July 24, 2025 • 23 mins
Hypothyroidism: What is it? What can cause it? What are the symptoms? In this episode we will go over the interesting history of hypothyroidism, how doctors diagnose the condition, as well as the current treatment used. Tune in to learn more!
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Resources:
British Thyroid Foundation: https://www.btf-thyroid.org/
Australian Thyroid Foundation: https://www.thyroidfoundation.org.au/
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3134382/
https://karger.com/hrp/article/95/6/546/828530/History-of-the-Thyroid
https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289
https://www.health.com/condition/thyroid/celebrities-with-thyroid-disorders
https://pmc.ncbi.nlm.nih.gov/articles/PMC2448803/
https://www.btf-thyroid.org/pages/category/hypothyroidism
https://www.healthdirect.gov.au/thyroid-gland
*This podcast is for entertainment purposes only. If you suspect you have a medical condition, please seek out an opinion of a medical professional.*
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Lately, you feel as though your muscles have become weaker than they once were.
(00:04):
This is also paired with a feeling of incredible stiffness and muscle pain.
You originally chalked this up to getting older and hurting yourself in the gym.
However, with the weeks passing by, it is almost as if nothing has changed, the pain continues.
You have also found that you just can't take the cold of winter anymore.
For some reason, this year, the cold seems to be affecting you much worse than it previously did.
(00:27):
As you struggle to drag your tired body out of the house to make it to brunch with your friend,
you notice that your face looks odd, almost puffy,
and that your trusty favourite jeans just won't do up anymore.
They no longer fit like they did last week.
As you check the time on your watch, you see that your heart rate is oddly slow,
only 42 beats per minute.
(00:48):
It has been like that often in the past few weeks.
You bring this up to your friend over brunch and she tells you to see a doctor.
Hello and Welcome to Anatomy Of Illness.
(01:11):
Today's episode is about hypothyroidism.
Before we get into the condition, we are going to start with the history.
So why do we know hypothyroidism exists?
In this episode, I may also refer to the condition as an underactive thyroid.
As with this condition, there is not enough of the thyroid hormone being produced.
We begin in the year 2697 BCE, all the way over in ancient China.
(01:35):
This is with the Yellow Emperor Hung Ti,
and his book known as the Yellow Emperor's Classic of International Medicine.
In this book, it would describe the use of seaweed as a form of treatment for goiter,
which is a condition caused by hypothyroidism.
Moving on to the 2nd century CE.
Here, the Roman satirical poet, Juvenal, would make his own comments about goiters.
(01:58):
“Quis tumidum guttur miratur in alpibus”,
which translates to "Who is surprised to see a swollen goiter in the Alps?"
In the European Alpine regions, there were a higher amount of people suffering from goiter,
physical deformities and intellectual disabilities at this time.
It had been known for quite some time that goiters were more common
(02:20):
amongst those who lived in the mountains than near the sea,
this being due to something missing from the diet.
Moving on to Li Shizen, who lived between 1518 and 1593 in ancient China.
He would discuss the use of iodine as a treatment for goiter in his pharmacopoeia.
The first detailed description of hypothyroidism would come in the year 1602.
(02:42):
This was by Felix Platter, who was a Swiss physician.
"It is usual that many infants suffer from innate folly.
Besides, the head is sometimes misshapen, the tongue huge and swollen, they are dumb.
The throat is often goitrous. Thus they present an ugly sight."
Now we move to the year 1757, as this is when the term cretinism first appeared
(03:06):
in the medical literature to describe those with this condition.
This is supposedly derived from either the Latin word Christianus,
due to the belief that those with the condition were unable to commit sin,
or it is suggested that it comes from the Swiss French word crestin, which also means Christian.
Likely to remind people that although these people with the condition had
physical defects and mental impairments, they were still people not beasts.
(03:31):
This term is no longer used in medicine.
Cretinism was initially used to mainly refer to congenital iodine deficiency syndrome,
or congenital hypothyroidism, so having an underactive thyroid from birth.
Moving on to Jean-François Coindet, who lived between the years 1774 and 1834.
He would discuss how effective various different preparations of iodine were
(03:55):
in the treatment of goitres. He found a tincture worked best in 1821.
This was in an attempt to have a prophylactic for those of his patients that had goitres.
Coindet in his travels through South America saw many people with goitres.
He believed that the problem causing the goitres was water not having enough oxygen.
I hope you know the chemical formula for water is H2O, which makes this one an interesting one.
(04:20):
However, his idea did have a point of reference, so he was not just pulling it out of thin air.
You'll get that joke in a second.
So his comparison between South America and the Alps in Europe,
which is a place that has reduced atmospheric pressure causing this thinking.
Realistically, both groups just had low iodine diets.
Coindet would advocate for the use of iodinated salt when travelling or living in these areas.
(04:44):
Now we are going to discuss the French chemist Adolphe Chatin, who lived between 1813 to 1901.
He was actually the first to suggest that goitres could be caused by iodine deficiencies.
“The main cause of goitre seems to be a low concentration of iodine in the drinking water
in certain areas. Changing the water source and the animal foods
(05:05):
and above all the eggs are rational treatments against this condition.”
