What is hypothyroidism?

Hypothyroidism is a common condition whereby the thyroid gland produces insufficient thyroid hormones such as triiodothyronine (T3), and thyroxine (T4). The thyroid is a small butterfly-shaped endocrine gland in the neck that is pivotal in regulating metabolism, energy levels, skin and bone maintenance and even mental activity.

When the thyroid hormone level drops, the body’s metabolism rate slows, leading to an array of symptoms such as slower heart rate, fatigue, abrupt weight gain, intolerance to cold temperatures and increased cholesterol levels. In severe cases, hypothyroidism can trigger potentially life-threatening complications such as myxedema coma, in which patients exhibit multiple organ abnormalities and progressive mental deterioration.

What causes hypothyroidism?

Hypothyroidism is caused by either primary or secondary factors such as:

  • Primary causes: primary hypothyroidism occurs when the thyroid gland is impaired or damaged leading to an inability to produce sufficient thyroid hormones (T3, and T4). This may include:
    • Hashimoto’s Thyroiditis: an autoimmune disorder in which the body’s immune system attacks itself– gradually destroying the thyroid gland. This causes a decrease in thyroid hormone production.
    • Iodine Deficiency: due to iodine deficiency, the thyroid’s ability to function at an optimal rate is disrupted, thereby causing the thyroid to produce insufficient thyroid hormones.
    • Radiation Therapy: patients who underwent radiation therapy for conditions such as head and neck cancer may be diagnosed with hypothyroidism due to a damaged thyroid gland.
    • Thyroid Surgery: a thyroid removal surgery, or a thyroidectomy can result in reduced thyroid hormone production
  • Secondary causes: secondary hypothyroidism is triggered by issues that occur in the brain such as the pituitary gland or the hypothalamus– both responsible for regulating thyroid hormone production:
    • Hypothalamus Disorders: the hypothalamus produces thyrotropin-releasing hormone (TRH), which triggers the pituitary gland to release thyroid-stimulating hormone (TSH). In the event the hypothalamus is injured due to trauma, tumours or cancer, it disrupts the communication flow, thereby causing secondary hypothyroidism.
    • Pituitary Gland Dysfunction: when the pituitary gland fails to release sufficient TSH, the thyroid will not receive signals or triggers to produce T3 and T4 hormones.
thyroid Singapore.
Hypothyroidism can occur when dysfunction of the hypothalamus and pituitary gland is evident.

Who is at risk of hypothyroidism in Singapore?

As common as hypothyroidism may be, there are certain risk factors that indicate a group of people who are more susceptible to developing the condition such as:

  • Age: although your risk of developing hypothyroidism increases as you age, those who are aged 60 years old and older have a higher risk of developing the condition.
  • Autoimmune disease: your chance of developing hypothyroidism is higher if you are diagnosed with certain autoimmune diseases such as type 1 diabetes, Addison’s disease, multiple sclerosis, rheumatoid arthritis, or vitiligo.
  • Ethnicity: hypothyroidism is more common amongst those of Asian or Caucasian descent.
  • Family history: you are more likely to develop hypothyroidism if you have a family history of the condition.
  • Gender: women have a higher risk of developing hypothyroidism compared to men.
  • Genetic disorder: your risk of developing hypothyroidism increases if you are diagnosed with certain genetic conditions such as Turner syndrome, Sjogern’s syndrome, and Down syndrome.
  • Pregnant: women who are pregnant or were pregnant within the last 6 months have an increased risk of developing hypothyroidism.
  • Prior thyroid surgery: a prior thyroid surgery increases your chances of developing hypothyroidism.
  • Radiation therapy: if you undergone radiation therapy on your upper chest level (throat, mouth, chest), then you have an increased risk of developing hypothyroidism.

What are the symptoms of hypothyroidism?

Symptoms of hypothyroidism often develop slowly, but gradually. Additionally, the symptoms of hypothyroidism vary between adults, adolescents, and infants.
Adults Adolescents Infants
  • Bradycardia (slower heart rate).
  • Brain fog.
  • Constipation.
  • Decreased in sexual interest.
  • Depression.
  • Drooping eyelids.
  • Dry, or coarse hair, and skin.
  • Extreme fatigue.
  • Frequent heavy menstruation.
  • Higher cholesterol levels.
  • Intolerance to cold temperatures.
  • Hoarser, or lower voice.
  • Memory problems.
  • Muscle aches, or stiffness.
  • Muscle weakness.
  • Numbness, or tingling sensation in your hands.
  • Puffiness in the eyes, or face.
  • Unexplained weight gain.
Although most children, and teenagers share similar symptoms with adults, they may also experience:  
  • Delayed puberty.
  • Delayed eruption of permanent teeth.
  • Poor growth, leading to short stature.
  • Poor mental development.
  • A bulge near the naval (umbilical hernia).
  • Constipation.
  • Dry skin.
  • Enlarged tongue.
  • Feeding issues.
  • Hoarse crying.
  • Jaundice.
  • Poor growth.
  • Poor muscle tone.
  • Poor weight gain.

How is hypothyroidism diagnosed in Singapore?

