Thyroid Warrior: Symptoms of Hypothyroidism and How to Reclaim Your Health
Symptoms of Hypothyroidism: An Overview
If your thyroid isn’t working properly, it has a tendency to make you feel like you were hit by a car the previous day. Just imagine being tired, emotional, depressed, overweight for no reason, and on top of everything your hair is falling out, you’re constipated, hands and feet are always freezing (ask my wife), and your brain feels like moosh. Undiagnosed hypothyroidism is not a pretty picture. Believe me. The good news is that it’s usually straightforward to diagnose with lab tests, and treatment regimens can more or less turn you into a normally functioning, healthy human being.
Hypothyroidism is when your thyroid gland does not make enough thyroid hormones, known as T3 and T4, to help regulate most of your body’s functions. For example, T3 regulates the metabolic rate of every cell in the body .
Symptoms can take years to develop, and will progressively get worse over time. Currently, it is estimated that 20 million people have some form of thyroid disease. According to The American Association of Clinical Endocrinologists, half of people who suffer from thyroid disorders – 10 million – are currently undiagnosed (1).
Why? Lack of awareness. Many people just don’t associate “feeling like crap” with “disease.” Or, medical practitioners overlook or misdiagnose hypothyroidism symptoms with normal aging or non-illness causes. The end result is that people don’t recognize their symptoms as hypothyroid, and so they slog through everyday tired, often depressed, and struggling with a host of other associated conditions.
The Good News About Hypothyroidism
Dr. Amy Meyers is a current tour de force expert on thyroid disease, and has pioneered treating it from a functional perspective. In her recent book, aptly names The Thyroid Connection, Meyers highlights the fact in glaring detail that untreated thyroid disease takes over your life. As in, it affects your work, relationship, and ability to be healthy. As said, “takes over your life” = “feel crummy all the time.”
But the book, in addition to her other programs, shows in great detail that despite how much thyroid disease symptoms can negatively impact daily functioning, you have every reason to easily live a completely normal, healthy life. I point out Amy Meyers because she has now spent years exploring the fact that hypothyroidism is not all doom and gloom.
In fact, the good news about hypothyroidism is that the road to health from a diagnoses can happen extremely quickly and dramatically. Reversing hypothyroidism symptoms is not all fun and games, but it’s extremely achievable with evidence based alternative medicine and small life changes. In fact, you will probably come out on the other end of your illness healthier than most people.
What is the Thyroid and What Does It Do?
It’s difficult to underestimate just how important this little butterfly shaped gland is. It sits right below your Adam’s apple, in front of your trachea (wind pipe). If it’s healthy, you will never even know it’s there because you won’t be able to feel it.
Just some of the wide ranging duties your thyroid has are:
- Regulate hormones
- Regulate metabolism
- Influence growth and development
- Regulate temperature
- Helps organs work well
As one person recently put it, “When it doesn’t work everything gets out of whack.” Out of whack is a good way to describe the feeling of untreated thyroid disease. The thyroid makes all of the above points function smoothly by secreting hormones, such as thyroxine (T4 – main hormone) and triiodothyronine (T3), which are collectively known as “thyroid hormone.”
Here’s how the thyroid works (see graphic above):
The hypothalamus, pituitary, and thyroid work together to maintain healthy levels of hormone.
The thyroid gland is controlled by the pituitary gland, which acts as a throttle for thyroid hormone production. The hypothalamus constantly monitors how much thyroid hormone is in your body, and if those levels are low then the hypothalamus tells the pituitary gland to step on the gas pedal. When this happens, the thyroid produces more hormone with the use of iodine.
If thyroid hormone levels are high, the pituitary will take the foot off of the gas pedal so to speak, and the thyroid will produce less hormone.
More Technical Description:
Your thyroid works via the hypothalamic-pituitary-thyroid axis (HPT axis). Your hypothalamus monitors thyroid hormone levels in the blood. If these levels are low, the hypothalamus releases a hormone called TRH, which stimulates the pituitary gland to produce thyroid-stimulating hormone (TSH).
