Underactive thyroid gland - hypothyroidism

Hypothyroidism: symptoms, causes and treatment

The symptoms of an underactive thyroid (hypothyroidism) are often relatively unspecific and those affected often suffer for quite a while before they suspect a malfunction of the thyroid function. Apparently unfounded fatigue, low resilience, poor performance, impaired skin or psychological problems can be associated with hypothyroidism.


The underactive thyroid gland is characterized by a reduced or no formation of hormones by the thyroid gland. A distinction is made between congenital and acquired forms of the disease. In addition, the causes can be divided into primary (cause directly in the thyroid) and secondary hypothyroidism (cause outside the thyroid).

Symptoms of hypothyroidism

The hypofunction is less common than hyperthyroidism, but it is still not uncommon. Women are affected more often than men, although the age at the time of diagnosis of the acquired forms of the disease is usually between 40 and 50 years. The possible complaints often differ significantly between the congenital and acquired forms of the disease. In the former, there may be massive developmental disorders, while in the acquired form, complaints such as poor performance or psychological problems are usually more noticeable. In the worst case scenario, both forms of myxedema coma, which is potentially fatal. A more detailed description of the respective symptoms is given in the context of the explanations about the acquired and congenital forms of the disease.

Congenital hypothyroidism

The thyroid gland lies in the form of a butterfly in the neck area and its main task is to produce and release the thyroid hormones T3 (triiodothyronine) and T4 (L-thyroxine), which have a fundamental influence on growth and development (of the brain and bones), the overall metabolism, oxygen consumption, heat production, nutrient turnover, heart activity and much more. The thyroid needs iodine for hormone production.

Congenital hypothyroidism (cretinism) arises from an iodine deficiency in the mother or the fetus during pregnancy, a defect in hormone formation (enzymopathy), the absence or malformation of the thyroid gland. The consequences are sometimes dramatic. There is a risk of development deficits in terms of body growth, bone and tooth maturation or even mental and physical retardation. The affected infants are described as conspicuously "lazy to drink" and sedentary and also suffer from constipation.

An early diagnosis through the legally required newborn screening in the first days of life serves the immediate medication of infants and decides on the further course of development. The drugs are needed for life, in contrast to nerve and brain maturation, body growth can be compensated later.

Acquired hypothyroidism

Acquired hypothyroidism manifests itself as a general slowdown in physical and psychological processes and rhythms: despite reduced appetite, body weight can increase, constipation, a slow heartbeat (bradycardia), increased sensitivity to cold, and a disturbed menstrual cycle. External signs include cool, dry skin (myxedema), eyelid edema, a hoarse, deep voice and brittle, shaggy hair. The development of a so-called goiter on the neck, which is often rated as typical for thyroid diseases, can also occur, but often does not occur.

The general underperformance, which often comes along with depressive moods and lack of drive, is often misunderstood as depression or (in older people) as an aging symptom. However, drastic mental disorders, including delusions, can also be triggered by hypothyroidism.

Causes: Primary and secondary hypothyroidism

The primary and secondary hypothyroidism are distinguished according to their cause.
The primary form is caused by the thyroid itself, e.g. as a result of inflammation of the thyroid gland (thyroiditis, especially Hashimoto's thyroiditis), after thyroid surgery or radiation therapy (radioiodine therapy). In secondary hypothyroidism, another link in the hormonal control circuit that is upstream of the thyroid gland is disturbed. If the function of the pituitary gland is impaired (e.g. with anterior lobe insufficiency), the thyroid gland receives no signal for the formation and release of its hormones. In addition to the pituitary gland, the hypothalamus can also be affected. Hypothyroidism can also be caused by iodine deficiency.

Naturopathic also causes heavy metal pollution, e.g. after amalgam removal and improper discharge, tension build-up due to different metal alloys in the mouth, chronic infections (e.g. with the Eppstein-Barr virus, herpes viruses, Yersinia) or certain vaccines suspected.


A primary hypothyroidism is already identified in many affected children as part of the newborn screening. Diagnosis is often more difficult with acquired hypothyroidism, because unspecific complaints such as poor performance or fatigue are not necessarily associated with a disorder of the thyroid function. If there is suspicion of hypothyroidism, this can easily be checked by means of a blood test. The concentration of thyroid hormones, certain antibodies and other biomarkers are reliable indicators of a disturbance in thyroid function.

The extent of possible changes in the thyroid gland can be checked using imaging methods such as an ultrasound examination or a so-called scintigraphy and, if necessary, a tissue sample (biopsy) can also be taken to determine the type of tissue changes.

Treatment of hypothyroidism

The therapy of hypothyroidism depends on its cause, the primary form is partly with a lifelong hormone dose that needs to be monitored by a doctor. Failure or inadequate treatment can lead to myxedema coma. In addition to increased symptoms of hypothyroidism, there are disturbances in consciousness, seizures, low temperature (hypothermia), breathing disorders and electrolyte derailment, which make immediate hospitalization absolutely necessary!


Naturally, for example, naturopathy can support or in the case of mild hypothyroidism. be treated with a nutritional therapy, with the regulation of the iodine balance in the foreground. In addition to the consumption of iodine-rich foods, it is advisable to avoid certain foods (especially cabbage vegetables) that inhibit iodine intake. Detoxification, draining procedures and homeopathic remedies are also often used to supplement the treatment of hypothyroidism. (jvs, fp)
Professional supervision: Barbara Schindewolf-Lensch (doctor)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Jeanette Viñals Stein, Barbara Schindewolf-Lensch


  • Professional Association of German Internists: Thyroid underfunction (accessed: August 13, 2019), internisten-im-netz.de
  • German Society for Pediatric and Adolescent Medicine (DGKJ) / German Society for Endocrinology e.V. (DGE): S2k guideline congenital primary hypothyroidism: diagnosis, therapy and follow-up, as of February 2011, awmf.org
  • Thyroid glands - Liga Deutschland e.V .: hyperthyroidism (accessed: 13.08.2019), lucky.patienten-bibliothek.de
  • Herold, Gerd: Internal Medicine 2019, self-published, 2018
  • SchilddrüsenZentrum Köln e.V .: Thyroid underfunction (accessed: 13.08.2019), schilddruesenzentrum-koeln.de
  • Mayo Clinic: Hypothyroidism (underactive thyroid) (accessed: August 13, 2019), mayoclinic.org

ICD codes for this disease: E00. E03, E06, E89ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Thyroid problems - most common thyroid problems, symptoms and treatment (January 2022).