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Question:
I took treatment for thyroid problem and I stopped it. I have hypothyroidism. At the beginning I had neck pain and swelling. Now the pain has settled and I do not take treatment. Will there be any problem in stopping the medication?
Answer:
Thyroid gland is a butterfly-shaped organ found at the front of the neck. Its main function is to secrete some chemicals known as hormones. Thyroxine is one such hormone secreted by this gland. Thyroxine is vital for proper functioning of every cell in the human body.
Deficiency of thyroid hormones is called “Hypothyroidism.” This is the second commonest hormonal problem requiring treatment. The first one is diabetes mellitus. There are several causes for hypothyroidism.
Common causes of hypothyroidism are;
- immune cell mediated damage to thyroid gland (autoimmune thyroiditis)
- man-made (iatrogenic) causes – e.g. radio-iodine treatment given for over-functioning thyroid gland, surgical removal of thyroid gland
- medications – e.g. amiodarone, lithium
- post-inflammation of thyroid gland – e.g. post-partum thyroiditis (inflammation of thyroid gland following childbirth), subacute thyroiditis.
The main symptoms of hypothyroidism are given in the tables below. [3] Apart from these, there can be other symptoms depending on the underlying cause. For example, subacute thyroiditis will cause painful neck swelling and fever in addition to the main symptoms.
Symptoms and signs
| Tiredness | Excess menstrual bleeding |
| Weakness | Infertility |
| Excess sleepiness | Weight gain |
| Inability to tolerate cold environment | Slowing of heart rate |
| Hair loss | Swelling in the front of neck (Goitre) |
| Constipation | Swelling of legs and body |
| Joint pain | Hoarse voice |
| Muscle cramp | Slow speech |
| Depression | Dry and cold skin |
It is important to remember that not every patient with hypothyroidism will notice these symptoms. Similarly, all of these symptoms will not be present in a single patient. These symptoms can be very subtle and may develop over a long period of time without being noticed.
Treatment of hypothyroidism is same for every patient regardless of the cause. It is to replace the lacking hormone; the thyroxine. This is usually a life-long treatment. Because the thyroid gland will never be able to produce enough amount of thyroxin to meet the body’s demand.
Since you have had neck pain in the beginning, it is likely that you had subacute thyroiditis. One important feature of subacute thyroiditis is that it usually self-resolves. But about 5-10% of people with this condition will go on to permanent hypothyroidism. [2] Similarly, 1 out of 5 women with post-partum thyroiditis will develop permanent hypothyroidism. [1] Nevertheless, it is also possible that your neck pain was something not connected to your thyroid problem at all. Therefore, it is important that you consult your doctor and have your thyroid blood tests (TSH and Free T4) done. This will confirm whether you are lacking or not lacking those hormones.
The major concern about untreated hypothyroidism is the long-term effect on blood cholesterol and the heart. People with untreated hypothyroidism have increased risk of heart attack. One may not realise these complications until late.
Author: Muneer
References
- Alexander, Pearce, et al. 2017. “2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum.” Thyroid 27(3): 315-389. doi:10.1089/thy.2016.0457.
- Lee, Stephanie L. 2018. Subacute Thyroiditis. 08 October. Accessed September 17, 2019. https://emedicine.medscape.com/article/125648-overview.
- Somasundaram, Noel; et. al. 2012. “Thyroid Disease.” Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2. S1-20. doi:10.4038/sjdem.v2i2.4786.