdida de
energa, y problemas de memoria. El hipotiroidismo se diagnostica con un simple anlisis
de sangre para la hormona estimulante de la tiroides (TSH). El hipotiroidismo se trata
mediante la sustitucin de la hormona tiroidea que falta con pldoras de tiroxina sinttica,
que la persona debe tomar todos los das por la vida. Con el tratamiento diario, la mayora
de los pacientes se recuperan completamente.
QUIENES PUEDEN DESARROLLAR

HIPOTIROIDISMO?
Hypothyroidism is one of the most common thyroid diseases. It affects people all over
the worldof every age, sex, race, and level of wealth and education.
About 2-3 percent of Americans have hypothyroidism and as many as 10-15% have
mild hypothyroidism. More than half of those with hypothyroidism do not know they
have it.
El hipotiroidismo es una de las enfermedades ms comunes de la tiroides. Afecta a
personas de todo el mundo, de todas las edades, sexo, raza y nivel de riqueza y
educacin.
Acerca de 2-3 por ciento de los estadounidenses tienen hipotiroidismo y tantos como 10
a 15% tienen hipotiroidismo leve. Ms de la mitad de las personas con hipotiroidismo no
saben que lo tienen
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FACTORES DE RIESGO QUE CONTRIBUYEN A

DESARROLLAR HIPOTIROIDISMO:
Have a close relative, such as a parent or grandparent, with an autoimmune disease

Hypothyroidism can develop at any age, but risk for developing it increases with age.
Hypothyroidism is more common in women than men; and, much more so in young
women than young men. The risk of hypothyroidism increases during pregnancy, after
delivery and around menopause.
Hypothyroidism is more common in whites and Asians than in other races and
ethnicities.
Have another autoimmune disorder, such as type 1 diabetes, rheumatoid arthritis,

multiple sclerosis, celiac disease, Addison's disease, pernicious anemia, or vitiligo
Have been treated with radioactive iodine or received radiation to the neck or upper
chest
Have had thyroid surgery
Have Down syndrome or Turner syndrome genetic disorders

Have bi-polar disease (manic depression)
Tener un pariente cercano, como un padre o un abuelo, con una enfermedad autoinmune
El hipotiroidismo puede desarrollarse a cualquier edad, pero el riesgo de desarrollarla aumenta
con la edad.
El hipotiroidismo es ms comn en las mujeres que en los hombres; y, mucho ms que en las
mujeres jvenes que entre los hombres jvenes. El riesgo de hipotiroidismo aumenta durante el
embarazo, despus del parto y alrededor de la menopausia.
El hipotiroidismo es ms comn en los blancos y los asiticos que en otras razas y etnias.
Tener otro trastorno autoinmune, como la diabetes tipo 1, artritis reumatoide, esclerosis
mltiple, enfermedad celaca, enfermedad de Addison, anemia perniciosa, o vitiligo
Haber sido tratada con yodo radiactivo o recibido radiacin en el cuello o la parte superior del
pecho
Ha tenido ciruga de tiroides
Tener sndrome de Down o el sndrome de Turner - trastornos genticos
Tiene enfermedad bipolar (maniaco depresivo)
SINTOMATOLOGA
Hypothyroidism has a variety of symptoms. Symptoms are something you see, feel and/or
experience yourself. Many of these symptoms are often confused with other health
conditions.
When your thyroid hormone levels are too low, your body's cells cannot get enough thyroid
hormone. This causes your body's processes to start slowing down. For example, the body
makes less heat and less energy, causing organs like the brain and bowels to move more
slowly. As the body slows, you may notice that you feel colder, you tire more easily, your
skin is getting drier, you're becoming forgetful and depressed, and you've started getting
constipated.
So hypothyroidism doesn't just cause symptoms; it can make other conditions worse.
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Symptoms of hypothyroidism usually appear slowly over several months or years. However,
some people develop symptoms of hypothyroidism quickly over a few months. In general,
the lower your thyroid hormone levels become and the longer they stay low, the more severe
your symptoms will be.
Subclinical (mild) hypothyroidism may cause mild symptoms or no symptoms at all. Severe
hypothyroidism usually causes severe symptoms.
Some people are very sick by the time they learn their diagnosis; others whose blood
tests show severe hypothyroidism have few if any symptoms. Because the symptoms are
so variable, the only way to know for sure if you have hypothyroidism is through blood
tests.
El hipotiroidismo tiene una variedad de sntomas. Los sntomas son algo que se ve, se
siente y / o la experiencia de s mismo. Muchos de estos sntomas a menudo se confunden
con otras condiciones de salud.
Cuando sus niveles de hormona tiroidea son demasiado bajos, las clulas del cuerpo no
pueden recibir suficiente hormona tiroidea. Esto hace que los procesos de su cuerpo para
comenzar a disminuir la velocidad. Por ejemplo, el cuerpo produce menos calor y menos
energa, causando rganos como el cerebro y los intestinos se muevan ms lentamente. A
medida que el cuerpo se ralentiza, usted puede notar que se siente ms fro, se cansan ms
fcilmente, su piel es cada vez ms seca, te ests convirtiendo olvidadizo y deprimido, y
que ha comenzado el estreimiento.
As que el hipotiroidismo no slo causa sntomas; puede empeorar otras condiciones. Los
sntomas de hipotiroidismo generalmente aparecen lentamente durante varios meses o
aos. Sin embargo,
algunas personas desarrollan sntomas de hipotiroidismo rpidamente en unos pocos
meses. En general, cuanto ms bajo sus niveles de hormona tiroidea vuelven y cuanto
ms tiempo se mantengan bajos, los ms graves los sntomas ser.
Subclnica (leve) hipotiroidismo puede causar sntomas leves o ningn sntoma en
absoluto. Hipotiroidismo severo generalmente causa sntomas graves.
Algunas personas son muy enfermo en el momento en que aprenden de su diagnstico;
otros cuyos anlisis de sangre muestran hipotiroidismo severo tienen pocos o ningn
sntoma. Debido a que los sntomas son tan variables, la nica manera de saber con
seguridad si usted tiene hipotiroidismo es a travs de anlisis de sangre.
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CARACTERSTICAS COMUNES DEL HIPOTIROIDISMO
Less energy
More fatigue, trouble awakening in the morning, need for more sleep, and
tendency to fall asleep during the day
Feeling cold when other people feel warm

Less sweating
Drier, itchier skin

Drier, coarser, more brittle hair
More hair loss (the amount differs in different people; patients don't go bald but
their hair can look thin)
Loss of appetite
Mild weight gain (5-20 pounds) and difficulty losing weight

(hypothyroidism doesn't cause obesity)
New or worsening problems with memory, slower thinking
New snoring
Muscle cramps and joint aches
New feeling of pins and needles in the hands and feet (paresthesia)
New or worsening constipation
Puffiness around the face (especially the eyes), hands, ankles, and feet because
of fluid build-up
Carpal tunnel syndrome
Heavier and/or more frequent menstrual periods, worse cramps, worse

premenstrual symptoms, milky discharge from the breasts
Feeling irritable
New or worsening depression-sadness or not caring about anything

New or worsening hoarse voice
New or worsening hearing loss

Goiter (swelling in the front of the neck, caused by enlargement of the thyroid)
Slowing of heart rate

