Hypothyroidism

Feeling constantly tired, gaining weight without explanation, or battling brain fog? You’re not alone. These are just a few signs that your thyroid—a small butterfly-shaped gland in your neck—might not be doing its job properly. This condition, known as hypothyroidism, affects millions of people worldwide, especially women, often going unnoticed for years. 

In this post, we’ll break down what hypothyroidism is, why it happens, and how you can spot the symptoms early. Whether you’ve been diagnosed or are just looking for answers, this guide will help you understand your thyroid better and take control of your health.

Hypothyroidism, often referred to as an underactive thyroid, is a medical condition where the thyroid gland does not produce enough thyroid hormones. The thyroid gland, located at the base of your neck, just below Adam's apple, produces two main hormones: triiodothyronine (T3) and thyroxine (T4). These hormones are critical for regulating your body's metabolism, influencing functions such as energy production, body temperature, heart rate, brain function, and the health of your skin, hair, and nails.

When the thyroid gland is underactive, it leads to a slowdown of metabolic processes throughout the body. This results in a range of symptoms, which can vary in severity depending on the degree of hormone deficiency. In essence, your body's functions are operating in a lower gear than they should be, leading to feelings of sluggishness and affecting multiple organ systems. It's a chronic condition that typically requires lifelong management with thyroid hormone replacement therapy to restore metabolic balance.

Hypothyroidism isn’t a one-size-fits-all condition. Depending on the cause and where the problem starts, it can be classified into different types. Understanding the type helps guide the right treatment. Here are the main types:

Primary Hypothyroidism

This is the most common type, where the problem lies directly in the thyroid gland itself. It either doesn't produce enough hormones or stops working effectively.

Causes include:

• Hashimoto’s thyroiditis (an autoimmune disease)
• Iodine deficiency
• Thyroid surgery or radiation
• Certain medications
   

Secondary Hypothyroidism

Here, the issue starts in the pituitary gland (in the brain), which normally tells the thyroid how much hormone to produce. If the pituitary isn’t sending the right signals, the thyroid won’t work properly—even if it's healthy.

Causes include:

• Pituitary tumors
• Head trauma
• Brain surgery or radiation
   

Tertiary Hypothyroidism

This rare type involves a malfunction in the hypothalamus, another part of the brain that controls the pituitary gland. If the hypothalamus doesn’t produce enough TRH (thyrotropin-releasing hormone), the chain reaction that regulates thyroid hormone production breaks down.

Congenital Hypothyroidism

Some babies are born with an underdeveloped or missing thyroid gland. Early diagnosis through newborn screening is crucial to prevent growth and developmental delays.

Subclinical Hypothyroidism

In this early stage, thyroid hormone levels are still in the normal range, but TSH (thyroid-stimulating hormone) is slightly elevated. There may be no symptoms, but it can progress to full hypothyroidism over time.

The vast majority of hypothyroidism cases are due to issues directly affecting the thyroid gland itself (primary hypothyroidism). Here's a breakdown of the most common causes:

Hashimoto's Thyroiditis: This is the most common cause of hypothyroidism in developed countries. It's an autoimmune disorder, meaning the body's immune system, which normally fights off infections, mistakenly attacks its own healthy thyroid cells. Over time, this chronic attack leads to inflammation and gradual destruction of the thyroid gland, impairing its ability to produce hormones. Genetic predisposition plays a significant role in Hashimoto's.
 

Iodine Deficiency: Iodine is an essential building block for thyroid hormones. If there isn't enough iodine in the diet, the thyroid gland cannot produce adequate T3 and T4. This is a common cause of hypothyroidism in regions where iodine intake is low, though it has become less prevalent in many countries due to the widespread use of iodised salt.
 

Thyroid Surgery (Thyroidectomy): If all or a significant portion of the thyroid gland is surgically removed (e.g., to treat thyroid cancer, a large goitre, or hyperthyroidism), the body will no longer be able to produce enough thyroid hormones, leading to permanent hypothyroidism.
 

Radioactive Iodine (RAI) Therapy: This treatment is often used for hyperthyroidism (overactive thyroid) or certain types of thyroid cancer. RAI works by destroying thyroid cells. While effective for hyperthyroidism, it frequently leads to permanent hypothyroidism, which then requires lifelong hormone replacement.