In turn, the TSH stimulates the thyroid to produce more thyroid hormones with (in part) the use of iodine. If the pituitary gland does not produce TSH (i.e., T3/T4 levels are high), then the (healthy) thyroid will produce less hormone.
Hypothalamus (monitors T3/T4) –> TRH –> Pituitary (controls production) –> TSH –> Thyroid (produces T3/T4)
Common Symptoms of Hypothyroidism
Like any illness/disease, every person with hypothyroidism will experience a different combination of symptoms that characterize their disease. They keywords here are combination and characterize. We all experience tiredness, coldness, weight gain, and the other symptoms listed below.
What separates “normal” from hypothyroid is that hypothyroid sufferers will experience several/many of these symptoms at the same time, chronically. Hypothyroid symptoms will also usually appear gradually and worsen over time as metabolism slows.
Something important to point out is that, historically, hypothyroidism has been difficult to diagnose in people over 60 years old mainly for two reasons: their symptoms are often mistaken for “normal aging”; and frequency of multiple symptoms decreases in older patients.
Here are the most common symptoms of hypothyroidism.
Lethargy: tiredness is a state of being
Lethargy is usually a mode of existence for people who suffer from hypothyroidism. This lethargy can range anywhere from chronic fatigue (very common), to being able to sleep all the time (common), to constantly feeling heavy and tired (common), to crippling weariness (uncommon). Typical hypothyroidism flavor of lethargy translates to being able to fall asleep on command, waking up feeling unrested, or feeling extremely tired after only moderate activity.
Chilliness: more sweaters than shirts in your closet
Your thyroid helps regulate internal temperature, and when it doesn’t work, your internal thermostat drops. Many websites claim “sensitivity to cold” as a primary symptom of hypothyroidism, but this is sort of like saying frostbite is “inconvenient.” With hypothyroidism it’s more like: always having cold hands and feet, often feeling cold in warm environments, AND strong sensitivity to cold.
Weight gain: hypothyroid is the only demographic no diet works on
Your thyroid hormone (T3 and T4) regulates metabolism. Without the hormone your metabolism can slow to a point of making glaciers look hasty. Hence why people with hypothyroidism either put on weight no matter what they eat, or can’t do anything (diet nor exercise) to lose a single pound.
Paresthesia: clinical term for that “pins and needles” feeling in hands/feet
Another common symptom of hypothyroidism is feeling that numb/tingly/pins and needles feeling in your hands or feet for no apparent reason.
Hair loss: professional drain clogger
The T4 hormone moderates hair cycles and other hair biology – without T4 your hair will be directly affected. No kidding, this symptom is often a tipoff for many undiagnosed hypothyroid victims, and is a sincere concern for people with diagnosed hypothyroidism. The symptoms look like this: you may notice that your shower drain becomes increasingly clogged from hair, excessive hair coming out when you brush your hair (even in clumps!), or you may start to see “empty” patches in odd spots on your head where your scalp shows through or on the sides of your eyebrows.
Abnormal menstrual cycle (women): getting pregnant seems impossible
Becoming pregnant or staying pregnant can be a major source of frustration and pain for subclinical hypothyroid victims. There is ongoing debate as to whether thyroid screening should be mandatory during pregnancy. The correlation between pregnancy troubles and hypothyroid is strong enough that the American Thyroid Association has issued multiple statements warning about the dangers of hypothyroidism and pregnancy. To name a few, increased complications of: miscarriage, still birth, infertility, anemia, preeclampsia, placental abruption, premature delivery, and so on. The good news is that with proper treatments and monitoring, hypothyroid victims often achieve normal pregnancy (my wife with Hashimoto’s had a wonderful pregnancy).