Slightly higher blood pressure
Higher cholesterol levels
Growth delay in children

menos energa
Ms de fatiga, dificultad para despertar en la maana, la necesidad de ms horas de sueo,
y la tendencia a quedarse dormido durante el da
Siente fro cuando otras personas se siente caliente
Menos de la sudoracin
piel ms picante Secadora
, ms gruesa, cabello ms frgil Secadora
Ms prdida de pelo (la cantidad vara en diferentes personas, los pacientes no van calva,
pero su pelo puede mirar delgado)
Prdida del apetito
Leve aumento de peso (5.20 libras) y dificultad para perder peso (hipotiroidismo no causa
la obesidad)
Nuevo o empeoramiento de los problemas de memoria, pensamiento lento
Nueva ronquidos
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Calambres musculares y dolor en las articulaciones
Nueva sensacin de hormigueo en las manos y los pies (parestesia)
estreimiento Nuevo o empeoramiento
Hinchazn alrededor de la cara (especialmente los ojos), las manos, los tobillos y los pies
debido a la acumulacin de lquido
El sndrome del tnel carpiano
perodos ms pesados y / o ms frecuentes, calambres menstruales peor, sntomas
premenstruales peor, la secrecin de leche de los pechos?
Sentirse irritable
Combatir la depresin tristeza Nuevo o empeoramiento o de no importar nada
Nuevo o empeoramiento voz ronca
Nuevo o empeoramiento de la prdida auditiva
bocio (inflamacin en la parte anterior del cuello, causada por el agrandamiento de la
glndula tiroides)
Disminucin de la frecuencia cardiaca
La presin arterial ligeramente superior
Los niveles ms altos de colesterol
Retraso del crecimiento en nios
If you have hypothyroidism, you may also have body changes that you cannot feel. For
example, you may not know that cholesterol is building up in your blood or that plaque is
hardening your arteries, both of which can increase your risk for heart attack.
Hypothyroidism does not just cause symptoms; it can make other health conditions
worse.
No one can predict exactly which symptoms a person will develop or how severe the
symptoms will be. Some people have many symptoms by the time they are diagnosed
with hypothyroidism. Others have few, if any, symptoms.
Because the symptoms are so variable, the only way to know for sure whether you
have hypothyroidism is with blood tests.
Si usted tiene hipotiroidismo, usted tambin puede tener cambios en el cuerpo que no
se puede sentir. Por ejemplo, usted no puede saber que el colesterol se acumula en la
sangre o que la placa es el endurecimiento de las arterias, los cuales pueden aumentar
el riesgo de ataque al corazn. El hipotiroidismo no slo causa sntomas; puede
empeorar otras condiciones de salud.
Nadie puede predecir exactamente qu sntomas que una persona desarrollar o la
gravedad de los sntomas sern. Algunas personas tienen muchos sntomas en el
momento en que son diagnosticados con hipotiroidismo. Otros tienen pocos, si alguno,
sntomas.
Debido a que los sntomas son tan variables, la nica manera de saber con seguridad si
usted tiene hipotiroidismo es mediante anlisis de sangre.
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CAUSAS
Hay muchas razones por las que las clulas de la tiroides no pueden producir suficiente
hormona tiroidea. Estas son las principales causas, desde la ms a la menos comn:
ENFERMEDAD AUTOINMUNE
The immune system normally protects the body against bacterial and viral "invaders." In
autoimmune diseases ("auto" means "self"), the immune system attacks a normal part of the
body. In autoimmune hypothyroidism, the immune system accidentally attacks cells in the
thyroid. This causes the cells to become inflamed and damaged, interfering with their ability
to make thyroid hormone. When enough thyroid cells have been destroyed, too few are left
to meet the body's need for thyroid hormone.
Autoimmune thyroid disease is more common in women than men. It can start at any age,
but becomes more common as people get older. In women, it often begins during pregnancy,
after delivery, or around menopause. The cause is likely a combination of an inherited
tendency and an as yet unknown trigger. Autoimmune hypothyroidism can begin suddenly,
but in most people it develops slowly over years.
The most common form of autoimmune hypothyroidism is called Hashimotos disease. This
can sometimes cause the thyroid to shrink over time.
El sistema inmunitario normalmente protege al cuerpo contra las bacterias y virus
"invasores". En las enfermedades autoinmunes ("auto" significa "yo"), el sistema
inmunolgico ataca a una parte normal del cuerpo. En el hipotiroidismo autoinmune, el
sistema inmune ataca a las clulas accidentalmente en la tiroides. Esto hace que las clulas
se inflamen y daado, lo que interfiere con su capacidad para producir la hormona tiroidea.
Cuando suficientes clulas tiroideas han sido destruidas, muy pocos se quedan para
satisfacer la necesidad del cuerpo de la hormona tiroidea.
La enfermedad tiroidea autoinmune es ms comn en mujeres que en hombres. Se puede
comenzar a cualquier edad,
pero se hace ms comn a medida que las personas envejecen. En las mujeres, a menudo
comienza durante el embarazo, despus del parto, o alrededor de la menopausia. La causa es
probable que una combinacin de una tendencia hereditaria y un disparador todava
desconocido. Hipotiroidismo autoinmune puede comenzar repentinamente, pero en la
mayora de las personas se desarrolla lentamente durante aos.
La forma ms comn de hipotiroidismo autoinmune se llama enfermedad de Hashimoto.
Esto a veces puede causar la tiroides para reducir el tamao con el tiempo.
EXTIRPACIN QUIRURGICA DE UNA PARTE O TODA LA TIROIDES

Some people with thyroid nodules, thyroid cancer, or Graves' disease need to have part or the
entire thyroid removed. Hypothyroidism results when the entire thyroid is removed or when
the remaining thyroid tissue no longer works properly.
Algunas personas con ndulos tiroideos, cncer de tiroides, o enfermedad de Graves
necesitan tener una parte o la totalidad de la tiroides eliminado. El hipotiroidismo se produce
cuando se extirpa toda la glndula tiroides o cuando el tejido tiroideo remanente ya no
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funciona correctamente.
TRATAMINETO CON RADIACIN

Some people with Graves' disease, nodular goiter, or thyroid cancer are treated with
131
radioactive iodine ( I). Radioactive iodine destroys the thyroid, which can result in
hypothyroidism. Hodgkin's disease, lymphoma, or cancers of the head or neck are treated
with radiation which can destroy the thyroid and result in hypothyroidism.
Algunas personas con la enfermedad de Graves, bocio nodular o cncer de tiroides son
tratados con yodo radioactivo (131I). El yodo radiactivo destruye la tiroides, que puede
resultar en hipotiroidismo. La enfermedad, el linfoma de Hodgkin o cncer de la cabeza o
el cuello son tratados con radiacin que puede destruir la tiroides y resultar en
hipotiroidismo.
HIPOTIROIDISMO CONGNITO (DESDE EL NACIMIENTO)