Congenital Hypothyroidism: Some babies are born with a thyroid gland that is malformed, absent, or unable to produce hormones properly. Early detection through newborn screening is crucial to prevent severe developmental delays.
 

Pituitary Gland Disorders (Secondary Hypothyroidism): The pituitary gland, located in the brain, produces Thyroid-Stimulating Hormone (TSH), which tells the thyroid gland to make T3 and T4. If the pituitary gland is damaged (e.g., by a tumour, surgery, or radiation), it may not produce enough TSH, leading to an underactive thyroid.
 

Radiation Therapy: Radiation treatment to the head and neck for other cancers (e.g., lymphomas) can damage the thyroid gland, leading to hypothyroidism months or even years later.
 

Postpartum Thyroiditis: Some women develop thyroid inflammation within a year after giving birth. This condition often presents as a temporary phase of hyperthyroidism followed by hypothyroidism, which may or may not resolve on its own.
 

Subacute Thyroiditis: This is a painful inflammation of the thyroid gland, often triggered by a viral infection. It can cause an initial period of hyperthyroidism (due to stored hormone release), followed by temporary hypothyroidism, before the thyroid usually recovers.

Certain Medications: Some drugs can interfere with thyroid hormone production or activity. 

Common symptoms include:

• Fatigue and Tiredness: This is one of the most common and often earliest signs. Feeling constantly drained, even after adequate sleep.
• Weight Gain: Unexplained weight gain or difficulty losing weight, despite no significant changes in diet or exercise. This is due to a slowed metabolism.
• Increased Sensitivity to Cold: Feeling cold all the time, even in warm environments, or intolerance to cold temperatures.
• Constipation: A slower metabolism can affect bowel movements, leading to infrequent stools.
• Dry Skin: Skin can become dry, rough, and scaly.
• Hair Thinning or Loss: Hair may become brittle, coarse, and prone to thinning, including eyebrows (particularly the outer third).
• Muscle Aches, Tenderness, and Stiffness: General body aches, muscle weakness, and joint pain.
• Swelling: Puffiness in the face, especially around the eyes, and swelling in the hands and feet.
• Hoarseness: A deeper, hoarse voice.
• Depression or Mood Changes: Feeling down, irritable, or experiencing symptoms akin to depression.
• Slowed Heart Rate (Bradycardia): The heart beats slower than normal.
• Impaired Memory and Concentration: Difficulty focusing, "brain fog," and forgetfulness.
• Menstrual Irregularities: Heavier or irregular periods in women.
• High Cholesterol: Hypothyroidism can lead to elevated cholesterol levels.
• Goitre: Swelling of the thyroid gland in the neck, which may be visible or palpable, due to the gland working harder to produce hormones.
• Reduced Sweating: Less perspiration than usual.
• Loss of Libido: Decreased sex drive.
• Anaemia: Lower red blood cell count.

It's important to note that you may not experience all of these symptoms, and their intensity can vary significantly from person to person. If you recognise a cluster of these symptoms, especially if they are persistent and unexplained, it's advisable to speak to your doctor.

Diagnosing hypothyroidism typically involves a combination of assessing your symptoms and performing specific blood tests. It's a relatively straightforward process once the condition is suspected.

Medical History and Physical Examination:

• Your doctor will first discuss your symptoms in detail, asking about their onset, duration, and severity. They'll also inquire about your family history of thyroid disease or other autoimmune conditions.
• During the physical examination, the doctor may check your pulse, blood pressure, and reflexes. They will gently feel your neck to check the size and texture of your thyroid gland for any enlargement (goitre) or nodules. They will also look for physical signs of hypothyroidism like dry skin, puffy eyes, or hair changes.

