Hypothyroidism: Effect on Voice

Introduction

The thyroid is a butterfly-shaped gland in the human body. The gland maintains the body’s homeostasis, basic functioning, metabolic rate, heart and digestive function, muscle control, and voice changes by secreting the hormones thyroxine (T4) and triiodothyronine (T3). The thyroid hormones influence an individual’s body weight and physical and neurological function.

The position of the thyroid gland is in the neck, with a direct connection to the larynx. It justifies the presence of voice changes in thyroid gland disorders. Hypothyroidism is a condition affecting millions worldwide. The disease incidence increases with age. Hypothyroidism is linked to voice changes.

What Is Hypothyroidism?

Hypothyroidism is when the thyroid gland fails to produce sufficient thyroid hormones in the human body. The symptoms are present on the face, voice, and speech. It is a common disorder in older women. Hypothyroidism is a common cause of tissue irritation.

An underactive thyroid gland impairs nerve function and causes body function to slow down. As a result, there is a reduction in the stimulation of nerves and muscles in the face. Therefore, individuals with hypothyroidism have dull facial expressions and droopy eyelids.

What Are The Symptoms of Hypothyroidism?

Symptoms of hypothyroidism are subtle compared to other thyroid diseases. Hypothyroidism can cause the following adverse health effects:

• Weight gain.

• Sensitivity to cold weather.

• Dry skin.

• Constipation.

• Heart rate changes.

• Facial swelling.

During the early stages, hypothyroidism causes sore throat. It is vital to address hypothyroidism in its initial stages. Failure to address hypothyroidism can cause extremely low thyroid levels, leading to several health complications such as uncontrolled weight gain, coma, or death.

How Hypothyroidism Can Affect Voice?

According to a report from the Eurasian Journal of Medicine, hypothyroidism can affect human speech and voice.

Hypothyroidism can affect an individual’s voice in the following ways:

• Vocal Fatigue: A slow metabolism causes vocal fatigue. Individuals with hypothyroidism have reduced voice endurance during speech or singing as their vocal muscles become weak.

• Hoarseness: A decreased thyroid function can affect vocal cord flexibility, resulting in hoarseness.

• Low Voice or Pitch: Thyroid hormones affect the length and tension of vocal cords, affecting the voice pitch. Hypothyroidism causes the vocal cords to become slack and causes the voice to sound lower in pitch.

• Slow Speech: Muscle weakness alters vocal cord function, making it difficult for hypothyroidism patients to project their voice effectively. As a result, their voice becomes soft and less audible.

• Reduced Range: The vocal range is altered in hypothyroidism due to changes in vocal cord tension and length. Such individuals find it challenging to produce certain pitches or speak in lower or higher registers.

Thyroid leaves affected individuals with a voice quality described as shaky. The onset of voice hoarseness is slow and gradual, undetected until later stages. A hoarse voice causes a loss of vocal range and intensity.

What Are the Various Ways Through Which Hypothyroidism Affects the Voice?

The vocal cord is an organ that produces sound and is located in the larynx. Thyroid hormones are responsible for these vocal structures' growth, maintenance, and development, influencing the pitch, tone, and overall voice quality. In hypothyroidism, reduced hormone levels could cause lower pitch and sensation of the vocal fatigue.

In some cases, voice changes related to hypothyroidism can be caused by conditions like Hashimoto’s thyroiditis. It is an autoimmune-related gland damage and hormonal imbalance. In women, postpartum hormonal shifts can temporarily cause hypothyroidism, resulting in voice issues.

Thyroid hormones affect the length and tension of vocal cords. In hypothyroidism, the reduced hormone levels cause laxity and reduced tension in the vocal cords. Weakening of the vocal cord contributes to a weak and tired-sounding voice. Thyroid hormones influence blood flow to tissues and vocal cords. During hypothyroidism, a reduced metabolic rate causes decreased blood flow to laryngeal tissues. Insufficient blood supply impacts vocal cord health, causing voice changes.

Thyroid hormones affect moisture and lubrication of the vocal cord's mucous membrane. In hypothyroidism, a decrease in mucous production leads to dryness of vocal cords. The dryness affects the smooth movement of the vocal cord during the speech, causing a rough or hoarse voice.

The thyroid hormones are vital for the proper functioning of the neuromuscular system. In hypothyroidism, the neuromuscular coordination is disrupted, causing a loss of precise control needed for voice modulation.

Thyroid hormones are vital in managing voice quality, as they directly affect the voice. Low thyroid levels cause increased polysaccharide levels and fluid accumulation within the lamina propria of vocal folds. When the thyroid gland enlarges due to hypothyroidism, the vocal cords become pinched or partially paralyzed due to their proximity. It also causes neural edema of the vagus nerve. When the thyroid hormone further decreases and remains uncorrected, the vocal cords develop a vibrating layer thickening. It is often called myxedema. Myxedema is a gelatinous thickening of vocal cords, causing a harsh smoker’s voice. The vibrating layer thickening and voice harshness can be of varying intensity. The vibrating capacity of the person’s voice also decreases.

Hypothyroidism is also known to affect the psychological well-being of affected individuals. Fatigue, lethargy, and mood changes contribute to a lack of vocal energy and enthusiasm.

How Are Hypothyroidism-Related Vocal Changes Treated?

Hypothyroidism patients can improve their voice clarity by taking small doses of thyroid hormone replacement. Synthetic thyroid hormones like Levothyroxine are prescribed to restore thyroid levels. If the condition is severe, then the individual requires surgery.

How to Care For Vocal Cords in Individuals With Hypothyroidism?

The following measures can preserve vocal cord well-being:

• Staying Hydrated: Proper hydration is essential for vocal cord well-being. Water lubricates the vocal cord and eases the strain on the patient’s voice.

• Vocal Warm-up: Gentle warm-up of the vocal cord before speaking or singing can improve vocal cord flexibility and reduce strain.

• Environmental Awareness: Individuals with hypothyroidism must avoid environments with excessive dryness or irritants, as they can exacerbate vocal issues.

• Talk With a Lower Voice: Lowering the voice can rest the vocal cords and enable recovery from fatigue.

Conclusion

Recent reports have shown hypothyroidism causes voice changes in affected patients, making their voices hoarse. These vocal changes are due to the direct influence of thyroid hormones on vocal structures and their surroundings. The vocal changes are less noticeable during the early disease stage but become evident gradually. Restoring the thyroid hormone level to normal reduces voice changes.