About 1 in 4,000 babies each year are born without a thyroid or with a partly formed thyroid.
A few babies have part or their entire thyroid in the wrong place (ectopic thyroid). In some
babies, the thyroid cells or their enzymes do not function correctly or are affected by
medications taken by the mother. In others, the thyroid may make enough hormone for a
while but later stop stops functioning as the child gets older or becomes an adult. In the
United States, all children are tested at birth for hypothyroidism.
Aproximadamente 1 de cada 4,000 bebs cada ao nacen sin una tiroides o con una tiroides
parcialmente formado. Algunos bebs tienen una parte o la totalidad de su tiroides en el lugar
equivocado (tiroides ectpico). En algunos bebs, las clulas tiroideas o sus enzimas no
funcionan correctamente o se ven afectados por los medicamentos tomados por la madre. En
otros, la tiroides puede producir suficiente hormona por un tiempo, pero luego dejar de
paradas que funciona como el nio crece o se convierte en un adulto. En los Estados Unidos,
todos los nios se ponen a prueba en el nacimiento para el hipotiroidismo.
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TIROIDITIS
Thyroiditis is an inflammation of the thyroid. It is usually caused by an autoimmune attack
(such as Hashimotos disease, postpartum thyroiditis or silent thyroiditis) or by a viral
infection. Thyroiditis can make the thyroid release its whole supply of stored thyroid
hormone into the blood at once, causing the thyroid to become overactive (hyperthyroidism)
for a brief period of time. Once the entire stored hormone has been released, the thyroid
becomes underactive. Almost all people with viral thyroiditis recover their thyroid function,
but about one-fourth of people with autoimmune thyroiditis have permanent
hypothyroidism.
La tiroiditis es una inflamacin de la glndula tiroides. Generalmente es causada por un
ataque autoinmune (como la enfermedad de Hashimoto, tiroiditis posparto o la tiroiditis
silenciosa) o por una infeccin viral. La tiroiditis puede hacer que la tiroides liberar la
totalidad de su suministro de hormona tiroidea almacenada en la sangre a la vez, haciendo
que la tiroides para convertirse hiperactiva (hipertiroidismo) durante un breve perodo de
tiempo. Una vez que toda la hormona almacenada ha sido puesto en libertad, la tiroides se
vuelve hipoactiva. Casi todas las personas con tiroiditis viral recuperar su funcin tiroidea,
pero aproximadamente una cuarta parte de las personas con tiroiditis autoinmune tener
hipotiroidismo permanente.
MEDICAMENTOS
Some medicines can interfere with the thyroid's ability to make thyroid hormone, leading to
hypothyroidism. Lithium is one of the most common medicines that cause hypothyroidism.
Others medicines that can cause hypothyroidism are amiodarone, interferon alpha, and
interleukin-2. All of these drugs are most likely to trigger hypothyroidism in people who
have a genetic tendency to autoimmune thyroid disease. Rarely, some people with the blood
cancer multiple myeloma who are treated with thalidomide can develop hypothyroidism.
Algunos medicamentos pueden interferir con la capacidad del tiroides para producir la
hormona tiroidea, lo que lleva al hipotiroidismo. El litio es uno de los medicamentos ms
comunes que causan hipotiroidismo. Otros medicamentos que pueden causar hipotiroidismo
son la amiodarona, el interfern alfa y la interleucina-2. Todos estos medicamentos son ms
propensas a desencadenar hipotiroidismo en personas que tienen una tendencia gentica a la
enfermedad tiroidea autoinmune. En raras ocasiones, algunas personas con el cncer de
sangre con mieloma mltiple tratados con talidomida pueden desarrollar hipotiroidismo.
MUY POCO O DEMASIADO YODO

The thyroid must have iodine to make thyroid hormone. Iodine comes into the body
in foods, mainly dairy products, chicken, beef, pork, fish, and iodized salt. The iodine
then travels through the blood to the thyroid. Keeping thyroid hormone production in
balance requires the right amount of iodine. People who live in undeveloped parts of
the world may not get enough iodine in their diet. Worldwide, iodine deficiency is
the most common cause of hypothyroidism, although it is a rare cause in the U.S.
Too much iodine can also cause or worsen hypothyroidism. The major source of too much
iodine is dietary supplements containing kelp, a kind of seaweed. Most of these supplements
are sold with the false promise of helping people lose weight. Other sources of too much
iodine are x-ray dyes, medicines like amiodarone, and some older expectorants (medicines
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that help clear the lungs and throat).
La tiroides debe tener yodo para producir hormona tiroidea. El yodo entra en el cuerpo en
los alimentos, principalmente productos lcteos, pollo, carne de res, cerdo, pescado y sal
yodada. El yodo luego viaja a travs de la sangre a la tiroides. Mantener la produccin de la
hormona tiroidea en equilibrio requiere la cantidad adecuada de yodo. Las personas que
viven en zonas subdesarrolladas del mundo no pueden obtener suficiente yodo en su dieta. A
nivel mundial, la deficiencia de yodo es la causa ms comn de hipotiroidismo, aunque es
una causa poco frecuente en los EE.UU.
El exceso de yodo tambin puede causar o empeorar el hipotiroidismo. La principal fuente
de demasiado yodo es suplementos dietticos que contienen algas marinas, una especie de
alga marina. La mayora de estos suplementos se venden con la falsa promesa de ayudar a
las personas a perder peso. Otras fuentes de demasiado yodo son tintes de rayos X,
medicamentos como la amiodarona, y algunos expectorantes mayores (medicamentos que
ayudan a limpiar los pulmones y la garganta).
DAO A LA HIPOFISIS
The pituitary gland tells the thyroid how much hormone to make. If the pituitary gland is
damaged by injury, a tumor, radiation, or surgery, it may no longer be able to give the
thyroid the right instructions, and the thyroid may stop making enough hormone.
La glndula pituitaria le dice a la tiroides cunta hormona para hacer. Si la glndula pituitaria
se daa por una lesin, un tumor, radiacin o ciruga, puede ya no ser capaz de dar la tiroides
las instrucciones correctas, y la tiroides puede dejar de producir suficiente hormona.
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PR EV E
NCIN
In countries where the diet does not contain enough iodine, taking iodine supplements
can prevent hypothyroidism. In the United States and other developed countries, where
most people's diet contains enough iodine, there is no known way to prevent
hypothyroidism.
Diagnosing hypothyroidism early by testing newborn babies, pregnant women, and people
with symptoms or risk factors is the best way to prevent it from worsening. The biggest risk
factor is having relatives with thyroid disease.
En los pases donde la dieta no contiene suficiente yodo, tomar suplementos de yodo puede
prevenir el hipotiroidismo. En los Estados Unidos y otros pases desarrollados, donde la
dieta de la mayora de la gente contiene suficiente yodo, no hay forma conocida de prevenir
el hipotiroidismo.
El diagnstico de hipotiroidismo temprano probando los bebs recin nacidos, mujeres
embarazadas y personas con sntomas o factores de riesgo es la mejor manera de prevenir
que empeore. El factor de riesgo ms importante es tener familiares con enfermedad
tiroidea.
DIAGNSTICO
A diagnosis is the art or act of identifying a disease from its signs and symptoms. A health
care professional, ideally a physician, considers several factors when identifying or
determining the nature and cause of hypothyroidism, including:
Your symptoms (changes in how you feel), medical history, risk factors, and family
history
A physical exam
Blood tests: The most sensitive test is TSH. In some circumstances, other tests, such as
free T4, free T4 index and total T4 may be helpful.
El diagnstico es el arte o acto de identificar una enfermedad por sus signos y sntomas. Un
profesional de la salud, lo ideal es un mdico, considera varios factores al identificar o
determinar la naturaleza y causa de hipotiroidismo, incluyendo:
Sus sntomas (cambios en cmo se siente), historia mdica, factores de riesgo y antecedentes
familiares
Un examen fsico
Exmenes de sangre: La prueba ms sensible es la TSH. En algunas circunstancias, otras
pruebas, como la T4 libre, ndice de T4 libre y total T4 pueden ser tiles.
CAMBIOS EN CMO TE
SIENTES
Hypothyroidism cannot be diagnosed based on symptoms alone. Most hypothyroid
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symptoms are common complaints that many people with a normally functioning thyroid
can have. These symptoms might be clues to conditions that may or may not be related to the
thyroid. One way to help figure out whether your complaints are symptoms of
hypothyroidism is to think about whether you have always had a symptom or whether the
symptom is a change from the way you used to feel (hypothyroidism could be indicated).
El hipotiroidismo no se puede diagnosticar con base en los sntomas. La mayora de los
sntomas de hipotiroidismo son quejas comunes que muchas personas con una tiroides que
funciona normalmente pueden tener. Estos sntomas podran ser indicios de condiciones que
pueden o no estar relacionados con la tiroides. Una forma de ayudar a averiguar si sus quejas
son sntomas de hipotiroidismo es pensar acerca de si usted ha tenido siempre un sntoma o
si el sntoma es un cambio de la forma en que sola sentirse (hipotiroidismo podra estar
indicada).
HISTIRIAL MDICO Y FANLIAR

Tell your doctor everything you can at your appointment. This includes information about:
Your overall health, especially changes in your health
Your familys health history, especially if a close relative (such as a parent or

grandparent) has hypothyroidism or another form of thyroid disease
If you have ever had thyroid surgery

