Hypothyroidism is defined as lower than optimal thyroid hormone (TH) production by the thyroid gland, resulting in too low or suboptimal plasma TH concentrations. The most frequent cause of hypothyroidism is thyroid dysfunction, also known as primary hypothyroidism. This type of hypothyroidism is characterized by a low or (low-)normal serum free thyroxine (FT4) concentration in combination with a (very) high or elevated thyrotropin (TSH) concentration, and can be a congenital or acquired problem. Worldwide, the most frequent causes of acquired primary hypothyroidism are iodine deficiency and (chronic) autoimmune thyroiditis. Autoimmune thyroiditis or Hashimoto’s disease (HD) is an autoimmune disorder, in which T- and B cells (slowly) destruct the thyroid gland. A key role in this process seems to be reserved for cytotoxic T cells that are activated by excessively stimulated CD4 positive T cells. Serological markers are anti-thyroid antibodies: anti-thyroid peroxidase and anti-thyroglobulin antibodies (TPO- and Tg-abs, respectively), produced by B cells.

In case of clinical suspicion of hypothyroidism, thyroid function assessment consists of TSH and FT4 measurement . HD is diagnosed by the presence of TPO- or Tg-abs, plus or minus characteristic thyroid ultrasound abnormalities, such as reduced echogenicity. Common, but also quite unspecific complaints in (primary) hypothyroidism are fatigue, weight gain with poor appetite, constipation, concentration problems and depression. Treatment of hypothyroidism consists of daily administration of levothyroxine (LT4) . LT4 is preferable to triiodothyronine (T3) because of its longer serum half-life . Furthermore, the thyroid gland mainly produces thyroxine (T4), which is converted into its active metabolite T3 in peripheral tissues.

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Mishita
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Journal of  Autoimmune Disorders