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Too little thyroid hormone. Symptoms include weight gain, constipation, dry skin, and sensitivity to the cold. Also called underactive thyroid.

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Thyroid hormone replacement for subclinical hypothyroidism

Subclinical hypothyroidism is a condition where some laboratory findings point at a thyroid gland not working properly. Patients with subclinical hypothyroidism may have vague, non‐specific symptoms of actual hypothyroidism (for example dry skin, cold skin or feeling colder, constipation, slower thinking, poor memory) but these thyroid‐related symptoms are not specific, that is why the diagnosis is based on test results. The fundamental question regarding people with subclinical hypothyroidism is whether they should be treated with thyroid hormones. To answer this question twelve studies of six to 14 months duration involving 350 people were analysed. Thyroid hormone therapy for subclinical hypothyroidism did not result in improved survival or decreased cardiovascular morbidity (for example less heart attacks or strokes). Data on health‐related quality of life and symptoms did not demonstrate significant differences between placebo and thyroid hormone therapy. Some evidence indicated that thyroid hormone had some effects on blood lipids and technical measurements of heart function. Adverse effects were inadequately addressed in most of the included studies and have to be urgently investigated in future studies, especially in older patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

High versus low dose of initial thyroid hormone replacement for congenital hypothyroidism

Congenital hypothyroidism is a condition that affects infants from birth and results from a missing or abnormally developed thyroid gland, abnormal production of thyroid hormones or a failure of the pituitary gland to stimulate thyroid hormone production. It affects approximately 1 in 3000 to 4000 newborn infants and early diagnosis and treatment is very important to achieve a good outcome.Treatment of congenital hypothyroidism consists of a daily dose of thyroid hormone (thyroxine). However, the initial dose of thyroxine required to improve outcomes for infants with this condition is unclear and has been the subject of several studies. Some studies have suggested that when infants with congenital hypothyroidism are treated with a higher dose of thyroxine compared with the standard dose, this results in earlier normalisation of the their thyroid hormones and leads to better developmental outcome and intelligence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Underactive thyroid: Deciding whether to treat subclinical hypothyroidism

Subclinical (latent) hypothyroidism means that the thyroid gland is still producing enough thyroid hormones. But some blood values may suggest the early stages of a hormone deficiency. Experts do not agree on whether subclinical hypothyroidism should be treated. It is not clear in which cases treatment would have advantages.If you already have noticeable (“overt” or “manifest”) hypothyroidism, the thyroid is no longer producing enough thyroid hormones. Thyroxine is the most important of the thyroid hormones. It helps regulate many of the body’s functions to balance your metabolism. Too little thyroxine can cause a number of different health problems. The symptoms range from cold hands to physical weakness, slower mental processes and depression. An underactive thyroid (hypothyroidism) is treated with hormone tablets that are taken once daily. These tablets act to replace the thyroxine that is not being produced. This can usually make the symptoms disappear completely.Subclinical hypothyroidism goes unnoticed. Only the body’s levels of TSH (“thyroid-stimulating hormone”) are too high. The thyroid is still producing enough thyroid hormones. The hormone TSH is produced in the pituitary gland and acts as a trigger for the thyroid to start producing the thyroid hormones. TSH levels that are just a little too high may be the first sign of the early stages of hypothyroidism: The pituitary gland responds to lower levels of thyroid hormones by increasing TSH production to activate the thyroid. It is also possible that TSH reaches higher levels only temporarily, for example after intense physical activity.It is estimated that about 5 out of 100 people have subclinical hypothyroidism. Slightly elevated TSH levels are usually detected by accident during a routine examination. But taken on their own they do not pose any health risk – often the effect is just temporary. Experts do not fully agree on how to decide in which cases subclinical hypothyroidism should be treated.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 8, 2014

Chinese herbal medicines for hypothyroidism

Hypothyroidism, also known as underactive or low thyroid, is a condition in which the thyroid gland does not produce sufficient amounts of thyroid hormones which are important for many functions of the body (metabolism). In adults hypothyroidism may cause fatigue and sluggishness, increased sensitivity to cold, constipation, pale and dry skin, brittle fingernails and hair, a puffy face, hoarse voice, unexplained weight gain, muscle aches, tenderness, stiffness and weakness, pain, stiffness or swelling in the joints, heavier than normal menstrual periods, and depression. Hypothyroidism in infants and teenagers may result in poor growth and mental development as well as delayed development of permanent teeth and puberty.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions to reduce harm to women and their children from untreated low levels of thyroid hormone in pregnancy