If you have ever had radiation to your neck to treat cancer
If you are taking any medicines that can cause hypothyroidism, such as amiodarone,
lithium, interferon alpha, interleukin-2, or thalidomide
Dgale a su mdico todo lo que pueda en su cita. Esto incluye informacin sobre:
Su estado general de salud, especialmente los cambios en su salud
antecedentes de salud de su familia, especialmente si un pariente cercano (como un padre
o abuelo) tiene hipotiroidismo u otra forma de enfermedad de la tiroides
Si alguna vez ha tenido una ciruga de tiroides
Si alguna vez ha tenido radiacin al cuello para tratar el cncer
Si est tomando medicamentos que pueden causar hipotiroidismo, tales como amiodarona,
litio, interfern alfa, interleucina-2 o la talidomida
PHYSICAL EXAM
In addition to listen
check
ing to your symptoms and your medical history, your doctor will
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your thyroid and look for physical signs of hypothyroidism, such as:
Dry skin
Swelling
Slower reflexes
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Slower heart rate
TSH AND T4 BLOOD TESTS

Your doctor may order one of the blood tests described here:
TSH TEST
TSH (thyroid-stimulating hormone) is the most important and sensitive test for diagnosing
and monitoring hypothyroidism. TSH is a simple blood test that measures how much T4
the thyroid is being asked to make. An abnormally high TSH test may mean you have
hypothyroidism.
WHAT IS TSH (THYROID-STIMULATING HORMONE)?
Your thyroid needs to be told how much thyroid hormone to make. The instructions come
from the pituitary gland. The system works as a feedback loop: special cells in your pituitary
gland determine the normal T4 range for your body. This is known as your set point. As
blood flows through your pituitary gland, these cells measure your T4 levels to determine
whether they are at your set point.
The pituitary cells communicate with your thyroid by sending their own hormone, TSH
(thyroid-stimulating hormone), into the blood. When your T4 levels are at your set point, the
pituitary gland sends out enough TSH to tell the thyroid to keep making the same amount of
T4. If the T4 levels get low, the pituitary sends out more TSH to tell the thyroid to make
more T4. The lower the T4 levels go, the higher the TSH goes. The opposite is also true: if
the T4 levels get too high, the pituitary sends out less TSH, telling the thyroid to make less
T4.
NORMAL AND ABNORMAL TSH LEVELS (mU/L)
T SH LEVE LS ME ASURE D T HROUGH B LOOD T EST
S:
0.0 0.4
0.4 4.0
4.0 - 10.0
10.00 +
hyperthyroidism
or suppressed
TSH
normal range of
TSH
subclinical (mild)
hypothyroidism
hypothyroidism
In most labs, the normal range for TSH is 0.4 mU/L to 4.0 mU/L. If the TSH measures above
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4.0 mU/L on both a first test and a repeat test, this may indicate hypothyroidism. Most
people whose thyroid works normally have a TSH between 0.4 mU/L and 4.0 mU/L. This
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range may be lower in pregnant women and higher in older people. If your TSH is between
2.5 and 4.0 mU/L your doctor may wish to test your blood for anti-thyroid peroxidase (antiTPO) antibodies. If you have these antibodies, you may have an autoimmune thyroid
disorder which is a risk factor for developing hypothyroidism. If so, you should have the
TSH test repeated at least once a year. There is no need to repeat a positive anti-TPO test.
Some physicians may want to reevaluate a previously reported negative anti-TPO test in
connection with a pregnancy.
Remember: as the T4 falls, the TSH rises (as the thyroid hormone supply falls, the
demand increases). As the T4 rises, the TSH falls (as the supply rises, the demand falls).
There is one exception to the rule that everyone with hypothyroidism has a high TSH. If the
pituitary stops working properly, it may not be able to send out normal amounts of TSH. In
this case, even though the thyroid itself may be healthy, if it does not get enough TSH, it
won't make enough T4. This disorder is called secondary, or central, hypothyroidism.
Fortunately, it is rare.
T4 TESTS
T4 (thyroxine) is produced by the thyroid gland. The free T4 and the free T4 index are both
simple blood tests that when combined with a TSH test offer results that tell how your
thyroid is functioning.
WAYS THAT HYPOTHYROIDISM CANNOT BE DIAGNOSED

Low body temperature is not a reliable measure of hypothyroidism. People with
hypothyroidism as well as people who do not have hypothyroidism can have temperature
well below 98.6 degrees F.
Reflexes may be slowed in hypothyroidism, but in many other conditions, too.
Saliva tests for thyroid disease are not accurate.
Swelling in the base of the neck: An underactive thyroid may look like a normal
thyroid or it may be larger or smaller. Even if your thyroid looks normal, you can
have thyroid disease.
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TR EA T M E
NT
THYROXINE (T4) REPLACEMENT
Hypothyroidism cannot be cured but it can be treated and, in most people, completely
controlled. Hypothyroidism is treated by replacing the amount of hormone that your own
thyroid can no longer make. This makes sure that your T4 and TSH stay at normal levels.
Synthetic thyroxine (also called L-thyroxine or levothyroxine) pills contain hormone like the
T4, which a healthy thyroid makes naturally. Synthetic thyroxine must be taken every day
for life.
Like the T4 that your own thyroid makes, each dose of synthetic thyroxine keeps working
in your blood for about a week. This lets the T4 levels in your blood stay steady so a
constant supply of T4 is available to your body cells. (Thyroxine takes about 4 weeks to
clear completely from the body.)
WHO SHOULD TREAT YOU

Many people with hypothyroidism can be treated effectively by their primary care doctor.
You might need to see an endocrinologist or thyroidologist for a second opinion or for
regular care if:
You have congenital hypothyroidism or another unusual cause for your

hypothyroidism
You are pregnant
You have autoimmune polyglandular syndromeautoimmune hypothyroidism

combined with one or more other autoimmune conditions, such as type 1 diabetes, Addison's
disease, or premature ovarian failure
You have another condition, like epilepsy, heart disease, or bowel disease that affects
the treatment of your hypothyroidism
You have trouble establishing the right dose of thyroxine
You have many questions and concerns that your regular doctor cannot answer
Most people with hypothyroidism can be treated as outpatients without any hospitalizations.
THYROXINE DOSE FACTORS

When you are first diagnosed with hypothyroidism, your doctor will determine your starting
dose of thyroxine based on:
Weight: the more you weigh, the higher your dose usually is
Age: older people should start on a low dose and raise it slowly to give their body
time to adjust with special attention to heart health. Because older people's bodies clear
drugs more slowly, they generally stay on lower doses. Special considerations also apply
to children.
Cause of hypothyroidism: if your thyroid has been removed, all of your T4 must be
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replaced with thyroxine. If your hypothyroidism is caused by autoimmune disease and is still
making some T4, you may only need a low dose of thyroxine. If you have had thyroid
cancer, you may need a higher-than-usual dose of thyroxine to keep your TSH near zero and
prevent the cancer from coming back
Other health conditions you have: if you have impaired intestinal absorption diseases
such as Celiac or Crohn's, or if you have had bariatric surgery, you may have trouble
absorbing thyroxine and may need a higher dose
Other medicines you are taking: if you take birth control pills, hormone replacement
therapy, antidepressants, anti-seizure or anticonvulsant medications, Zoloft, Tegretol,
Dilantin, Phenobarbital, proton pump inhibitors to reduce stomach acid production, or
dietary supplements, such as calcium, iron or soy, you may need a higher dose of
thyroxine. If you take testosterone or niacin, you may need a lower dose of thyroxine
Your starting dose is your doctors best estimate of the amount of thyroxine you need. Your
doctor may purposely start you on a low dose to prevent you from getting symptoms of too
much thyroxine, like anxiety, restlessness, nervousness, and a racing heart. The doctor may
then raise your dose gradually. Over time your thyroxine dose may need to be adjusted.
Because thyroxine is a slow-acting hormone, it may take several weeks before your body
adjusts and you start to feel their effects. After about 6 to 10 weeks, your body will have
adjusted enough that your doctor can test your TSH again to see whether your TSH has gone
down.
Every person responds differently to thyroxine, and you may need a higher or lower dose
than someone who started out with the same TSH as you. You will eventually reach a stable
dose, and you may stay on that dose for many years.
Thyroxine comes in multiple strengths, each with its own pill color. When you get your pills,
make sure you have been given the right strength.
Many people have to take two thyroxine pillssometimes of two different strengthsto get
the right dose. If your dose needs to be 163 mcg, your doctor might give you prescriptions
for 75 mcg pills and for 88 mcg pills. Taken together, they equal 163 mcg.
Getting the right dose for you is just a matter of taking your pills as prescribed and getting
regular blood tests. A small change in your thyroxine dose can make a big change in how
you feel and function. If you are on the right dose, all your symptoms caused by
hypothyroidism should disappear.
TAKING YOUR THYROXINE PILLS

