Hypothyroidism in Nigeria: Symptoms and Treatment

 

By: Doreen Udoudom. Datelinehealth Africa Volunteer Freelance Writer, with editorial support from The DLHA Team

 

 

Key Facts

• Hypothyroidism is when the thyroid gland is underactive and produces less of its chemical products (thyroid hormones).

• Symptoms of hypothyroidism include impaired memory, weight gain and constipation.

• The most common causes of hypothyroidism in Nigeria are iodine deficiency and autoimmune inflammation (thyroiditis).

• Treatment involves iodine supplementation in food and medication. 

 

What is hypothyroidism?

Hypothyroidism is a condition that occurs when the thyroid gland is unable to produce enough thyroid hormones for the body. 

 

The thyroid gland is a butterfly-shaped organ located at the base of the neck in front of the Adam's apple (see figure 1).

 

It produces two major chemical products, called hormones (thyroid hormones, T3 and T4). These hormones aid energy production processes (i.e., metabolism) in the body. 

 

The production of the thyroid gland hormones is under the control of a master hormone controlling gland at the base of the brain called the anterior pituitary gland. This gland itself is also under the control of a part of the brain called the hypothalamus. There is a dynamic functional relationship between these three structures as depicted in figure 2.

 

When there are insufficient amounts of thyroid hormones, metabolic processes in the body are reduced. For example, if there is less amount of thyroid hormone reaching your brain, you might experience mood swings or depression. With reduced amounts of thyroid hormone reaching your stomach and intestine, you might have constipation or other abdominal issues.

 

Globally and in Nigeria, women have a higher risk for hypothyroidism than men. The mean age of patients with the condition in Nigeria is much lower (< 50 years) than seen globally (> 50 years). ^{(1, 3)}

 

How common is hypothyroidism in Nigeria?

The prevalence of hypothyroidism in Nigeria has not been thoroughly studied and existing data are poor in quality.

 

A study carried out from January 2016 to December 2017 at the Endocrine Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west, Nigeria showed a prevalence rate of 10.75% among patients presenting with thyroid disorder. ⁽¹⁾

 

Another study carried out from January 2016 to January 2019 in the University of Nigeria Teaching Hospital, Enugu, Southeastern Nigeria indicated a prevalence rate of 0.9% for hypothyroidism in the outpatient clinic of the hospital. ⁽³⁾

 

More studies need to be carried out to ascertain the exact epidemiology of hypothyroidism among the Nigerian population.

 

What causes hypothyroidism?

Hypothyroidism can be caused by any of the following:

• Too much or too little iodine obtained from food and in blood.

• Treatment of an overactive thyroid gland (hyperthyroidism).

• Auto-immune diseases generally and of the thyroid gland specifically. 

• Surgery that removes substantial amount of the thyroid gland.

• Radiation treatment of certain disorders of the thyroid and other head and neck related cancers that damages the thyroid gland.

• Inflammation of the thyroid gland.

• Medicines that affect thyroid function. 

• Pregnancy

• Congenital disorder (Baby born without or with a partial thyroid gland. Or with a thyroid gland in an abnormal location). In these cases, the thyroid gland does not work well during pregnancy and after birth.   

 

What may increase the chances of hypothyroidism?

You are at risk of having an underactive thyroid if you:

• have type1 diabetes or rheumatism

• are female 

• have certain genetic disorders (e.g., Turner syndrome) 

• are pregnant / given birth recently

• have a family history of thyroid disorder

• have treated thyroid problems in the past 

 

What are the symptoms of hypothyroidism?

The symptoms of hypothyroidism are vague and may mimic symptoms of other ailments See figure 3). 

If you have experienced more than six of the symptoms below, there is a high chance that you are suffering from hypothyroidism.

 

Some of the symptoms include:
 

• Drowsiness.

• Hoarse voice.

• Mood swings and changes such as anxiety, and depression.

• Changes in the menstrual cycle.

• Fatigue.

• Slow heart rate (Bradycardia)

• Changes in appetite.

• Constipation.

• Hair loss.

• Weight gain.

• Impaired memory.

• Dry skin.

• Low sex drive.

• Brittle nails.

• Always feeling cold even in hot temperatures.

• Infertility.

 

What are the adverse effects of hypothyroidism?

Late detection or untreated hypothyroidism can cause complications such as:

• Hypothermia (Low body temperature).

• Anaemia.

• Goiter (Enlargement of the thyroid gland with a visible bulge in the front of the neck.

• Heart disease.

• Infertility: Women who find it difficult to conceive may be suffering from hypothyroidism.

• Coma

• Congenital cretinism (Stunted physical and mental growth and development of childhood) due to congenital hypothyroidism.

 

How do doctors diagnose hypothyroidism?

Doctors diagnose hypothyroidism by: 

• Asking about your family and medical history.

• Asking about the symptoms you are experiencing.

• Performing a general physical examination on you. This will also include a focused examination of your thyroid gland in the neck.

• Ordering several tests to check the amount of chemical products that the thyroid gland secretes into the blood and others. 

• Performing imaging studies of your neck. For example, an ultrasound scan can be used to observe the thyroid gland for the presence of lumps or nodules.
   
• Taking tiny samples from your thyroid gland for study (biopsy).

 

How is hypothyroidism treated?