The thyroid is a butterfly‐shaped gland at the front of the oesophagus/throat that produces thyroid hormone. Thyroid hormone helps the body to make energy, keeps body temperature regulated and assists other organs in their functions. Hypothyroidism (a deficiency of thyroid hormone) is a relatively common illness that can cause fatigue, constipation, muscle cramps and weakness, hair loss, dry skin, intolerance to cold, depression and weight gain. Medication is with levothyroxine. Selenium is a trace element that changes the expression of selenoproteins. These act as antioxidants and appear to decrease thyroid inflammation in autoimmune thyroiditis. Pregnant women with subclinical hypothyroidism have abnormal thyroid hormone levels but no symptoms. They are at a increased risk of miscarriage, pre‐eclampsia and preterm birth with impaired neuropsychological development in the child.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Iodine supplementation for preventing iodine deficiency disorders in children

Iodine deficiency causes mental retardation in children as well as an enlarged thyroid gland (goitre) and sometimes deficiencies in thyroid hormones in people of all ages. It still exists in large parts of the world. This review looked at studies with a comparison group of iodine supplementation in children. Twenty‐six studies were included, but these were generally of poor quality. Iodine was given as iodised oil, salt or water. Giving iodine generally decreased thyroid size and increased iodine in the urine. One study suggested a reduction in infant mortality. In some studies there was a trend towards better developmental outcomes after iodine prophylaxis. There was some concern in studies using iodised salt that small children may not eat enough salt to achieve adequate iodine status. Adverse effects were reported, and most of them were minor and did not last long. More high quality long term studies measuring outcomes related to child development, to deaths associated with iodine‐deficiency, and to intervention programmes relevant to children in developed countries, are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for residual or metastatic differentiated thyroid cancer

After the removal of the thyroid gland (thyroidectomy) thyroid hormones have to be substituted to attain a normal way of life. Thyroid hormone withdrawal for four to six weeks has been used for more than 50 years for the treatment of metastatic differentiated thyroid cancer after thyroidectomy because residual cancer cells may then be better destroyed by radiation therapy using radioiodine. Another therapeutic approach to prepare for radiation uses injections of technologically created (recombinant) human thyroid‐stimulating hormone (thyrotropin, TSH) to avoid the symptoms of a malfunctioning thyroid gland (hypothyroidism), which are caused by thyroid hormone withdrawal. This technique has been approved for use in the diagnosis of recurrent and metastatic differentiated thyroid cancer and in the preparation of patients for elimination of normal thyroid remnants after thyroid surgery, but not for treatment of known locally recurrent or metastatic disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Research studies: What are the advantages and disadvantages of combined treatment with antithyroid drugs and radioiodine?

Using antithyroid drugs before, during or after radioiodine therapy reduces the side effects of the treatment, but the trade-off is a similar reduction in treatment effectiveness.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 9, 2014

Underactive thyroid: Overview

If you suddenly start feeling tired and listless all the time and notice a slow pulse and constipation, you may wonder what the cause might be. These kinds of symptoms can have any number of causes, but they are typical of an underactive thyroid (hypothyroidism). A blood test can tell you for sure whether you have it.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 8, 2014

Overactive thyroid: Overview

The thyroid gland helps regulate many of the body’s functions. An overactive thyroid causes some of these functions to speed up. Hyperthyroidism often leads to a visible enlargement of the thyroid gland (goiter).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 9, 2014

Thyroid function tests

The thyroid is a vitally important hormonal gland, which mainly works for the body’s metabolism. It is located in the front part of the neck below the voice box and is butterfly-shaped. The functions of the thyroid gland include the production of the thyroid hormones triiodothyronine (T3) and tetraiodothyronine, also called thyroxine (T4).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 30, 2016

How does the thyroid work?

The thyroid is a vitally important hormonal gland that regulates metabolism and growth in the body. The thyroid hormones T3 and T4 increase the basal metabolic rate. In other words, they make the body cells work harder, using more energy. If more energy is needed for metabolic processes in the body – for instance for growth, when it is cold, or during pregnancy – more hormones are produced and transported into the blood.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 7, 2015

Screening and subsequent treatment for thyroid dysfunction before or during pregnancy to improve outcomes for mothers and their babies

The thyroid is a large gland in the neck that produces hormones that help to regulate the chemical processes in the body that maintain life, including growth and energy use. If a woman has an overactive thyroid (hyperthyroidism), or an underactive thyroid (hypothyroidism) in pregnancy which is not managed, there is a possibility of poor outcomes for the mother and her baby. The mother may be more likely to develop high blood pressure and protein in the urine (pre‐eclampsia), give birth before 37 weeks of gestation (preterm birth), and her baby may develop disabilities (such as cerebral palsy, blindness, deafness and other developmental delays including intellectual impairment). Managing thyroid dysfunction in pregnancy (e.g. thyroxine for hypothyroidism, or antithyroid medication for hyperthyroidism) may improve outcomes for mothers and their babies. There are different methods of screening for thyroid dysfunction, including case finding, which means screening only pregnant women who are thought to be at high risk of thyroid dysfunction, or universal screening, which involves screening all pregnant women. Although universal screening may help to diagnose more women with hyperthyroidism or hypothyroidism than case finding, it could also lead to more women having medications and may be costly. It is not currently clear what the effects are of these different methods of screening for thyroid dysfunction for the mother and her baby, and health services.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Radioiodine treatment for pediatric Graves' disease