What's most important is that you start treatment right away and remember to take your pill
every day - every day. Your doctor might prescribe that you take the same dose every day
or different doses on different days. Following these instructions allows your doctor to
accurately measure how your TSH is responding to treatment.
Thyroxine replaces the hormone that your thyroid can no longer make. Thyroxine is not like
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an antibiotic that you take for a week or two weeks until your infection is treated. The only
way to control your hypothyroidism is to take your pill every day for the rest of your life.
If you stop taking your pills for any reason, your hypothyroidism will return.
Some people who have hypothyroidism without any symptoms say that they do not want to
take pills because they feel fine. They still need to be treated because their body functions
are slowing down even if they cannot feel it.
TIPS FOR TAKING YOUR THYROXINE PILLS

These tips may help you take your pills everyday:
Take your pill at the same time every dayfirst thing in the morning or last thing at
night works well for many peopleand make it part of your daily routine. For example, you
may remember to take your pill if you take it before or after brushing your teeth.
For many people, it is easy to forget whether they have taken their daily pill. To keep
better track of your pills, store them in a container that has a box marked for each day of the
week. Whatever container you use, keep it tightly closed so your pills stay dry.
Store your pills in the room where you will best remember to take them. As with all
medicines, keep thyroxine out of the reach of children.
You can take your pill with any liquid except soy milk. Cow's milk is probably fine.
Grapefruit juice and coffee should be avoided. Do not try to swallow your pill without
liquid; if it dissolves in your mouth or throat, not enough medicine will be absorbed into your
blood.
It does not matter whether you take your pill on an empty stomach or with food, as
long as you always do the same thing. That is because foods and medicines can interfere with
the body's ability to absorb thyroxine. If you always take your pill with food, you may need a
higher dose than if you always take it on an empty stomach.
Wait 4 hours after taking thyroxine before you eat foods that contain soy (including
soy formula for babies), take calcium supplements, iron supplements, or antacids that contain
either calcium or aluminum hydroxide, or take other medicines such as cholestyramine
(Questran(), colestipol (Colestid), or sucralfate (Carafete).
GIVING THYROXINE TO BABIES

To give thyroxine to a baby, crush the thyroxine pill between two spoons, mix it with a little
water or breast milk, and immediately squirt it inside the baby's cheek with a medicine
dropper. Then, nurse or bottle-feed the baby. Do not try to crush the thyroxine pill and mix it
into in a bottle. Thyroxine loses its strength in liquid.
GIVING THYROXINE TO CHILDREN WHO CANNOT SWALLOW

PILLS
You can give a thyroxine pill to a child the same way as a babycrush the thyroxine pill
between two spoons, mix it with a little water, and immediately squirt it inside the baby's
cheek with a medicine dropper. Or, put the pill in a small paper cup with just enough water to
dissolve the pill and have the child drink the solution. Then, put a little more water in the
cup
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to catch any more bits of the pill and have the child drink that.
WHY YOU SHOULD ALWAYS TAKE THE SAME BRAND OF

THYROXINE
The available brands of thyroxine are Synthroid, Levothroid, Unithroid tablets, and
Tirosint gel capsules. The U.S. Food and Drug Administration (FDA) regulates all of these
brands. All are safe and effective.
Each brand contains the same active ingredient, but each is made a little differently. Because
these small differences affect the way that the body absorbs the drug, the FDA has not ruled
that these products are interchangeable (it is not safe to substitute one for another). If you
change from one brand to another, even at the same dose, your body may absorb and respond
to it differently. This means that if you switch to a new drug, you need a TSH test 6 to 12
weeks later and your new dose may need to be adjusted.
The American Thyroid Association recommends that once you get used to one brand of
thyroxine, you continue with that brand. The ATA also recommends that you use brand name
drug rather than a generic drug. This is because generic drugs can be substituted with other
generic drugs from different manufacturers of levothyroxine each time you get your
prescriptions refilled. Make sure the pharmacist gives you the same brand each time you pick
up your pills.
IF YOU MISS A PILL

It is not serious to miss just one pill because thyroxine stays in your blood for a long time.
For example, if you remember this afternoon that you did not take your pill this morning,
take it now. If today you remember that you did not take yesterdays pill, you can take two
pills in one dayif possible, take one of the pills in the morning and the other one in the
evening.
If you are sick and vomit up a pill, do not take an extra pill. Wait and take your next
regular dose tomorrow. However, if you vomit up a pill because you are pregnant and
having morning sickness, take another pill at bedtime when you are less likely to feel sick.
It is much more serious to miss one thyroxine pill every week. This is because your body
will react as though are you taking a lower dose than needed. For example, suppose you are
prescribed 100 mcg of thyroxine a day; this adds up to 700 mcg of thyroxine a week. If you
miss one pill every week, you would only be taking 600 mcg of thyroxine a week, or 86
mcg of thyroxine a day. If you miss two pills every week, you are taking only 500 mcg of
thyroxine a week, or 71 mcg of thyroxine a day. If you miss several thyroxine pills, do not
try to make it up. Just start over with daily pills and figure out how best remember to take
them.
Keep track of how often you miss your thyroxine pills so you can tell your doctor next
time your TSH is tested.
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IF YOU BECOME PREGNANT

If you become pregnant, take your thyroxine dose as prescribed. Thyroxine is safe for
women who are pregnant. In fact, if you are pregnant, you need thyroxine more than
ever because it provides T4 for both yourself and your developing baby.
You should see your doctor as soon as you find out you are pregnant or even before
becoming pregnant if possible. You and your doctor will work closely throughout your
pregnancy to ensure the best possible health for yourself and your baby. Your doctor should
test your TSH several times while you are pregnant. You may raise your thyroxine dose by
as much as 30 to 50 percent because your body needs more T4 to handle the physical
demands of pregnancy. After the baby is born, your body returns to needing the same amount
of T4 as before you got pregnant.
Many experts recommend that all women get tested for thyroid disease if they are thinking of
becoming pregnant or as soon as they learn that they are pregnant. If you are diagnosed with
hypothyroidism during your pregnancy, you must begin thyroxine treatment right away and
continue treatment and testing at least every 6 to 8 weeks until you deliver. Then your TSH
levels will determine whether you need to continue treatment.
TREATMENT CONSIDERATIONS
SHOULD SUBCLINICAL (MILD) HYPOTHYROIDISM BE
TREATED?
Subclinical (mild) hypothyroidism is defined as a T4 in the normal range with a slightly high
TSH that ranges from 4.0 to 10.0 mU/L. Subclinical hypothyroidism usually causes few or
no symptoms. Experts have not come to an agreement on whether to treat people, including
children, with subclinical hypothyroidism although some Pediatricians believe treating
children offers special benefits.
Some doctors treat all people with subclinical hypothyroidism. Some treat only people who
have symptoms. Some treat those with anti-TPO antibodies or a high cholesterol. Some do
not treat people with subclinical hypothyroidism but instead test them on a regular basis to
see whether their TSH rises higher.
Research is still needed on whether people with subclinical hypothyroidism stay healthier if
they are treated or whether their health is at risk if they are not treated (it is possible that even
subclinical hypothyroidism can increase people's risk for heart problems). However, there is
no harm in treating people with subclinical hypothyroidism, as long as they are given the
correct thyroxine dose.
People with a TSH in the high-normal range of 2.6 and 4.0 mU/L may wish to keep
being tested to see whether their levels rise to the level of hypothyroidism.
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HOW HELPFUL ARE TREATMENTS COMBINING T4 WITH T3?

