Hypothyroidism

What it is

Hypothyroidism is the condition in which the thyroid produces fewer hormones than the body needs, slowing down the entire metabolism. It is much more common in women, especially after age 40 and postpartum, and tends to set in slowly, with symptoms that are often mistaken for everyday tiredness. The most common cause in Brazil is Hashimoto's thyroiditis, an autoimmune disease. Diagnosis is simple, made with a blood test, and hormone replacement treatment, when properly adjusted, restores the patient's energy, weight control and regular menstrual cycle. Follow-up with the endocrinologist ensures the correct dose over time.

Most common symptoms

• Fatigue and sleepiness even after sleeping well
• Weight gain without any change in habits
• Feeling colder than usual
• Dry skin, hair loss and brittle nails
• Constipation and body swelling
• Irregular or very heavy periods
• Slower thinking and low mood

Causes and risk factors

• Hashimoto's thyroiditis (autoimmune)
• Previous treatment with radioactive iodine or thyroid surgery
• Iodine deficiency or excess
• Use of medications such as lithium and amiodarone
• Pituitary gland disorders (central hypothyroidism)

How it is diagnosed

Diagnosing hypothyroidism starts with a discussion of symptoms and family history, followed by a physical exam focused on the neck, skin and reflexes. Confirmation comes from blood tests: TSH, which rises when the thyroid is underactive, and free T4, which shows how much hormone is available. Anti-TPO antibody testing helps identify an autoimmune origin, and a thyroid ultrasound is ordered when the gland is enlarged or nodules are present. In some cases, TSH is only slightly altered — so-called subclinical hypothyroidism — and the decision to treat depends on symptoms, age and whether the patient wants to become pregnant.

How we treat it at Femi Saúde

Treatment consists of thyroid hormone replacement in tablet form, taken on an empty stomach every day. The dose is individual and depends on weight, age, severity and conditions such as pregnancy or heart disease. After starting or adjusting the dose, TSH is rechecked in about six to eight weeks until balance is reached; after that, monitoring is usually done once a year. Throughout this process, the endocrinology team at Femi Saúde also advises on interactions with other medications and supplements, such as calcium and iron, which interfere with absorption, and closely follows patients who are planning to become pregnant, since hormone needs increase during pregnancy.

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