On-Call Advice

Blue Ridge Region physicians of Sentara Martha Jefferson Hospital and Sentara RMH Medical Center answer your health and wellness questions

What is an underactive thyroid, what causes it and how is it treated?

An underactive thyroid, also known as hypothyroidism, is a condition in which the thyroid gland does not produce enough thyroid hormones. The thyroid, which lies below the voice box on the trachea (the “windpipe”), produces hormones that help regulate the body’s metabolism.

Early symptoms of hypothyroidism like fatigue are often overlooked, but as the patient’s metabolism continues to slow, additional symptoms may appear, including sluggishness; increased sensitivity to cold; constipation; pale, dry skin and brittle nails; hoarse voice; elevated cholesterol levels; unexplained weight gain; muscle aches, tenderness and stiffness; heavier-than-normal periods; and depression. Untreated hypothyroidism can lead to joint pain, obesity, infertility and heart disease. 

Various conditions may result in hypothyroidism. In some cases, certain autoimmune diseases may cause the immune system to produce antibodies that attack the thyroid. More rarely, a disorder of the pituitary gland—often the result of a benign brain tumor—can cause the condition. Also, some people are born with thyroid disease. 

Certain medications also may cause hypothyroidism—for example, lithium, which is used in treating psychiatric disorders, and amiodarone, which is used to treat irregular heart rhythms. Other potential causes include radiation therapy, thyroid surgery, pituitary gland disorder, pregnancy, iodine deficiency, and having a parent or grandparent with autoimmune disease. 

Hypothyroidism affects people of all ages, but women over age 50 are most commonly affected. The condition is diagnosed by measuring thyroid hormone levels in the blood. 

Doctors recommend that middle-aged women be screened for hypothyroidism during routine physicals. Some doctors also recommend testing pregnant women or women who are thinking of becoming pregnant. Men are more likely to develop hypothyroidism after age 60, so men in that age group should be screened regularly.

Although there is no cure for hypothyroidism, typically the condition is treated with hormone replacement therapy, using the synthetic thyroid hormone levothyroxine. This is an oral medication that must be taken for the rest of a person’s life. However, with proper management under a physician’s care, hypothyroidism generally does not interfere with the ability to enjoy a happy, fulfilling lifestyle.

What is shingles, and why do some people continue to have pain after shingles goes away?

Shingles is a painful, blistering skin rash caused by the varicella-zoster virus, the same virus that causes chickenpox. Unfortunately, after the rash and blisters of shingles have gone away, the associated nerve pain sometimes continues. 

After a person has had chickenpox, the varicella-zoster virus lies inactive in certain nerves close to the spinal cord. For some unknown reason, this virus can reactivate later in life in the form of shingles. Shingles can occur at any age, but it’s more common in elderly people and in those with weakened immune systems. 

When a person gets shingles, a red rash generally appears first, followed by small, itching blisters that burst, ooze and then crust over. The primary symptom of shingles is pain, which may begin even before the rash appears, and may be accompanied by sensations of burning, itching, tingling or numbness. Symptoms are usually confined to a small area and are virtually always located only on one side of the body. 

Shingles usually goes away by itself in two to three weeks, but prompt treatment with antiviral medications can reduce the severity and duration of symptoms. 

If pain and burning continue after the rash and blisters have gone away, this condition is called postherpetic neuralgia (the word neuralgia means “nerve pain”). This neuralgia, which results from nerve damage caused by the outbreak of shingles, has symptoms resembling those of shingles and may include pain, itching, numbness and weakness. 

There is no cure for postherpetic neuralgia, and the pain may last months or years. Use of certain prescription medications, however, may help provide temporary relief. 

People who think they may be developing shingles—that is, they experience pain or burning with a rash or small blisters on one side of the body—should see their physician right away. Starting antiviral medication within 72 hours of developing shingles helps reduce the severity of shingles symptoms and lessens the risk of developing postherpetic neuralgia. 

People who are 50 and older should ask their doctor about whether Shingrix, the shingles vaccine, is appropriate for them. 

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