A healthy thyroid makes 14 times as much T4 as T3. T4 is turned into T3 by normal bodily
processes. When tissue cells remove T4 from the bloodstream, they change some of it into
T3. In fact, more than 80% of the T3 in your blood is made from T4 that has been changed
by the liver and other tissues outside the thyroid. Underactive thyroids still make both T4
and T3-just not enough. Because the failing thyroid still makes some T3, and because
body tissues turn some T4 into T3, most hypothyroid patients need to be treated only with
T4.Most people with hypothyroidism need to be treated only with T4. In these patients,
having the right amount of T4 allows the body to make the right amount of T3.
All brand-name thyroxine pills in the United States contain only T4. However, some
researchers have wondered whether a combination of T4 and T3 might be better. Early
studies have shown that some people felt better on the combination, but the improvement did
not last. Unlike thyroxine pills, which work for a week, the only FDA-approved brand of T3
works in the body for just a few hours. This means that people taking T3 need several doses
a day. Another problem is that taking T3 pills interferes with the body's normal ability to
adjust T3 levels, so the T3 levels that the pills give to people cannot match the body's normal
patterns. This makes some people feel worse on combined therapy. A T4-T3 combination
might be of some help to people who have had their whole thyroid removed and cannot make
any T4 or T3 of their own. If people want to try a combination of T4 and T3 combination,
the ATA recommends that their doctor give them at most 5 mcg of T3 twice a day, and, in
turn, reduce their T4 dose. Taking too much T3 can seriously harm the heart.
THYROXINE FROM ANIMALS

Before synthetic forms of thyroxine became available, animal thyroid saved many lives.
Now, people are safer taking synthetic thyroxine. Some people argue that pills made from
animal thyroids are more natural, but these pills pose several dangers.
Pills made from animal thyroid are not purified. They contain some proteins that do
not normally appear in the human bloodstream. Thyroxine made in a lab is exactly the same
hormone that a human thyroid makes, but in a pure form.
The balance of T4 to T3 in animals is not the same as in humans, so the hormones in

animal thyroid pills are not necessarily natural for the human body.
The amounts of T4 and T3 can vary in every batch of animal thyroid, making it
harder to keep both hormones level.
Case reports suggest possible allergic reactions tied to components within animal
thyroid preparations.
In sum, synthetic thyroxine is much safer than animal thyroid.
THYROXINE AND WEIGHT LOSS

Hypothyroidism can cause a mild weight gain of 5 to 20 pounds, but does not cause obesity.
People who have gained a lot of weight should find the real cause. People with
hypothyroidism who are started on the right thyroxine dose will not suddenly lose weight,
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but they should find it easier to lose weight if they try. People who take too high of a
thyroxine dose in the hope of rapid weight loss can weaken their muscles and bones and
damage the heartall of which can make it harder to exercise. Worse yet, a high dose of
thyroxine can cause increased hunger. So instead of losing weight, people may gain weight.
People with a normal TSH should never take thyroxine pills for weight loss.
INEFFECTIVE TREATMENTS
Chinese herbs, selenium, iodine-tyrosine supplements, kelp (a kind of seaweed), and other
herbal remedies high in iodine may promise to treat hypothyroidism, but they do not work.
Once the thyroid stops functioning, taking extra iodine or other substances will not help it
work better. In fact, taking too much iodine can worsen both hypothyroidism and
hyperthyroidism. Worse yet, taking these can prevent people from getting the thyroxine
treatment that they really need.
SIDE EFFECTS AND COMPLICATIONS OF TREATMENT

The only dangers of thyroxine are caused by taking too little or too much. If you take too
little, your hypothyroidism will continue. If you take too much, you can develop the
symptoms of hyperthyroidisman overactive thyroid. The most common symptoms of too
much thyroid hormone are fatigue, the inability to sleep, greater appetite, nervousness,
shakiness, feeling hot when other people are cold, muscle weakness, shortness of breath, and
a racing, skipping heart. Hyperthyroidism can also cause changes that you cannot feel, like
bone loss (osteoporosis) and an irregular heartbeat.
People who have hyperthyroid symptoms should have their TSH tested. If it is below normal,
their thyroxine dose needs to be lowered.
People who have had thyroid cancer need to take higher-than-usual thyroxine doses. This
increases their risk for bone loss. If you are being treated with thyroxine following thyroid
cancer, you should take plenty of calcium through food and supplements. Your doctor should
also monitor your bone density regularly.
Thyroxine pills do not harm the thyroid gland.
FO L LO W UP
REPEAT BLOOD TESTS
After a change in your thyroxine dose, you will need to have your TSH checked about every
6 to 10 weeks. You may need tests more often if you are pregnant or you are taking a
medicine that interferes with your body's ability to use thyroxine. The goal of treatment
for hypothyroidism is to get your TSH in the normal range and keep it there. The
American Thyroid Association recommends that your doctor try to keep your TSH within
a narrow
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range of 0.5 to 2.0 mU/L. Within this range, your body gets the best possible amount
of thyroxine and you are likely to feel the best.
Babies must get all their daily treatments and have their TSH levels checked as they grow
to prevent mental retardation and stunted growth (cretinism).
NORMAL VARIATION IN TSH LEVELS

TSH levels can vary, even when you are taking the same dose of thyroxine. Do not worry if
you get a result of 0.8 mU/L on one TSH test and 1.1 mU/L on your next test. It does not
mean that your hypothyroidism is getting worse. Differences in test results are expected:
TSH levels can vary because the pituitary sends out TSH in pulses rather than a
steady stream.
Labs cannot measure every test exactly the same way. For example, if a lab runs two
tests on one blood sample, it may get two slightly different results.
TSH levels normally go up at night and come down during the day. There is some
evidence that T4 levels also vary slightly throughout the day.
BE SURE TO FOLLOW UP WITH YOUR DOCTOR IF.

Once you have established the thyroxine dose right for you, TSH tests are necessary about
once a year. You need to make an appointment to discuss with your physician if you:
Feel a change in your symptoms. If your TSH turns out to be high, hypothyroidism is
probably causing your symptoms. But if your TSH is normal, it means something else is
causing your symptoms
Want to change your thyroxine dose or brand, or change to taking your pills with or
without food
Gain or lose a lot of weight without changing your diet or exercise routine. For some
people, even a change of 10 pounds or less can signal that something is wrong
Start or stop taking a drug that can interfere with absorbing thyroxine, or you change
your dose of such a drug (see "How your thyroxine dose is decided," above). For example, if
you start taking estrogen in a birth control pill or in hormone replacement therapy, you may
need to raise your dose. If you stop taking the drug, you may need to lower your dose
Are not taking your thyroxine pill every day. It is very important to be truthful when
telling your doctor how many pills you have missed. If you have missed pills but say that
you have taken them as prescribed and if your TSH test is then high, your doctor may think
that your hypothyroidism is getting worse and may raise your thyroxine dose
Want to try to stop thyroxine treatment. If ever you think you are doing well enough
not to need thyroxine treatment any longer, try it only under your doctor's close supervision.
Rather than stopping your pills completely, you might ask your doctor to try lowering your
dose. If your TSH increases, you will know that you need to continue treatment. You should
never stop thyroxine treatment on your own. You must take your thyroxine every day, most
likely for the rest of your life.
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IF HYPOTHYROIDISM IS NOT TREATED OR IF TREATMENT