Blood Tests (Thyroid Function Tests):

• Blood tests are the definitive way to diagnose hypothyroidism. The most important tests are:
  • Thyroid-Stimulating Hormone (TSH) Test: This is the primary and most sensitive test for hypothyroidism. TSH is produced by the pituitary gland and acts as a messenger, telling the thyroid gland how much T3 and T4 to produce.
    • High TSH levels indicate that the pituitary gland is working harder than usual, trying to stimulate an underactive thyroid to produce more hormones. This is characteristic of primary hypothyroidism.
    • Low or normal TSH levels with low thyroid hormones might suggest secondary or tertiary hypothyroidism (a problem with the pituitary or hypothalamus, respectively), though this is much rarer.
  • Free Thyroxine (Free T4) Test: This test measures the amount of free (unbound and active) thyroxine hormone circulating in your blood.
    • Low Free T4 levels along with high TSH levels confirm primary hypothyroidism.
    • Normal Free T4 levels with elevated TSH indicate subclinical hypothyroidism.
  • Free Triiodothyronine (Free T3) Test: This test measures the active form of thyroid hormone. It's often checked alongside T4 but is less commonly used for initial diagnosis of hypothyroidism, as T3 levels may remain normal even when T4 levels are low.

Thyroid Antibody Tests (for Hashimoto's):

• If Hashimoto's thyroiditis is suspected as the cause of hypothyroidism (especially if TSH is high and T4 is low), your doctor may order tests for specific antibodies:
  • Anti-thyroid peroxidase (TPO) antibodies: These are present in most people with Hashimoto's thyroiditis.
  • Anti-thyroglobulin (Tg) antibodies: Also common in Hashimoto's, though less specific than TPO antibodies.
• The presence of these antibodies confirms the autoimmune nature of the condition.

Other Tests (Less Common):

• Thyroid Ultrasound: May be performed if a goitre is present or if nodules are suspected, to assess the size, shape, and structure of the thyroid gland.
• Iodine Urine Test: In areas where iodine deficiency is suspected, a urine test can measure iodine levels.

Once a diagnosis is confirmed, your doctor will determine the type and severity of hypothyroidism and recommend the appropriate treatment.

The treatment for hypothyroidism is typically straightforward, effective, and lifelong. It involves replacing the thyroid hormones that your body is no longer producing sufficiently.

Levothyroxine (L-Thyroxine) Replacement Therapy:

• This is the standard and most common treatment for hypothyroidism. Levothyroxine is a synthetic (man-made) version of thyroxine (T4), the primary hormone produced by the thyroid gland.
• It's an oral medication (Brands available: Thyronorm, Eltroxin, Thyrox), usually taken once daily, typically in the morning, on an empty stomach, about 30-60 minutes before food, coffee, or other medications. This is crucial because many substances can interfere with its absorption.
• The goal of levothyroxine therapy is to restore normal thyroid hormone levels, thereby alleviating symptoms and preventing complications.
• Dosage: The starting dose varies depending on your age, weight, the severity of your hypothyroidism, and any underlying heart conditions. Your doctor will start with a low dose and gradually adjust it based on your TSH levels (and sometimes Free T4 levels) at regular intervals (usually every 4-8 weeks initially). Once stable, blood tests may be done once or twice a year.
• Consistency is Key: It is vital to take your medication at the same time each day and not to miss doses. Stopping or changing your dose without consulting your doctor can lead to a return of symptoms or other health issues.
• Monitoring: Regular blood tests are essential to ensure you are on the correct dose. Too high a dose can lead to symptoms of hyperthyroidism (e.g., heart palpitations, anxiety, weight loss), while too low a dose means your hypothyroidism is not adequately controlled.

Considerations for Combination Therapy (T4 and T3):

• While levothyroxine (T4) is effective for most people, some individuals (a small percentage) may not feel completely well on T4 alone, even when their TSH levels are normalised. This is because the body converts T4 into T3 (the more active form of the hormone).
• In such cases, your doctor might consider a trial of combination therapy, adding a synthetic T3 hormone (liothyronine) to your levothyroxine dose. However, this is not a routine treatment and is only considered for select patients under strict medical supervision due to potential side effects and the need for careful monitoring.

Dietary Considerations:

• Certain foods and supplements can interfere with levothyroxine absorption. These include:
  • High-fibre foods: Can reduce absorption.
  • Soy products: Can interfere with absorption.
  • Iron supplements: Should be taken at least 4 hours apart from levothyroxine.
  • Calcium supplements: Should also be taken at least 4 hours apart.
  • Antacids containing aluminium or magnesium: Can interfere with absorption.
• It's important to inform your doctor and pharmacist about all medications and supplements you are taking.