However, not everyone agreed with Chatin's views, with the German chemist Baumann
remarking that “they were consigned to eternal oblivion”.
We're going into the year 1850 now.
Meeting with Thomas Blizard Curling.
He would describe the two cases of young girls in what was in the day called an idiot asylum.
(05:29):
The first girl was 10 years old and her growth was severely stunted.
“The countenance had a marked and very unpleasant idiotic expression, had very little power of
locomotion, but could manage to walk from chair to chair with little assistance.
She had no power of speech.” In her case, no goitre was present.
The other young girl Curling would describe was much younger.
(05:51):
She was only six months old and “was plump, but had a marked idiotic expression,
a large face with a small head and very receding forehead.
The tongue was large and protruding from the mouth.”
Both of these girls would pass away with an autopsy being performed.
On autopsy, they were unable to find any sign of the thyroid gland in either girl.
(06:12):
Curling would comment, “I am not acquainted with any case on record
in which a deficiency of the thyroid gland has been observed in the human body.
In countries where cretinism and bronchocele prevail, it was long supposed that there was
some connection between the defective condition of the brain and the hypertrophy of the thyroid.”
Bronchocele is an old term for goitres in this case.
(06:35):
20 years later, we would have the comment of Fagge from Guy's hospital.
He would discuss the links between goitre and hypothyroidism.
He would come to the conclusion that “sporadic cretinism, instead of being associated with goitre,
appears to be attended with a wasting or an absence of the thyroid body.”
Sporadic cretinism in today's medicine would mean congenital hypothyroidism.
(06:58):
So being born with an underactive thyroid or without one.
This condition can also be caused by not having enough iodine during pregnancy.
So your mother having hypothyroidism due to a low iodine diet.
Now we go into the year 1878 with William Ord.
He would coin the term myxedema, the name actually coming from
(07:20):
jelly-like swelling found in the connective tissue.
Going to Professor Theodor Kocher of Bern in the year 1883,
he was a surgeon who, after performing 101 surgeries on his patients,
mind you this was a large amount for this time by the way,
he would read a paper that would discuss the removal of the thyroid.
(07:40):
After reading this, he would call all 101 patients.
Those who had gone through a total removal of the thyroid gland
were suffering from the same symptoms as those who were labeled as having cretinism.
Also in 1883, but in November,
Dr. Dawtrey Drewitt would be presenting the case of a patient with classical hypothyroidism
to a group of doctors at the Clinical Society of London.
(08:03):
Someone in the crowd would make the comment that the three conditions closely resembled each other.
These being cretinism, removal of the thyroid and myxedema.
Now we discuss Sir William Horsley.
He was interested in the real purpose of the thyroid gland,
as many believed that it did not serve a purpose at this time
or had ideas which differed to what the thyroid actually does.
(08:25):
Horsley would do several experiments which would lead to his views on myxedema,
the condition being caused by the thyroid gland no longer functioning or no longer being there.
He would also sum up his and others research on hypothyroidism in 1885.
“Various as have been the surmises as to the function of the thyroid gland.
It is not surprising that although a rest of it had been vaguely
(08:47):
known for hundreds of years to be connected with the cretinus state,
cretinism, as is well known, had been attributed to every course except
for the destruction of the thyroid, chalky water, damp close air,
miasma, insufficient food, and so forth.
And hereditary influence have all been credited with the power of causing the imbecile condition,
(09:09):
which is so familiar to everyone.”
In 1891, George Redmayne Murray would publish the first case of a patient with hypothyroidism,
being given a thyroid extract. This was through an injection.
This patient lived almost another 30 years on these thyroid extract medications.
In either the year 1892 or the year 1893,
(09:30):
there would be the case of a woman dying from myxedema in Londonderry, Ireland.
However, a doctor by the name of David Thompson would intervene after being asked to see her.
He had recently read about the use of thyroid extracts in the case of myxedema and hypothyroidism.
So after seeing her, he got a hold of some sheep
thyroids and prepared them, giving her the extracts to see if she would get better.
(09:54):
Well, she did, stunning everyone.
In 1914, Edward Calvin Kendall would first crystallize thyroxine.
However, it would not be until 15 months later that this process would be mastered.
If you are enjoying this episode and think a friend might also,
you should share it with them as it helps us grow.
What is hypothyroidism?
Hypothyroidism is when the thyroid is unable to make enough of the hormones
(10:18):
that the thyroid produces. The thyroid produces two main hormones.
These are thyroxine, which is T4, and triiodothyronine. This is T3.
These hormones have influence over every cell in your body.
They affect your metabolism, how fast your body uses up fats and carbohydrates.
They help to control your body temperature,
(10:38):
help to control your heart rate and even how much protein your body makes.
These are very important hormones.
But what are some of the risk factors for the development of hypothyroidism?
There are several risk factors that can increase your risk of developing hypothyroidism.
These include being a woman, having a family history of thyroid disease,
having a different autoimmune disease like type 1 diabetes, which we discussed in episode 26,
(11:01):
or celiac disease, which we talked about in episode 10.