IS STOPPED
BABIES AND CHILDREN
Thyroid hormone is essential for the brain to develop normally. In a healthy pregnancy, the
womens thyroid supplies the developing baby with thyroid hormone during the first
trimester. In the second trimester, the developing baby's thyroid starts to make its own
hormone. Once babies are born, they must depend completely on their own thyroid.
Too little thyroid hormone can keep the brain from developing normally. If the pregnant
woman has hypothyroidism, she cannot give her developing baby enough thyroid hormone.
When a woman with untreated or undertreated hypothyroidism delivers a baby who has a
normal thyroid, the baby's IQ may be a few points lower than it would have been otherwise,
but the child is not at increased risk for birth defects. If a baby does not get enough thyroid
hormones, it cannot maintain normal thyroid hormone levels before or after birth.
Hypothyroidism that begins before birth and through the age of 3, when left untreated, puts
babies and children at risk for mental retardation. Untreated severe hypothyroidism slows
both brain development and physical growth (cretinism). In the United States and some other
developed countries, all babies are tested for hypothyroidism a few days after birth so that
they can be diagnosed and begin treatment right away, if hypothyroid.
HYPOTHYROIDISM CAUSED BY IODINE DEFICIENCY

The body needs iodine to make thyroid hormone. People who live in parts of the world where
they do not get enough iodine from their food may develop hypothyroidism. This, in turn,
puts babies and children at increased risk of developing hypothyroidism. For example, a
woman with hypothyroidism is not able provide the fetus with enough thyroid hormone
during its development; once the baby is born, its own thyroid cannot make enough hormone.
Hypothyroidism prevents the brain and body from developing normally. Worldwide, iodine
deficiency is the major cause of hypothyroidism and preventable mental retardation.
PEOPLE OF ALL AGES

No one can predict whether hypothyroidism will worsen. Subclinical (mild)
hypothyroidism may never get worse or it may get worse over months or years. If people
with autoimmune hypothyroidism also have high levels of anti-TPO antibodies, their
hypothyroidism is more likely to worsen, although there is no way to predict how quickly.
Anti-TPO antibodies attack the enzyme within the thyroid that helps thyroid cells make
hormone. It is not known whether treating hypothyroidism prevents it from worsening.
SEVERE HYPOTHYROIDISM (MYXEDEMA)

The worse untreated hypothyroidism becomes, the less the body is able to cope with
stressors like cold weather, infections or even minor surgery. Severe hypothyroidism is
called
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myxedema. Usually it takes years for hypothyroidism to reach the point of myxedema, but
people who do not have a thyroid (because of surgery or radioactive iodine treatment) can
progress to myxedema in months. In people with myxedema, the body slows to the point
that it starts to shut down. At its worst, the person falls into a coma. To survive a myxedema
coma, people need good supportive care in the hospital intensive care unit. Myxedema is
now rare in developed countries.
KE E PI N G O TH ER P E OP L E I N FOR M E D
TELL YOUR FAMILY
Because thyroid disease runs in families, you should explain your hypothyroidism to your
blood relatives and encourage them to get a TSH test. If it is normal, they should be
retested if they develop symptoms, or at least every 5 years.
TELL YOUR OTHER DOCTORS AND PHARMACIST

Keep your other doctors and your pharmacist informed about your hypothyroidism and about
the drug and dose with which it is being treated. If you start seeing a new doctor, tell the
doctor that you have hypothyroidism and you need your TSH tested every year. If you see
an endocrinologist, ask that copies of your reports be sent to your primary care doctor.
You do not need to wear a medical alert bracelet, but it would be wise to keep a card in your
wallet that lists:
Your name and contact information
Your doctor's name and contact information
That you have hypothyroidism and any other diseases or healthy conditions
Your thyroxine brand name and dose
PAR T N ERS H IP BE T W E EN YO U AN D YOUR D OC

TO R
The more you and your doctor work as a team, the healthier you will be.
YOUR JOBS
Because you will probably have hypothyroidism for the rest of your life, you have to be your
own main caretaker. You cannot depend on your doctor to do all the work for you. You have
to fill your prescriptions and take your pills every day. You have to make and keep your
appointments for blood tests and doctor visits. When you go for visits, you have to tell your
doctor how you are feeling and be honest in saying how often you miss your pills. Before
you visit your doctor, write a list of all the things you want to ask or tell him or her so you do
not forget.
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YOUR DOCTORS JOBS

Your doctor should explain hypothyroidism to you and how it is treated. He or she should
also answer any questions that you have and listen to your concerns. The doctor should take
your symptoms into account when adjusting your thyroxine dose and give you your blood
test results. Choose a doctor who keeps up to date about advances in the diagnosis and
treatment of thyroid disease.
YO UR E MO T IO NA L N E E
DS
Many people are diagnosed with hypothyroidism after feeling sick for years or believing
or being told their symptoms are "all in your head," "just stress," or "a normal part of aging."
Some people are so relieved finally to know what is wrong that they are eager to start
treatment so they can begin to feel better. Other people are so exhausted and depressed by
the time they are diagnosed that they do not believe they have the energy to work at
getting better or may fear they will never feel well again.
It is important to be patient as you begin treatmentpatient with yourself and the changes
happening in your body, patient with your doctor, and patient with the people who are going
through this with you. It can take weeks before the thyroxine starts working to a point that
you begin feeling better and months before you and your doctor get the dose exactly right.
But for most people, the effort is worthwhile. Most people treated with thyroxine feel better
than they have in years.
L IV I NG W ITH HYPO THYROI D

ISM
There is no cure for hypothyroidism, and most people have it for life. Over time, your
hypothyroidism may become more or less severe. As a result, your thyroxine dose may
need to change. You have to make a lifetime commitment to treatment. You should never
stop thyroxine treatment on your own. If you do, your symptoms will return.
If you take your pills every day and work with your doctor to establish the correct thyroxine
dose, you should be able to keep your hypothyroidism completely controlled throughout
your life. Your symptoms should disappear and the serious effects of low thyroid hormone
should stop getting worse and should actually improve. If your hypothyroidism is wellcontrolled, it will not shorten your lifespan.
MANY QUESTIONS ABOUT HYPOTHYROIDISM REMAIN MYSTERIES

For example: Which genes increase people's risk for thyroid disease? What triggers the
start of thyroid disease? Why does the immune system attack the thyroid? These are among
the questions that researchers, including members of the American Thyroid Association, are
working hard to answer.
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Medical Terms in this Booklet

