The thyroid gland is a small inconspicuous butterfly shaped organ located in the front of the neck which stares back at you each time you look into the mirror. This small gland produces two vital hormones in small quantities that have a major impact on your metabolism, your heart, your digestion, your skin and finally on the way your brain works. When the gland gradually stops functioning because of various reasons we develop deficiency of these vital hormones and develop the disease manifestations of Hypothyroidism. There are ten things that I believe every woman should know about this diseaseCan I get this disease?For some still mysterious reason hypothyroidism is five to ten times more likely to occur in women. It is an extremely common disease. Studies from South India suggest that one in seven women over the age of 30 suffer from some degree of thyroid hormone deficiency and more than half of them are not even aware about it. So you have a one in seven chance of suffering from the diseaseHow do I know that I have the disease?The symptoms of hypothyroidism are very vague and develop gradually over a period of time that you might not even notice it. The deficiency of the hormone leads to slowing of your metabolism leading to a gradual increase in weight, puffiness of the face especially around the eyes, vague aches and pains, cramping of muscles, constipation, drying of skin, unexplained tiredness, excessive daytime sleepiness and menstrual abnormalities like delayed periods or unusually heavy bleeding with periods. An easy way to increase your chances of making a self diagnosis and considering meeting a doctor is to score yourself on the questionnaire given. If you score more than 0 points, the chances are high that you may be suffering from thyroid hormone deficiency and you need to meet a doctor.Which doctor do I visit?Since hypothyroidism is a very common disorder, a good medical specialist is able to diagnose and treat a patient with this disease satisfactorily. Rarely a second opinion is required from an endocrinologist who is a specialist in hormone diseases.How will the doctor confirm if I have hypothyroidism?The doctor has two options to confirm the disease. A reasonable way is to measure the levels of the two thyroid hormones (called T3 and T4) in the blood and a low level of these hormones would confirm the deficiency. However these hormones are very small molecules and are present in very small quantities in the blood making these tests more difficult and less reliable. So the second option is usually chosen. The second option is to measure another hormone in the blood called Thyroid stimulating hormone (TSH) which is a hormone secreted by the pituitary (master) gland. In a normal patient this hormone regulates the thyroid gland to produce thyroid hormones. In thyroid hormone deficiency the pituitary starts producing higher quantities of TSH in order to coax the thyroid to produce more thyroid hormones. So an elevated TSH measurement would be an indirect way to confirm hypothyroidism. This measurement is much simpler and more reliable than measuring the thyroid hormones directly.Can TSH be elevated above normal without thyroid hormone deficiency?In early thyroid hormone deficiency the thyroid hormones may still be in the normal range with elevated TSH levels. This condition is called subclinical hypothyroidism and a decision to treat or to wait and monitor it at a later date is taken by the doctor using his judgment. A definite reason to treat subclinical hypothyroidism immediately in a woman is if they are pregnant or they plan to conceive a child in the immediate future.How is hypothyroidism treated and for how long?Most causes of thyroid hormone deficiency are permanent and hence require treatment lifelong. Rarely the thyroid hormone deficiency may recover after a period of time. Treating the disorder is simple. Synthetic T4 (Levothyroxine) is used to replace the lack of natural T4. The synthetic T4 is converted to T3 in the body and so additional T3 is not required. The drug is sold in India under the brand names of EltroxinTM and ThyronormTM. Both drugs are similar in nature and either can be used to treat hypothyroidism, but it is better to stick to the same brand.Are there any precautions while taking this medicine?As levothyroxine is a replacement the drug is extremely safe when consumed over long periods of time. The drug is best absorbed when taken on empty stomach in the morning with plain water. It is better for wait for 30 minutes before consuming any breakfast or beverages. The drug stays in the blood for over 7 days, so even if a dose is missed it can be safely added to the next day’s dose. It is however important to make sure the weekly requirements are met. One easy way to ensure this is to use a pill box and add the week’s dose of levothyroxine into the box every Sunday. Any pills left over by next Sunday should be consumed on Sunday morning before refilling the pill box with the next week’s medicine. Elderly women with an underlying heart disease need to be started on the drug slowly at a small dose over a couple of months. This is to avoid a sudden increase in metabolic rate which would require more oxygen to the heart. However even with severe heart disease the bad consequences of not treating hypothyroidism exceed the problems associated with treating it.Is the drug safe in case I get pregnant?The drug is extremely safe in pregnancy. In fact the requirements of thyroid hormone go up in pregnancy as the fetus also depends on the mother for thyroid hormones in the first three months of life. It is safe to increase the dose by 50% immediately on confirming pregnancy. Later the drug may need dose adjustment using blood levels of T4 (thyroid hormone) to guide further increases in dose. This is best done by an endocrinologist and the hormones should be measured at least three to four times during the course of pregnancy. The dose maybe reduced to the pre-pregnancy dose after delivery. The drug is safe during breast feeding.Are there any changes required in my diet if I have hypothyroidism?There are no dietary restrictions in Hypothyroidism. Normal Iodized salt may continue to be used. In case you are overweight restricting fatty and high calorie foods and desserts maybe required along with regular aerobic exercise. No special vitamin supplements are required if a healthy balanced diet is consumed. Do I need to recheck the hormones repeatedly?After the medicine is prescribed initially for Hypothyroidism the dose of the medicine is adjusted by rechecking the TSH levels after a period of 4 – 6 weeks. Subsequently the TSH levels are checked at three monthly intervals till the normal levels of TSH are achieved on a stable dose of levothyroxine tablets on two or more occasions. Subsequently a yearly TSH check up is advised lifelong.