The thought behind this is that if your immune system is already causing one condition
by attacking healthy cells, it may do this to other areas.
Hypothyroidism may also be caused by radiation to your upper chest or neck area.
This is due to the radiation potentially causing damage to your thyroid.
(11:22):
Having previous thyroid surgery, as with partial removal or even full removal,
you may not be able to make enough of the thyroid hormone,
having received previous treatment for hypothyroidism.
Yes, this sounds counterintuitive,
having too much of the thyroid hormones and going to not having enough.
However, sometimes it can be overdone with treatment.
(11:42):
So what are some of the potential causes of hypothyroidism?
Well, there are many potential causes of hypothyroidism.
These include autoimmune disease.
If you remember episode 36, which was Hashimoto's disease or Hashimoto's thyroiditis,
a brief explanation of this is the condition is caused by the immune
system making antibodies and attacking healthy tissue.
(12:04):
In this case, it attacks the thyroid gland.
This affects your ability to make thyroid hormones.
Autoimmune disease is the most common cause of hypothyroidism,
and this is most often caused by Hashimoto's disease.
However, it was not always the most common cause.
We'll get to that in a minute.
There are other causes, however, these include thyroiditis.
(12:24):
This is what occurs when your thyroid becomes inflamed.
This can either be due to an infection or due to an autoimmune condition
or other medical conditions that affect the thyroid gland.
With this, it may cause a spike in your thyroid's activity,
causing it to release all the stored hormones.
This is hyperthyroidism.
After this, the thyroid becomes underactive, which is hypothyroidism.
(12:47):
Radiation therapy when there is radiation used to treat cancers of the head and neck areas.
This can cause damage to the thyroid gland, which in turn can cause hypothyroidism.
Medicine.
There are various medicines that can actually cause hypothyroidism.
These include medicines like lithium.
This medicine is used to treat certain psychiatric disorders.
(13:08):
So using it carefully and testing to make sure there are no issues with your thyroid.
When being on this medication, thyroid surgery,
if you have had a surgery to remove part of the thyroid or all of the thyroid,
this can decrease the thyroid's ability to produce hormones
or even stop its ability to produce these hormones.
There are also less common causes of hypothyroidism.
(13:29):
However, these can still occur.
These include birth defects.
Some babies can develop hypothyroidism due to being born without a thyroid
or being born with a thyroid gland that does not function correctly.
In other cases, children can have an inherited condition that causes a thyroid disorder.
Pregnancy.
In some cases, people can develop hypothyroidism during or after pregnancy.
(13:52):
If it occurs during pregnancy but is not treated,
this can increase the risk of several issues during pregnancy.
These include pregnancy loss, premature delivery,
and the development of another condition called preeclampsia.
We discussed preeclampsia in episode six, but essentially this condition causes the blood
pressure during pregnancy to rise significantly.
Hypothyroidism during pregnancy can also affect the development of the fetus.
(14:16):
Pituitary disorder.
This form of hypothyroidism is incredibly rare.
It is caused by the pituitary gland not making enough of the thyroid hormone,
specifically the thyroid stimulating hormone or TSH.
This in most cases is caused by a non-cancerous tumor growing on the pituitary gland,
not having enough iodine in the diet.
(14:37):
This is rare now, however, it used to be the most common cause of hypothyroidism.
So for the production of the thyroid hormones, iodine is needed.
This is found in a variety of foods, including seafood,
seaweed, iodized salt, as well as plants grown in iodine-rich soil.
Some foods will have extra iodine added if the diet is deficient in iodine.
(14:59):
When you don't eat enough of these foods, you can start to develop hypothyroidism.
However, with hypothyroidism, if you start eating too much iodine,
this can make the condition worse if you just start doing this suddenly though.
How do we diagnose hypothyroidism?
When it comes to hypothyroidism, the symptoms of this condition mimic several other conditions.
This can make it difficult to diagnose.
(15:21):
Because of this, tests have to be done to rule out other conditions.
So after telling a doctor about your symptoms, they will request a blood test.
This blood test will check your levels of TSH and your levels of T4.
If this test shows that you have high levels of TSH
and low levels of T4, then the test will be redone.
If this test also shows high levels of TSH and low levels of T4,
(15:45):
they will then give you the diagnosis of hypothyroidism.
When it comes to the test, the results can be affected by certain medicines or supplements.
These include things like biotin.
So be sure to inform your doctor before having these blood tests done.
In some cases, they may also check your T3 and check to see if there are any autoimmune markers
to see if it is an autoimmune condition causing your symptoms.
(16:07):
We will get right into the symptoms and presentation right after this little break.
This podcast is supported by listeners like you on Buy Me A Coffee.
What symptoms might you have if you had hypothyroidism?
(16:30):
There are several symptoms you may experience if you had hypothyroidism.
As the condition worsens without a diagnosis, these symptoms will become more severe.
These symptoms include fatigue and tiredness, weight gain and a puffy face.
You may initially put this down to getting older.
However, this is due to the condition causing your metabolism to slow down.