Erectile dysfunction (men): Casanova wasn’t hypothyroid
A 2005 study found that 65% of hypothyroid men complain of erectile dysfunction or low libido. A 2008 study published in the Journal of Clinical Endocrinology and Metabolism found that nearly 4 out of 5 with hypothyroidism men show some level of erectile dysfunction, and that “ED is extremely common in males with dysthyroidism.” Dysthyroidism is simply a term imperfect development of the thyroid (i.e. hyper- or hypothyroidism). Men who are considering or already taking erectile dysfunction medicine might better spend their money on a thyroid panel.
Depression: an unfortunate link
Clinically speaking, it’s not exactly clear why hypothyroidism would cause depression, but studies have shown that the link is irrefutable (2). Unfortunately, nearly 75% of women who were prescribed anti-depressants have NOT been tested for dysthyroidism. As Hypothyroidmom said, “Before anyone starts taking an antidepressant, they should have complete medical workup done to determine if underlying medical issues including low thyroid are the cause of the depression.”
Consequences of Hypothyroidism
So, what happens if you have undiagnosed hypothyroidism that goes unchecked? Well, the picture isn’t pretty. If you are undiagnosed and (after reading the above symptoms) have a growing suspicious that your thyroid is the instigator of your health problems, then pay attention to the following symptoms which develop as a consequence of untreated hypothyroidism.
Gastro intestinal problems
Hypothyroidism is a common cause of constipation, bloating, and discomfort resulting from diminished motility (contractions) of the intestines. It can also cause decreased motility in the esophagus, which leads to difficulty swallowing, heartburn, and indigestion.
Slow cognitive function
Untreated hypothyroidism commonly leads to what is best described as chronic brain fog – slowed thinking, delayed processing, and trouble with memory. It might be best described as constantly feeling like your head is up in the clouds.
Simply put, people with subclinical hypothyroidism are 340% more likely to develop cardiovascular disease than people with normal thyroids because hypothyroidism causes changes in the hearts ability to contract, oxygen consumption, cardiac output, and blood pressure.
The thyroid hormone T3 regulates your liver’s ability to turn (“catabolize”) cholesterol into bile. With low T3 levels, the liver can’t break down the cholesterol, and the un-catabolized cholesterol simply end up in hypothyroid victims’ bloodstreams.
Alzheimer’s and Dementia
An extensive study has found a strong association between low/high thyroid functioning and developing Alzheimer’s disease.
Underlying Causes of Hypothyroidism
As discussed, hypothyroidism is when your thyroid is not producing much (if any) thyroid hormone (T4 and T3). This can happen for a number of reasons. The two warning signs are:
- High TSH levels
- Low T4/T3 levels
One can develop hypothyroidism for a number of reasons:
- Autoimmune disease (Hashimoto’s thyroiditis): the body attacks the thyroid and destroys functioning
- Cell phone usage: while not well studied, this preliminary study found a definitive correlation between sub-optimal thyroid function and cell phone usage – crazy!
- Glyphosate: a proven endocrine disruptor (thyroid is an endocrine organ), among other extremely nasty disruptions
- Congenital: born with an under-performing or non-working thyroid
- Too much/little iodine: the thyroid must have iodine to make thyroid hormone, and too much/little iodine will hamper the thyroid’s ability to make hormone
- Pituitary gland malfunction: remember that the pituitary gland tells the thyroid how much hormone to make, and if it can’t communicate then the thyroid will not produce hormone
- Surgery: part or all of the thyroid was removed during surgery, with obvious consequences
- Medicines: some medicines, such as lithium, interferon alpha, and interleukin-2, can prevent the thyroid from functioning normally
- Toxins: many environmental toxins are bad for the thyroid because they are primary endocrine disruptors
- Infections: infections can trigger autoimmune disease that affects the thyroid
In general, autoimmune disease is the most common cause of hypothyroidism, and among thyroid-autoimmune diseases Hashimoto’s is the most common. Treatment may depend on what the cause is.
Must-know Risk Factors for Thyroid Disorders
You may be wondering what the point of knowing the risk factors are. To be frank, risk factors may or may not matter in diagnoses. The point is that when you are running down the list of symptoms and cross checking them against your own experience, you should also take into account how many risk factors are true for you. For example, if you have many risk factors but currently no symptoms, it would probably be a good idea to test your thyroid levels every year and catch thyroid problems early on should they develop.