Despite hypothyroidism being a common condition, it can be challenging to diagnose as the symptoms are universal and can be mistaken for other conditions. Diagnosing hypothyroidism may necessitate a combination of physical examination, medical evaluation and blood tests to gauge the functionality of the thyroid gland. Generally, the diagnostic procedure involves:

  • Physical Examination: during the initial consultation, the assessment will begin with a physical examination of dry skin)if evident) and palpable thyroid enlargement. Additionally, your healthcare provider will also collect medical and family history to determine if your hypothyroidism is caused by primary or secondary causes.
  • Medical Examination: additionally, a medical examination will be performed to determine the speed of your reflexes and your heart rate (to ascertain if it is slower than normal).
  • Blood Tests: to assess your thyroid function several blood tests may be necessary such as;
    • Thyroid-Stimulating Hormone (TSH) Test: the TSH test blood test measures the level of TSH in your blood, which is produced by the pituitary gland. If your thyroid is underactive, TSH levels will be high, as the pituitary gland attempts to stimulate thyroid hormone production. Additionally, a high TSH level is a key indicator of hypothyroidism.
    • Thyroxine (T4) Test: T4 is a hormone directly produced by the thyroid gland. A low T4 level, combined with a high TSH level confirms hypothyroidism. In cases of subclinical hypothyroidism, TSH may be elevated, but T4 and triiodothyronine (T3) levels remain within the normal range.
    • Triiodothyronine (T3) Test: a T3 test is conducted if T4 levels are normal. Low T3 levels can indicate hypothyroidism but they may remain normal in subclinical cases.
    • Thyroid Antibody Tests: if autoimmune thyroid conditions are suspected, such as Hashimoto’s disease, antibody tests may be ordered to detect specific antibodies that attack the thyroid.
blood test Singapore.
A blood test is performed to confirm a hypothyroidism diagnosis.

How is hypothyroidism treated in Singapore?

If you are diagnosed with hypothyroidism, treatment is aimed at managing your triggers, symptoms and thyroid levels.

  • Medication: the most common treatment involves taking an oral medication known as levothyroxine, which is a synthetic form of the hormone thyroxine (T4). Levothyroxine functions by helping to restore normal hormone levels and alleviates symptoms like fatigue, weight gain, and intolerance to cold temperatures. However, it may take a few weeks to feel its full effects, which will require you to be regularly and closely monitored by a doctor till the optimal dosage is identified.
  • Dietary changes: some dietary guidelines can help improve your thyroid health such as consuming iodine-rich foods such as dairy (milk, yoghurt, and cheese), eggs, seafood, and iodised salt. On the other hand, excessive soy consumption can deteriorate thyroid function. As such, it is encouraged to control consuming tofu, soy milk, soybeans, soy sauce, and vegan cheese.

It goes without saying that thyroid health is important as it impacts your overall health and well-being. If you suspect that you might be impacted by hypothyroidism, schedule your appointment today to reclaim autonomy over your thyroid health.

Frequently Asked Questions

The key difference between hypothyroidism and hyperthyroidism is in how the thyroid gland regulates metabolism:

  • Hyperthyroidism occurs when the thyroid gland produces excessive thyroid hormone, subsequently accelerating the body’s metabolism, leading to symptoms like rapid heartbeat, weight loss, nervousness, excessive sweating and irritability.
  • Hypothyroidism, on the other hand, is when the thyroid gland produces insufficient thyroid hormone, slowing down the metabolism. This leads to symptoms such as fatigue, weight gain, depression, dry skin and sensitivity to cold.

Yes, hypothyroidism can contribute to erectile dysfunction (ED). According to a study, thyroid disorders, including hypothyroidism are linked to sexual dysfunction in men such as decreased libido, and ED. Hypothyroidism's impact on hormone levels, and metabolism can disrupt sexual function leading to issues like reduced sexual desire and impaired erectile function.

Hypothyroidism-induced weight gain can occur due to the slowing of metabolism. However, a study discovered that hypothyroidism could contribute to some weight increase, it is usually modest, typically around 2 to 5 kilograms. This is mainly due to water retention rather than excessive fat accumulation.

Failure to treat and manage hypothyroidism earlier spells many potential health-related complications, such as:

  • Cardiovascular issues: hypothyroidism increases the risk of heart problems, such as heart failure. This is because people with hypothyroidism tend to have higher “bad” cholesterol levels.
  • Enlarged goitre: hypothyroidism can lead to an enlarged goitre, leading to swallowing and breathing difficulties.
  • Infertility: the low thyroid hormone levels can disrupt a woman’s ovulation, making it difficult to conceive.
  • Myxedema coma: myxedema coma is a life-threatening condition that demands emergency medical treatment.
  • Peripheral neuropathy: peripheral neuropathy indicates that the nerves that carry information from the brain to the spinal cord and throughout the body are damaged. This can result in pain, numbness and tingling in the legs and arms.
Symptoms such as fatigue, weight gain, brain fog and depression can drastically impact daily functioning, mood and energy levels. That is why it is important to address hypothyroidism immediately to better manage symptoms and their severity.
No, it is impossible to prevent hypothyroidism especially if it is caused by autoimmune diseases or genetic predisposition.
No, hypothyroidism does not go away on its own. However, one can get on top of the symptoms induced by the condition with consistent treatment and management. Delaying treatment can trigger a list of complications, some of which can be life-threatening.

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