Several complications can occur if you have an underactive thyroid that is not treated. If you have an untreated underactive thyroid, your risk of developing cardiovascular disease is increased. This is because having low levels of the hormone thyroxine can lead to increased levels of cholesterol in your blood. High cholesterol can cause fatty deposits to build up in your arteries, restricting the flow of blood. Contact your doctor if you're being treated for an underactive thyroid and you develop chest pain, so that any problems can be detected and treated, if necessary. A goitre is an abnormal swelling of the thyroid gland that causes a lump to form in the throat. Goitres can develop in people with an underactive thyroid when the body tries to stimulate the thyroid to produce more thyroid hormones. If an underactive thyroid is not treated during pregnancy, there's a risk of problems occurring. These include: These problems can usually be avoided with treatment under the guidance of a specialist in hormone disorders
(an endocrinologist). Therefore, tell a GP if you have an underactive thyroid and you're pregnant or trying to get pregnant. Myxoedema comaIn very rare cases, a severe underactive thyroid may lead to a life-threatening condition called myxoedema coma. This is where the thyroid hormone levels become very low, causing symptoms such as confusion, hypothermia and drowsiness. Myxoedema coma requires emergency treatment in hospital. It's usually treated with thyroid hormone replacement medicine given directly into a vein. In some cases, other treatments such as breathing support, antibiotics and steroid medicine (corticosteroids) are also required. Page last reviewed: 10 May 2021 We read with interest the thorough Seminar on hypothyroidism (Sept 23, 2017, p 1550), in which the authors implicate that hypothyroidism is a cause of hypertension. However, hypertension is not a typical sign of hypothyroidism. This misconception is more than 80 years old with Owen Thompson and colleagues reporting a high incidence of hypertension in myxoedema. Since then, many uncontrolled observational studies have shown that elevated blood pressure in patients with hypothyroidism returns to within normal range after thyroid hormone substitution. In a meta-analysis of 50 147 patients with subclinical hypothyroidism, systolic blood pressure was marginally elevated (1·47 mm Hg, 95% CI 0·54–2·39, p=0·002) compared with euthyroid individuals; however, diastolic blood pressure was not significantly different. This variance can be attributed to an age difference between patients with hypothyroidism and euthyroid individuals. Even in patients with severe hypothyroidism after total thyroidectomy and radioiodine ablation, withdrawal of levothyroxine caused only a modest increase in blood pressure (5·1/8·2 mm Hg, measured by 24 h ambulatory blood-pressure monitoring). In subclinical hypothyroidism, thyroid hormone substitution does not lower blood pressure, which was thoroughly documented by David J Stott and colleagues in a double-blind, randomised, placebo-controlled, parallel-group trial involving 737 patients. Therefore, clinicians should treat hypertension in patients with firmly established hypertension, regardless of whether hypothyroidism is present. FHM is a consultant or has advisory relationships with Pfizer, Abbott, Servier, Medtronic, WebMD, Menarini, Ipca, American College of Cardiology, and Hikma. LH declares no competing interests. References
Article InfoPublication HistoryPublished: 06 January 2018 IdentificationDOI: https://doi.org/10.1016/S0140-6736(17)33320-2 Copyright© 2017 Elsevier Ltd. All rights reserved. ScienceDirectAccess this article on ScienceDirect
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