In the eyes of hypothyroidism, we are not all created equal. There are a handful of risk factors that significantly increase the likelihood that you will develop hypothyroidism. In general however, the three primary risk factors are age, sex, and gender.
The long and short of it is that being past middle age and/or female are major strikes against avoiding thyroid complications:
- Woman are 5 times more likely [see appendix 13] to develop thyroid problems (sources vary on this, ranging anywhere from 2-10 times depending on the source)
- Being over 60 years of age – up to ¼ of all patients in nursing homes may have hypothyroidism (4)
- Genetics – 70%-80% of susceptibility to autoimmune thyroid disease is based on genetics
- You have a history of smoking
Other risk factors that increase your likelihood of having a thyroid disorder that you should pay attention to are:
- You have been exposed to radiation in the neck/head area
- You have had surgery on your thyroid
- In postpartum period – see postpartum hypothyroidism
- You have a history of smoking
- You already have an autoimmune disorder (such as psoriasis, arthritis, etc.)
Link Between Thyroid Disease and Environmental Toxins
In so many ways, we are at the mercy of our environment. Recent studies give mounting evidence that many common chemicals in our (1st world) environment inhibit or harm thyroid function.
Now, it’s easy to go overboard and become manic about avoiding all of the below items. All that will do is stress you out – a little exposure to the items below is inevitable because they environmental toxins are literally everywhere. But if you are not careful, you can inadvertently expose yourself to many the list below and that may not end well. Here are some toxins that recently published studies have concluded are environmental risks for thyroid malfunction:
Mercury (commonly found in: cosmetics, fish, pesticides, vaccines) is particularly nasty because it is similar in structure to iodine, and your thyroid will soak up and store mercury very quickly. Other metals to look out for are nitrates (commonly found in: cured/processed meats) which block iodine absorption, and perchlorate (commonly found in: jet fuel, fireworks, air bags) which can easily end up in our water supply and food supply because of runoff.
Dioxin is one wicked dude. It is the primary toxic component of agent orange – enough said. If you get it into your system its half-life in the body is 7-11 years, and it’s potential damage to your thyroid is permanent (5). Dioxins are by-products of industrial processes (i.e., waste centers), and enter our bodies through contaminated food.
Believe it or not, excessive soy may disrupt the body’s ability to absorb iodine because isoflavone (which in excess can also give men breasts) inhibits thyroid peroxidase (TPO), which is an enzyme in the thyroid that produces thyroid hormone. It’s not like you necessarily need to give up soy, but pay attention to your risk factors and the amount of soy in your diet. It should also be noted that isoflavone does not seem to inhibit thyroid function in otherwise healthy individuals with adequate iodine intake [see appendix 61-63].
Not only do pesticides seem to be killing off our world’s honeybee’s (do a Google search for Neonicotinoids), they can also hurt thyroid function. This study found that women married to men who used pesticides were twice as likely (!!!) to develop thyroid disease.
Another evil little chemical is perfluorooctanoic acid (PFOA), and it’s everywhere. It’s used to make Teflon (used in cooking), food wrappers (stores food), microwave popcorn bags (eaten at movies), and a number of other consumer goods. A large study on PFOA, which was funded by part of a $100 million settlement with DuPont over allegedly dumping PFOA in a region’s drinking water supply, concluded that PFOA can affect thyroid function at even modest levels of exposure.
Antibacterial products with Triclosan
Believe it or not, check out the ingredients on your soap, lotion, and toothpaste. Triclosan is an antibacterial chemical that not only kills bad bugs but may significantly impact thyroid hormone levels.
Thyroid Hormone Explanation and Diagnoses
In general, diagnosing hypothyroidism is fairly straightforward. In the past, basal body temperature was used to aid in diagnosing thyroid disease. Currently, there are several tests to assess how your thyroid is functioning, and they should be used in conjunction, such as with the Thyroid Panel Test, and not alone.