Hypothyroidism is readily treatable. The treatment in the African context includes:

• Dietary iodine supplementation as necessary, and
   
• Medication to replace the deficient thyroid hormones. 

 

The most common and effective medication for hypothyroidism is the daily use of a drug called levothyroxine. ⁽²⁾

 

Levothyroxine is the synthetic form of the thyroid hormone thyroxine (T4), which is normally produced by the thyroid gland. 

 

 The medication is usually taken once a day, preferably in the morning on an empty stomach.

 

After starting the medication, your doctor will schedule periodic follow-up visits to monitor your thyroid hormone levels and adjust the dosage if necessary. 

 

Is hypothyroidism preventable?

Hypothyroidism is not preventable. To avoid developing complications, it is important to take note of your symptoms and speak with your healthcare provider early for appropriate care.

 

However, there are tips that you can adopt to help reduce the likelihood of you developing an underactive thyroid gland disorder. Some of these include:

• Healthy diet: Eating healthy foods such as liver, fish and eggs can help improve thyroid function. If you get bored of eating the same thing daily, you can consult a nutritionist to recommend foods that are balanced and suit your lifestyle.

• Avoid a sedentary lifestyle: Exercising regularly can help prevent hypothyroidism. Aim for at least 30 minutes of low-intensity workouts daily.

• Avoid foods that cause goiter (goitrogens): Goitrogens interfere with how the thyroid gland produces thyroid hormone. You should avoid them. Examples of such foods are corn, peanuts, cassava and soybeans and more. ⁽⁴⁾

• Manage stress: Stress is bad for thyroid function. Engage in activities for managing stress like meditation, yoga, deep breathing exercises or just do hobbies that help you relax. Getting enough sleep and also maintaining a work-life balance is important to reduce stress.

• Regular checkups: It is important to schedule regular health checkups with your healthcare provider especially if you experience symptoms such as impaired memory or depression or have a family history of thyroid disorders. Early detection will help prevent adverse effects in the long run.

 

At the public level, suggestions for lowering the burden of hypothyroidism within African communities include:
 

• Public Awareness Campaigns: Governments and non-governmental organisations and other stakeholders should create public awareness programs to educate the population about thyroid health, symptoms of thyroid disorders, and the importance of regular check-ups.

• Dietary iodine supplementation: Food regulatory authorities should require food manufacturers to use iodized salt in food production especially high staple food consumed in large quantities.

• School health programs: Supply and promote healthy eating in schools, as well as raise awareness among children and adolescents about the importance of a healthy lifestyle, avoiding junk foods and regular exercise to improve thyroid function.

• Workplace wellness programs: Employers of labour should implement workplace wellness programs that promote healthy lifestyles and less stressful activities. Provide resources for employees to access health services.

• Training: Community health workers should receive continuous training to improve their knowledge and skills to effectively screen for thyroid disorder in the community and channel patients to appropriate levels of care. This will help to identify hypothyroidism early and treat it properly.

 

How does hypothyroidism impact the community?

The impact of thyroid disorders like hypothyroidism in Nigeria can be quite complex. It may affect economic, work productivity, creativity, child development and many other aspects of community life.

 

As hypothyroidism requires medical diagnosis, treatment, and long-term management, people with this condition may incur expenses related to doctor visits, laboratory tests, prescription medications (such as thyroid hormone replacement therapy), and regular follow-up appointments. These healthcare costs can put a huge financial burden on individuals, their families and the public healthcare expenditure generally.

 

Workers having symptoms of hypothyroidism, such as fatigue, reduced concentration, and impaired memory are not likely to perform optimally in the workplace. This can result in decreased productivity, absenteeism and job loss. 

 

Hypothyroidism can also affect children's cognitive development and academic performance if left untreated or undiagnosed. This can limit their education, creativity, intellect and future mental and socio-economic opportunities.

 

Takeaway

Hypothyroidism is caused by the inability of the thyroid gland to produce enough thyroid hormones.

Early detection and treatment is important to avoid complications.

With the right diet, medication and follow up care, people with hypothyroidism can live healthy and purposeful lives.

 

 

Sources

1. Ale AO, Aloro OB, Adepoju AI, Odusan O. The spectrum of thyroid disorders at the Endocrine Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west, Nigeria. Annals of Health Research. Volume 5, Issue No 1: 85-92 January -June 2019 doi: 10.30442/ahr.0501-9-39

2. Chiovato L, Magri F, Carlé A. Hypothyroidism in Context: Where We've Been and Where We're Going. Adv Ther. 2019 Sep;36(Suppl 2):47-58. doi: 10.1007/s12325-019-01080-8. Epub 2019 Sep 4. PMID: 31485975; PMCID: PMC6822815.

3. Okafor EN, Ugonabo MC, Chukwukelu EE, Okonkwo IN, Ezigbo E, Odurukwe O. Prevalence and Pattern of Thyroid Disorders among Patients Attending University of Nigeria Teaching Hospital, Enugu, Southeastern Nigeria. Niger Med J. 2019 Mar-Apr;60(2):62-67. doi: 10.4103/nmj.NMJ_34_19. 

4. Goitrogens, Thyroid Disease, and Your Diet. Verywell. Updated October 12, 2022. Accessed May 26, 2023. 

Related:

Hyperthyroidism in Nigeria: Causes, Symptoms, Diagnosis and Treatment

Published: May 29, 2023

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