Graves' disease is a common cause of hyperthyroidism in children and adolescents which excessive amounts of thyroid hormones circulating in the blood. Affected children and adolescents suffer from increased heart beats, warm moist skin, fatigue, weight loss, raised body temperature, eye and other problems. Application of radioactive iodine (radioiodine), surgical removal of the thyroid gland or drugs that interfere with the production of thyroid hormones (antithyroid drugs) are used to treat this disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Radioiodine therapy versus antithyroid medications for Graves' disease

Graves' disease is an autoimmune disorder, which means that the body's immune systems attacks the body itself by means of antibodies. These antibodies stimulate the thyroid gland to produce and secrete excessive amounts of thyroid hormones (hyperthyroidism). Graves' disease is the most common cause of hyperthyroidism. Other typical characteristics of Graves' disease are goitre and eye disease (Graves' ophthalmopathy or orbitopathy). Currently, antithyroid medications such as methimazole or propylthiouracil and radioactive iodine (radioiodine, given either in a capsule or in a tasteless solution in water) are most often used for the treatment of Graves' disease. Radioiodine destroys most cells in the thyroid gland, so that secretion of thyroid hormones is massively reduced. Antithyroid medications block the production of thyroid hormones, also leading to a decrease in the production of these hormones.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Octreotide for treatment of chylothorax in newborns

Collection of lymphatic fluid in the chest cavity is called chylothorax. Routine management of this condition involves treatment of the underlying condition, draining of fluid, putting a tube in the chest wall until all the fluid is drained and rarely surgery. Octreotide is a drug that may reduce the production and accumulation of fluid and allow babies to recover faster. No trials have evaluated the safety and efficacy of this drug in babies and only case reports are available. Future studies are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antithyroid drug regimen for treating Graves' hyperthyroidism

People who have Graves' hyperthyroidism have thyroid glands which are releasing too much thyroid hormone. This can cause goitres (swelling in the neck around the thyroid gland), sweating, bowel or menstrual problems, and other, especially eye symptoms (ophthalmopathy). Treatments include anti‐thyroid drugs, surgery or radiation to reduce thyroid tissue. There are several choices to be made when considering the drug treatment of Graves' hyperthyroidism including the choice of drug, dose, duration of therapy, addition of thyroid hormone (thyroxine) and when to discontinue therapy. The antithyroid drugs which were used in the included randomised controlled trials (RCTs) comprised carbimazole, propylthiouracil and methimazole.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

No evidence found from randomised trials for drugs to treat pregnant women with hyperthyroidism

Hyperthyroidism in pregnancy is a rare, serious condition which can increase the risks of miscarriage, stillbirth, preterm birth, and intrauterine growth restriction. Pregnant women who are hyperthyroid may also develop severe pre‐eclampsia or placental abruption. Most of these women have Graves' disease, an autoimmune disease most common in women aged 20 to 40 years. Most pregnant women with hyperthyroidism are diagnosed with thyroid disease prior to conception and will have previously received treatment for the condition. Generally only drug therapy is considered for treating pregnant women with hyperthyroidism. Radioiodine treatment is not used in pregnancy because it destroys the fetal thyroid gland, resulting in permanent hypothyroidism in the newborn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Iodine supplementation for women before, during or after pregnancy

It is estimated that over 1.8 billion people worldwide do not get enough iodine in their diet, putting them at risk of iodine deficiency. Iodine is an essential nutrient needed in small amounts for the body to make thyroid hormones. The World Health Organization (WHO) recommends that iodine is added to salt to prevent problems caused by lack of iodine. Women who are pregnant or breastfeeding need extra iodine, which puts them at greater risk of deficiency. The breast milk contains iodine for the infant.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Thyroid hormone supplementation for the prevention of morbidity and mortality in infants undergoing cardiac surgery

There is insufficient evidence to advocate the use of triiodothyronine supplementation for the prevention of postoperative morbidity and mortality in infants who undergo cardiopulmonary bypass.Thyroid hormones are integral in cellular metabolism and haemodynamic stability. A transient acquired hypothyroidism occurs after cardiopulmonary bypass and is thought to be associated with low cardiac output, left ventricular dysfunction, increased vascular resistance and impaired ventilatory drives. Thyroid hormone supplementation has been postulated as a possible therapeutic option to improve postoperative outcome measures. This review highlights the lack of evidence concerning the benefits and harms of triiodothyronine supplementation in infants who undergo cardiopulmonary bypass.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

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