Addisons disease: permanent loss of function of the adrenal glands, which make
essential steroid hormones for the body
anemia: too few of the red blood cells that deliver essential oxygen to the body's cells
antibodies: proteins that the body's immune system makes to invaders like bacteria
and viruses
anti-TPO antibodies: in autoimmune thyroid disease, proteins that attack the
thyroid peroxidase (TPO) enzymes that help the thyroid make hormone
autoimmune disease: any disease in which the body's immune system, designed to
protect the body from viruses and bacteria, attacks a normal (healthy) part of the body
autoimmune thyroiditis: inflammation of the thyroid, caused by autoimmune disease
atrophic thyroiditis: a form of autoimmune thyroiditis in which the immune system's
attack on the thyroid causes it to shrink and stop making thyroid hormone
coma: unconsciousness from which a person cannot be awakened
congenital hypothyroidism: hypothyroidism in a newborn baby
cretinism: mental and physical retardation caused by severe congenital hypothyroidism
deficiency: a lack; too little
ectopic: in the wrong place; an ectopic thyroid is usually in the tongue and/or upper neck
endocrine gland: any gland that produces and releases hormones directly into the blood;
for example, the thyroid, pituitary, adrenals, and pancreas
endocrinologist: a medical doctor who specializes in endocrinology, the treatment
of endocrine gland diseases like thyroid disease and diabetes
enzyme: protein that helps chemical processes take place within the body but does not
get used up in the process; the major enzymes in the thyroid are peroxidases
feedback loop: a system in which A affects B, which in turn affects A again
fetus: a developing baby
free T4: the thyroid hormone T4 that circulates in the blood unattached to a protein and
that can be taken up by cells in tissues
free T4 index: an estimate of the amount of free T4 in the blood
gland: an organ or tissue that makes and sends out a hormone or other substance goiter: an
enlarged thyroid, which can cause swelling in the front of the neck Graves disease:
autoimmune hyperthyroidism, usually with goiter and eye symptoms Hashimotos
thyroiditis (also called Hashimotos disease): autoimmune thyroiditis in which the
immune system's attack on the thyroid causes a goiter and, sometimes, hypothyroidism
hormone: substance, made by an organ or tissue, that affects the function of one or
more other organs
hyperthyroidism: an overactive thyroid
hypothyroidism: an underactive thyroid
I 131: one of several forms of radioactive iodine; low-dose I 131 is used for medical
testing and to destroy an overactive thyroid
infiltrate: to deposit an abnormal substance in a tissue
immune system: the body's way of protecting itself from invaders like bacteria and viruses
inflammation: the body's response to injured cells
iodine: chemical element that is an essential ingredient of thyroid hormone
mcg: unit of measure, abbreviation for "micrograms"; thyroxine doses may be measured
in mcg (also written as ug); 50 mcg = .05 mg (milligrams)
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metabolism: all the processes by which the body makes and uses energy and builds tissues
mild hypothyroidism (also called subclinical hypothyroidism): a T4 in the normal
range, but a slightly high TSH of 4.0 to 10.0 mU/L, causing few or no symptoms
mU/L: unit of measure, abbreviation for "milliunits per liter"; TSH levels are measured
in mU/L
myxedema: severe hypothyroidism; the brain, heart, lungs, kidneys, and other organs slow
to the point that they cannot keep up critical functions like maintaining temperature, heart
rate, blood pressure, and breathing
myxedema coma: often-fatal unconsciousness resulting from severe hypothyroidism
nodule: small abnormal mass or lump; nodules in the thyroid are very common, but few
are cancerous
paresthesias: feeling of pins and needles in the hands and feet
pituitary gland: from its position in the base of the brain, the pituitary monitors most
basic body functions and sends out hormones that control those functions, for example, the
rate at which the thyroid makes hormone
polyglandular autoimmune syndromes: combinations of autoimmune diseases
affecting both endocrine and non-endocrine organs and usually involving the thyroid
postpartum: after giving birth
premature ovarian failure: before the normal age for menopause, the ovaries' loss of
ability to produce estrogen and release eggs, leaving a woman unable to become pregnant
radioactive iodine (also called radioiodine): iodine that has naturally or artificially
been made radioactive; see "I 131" above
secondary hypothyroidism: hypothyroidism caused not by damage to the thyroid but
by damage to the pituitary gland, preventing it from being able to tell the thyroid to make
hormone
set point: the body's preferred level or range for a function; for example, the pituitary
gland knows the body's normal T4 range (set point) and works to keep the T4 within that
range silent: not causing symptoms
subclinical (mild) hypothyroidism (also known as mild hypothyroidism): a T4 in the
normal range, but a slightly high TSH of 4.0 to 10.0 mU/L, causing few or no symptoms
supportive care: general medical care, such as nutrition and fluids, to help a person
recover when no targeted treatment can improve the person's condition
suppressive treatment: thyroxine dose high enough to keep the TSH below normal
syndrome: a combination of symptoms
synthetic: made in a laboratory
T3: triiodothyronine, a hormone with 3 iodine molecules, made in small amounts by
the thyroid and in larger amounts from T4 in other body tissues
T4: thyroxine, the main hormone made by the thyroid
thyroid: a gland, normally in the lower front of the neck, that makes and sends out the
hormones T4 and T3 that regulate the metabolism of every cell in the body
thyroid hormones: T4 and T3, the products of the thyroid
thyroiditis: inflammation of the thyroid
thyroidologist: a medical doctor who specializes in the diagnosis and treatment of
thyroid diseases
thyroid peroxidase (TPO) enzymes: enzymes within the thyroid that help thyroid
cells make hormone
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thyroid stimulating hormone (TSH): hormone that the pituitary gland makes and
sends into the blood to tell the thyroid how much T4 and T3 to make
thyroxine: T4, the main hormone made by the thyroid; also, pills used to
treat hypothyroidism by replacing the missing T4
trimester: three months; the nine months of a pregnancy are broken into three trimesters
TPO: thyroid peroxidase
TSH: thyroid-stimulating hormone
TO L E AR N M O
RE
Visit the ATA web site, www.thyroid.org, to learn more about hypothyroidism. There you
will find:
names of thyroid specialists in your area,
access to Friends of the ATA newsletter emailed to you with the latest thyroid news
updates
Clinical Thyroidology for Patients, a monthly publication describing the latest

thyroid research,
The most recent guidelines for the management of thyroid diseases and thyroid
cancer,
Links to the ATA Alliance for Patient Education -- organizations that help patients,
And, current and up-to-date information and education about thyroid disorders.
You may also want to read the following books about hypothyroidism that were written by
members of the ATA:
How Your Thyroid Works, 4th edition, by H. Jack Baskin, M.D. Adams Press, Chicago IL,
1995.
The Harvard Medical School Guide to Overcoming Thyroid Problems by Jeffrey R. Garber,
M.D. with Sandra Sardella White, McGraw-Hill, New York 2005.
The Thyroid Gland: A Book for Thyroid Patients, by Joel I. Hamburger, M.D. Michael M.
Kaplan, M.D. (self-published) Southfield, Michigan, 1991.
The Thyroid Sourcebook by M. Sara Rosenthal with a foreword by Robert Volpe, M.D.,
Lowell House, Los Angeles 1998.
Could It Be My Thyroid? The Complete Guide to the Causes, Symptoms, Diagnosis, and
Treatments of Thyroid Problems (Foreword by George H.W. Bush) by Sheldon Rubenfeld,
M.D. The Thyroid Society for Education and Research, Houston, Texas, 1996, 2002, 2003.
The Thyroid Book A Book for Patients by Martin I. Surks, M.D. (self-published) 1993, 1999.
th
Your Thyroid: A Home Reference, 4 edition, by Lawrence C. Wood, M.D., David S.

Cooper, M.D., and E. Chester Ridgway, M.D. Ballantine Books, New York, NY, 2006.
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H YP O T H Y R O I D I S M

A BOOKLET FOR PATIENTS AND THEIR FAMILIES

A publication of the American Thyroid

C O P YR IG H T 2013 A ME R I C A N T HYR O I D A S SOC I

American Thyroid Association Hypothyroidism

THE AMERICAN T HYROID A SSOCIATION ( ATA)

ATA PATIENT RESOURCES

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

QUIENES PUEDEN DESARROLLAR

American Thyroid Association Hypothyroidism

FACTORES DE RIESGO QUE CONTRIBUYEN A

Have a close relative, such as a parent or grandparent, with an autoimmune disease

Have another autoimmune disorder, such as type 1 diabetes, rheumatoid arthritis,

Have Down syndrome or Turner syndrome genetic disorders

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

CARACTERSTICAS COMUNES DEL HIPOTIROIDISMO

Feeling cold when other people feel warm

Drier, itchier skin

Mild weight gain (5-20 pounds) and difficulty losing weight

New or worsening constipation

Carpal tunnel syndrome

Heavier and/or more frequent menstrual periods, worse cramps, worse

New or worsening depression-sadness or not caring about anything

New or worsening hearing loss

Slowing of heart rate

Higher cholesterol levels

Growth delay in children

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

EXTIRPACIN QUIRURGICA DE UNA PARTE O TODA LA TIROIDES

American Thyroid Association Hypothyroidism

TRATAMINETO CON RADIACIN

HIPOTIROIDISMO CONGNITO (DESDE EL NACIMIENTO)

American Thyroid Association Hypothyroidism

MUY POCO O DEMASIADO YODO

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

HISTIRIAL MDICO Y FANLIAR

Your familys health history, especially if a close relative (such as a parent or

If you have ever had thyroid surgery

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism

American Thyroid Association Hypothyroidism