The hallmark of hypothyroidism diagnoses is one or a combination of one of high TSH levels, low T4 and T3 levels, high rT3 levels, and/or high antibodies. The tests you would normally take to assess thyroid function are as follows:
Thyroid Panel Test
A Thyroid Panel lab test is a combination of the main tests for thyroid disease: TSH test, T4 test, T3 test, rT3 test, Thyroid Peroxidase Antibodies test, and Thyroglobulin Antibodies test. This panel is almost always used to diagnose thyroid disease. We go over each of the tests below.
A TSH lab test measures how much TSH your pituitary gland is producing. Remember that high TSH levels indicate low thyroid hormone (hypothyroidism) production because your pituitary is trying to tell your thyroid (with TSH) to produce more. Low TSH indicates high thyroid hormone (hyperthyroidism) production because your pituitary is trying to tell your thyroid to back off production.
A T4 lab test measures Thyroxine levels. T4 is the main hormone produced by the thyroid. Low levels of T4 (hypothyroidism) causes many of the trademark symptoms of hypothyroidism: depression, weight gain, hair loss, and cold intolerance.
See this article which discusses T4 lab tests in detail.
A T3 lab test measures the level of thyroid hormone Triiodothyronine in your body. T3 is the “active” version of T4, and is converted from T4 by the presence of iodine and friendly gut-flora (Lactobacillus acidophilus and Bifidobacteria). T3 affects almost every physiological process in the body (growth, development, metabolism, body temperature, heart rate).
Reverse T3 Test (rT3)
An rT3 lab test measures the level of Reverse T3 in the body. With a normally functioning thyroid, about 20% of T4 is converted into T3. rT3 is essentially T3 in the body that has become “inactive.” In other words, rT3 is T3 that isn’t doing anything. But here’s the caveat: your body still recognizes Reverse T3 as plain old T3 (rT3 blocks T3 receptors) and will therefore not continue to convert T4 into T3 because your body thinks the T3 supply is full.
Thyroid Autoantibodies (TAA) and (TPO) Test
The TAA and TPO lab tests are used to see if the autoimmune system is attacking thyroid processes. TAA checks to see if autoantibodies are attacking thyroglobulin (thyroid hormone), which may lead to the destruction of the thyroid. TPO (also called TPOAb) tests to see if antibodies are attacking the enzyme that makes thyroid hormone (i.e., Hashimoto’s).
Free T3 and T4
Free T3 and T4 will be included with a regular T3 and T4 test. Free T3 and T4 simply haven’t been hitched-up (bind) with the protein (thyroxine-binding globulin) that transports them around the body. When we talk about T3 and T4 tests, we are talking about total T3 and T4 (bound and free). Free T3 and free T4 are just the unbound hormones.
Treatment for Hypothyroidism
When a diagnoses has been made, the most common treatment for hypothyroidism is Thyroid hormone replacement. The goal of hormone replacement is to relive symptoms of hypothyroidism by simply replacing what your body isn’t making and decrease elevated TSH levels to normal range.
Typical treatments begin with synthetic T4 (levothyroxine), such as with Synthroid or Levoxyl. Generally, low doses are given at first and slowly increased until thyroid hormone levels are within the healthy range. A 2009 paper suggest that it is more effective to take thyroid medication just before bed rather than in the morning.
Beyond conventional treatment, we highly suggest you consider the nutritional suggestions below, as healthy thyroid function is also strongly dependent on the nutrients listed below.
Supporting a Healthy Thyroid
The following minerals are all extremely important – if not essential – to healthy thyroid function.
- Vitamin E
- Vitamin D
- Vitamin B12
For more information on why these nutrients are so important for thyroid function, this is a great article.
Want to know what your thyroid levels are? Click here to order the test yourself!
Thank you for reading! Your path to enhanced cellular wellness starts here!
