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Autoimmune Thyroid Disease in Women Continued

Ann Witt, M.D., and Natalie Staats Reiss, Ph.D.

Treatment:

Some thyroiditis will resolve without treatment. If necessary, levothyroxine, or thyroid hormone replacement is the treatment for hypothyroidism. Usually, blood levels of TSH are monitored every couple of months to adjust the dosing as needed while also following symptoms.

Initial hyperthyroidism symptoms are often treated with beta-blockers like atenolol or propranolol to slow the heart rate. Once the cause of the hyperthyroidism is identified, then further treatment is tailored toward that cause. For example, Grave's disease is treated initially with anti-thyroid medications, such as methimazole or PTU (propylthiouracil). Often, an endocrinologist will treat a person for about a year in hopes that the disease will go into remission (a person no longer has symptoms). If these medications are not tolerated, or remission does not occur, then other possible treatments include surgical removal of the thyroid gland or radioactive iodine treatment to permanently limit the gland's production of thyroid hormone. Both of these treatment options carry a high risk of making someone develop hypothyroidism. As mentioned above, if hypothyroidism occurs, then thyroid hormone replacement therapy is needed.

Prognosis:

The prognosis of autoimmune thyroid disease depends on the specific diseases involved. Twenty percent of women with Grave's disease will have normal thyroid function after one year (this is more likely to occur in women with mild cases of the disorder). Thirty to forty percent of Grave's patients treated with anti-thyroid medications will go into remission, but 15% of these individuals will then go on to develop hypothyroidism ten to fifteen years later. Grave's disease increases the likelihood of developing other autoimmune diseases such as Type I diabetes, vitiligo (decreased pigment in patches of skin), myasthenia gravis (muscle weakness that increases with activity and decreases with rest) and celiac disease (a condition that affects the intestines).

Postpartum thyroiditis is usually a temporary condition, and most people will recover within one year. However, 50% of women will then go on to develop hypothyroidism within the next seven years. There is an increased chance of recurrence with future pregnancies.

Impact on Mental Health:

There is a higher rate of depression in women with low thyroid hormone levels as compared to women without hypothyroidism. Some studies also show an increased rate of depression in women whose thyroid level is borderline low (sub clinical hypothyroidism). Typically, depressive symptoms subside when a person is successfully treated for hypothyroidism.

Study results have been mixed on the relationship between mood disorders and hyperthyroidism. Some research suggests that women with hyperthyroidism have an increased rate of anxiety and depression, as well as a decreased quality of life. Other studies do not show this connection between mood and hyperthyroidism. Further studies are necessary to determine whether excessive thyroid hormone causes psychological problems.