These symptoms will eventually continue to progress into dry skin,
(16:53):
coarse hair and skin. Your hair may also thin out being more sensitive to the cold
than you may have previously been.
You may experience muscle weakness, muscle aches, tenderness and stiffness.
Your heart rate can also slow down below the normal rate.
This is called bradycardia.
In adults, this is a heart rate below 60 beats per minute.
You may also experience depression and memory issues.
(17:16):
If you are a woman, you may experience changes in your menstrual cycle.
These may be periods that are heavier than usual or irregular.
Hypothyroidism can affect teenagers and children.
They often have similar symptoms to adults, but they may also experience
poor growth, which can cause a short stature, delayed puberty,
delayed development of their permanent teeth, poor mental development.
(17:39):
Hypothyroidism can also affect infants.
This occurs in babies who are born with either a thyroid gland that does not work correctly,
or in some cases, they can be born without one.
It can take some time for these infants to begin to show symptoms,
but when they do, their symptoms may include problems with feeding,
having poor growth and poor weight gain, poor muscle tone, an enlarged tongue,
(18:00):
an umbilical hernia, this may look like a soft swelling or a bulge near the belly button,
dry skin, constipation and hoarse crying.
In infants, untreated hypothyroidism can lead to severe mental and physical developmental issues.
What complications should a doctor be aware of when it comes to hypothyroidism?
Doctors should be aware of several other conditions that can occur with hypothyroidism.
(18:22):
These include goiters.
A goiter is when the thyroid gland becomes larger than it normally is.
When the goiter becomes quite large, it can lead to issues with swallowing or breathing,
as there is only so much room in the neck for everything to be in there,
and the goiter is taking out the space it shouldn't.
Peripheral neuropathy.
With hypothyroidism that has been untreated for prolonged periods of time,
(18:45):
it can start to damage the peripheral nerves.
These nerves being nerves that take information from the brain
and spinal cord to the rest of your body.
So if these are damaged, it can cause several uncomfortable symptoms.
These include pain, numbness or tingling in both the arms and the legs.
Heart problems.
Those who have hypothyroidism can be at a higher risk for developing heart disease and heart failure.
(19:08):
This is due to the tendency to develop high levels of low-density lipoprotein
cholesterol or LDL cholesterol. This is considered the bad cholesterol.
This tendency occurs with having an underactive thyroid.
Myxodema coma.
This is a life-threatening but rare condition that can occur if hypothyroidism is left untreated
for a prolonged period. Myxodema comas can be triggered by several things.
(19:33):
These include infections, sedatives or other stresses in the body.
The symptoms of this include intense cold intolerance and drowsiness.
This then will progress to an extreme lack of energy and finally unconsciousness.
This is a medical emergency that needs a fast medical treatment.
The longer you wait, the less likely you are to be able to treat someone with this.
(19:54):
Infertility.
Having low levels of thyroid hormone can interfere with ovulation which also can limit fertility.
Various causes of hypothyroidism can also harm fertility like having various autoimmune disorders.
Birth defects.
Babies born during a pregnancy where there was untreated hypothyroidism.
This can either be caused by the pregnancy or unrelated may have a higher risk of birth defects
(20:18):
in comparison to mothers who do not have thyroid diseases or issues during pregnancy.
On this note, infants born with hypothyroidism, if they go untreated for prolonged periods,
are at risk of having serious physical and mental developmental problems.
However, if the condition is caught within the first few months of life
and treated, the infant has excellent chances of
(20:39):
typical development when compared to others that do not have thyroid issues.
How do we treat hypothyroidism?
When it comes to hypothyroidism, the treatment of this condition is lifelong.
Current treatment involves the use of synthetic versions of the thyroid hormone.
This is known as levothyroxine.
This replaces the hormone that would have been made by the thyroid originally.
(21:00):
After treatment is started, follow-up appointments will be done
as well as follow-up blood tests to ensure the dosage is correct.
Are there any famous people with hypothyroidism?
There are actually several.
These include Sofia Vergara.
She is the Colombian-American actress that you may remember from Modern Family.
She was diagnosed with thyroid cancer initially in 2000.
(21:22):
This was actually at her son's endocrinologist appointment
when the doctor also wanted to check her.
This is when they found a lump in her neck that turned out to be thyroid cancer.
Vergara had no symptoms at the time she was diagnosed.
After her diagnosis, she had her thyroid removed,
leaving her with no ability to produce thyroid hormone,
which is a form of hypothyroidism considering no thyroid,
(21:43):
underactive thyroid, same thing essentially.
If you would like to check out a foundation for those in the UK,
there is the British Thyroid Foundation.
They provide funding for research to better the outcomes
for those experiencing thyroid conditions and improve the treatment options.
They provide peer support through various forms and also have up-to-date information
available for anyone who has been diagnosed with thyroid conditions, including hypothyroidism.
(22:07):
And for those in Australia, there is the Australian Thyroid Foundation.
They aim to raise awareness about diseases affecting the thyroid, including hypothyroidism.
They also provide support to those who have been diagnosed
with these conditions that affect the thyroid.