Health Disclaimer: It is recommended the reader of this site consult with a qualified health care provider of their choice when using any information obtained from this site, affiliate sites and other online websites and blogs. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
- Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate with biochemical disease? J Gen Intern Med. 1997 Sep;12(9):544-50.
- Videla LA, Fernández V, Tapia G, Varela P. Thyroid hormone calorigenesis and mitochondrial redox signaling: upregulation of gene expression. Front Biosci. 2007 Jan 1;12:1220-8.
- Pearce EN. National trends in iodine nutrition: is everyone getting enough? Thyroid. 2007 Sep;17(9):823-7.
- Segerson TP, Kauer J, Wolfe HC, et al. Thyroid hormone regulates TRH biosynthesis in the paraventricular nucleus of the rat hypothalamus. Science. 1987 Oct 2;238(4823):78-80.
- Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002 Oct;53(4):865-71.
- Roelfsema F, Pereira AM, Biermasz NR, et al. Diminished and irregular TSH secretion with delayed acrophase in patients with Cushing’s syndrome. Eur J Endocrinol. 2009 Nov;161(5):695-703.
- Kelly GS. Peripheral metabolism of thyroid hormones: a review. Altern Med Rev. 2000 Aug;5(4):306-33.
- Deng J, Zhou Y, Bai M, Li H, Li L. Anxiolytic and sedative activities of Passiflora edulis f. flavicarpa.J Ethnopharmacol. 2010 Mar 2;128(1):148-53.
- Weeks BS. Formulations of dietary supplements and herbal extracts for relaxation and anxiolytic action: Relarian.Med Sci Monit. 2009 Nov;15(11):RA256-62.
- The American Thyroid Association. http://www.thyroid.org/patients/brochures/Hypo_brochure.pdf Accessed March 18, 2011.
- Garduño-Garcia Jde J, Alvirde-Garcia U, López-Carrasco G, et al. TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. Eur J Endocrinol. 2010 Aug;163(2):273-8.
- Dayan CM, Saravanan P, Bayly G. Whose normal thyroid function is better—yours or mine? Lancet. 2002 Aug 3;360(9330):353.
- Wilson GR, Curry RW Jr. Subclinical thyroid disease. Am Fam Physician. 2005 Oct 15;72(8):1517-24.
- Ebert EC. The thyroid and the gut. J Clin Gastroenterol. 2010 Jul;44(6):402-6.
- Romaldini JH, Sgarbi JA, Farah CS. Subclinical thyroid disease: subclinical hypothyroidism and hyperthyroidism. Arq Bras Endocrinol Metabol. 2004 Feb;48(1):147-58.
- Hennessey JV, Scherger JE. Evaluating and treating the patient with hypothyroid disease. J Fam Pract. 2007 Aug;56(8 Suppl Hot Topics):S31-9.
- Cole DP, Thase ME, Mallinger AG, et al. Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry. 2002 Jan;159(1):116-21.
- Hogervorst E, Huppert F, Matthews FE, Brayne C. Thyroid function and cognitive decline in the MRC Cognitive Function and Ageing Study. Psychoneuroendocrinology. 2008 Aug;33(7):1013-22.
- Samuels MH, Schuff KG, Carlson NE, et al. Health status, mood, and cognition in experimentally induced subclinical hypothyroidism. J Clin Endocrinol Metab. 2007 Jul;92(7):2545-51.
- Anjana Y, Tandon OP, Vaney N, Madhu SV. Cognitive status in hypothyroid female patients: event-related evoked potential study. Neuroendocrinology. 2008;88(1):59-66.
- Kritz-Silverstein D, Schultz ST, Palinska LA, Wingard DL, Barrett-Connor E. The association of thyroid stimulating hormone levels with cognitive function and depressed mood: the Rancho Bernardo study. J Nutr Health Aging. 2009 Apr;13(4):317-21.
- Kvetny J, Heldgaard PE, Bladbjerg EM, Gram J. Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf). 2004 Aug;61(2):232-8.
- Duntas LH, Biondi B. New insights into subclinical hypothyroidism and cardiovascular risk. Semin Thromb Hemost. 2011 Feb;37(1):27-34.