If you want to check out the sources, social medias, or any other links,
you can head to anatomyofillness.com.
If you enjoyed this episode and would like to hear more,
(22:28):
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If you would like to join our community, you can join us on Discord or Instagram.
Otherwise, stick around for the next episode.
Did you know that the thyroid actually produces three hormones?
(22:53):
The first two being thyroxine, which is T4, and triiodothyronine, which is T3.
T3 is the active version of T4.
But what is the third hormone?
Well, the thyroid also makes calcitonin, which controls your calcium levels.
This is done by the C cells in the thyroid.
Lately, you feel as though your muscles have become weaker than they once were.
(00:04):
This is also paired with a feeling of incredible stiffness and muscle pain.
You originally chalked this up to getting older and hurting yourself in the gym.
However, with the weeks passing by, it is almost as if nothing has changed, the pain continues.
You have also found that you just can't take the cold of winter anymore.
For some reason, this year, the cold seems to be affecting you much worse than it previously did.
(00:27):
As you struggle to drag your tired body out of the house to make it to brunch with your friend,
you notice that your face looks odd, almost puffy,
and that your trusty favourite jeans just won't do up anymore.
They no longer fit like they did last week.
As you check the time on your watch, you see that your heart rate is oddly slow,
only 42 beats per minute.
(00:48):
It has been like that often in the past few weeks.
You bring this up to your friend over brunch and she tells you to see a doctor.
Hello and Welcome to Anatomy Of Illness.
(01:11):
Today's episode is about hypothyroidism.
Before we get into the condition, we are going to start with the history.
So why do we know hypothyroidism exists?
In this episode, I may also refer to the condition as an underactive thyroid.
As with this condition, there is not enough of the thyroid hormone being produced.
We begin in the year 2697 BCE, all the way over in ancient China.
(01:35):
This is with the Yellow Emperor Hung Ti,
and his book known as the Yellow Emperor's Classic of International Medicine.
In this book, it would describe the use of seaweed as a form of treatment for goiter,
which is a condition caused by hypothyroidism.
Moving on to the 2nd century CE.
Here, the Roman satirical poet, Juvenal, would make his own comments about goiters.
(01:58):
“Quis tumidum guttur miratur in alpibus”,
which translates to "Who is surprised to see a swollen goiter in the Alps?"
In the European Alpine regions, there were a higher amount of people suffering from goiter,
physical deformities and intellectual disabilities at this time.
It had been known for quite some time that goiters were more common
(02:20):
amongst those who lived in the mountains than near the sea,
this being due to something missing from the diet.
Moving on to Li Shizen, who lived between 1518 and 1593 in ancient China.
He would discuss the use of iodine as a treatment for goiter in his pharmacopoeia.
The first detailed description of hypothyroidism would come in the year 1602.
(02:42):
This was by Felix Platter, who was a Swiss physician.
"It is usual that many infants suffer from innate folly.
Besides, the head is sometimes misshapen, the tongue huge and swollen, they are dumb.
The throat is often goitrous. Thus they present an ugly sight."
Now we move to the year 1757, as this is when the term cretinism first appeared
(03:06):
in the medical literature to describe those with this condition.
This is supposedly derived from either the Latin word Christianus,
due to the belief that those with the condition were unable to commit sin,
or it is suggested that it comes from the Swiss French word crestin, which also means Christian.
Likely to remind people that although these people with the condition had
physical defects and mental impairments, they were still people not beasts.
(03:31):
This term is no longer used in medicine.
Cretinism was initially used to mainly refer to congenital iodine deficiency syndrome,
or congenital hypothyroidism, so having an underactive thyroid from birth.
Moving on to Jean-François Coindet, who lived between the years 1774 and 1834.
He would discuss how effective various different preparations of iodine were
(03:55):
in the treatment of goitres. He found a tincture worked best in 1821.
This was in an attempt to have a prophylactic for those of his patients that had goitres.
Coindet in his travels through South America saw many people with goitres.
He believed that the problem causing the goitres was water not having enough oxygen.
I hope you know the chemical formula for water is H2O, which makes this one an interesting one.
(04:20):
However, his idea did have a point of reference, so he was not just pulling it out of thin air.
You'll get that joke in a second.
So his comparison between South America and the Alps in Europe,
which is a place that has reduced atmospheric pressure causing this thinking.
Realistically, both groups just had low iodine diets.
Coindet would advocate for the use of iodinated salt when travelling or living in these areas.
(04:44):
Now we are going to discuss the French chemist Adolphe Chatin, who lived between 1813 to 1901.
He was actually the first to suggest that goitres could be caused by iodine deficiencies.
“The main cause of goitre seems to be a low concentration of iodine in the drinking water
in certain areas. Changing the water source and the animal foods
(05:05):
and above all the eggs are rational treatments against this condition.”
However, not everyone agreed with Chatin's views, with the German chemist Baumann
remarking that “they were consigned to eternal oblivion”.
We're going into the year 1850 now.
Meeting with Thomas Blizard Curling.
He would describe the two cases of young girls in what was in the day called an idiot asylum.
(05:29):
The first girl was 10 years old and her growth was severely stunted.