- Saito I, Ito K, Saruta T. Hypothyroidism as a cause of hypertension. Hypertension. 1983 Jan-Feb;5(1):112-5.
- Stabouli S, Papakatsika S, Kotsis V. Hypothyroidism and hypertension. Expert Rev Cardiovasc Ther. 2010 Nov;8(11):1559-65.
- Duntas LH. Thyroid disease and lipids. Thyroid. 2002 Apr;12(4):287-93.
- Rodondi N, den Elzen WPJ, Bauer DC, et al. Subclinical Hypothyroidism and the Risk of Coronary Heart Disease and Mortality. JAMA. 2010;304(12):1365-1374.
- Stamatelopoulos KS, Kyrkou K, Chrysochoou E, et al. Arterial stiffness but not intima-media thickness is increased in euthyroid patients with Hashimoto’s thyroiditis: The effect of menopausal status. Thyroid. 2009 Aug;19(8):857-62.
- Caparević Z, Bojković G, Stojanović D, Ilić V. Dyslipidemia and subclinical hypothyroidism. Med Pregl. 2003 May-Jun;56(5-6):276-80.
- Perk M, O’Neill BJ. The effect of thyroid hormone therapy on angiographic coronary artery disease progression. Can J Cardiol. 1997 Mar;13(3):273-6.
- Joshi JV, Bhandarkar SD, Chadha M, et al. Menstrual irregularities and lactation failure may precede thyroid dysfunction or goitre. J Postgrad Med. 1993 Jul-Sep;39(3):137-41.
- Poppe K, Velkeniers B, Glinoer D. Thyroid disease and female reproduction.
Clin Endocrinol (Oxf). 2007 Mar;66(3):309-21.
- Doucet J, Trivalle C, Chassagne P, et al. Does age play a role in clinical presentation of hypothyroidism? J Am Geriatr Soc. 1994 Sep;42(9):984-6.
- Lorini R, Gastaldi R, Traggiai C, Perucchin PP. Hashimoto’s Thyroiditis. Pediatr Endocrinol Rev. 2003 Dec;1 Suppl 2:205-11; discussion 211.
- Meloni A, Mandas C, Jores RD, Congia M. Prevalence of autoimmune thyroiditis in children with celiac disease and effect of gluten withdrawal. J Pediatr. 2009 Jul;155(1):51-5, 55.e1.
- Najib U, Bajwa ZH, Ostro MG, Sheikh J. A retrospective review of clinical presentation, thyroid autoimmunity, laboratory characteristics, and therapies used in patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2009 Dec;103(6):496-501.
- Aamir IS, Tauheed S, Majid F, Atif A. Frequency of autoimmune thyroid disease in chronic urticaria. J Coll Physicians Surg Pak. 2010 Mar;20(3):158-61.
- Kiyici S, Gul OO, Baskan EB, et al. Effect of levothyroxine treatment on clinical symptoms and serum cytokine levels in euthyroid patients with chronic idiopathic urticaria and thyroid autoimmunity. Clin Exp Dermatol. 2010 Aug;35(6):603-7.
- Tohei A. et al J Reprod Dev. Studies on the functional relationship between thyroid, adrenal and gonadal hormones. 2004 Feb;50(1):9-20.
- Jordan RM. Myxedema coma. Pathophysiology, therapy, and factors affecting prognosis. Med Clin North Am. 1995 Jan;79(1):185-94.
- The National Women’s Health Information Center. http://www.womenshealth.gov/faq/thyroid-disease.cfm. Accessed March 17, 2011.
- Paknys G, Kondrotas AJ, Kevelaitis E. Risk factors and pathogenesis of Hashimoto’s thyroiditis. Medicina (Kaunas). 2009;45(7):574-83.
- McLachlan SM, Nagayama Y, Pichurin PN, et al. The link between Graves’ disease and Hashimoto’s thyroiditis: a role for regulatory T cells. Endocrinology. 2007 Dec;148(12):5724-33.