“The countenance had a marked and very unpleasant idiotic expression, had very little power of
locomotion, but could manage to walk from chair to chair with little assistance.
She had no power of speech.” In her case, no goitre was present.
The other young girl Curling would describe was much younger.
(05:51):
She was only six months old and “was plump, but had a marked idiotic expression,
a large face with a small head and very receding forehead.
The tongue was large and protruding from the mouth.”
Both of these girls would pass away with an autopsy being performed.
On autopsy, they were unable to find any sign of the thyroid gland in either girl.
(06:12):
Curling would comment, “I am not acquainted with any case on record
in which a deficiency of the thyroid gland has been observed in the human body.
In countries where cretinism and bronchocele prevail, it was long supposed that there was
some connection between the defective condition of the brain and the hypertrophy of the thyroid.”
Bronchocele is an old term for goitres in this case.
(06:35):
20 years later, we would have the comment of Fagge from Guy's hospital.
He would discuss the links between goitre and hypothyroidism.
He would come to the conclusion that “sporadic cretinism, instead of being associated with goitre,
appears to be attended with a wasting or an absence of the thyroid body.”
Sporadic cretinism in today's medicine would mean congenital hypothyroidism.
(06:58):
So being born with an underactive thyroid or without one.
This condition can also be caused by not having enough iodine during pregnancy.
So your mother having hypothyroidism due to a low iodine diet.
Now we go into the year 1878 with William Ord.
He would coin the term myxedema, the name actually coming from
(07:20):
jelly-like swelling found in the connective tissue.
Going to Professor Theodor Kocher of Bern in the year 1883,
he was a surgeon who, after performing 101 surgeries on his patients,
mind you this was a large amount for this time by the way,
he would read a paper that would discuss the removal of the thyroid.
(07:40):
After reading this, he would call all 101 patients.
Those who had gone through a total removal of the thyroid gland
were suffering from the same symptoms as those who were labeled as having cretinism.
Also in 1883, but in November,
Dr. Dawtrey Drewitt would be presenting the case of a patient with classical hypothyroidism
to a group of doctors at the Clinical Society of London.
(08:03):
Someone in the crowd would make the comment that the three conditions closely resembled each other.
These being cretinism, removal of the thyroid and myxedema.
Now we discuss Sir William Horsley.
He was interested in the real purpose of the thyroid gland,
as many believed that it did not serve a purpose at this time
or had ideas which differed to what the thyroid actually does.
(08:25):
Horsley would do several experiments which would lead to his views on myxedema,
the condition being caused by the thyroid gland no longer functioning or no longer being there.
He would also sum up his and others research on hypothyroidism in 1885.
“Various as have been the surmises as to the function of the thyroid gland.
It is not surprising that although a rest of it had been vaguely
(08:47):
known for hundreds of years to be connected with the cretinus state,
cretinism, as is well known, had been attributed to every course except
for the destruction of the thyroid, chalky water, damp close air,
miasma, insufficient food, and so forth.
And hereditary influence have all been credited with the power of causing the imbecile condition,
(09:09):
which is so familiar to everyone.”
In 1891, George Redmayne Murray would publish the first case of a patient with hypothyroidism,
being given a thyroid extract. This was through an injection.
This patient lived almost another 30 years on these thyroid extract medications.
In either the year 1892 or the year 1893,
(09:30):
there would be the case of a woman dying from myxedema in Londonderry, Ireland.
However, a doctor by the name of David Thompson would intervene after being asked to see her.
He had recently read about the use of thyroid extracts in the case of myxedema and hypothyroidism.
So after seeing her, he got a hold of some sheep
thyroids and prepared them, giving her the extracts to see if she would get better.
(09:54):
Well, she did, stunning everyone.
In 1914, Edward Calvin Kendall would first crystallize thyroxine.
However, it would not be until 15 months later that this process would be mastered.
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What is hypothyroidism?
Hypothyroidism is when the thyroid is unable to make enough of the hormones
(10:18):
that the thyroid produces. The thyroid produces two main hormones.
These are thyroxine, which is T4, and triiodothyronine. This is T3.
These hormones have influence over every cell in your body.
They affect your metabolism, how fast your body uses up fats and carbohydrates.
They help to control your body temperature,
(10:38):
help to control your heart rate and even how much protein your body makes.
These are very important hormones.
But what are some of the risk factors for the development of hypothyroidism?
There are several risk factors that can increase your risk of developing hypothyroidism.
These include being a woman, having a family history of thyroid disease,
having a different autoimmune disease like type 1 diabetes, which we discussed in episode 26,
(11:01):
or celiac disease, which we talked about in episode 10.
The thought behind this is that if your immune system is already causing one condition
by attacking healthy cells, it may do this to other areas.
Hypothyroidism may also be caused by radiation to your upper chest or neck area.
This is due to the radiation potentially causing damage to your thyroid.
(11:22):
Having previous thyroid surgery, as with partial removal or even full removal,
you may not be able to make enough of the thyroid hormone,
having received previous treatment for hypothyroidism.
Yes, this sounds counterintuitive,
having too much of the thyroid hormones and going to not having enough.
However, sometimes it can be overdone with treatment.
(11:42):
So what are some of the potential causes of hypothyroidism?
Well, there are many potential causes of hypothyroidism.
These include autoimmune disease.
If you remember episode 36, which was Hashimoto's disease or Hashimoto's thyroiditis,
a brief explanation of this is the condition is caused by the immune
system making antibodies and attacking healthy tissue.
(12:04):
In this case, it attacks the thyroid gland.
This affects your ability to make thyroid hormones.
Autoimmune disease is the most common cause of hypothyroidism,
and this is most often caused by Hashimoto's disease.
However, it was not always the most common cause.
We'll get to that in a minute.
There are other causes, however, these include thyroiditis.
(12:24):
This is what occurs when your thyroid becomes inflamed.
This can either be due to an infection or due to an autoimmune condition
or other medical conditions that affect the thyroid gland.
With this, it may cause a spike in your thyroid's activity,
causing it to release all the stored hormones.
This is hyperthyroidism.
After this, the thyroid becomes underactive, which is hypothyroidism.
(12:47):
Radiation therapy when there is radiation used to treat cancers of the head and neck areas.
This can cause damage to the thyroid gland, which in turn can cause hypothyroidism.
Medicine.
There are various medicines that can actually cause hypothyroidism.
These include medicines like lithium.
This medicine is used to treat certain psychiatric disorders.
(13:08):
So using it carefully and testing to make sure there are no issues with your thyroid.
When being on this medication, thyroid surgery,
if you have had a surgery to remove part of the thyroid or all of the thyroid,
this can decrease the thyroid's ability to produce hormones
or even stop its ability to produce these hormones.
There are also less common causes of hypothyroidism.
(13:29):
However, these can still occur.
These include birth defects.
Some babies can develop hypothyroidism due to being born without a thyroid
or being born with a thyroid gland that does not function correctly.
In other cases, children can have an inherited condition that causes a thyroid disorder.
Pregnancy.
In some cases, people can develop hypothyroidism during or after pregnancy.
(13:52):
If it occurs during pregnancy but is not treated,
this can increase the risk of several issues during pregnancy.
These include pregnancy loss, premature delivery,
and the development of another condition called preeclampsia.
We discussed preeclampsia in episode six, but essentially this condition causes the blood
pressure during pregnancy to rise significantly.
Hypothyroidism during pregnancy can also affect the development of the fetus.
(14:16):
Pituitary disorder.
This form of hypothyroidism is incredibly rare.
It is caused by the pituitary gland not making enough of the thyroid hormone,
specifically the thyroid stimulating hormone or TSH.
This in most cases is caused by a non-cancerous tumor growing on the pituitary gland,
not having enough iodine in the diet.
(14:37):
This is rare now, however, it used to be the most common cause of hypothyroidism.
So for the production of the thyroid hormones, iodine is needed.
This is found in a variety of foods, including seafood,
seaweed, iodized salt, as well as plants grown in iodine-rich soil.
Some foods will have extra iodine added if the diet is deficient in iodine.
(14:59):
When you don't eat enough of these foods, you can start to develop hypothyroidism.
However, with hypothyroidism, if you start eating too much iodine,
this can make the condition worse if you just start doing this suddenly though.
How do we diagnose hypothyroidism?
When it comes to hypothyroidism, the symptoms of this condition mimic several other conditions.
This can make it difficult to diagnose.
(15:21):
Because of this, tests have to be done to rule out other conditions.
So after telling a doctor about your symptoms, they will request a blood test.
This blood test will check your levels of TSH and your levels of T4.
If this test shows that you have high levels of TSH
and low levels of T4, then the test will be redone.
If this test also shows high levels of TSH and low levels of T4,
(15:45):
they will then give you the diagnosis of hypothyroidism.
When it comes to the test, the results can be affected by certain medicines or supplements.
These include things like biotin.
So be sure to inform your doctor before having these blood tests done.
In some cases, they may also check your T3 and check to see if there are any autoimmune markers
to see if it is an autoimmune condition causing your symptoms.
(16:07):
We will get right into the symptoms and presentation right after this little break.
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What symptoms might you have if you had hypothyroidism?
(16:30):
There are several symptoms you may experience if you had hypothyroidism.
As the condition worsens without a diagnosis, these symptoms will become more severe.
These symptoms include fatigue and tiredness, weight gain and a puffy face.
You may initially put this down to getting older.
However, this is due to the condition causing your metabolism to slow down.
These symptoms will eventually continue to progress into dry skin,
(16:53):
coarse hair and skin. Your hair may also thin out being more sensitive to the cold
than you may have previously been.
You may experience muscle weakness, muscle aches, tenderness and stiffness.
Your heart rate can also slow down below the normal rate.
This is called bradycardia.
In adults, this is a heart rate below 60 beats per minute.
You may also experience depression and memory issues.
(17:16):
If you are a woman, you may experience changes in your menstrual cycle.
These may be periods that are heavier than usual or irregular.
Hypothyroidism can affect teenagers and children.