- Selenkow HA, Wyman P, Allweiss P. Autoimmune thyroid disease: an integrated concept of Graves’ and Hashimoto’s diseases. Compr Ther. 1984 Apr;10(4):48-56.
- Wasniewska M, Corrias A, Arrigo T, et al. Frequency of Hashimoto’s thyroiditis antecedents in the history of children and adolescents with graves’ disease. Horm Res Paediatr. 2010;73(6):473-6.
- Costeira MJ, Oliveira P, Ares S, Roque S, de Escobar GM, Palha JA. Parameters of thyroid function throughout and after pregnancy in an iodine-deficient population. Thyroid. 2010 Sep;20(9):995-1001.
- Drews K, Seremak-Mrozikiewicz A. The Optimal Treatment of Thyroid Gland Function Disturbances During Pregnancy. Curr Pharm Biotechnol. 2011;12(5):774-80.
- Clarke N, Kabadi UM. Optimizing treatment of hypothyroidism.Treat Endocrinol. 2004;3(4):217-21.
- Arnow WS. The heart and thyroid disease. Clin Geriatr Med. 1995May;11:219–29.
- Pollock MA, Sturrock A, Marshall K, et al. Thyroxine treatment in patients with symptoms of hypothyroidism but thyroid function tests within the reference range: randomised double blind placebo controlled crossover trial. BMJ. 2001 Oct 20;323(7318):891-5.
- Sesmilo G, Simó O, Choque L, et al. Serum free triiodothyronine (T3) to free thyroxine (T4) ratio in treated central hypothyroidism compared with primary hypothyroidism and euthyroidism. Endocrinol Nutr. Epub 2010 Dec 31.
- Escobar-Morreale HF, Obregón MJ, Escobar del Rey F, Morreale de Escobar G. Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Invest. 1995 Dec;96(6):2828-38.
- Escobar-Morreale HF, del Rey FE, Obregón MJ, de Escobar GM. Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat. Endocrinology. 1996 Jun;137(6):2490-502.
- Sawaka AM, Gerstein HC, et al. Does a combination regimen of thyroxine (T4) and 3,5,3’-triiodothyronine improve depressive symptoms better than T4 alone in patients with hypothyroidism? Results of a double-blind randomized, controlled trial. J Clin Endocrinol Metab. 2003 Oct;88(10):4551–5.
- Walsh JP, Stuckey BG. What is the optimal treatment for hypothyroidism? Med J Aust. 2001Feb 5;174(3):41–3.
- Dhal P et al. Thyrotoxic cardiac disease. Curr Heart Fail Rep. 2008 Sep;5(3):170-6.
- Gaby AR. Sub-laboratory hypothyroidism and the empirical use of Armour thyroid. Altern Med Rev. 2004 Jun;9(2):157-79.
- Benvenga S, Bartolone L, Pappalardo MA, et al. Altered intestinal absorption of L-thyroxine caused by coffee.Thyroid. 2008 Mar;18(3):293-301.
- Sperber AD, Liel Y. Evidence for interference with the intestinal absorption of levothyroxine sodium by aluminum hydroxide. Arch Intern Med. 1992 Jan;152(1):183-4.
- Campbell NR, Hasinoff BB, Stalts H, et al. Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism. Ann Intern Med. 1992 Dec 15;117(12):1010-3.
- Doerge DR, Sheehan DM. Goitrogenic and estrogenic activity of soy isoflavones. Environ Health Perspect. 2002 Jun;110 Suppl 3:349-53.
- Chang HC, Doerge DR. Dietary genistein inactivates rat thyroid peroxidase in vivo without an apparent hypothyroid effect. Toxicol Appl Pharmacol. 2000 Nov 1;168(3):244-52.
- Dillingham BL, McVeigh BL, Lampe JW, Duncan AM. Soy protein isolates of varied isoflavone content do not influence serum thyroid hormones in healthy young men. Thyroid. 2007 Feb;17(2):131-7.