They often have similar symptoms to adults, but they may also experience
poor growth, which can cause a short stature, delayed puberty,
delayed development of their permanent teeth, poor mental development.
(17:39):
Hypothyroidism can also affect infants.
This occurs in babies who are born with either a thyroid gland that does not work correctly,
or in some cases, they can be born without one.
It can take some time for these infants to begin to show symptoms,
but when they do, their symptoms may include problems with feeding,
having poor growth and poor weight gain, poor muscle tone, an enlarged tongue,
(18:00):
an umbilical hernia, this may look like a soft swelling or a bulge near the belly button,
dry skin, constipation and hoarse crying.
In infants, untreated hypothyroidism can lead to severe mental and physical developmental issues.
What complications should a doctor be aware of when it comes to hypothyroidism?
Doctors should be aware of several other conditions that can occur with hypothyroidism.
(18:22):
These include goiters.
A goiter is when the thyroid gland becomes larger than it normally is.
When the goiter becomes quite large, it can lead to issues with swallowing or breathing,
as there is only so much room in the neck for everything to be in there,
and the goiter is taking out the space it shouldn't.
Peripheral neuropathy.
With hypothyroidism that has been untreated for prolonged periods of time,
(18:45):
it can start to damage the peripheral nerves.
These nerves being nerves that take information from the brain
and spinal cord to the rest of your body.
So if these are damaged, it can cause several uncomfortable symptoms.
These include pain, numbness or tingling in both the arms and the legs.
Heart problems.
Those who have hypothyroidism can be at a higher risk for developing heart disease and heart failure.
(19:08):
This is due to the tendency to develop high levels of low-density lipoprotein
cholesterol or LDL cholesterol. This is considered the bad cholesterol.
This tendency occurs with having an underactive thyroid.
Myxodema coma.
This is a life-threatening but rare condition that can occur if hypothyroidism is left untreated
for a prolonged period. Myxodema comas can be triggered by several things.
(19:33):
These include infections, sedatives or other stresses in the body.
The symptoms of this include intense cold intolerance and drowsiness.
This then will progress to an extreme lack of energy and finally unconsciousness.
This is a medical emergency that needs a fast medical treatment.
The longer you wait, the less likely you are to be able to treat someone with this.
(19:54):
Infertility.
Having low levels of thyroid hormone can interfere with ovulation which also can limit fertility.
Various causes of hypothyroidism can also harm fertility like having various autoimmune disorders.
Birth defects.
Babies born during a pregnancy where there was untreated hypothyroidism.
This can either be caused by the pregnancy or unrelated may have a higher risk of birth defects
(20:18):
in comparison to mothers who do not have thyroid diseases or issues during pregnancy.
On this note, infants born with hypothyroidism, if they go untreated for prolonged periods,
are at risk of having serious physical and mental developmental problems.
However, if the condition is caught within the first few months of life
and treated, the infant has excellent chances of
(20:39):
typical development when compared to others that do not have thyroid issues.
How do we treat hypothyroidism?
When it comes to hypothyroidism, the treatment of this condition is lifelong.
Current treatment involves the use of synthetic versions of the thyroid hormone.
This is known as levothyroxine.
This replaces the hormone that would have been made by the thyroid originally.
(21:00):
After treatment is started, follow-up appointments will be done
as well as follow-up blood tests to ensure the dosage is correct.
Are there any famous people with hypothyroidism?
There are actually several.
These include Sofia Vergara.
She is the Colombian-American actress that you may remember from Modern Family.
She was diagnosed with thyroid cancer initially in 2000.
(21:22):
This was actually at her son's endocrinologist appointment
when the doctor also wanted to check her.
This is when they found a lump in her neck that turned out to be thyroid cancer.
Vergara had no symptoms at the time she was diagnosed.
After her diagnosis, she had her thyroid removed,
leaving her with no ability to produce thyroid hormone,
which is a form of hypothyroidism considering no thyroid,
(21:43):
underactive thyroid, same thing essentially.
If you would like to check out a foundation for those in the UK,
there is the British Thyroid Foundation.
They provide funding for research to better the outcomes
for those experiencing thyroid conditions and improve the treatment options.
They provide peer support through various forms and also have up-to-date information
available for anyone who has been diagnosed with thyroid conditions, including hypothyroidism.
(22:07):
And for those in Australia, there is the Australian Thyroid Foundation.
They aim to raise awareness about diseases affecting the thyroid, including hypothyroidism.
They also provide support to those who have been diagnosed
with these conditions that affect the thyroid.
If you want to check out the sources, social medias, or any other links,
you can head to anatomyofillness.com.
If you enjoyed this episode and would like to hear more,
(22:28):
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If you would like to join our community, you can join us on Discord or Instagram.
Otherwise, stick around for the next episode.
Did you know that the thyroid actually produces three hormones?
(22:53):
The first two being thyroxine, which is T4, and triiodothyronine, which is T3.
T3 is the active version of T4.
But what is the third hormone?
Well, the thyroid also makes calcitonin, which controls your calcium levels.
This is done by the C cells in the thyroid.
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