Management of Underlying Causes:

• If the hypothyroidism is due to iodine deficiency, iodine supplementation (under medical guidance, as excessive iodine can also cause thyroid problems) may be considered.
• For medication-induced hypothyroidism, your doctor may consider adjusting or changing the offending medication if possible.

While conventional treatment with levothyroxine remains the gold standard for hypothyroidism, many people explore alternative or complementary therapies to support their thyroid health and overall well-being. These approaches are not a replacement for prescribed medication but may enhance quality of life when used alongside medical care. Always consult your doctor before starting any alternative therapy.

1. Dietary Changes

Food can play a supportive role in managing symptoms. Some people benefit from:

• Selenium-rich foods (like Brazil nuts, sunflower seeds)
• Zinc sources (pumpkin seeds, legumes)
• Anti-inflammatory diet (rich in fruits, vegetables, whole grains, and healthy fats)
• Limiting goitrogens (found in raw cruciferous vegetables like cabbage and broccoli) in large quantities
   

2. Herbal Remedies

Certain herbs may help support thyroid function or reduce inflammation, though scientific evidence is still emerging. As herbal supplements can interact with thyroid medications. Use only under professional guidance.

• Ashwagandha: May help regulate thyroid hormones and manage stress.
• Guggul: Used in Ayurveda for thyroid support.
• Bladderwrack: A seaweed rich in iodine, used cautiously in iodine-deficient individuals.
   

3. Yoga and Stress Management

Chronic stress can worsen thyroid imbalance. Mind-body practices like yoga, meditation, and Tai Chi can help reduce stress, improve metabolism, and support hormonal balance.
 

4. Acupuncture

Some people find that acupuncture helps with fatigue, mood swings, and overall energy levels. While evidence is limited, it may offer relief from symptoms for certain individuals.

5. Homeopathy and Ayurveda

In systems like homeopathy and Ayurveda, treatments are personalized based on the individual's constitution and root imbalances. Some people report improvement in energy and mood, but these should be used only as complementary options alongside conventional care.

Remember that alternative therapies are best used to support—not substitute—thyroid hormone replacement therapy. Work closely with your healthcare provider to ensure a safe and balanced approach to managing hypothyroidism.

Several factors can increase your risk of developing hypothyroidism:

• Female gender: Women are significantly more likely to develop hypothyroidism.
• Age: Risk increases with age, particularly after 60.
• Family history: Having a close relative with autoimmune thyroid disease (Hashimoto's or Graves' disease).
• Autoimmune diseases: Presence of other autoimmune conditions (e.g., Type 1 diabetes, rheumatoid arthritis, lupus, pernicious anaemia, Addison's disease, celiac disease).
• Previous thyroid problems: History of hyperthyroidism, goitre, or thyroid surgery.
• Radiation therapy: Radiation to the head or neck for cancer treatment.
• Certain medications: Drugs like lithium, amiodarone, and some cancer therapies.
• Iodine deficiency: Insufficient dietary intake of iodine (less common in iodine-sufficient regions).
• Pregnancy and postpartum period: Women can develop thyroid issues after childbirth.
• Down syndrome and Turner syndrome: Increased risk in individuals with these genetic disorders.

If left untreated or inadequately treated, hypothyroidism can lead to a range of complications, some of which can be severe and life-threatening.

• Goitre: Enlargement of the thyroid gland due to constant stimulation by TSH.
• Heart problems: Increased risk of high cholesterol and heart disease, including heart failure.
• Myxoedema coma: A rare, life-threatening complication of severe, long-standing hypothyroidism, leading to extreme lethargy, hypothermia, and unconsciousness.
• Mental health issues: Depression, anxiety, and impaired cognitive function can worsen.
• Peripheral neuropathy: Nerve damage, often leading to numbness, tingling, and pain in extremities.
• Infertility: Can cause ovulatory dysfunction and difficulty conceiving in women.
• Birth defects: Untreated hypothyroidism during pregnancy can lead to developmental problems in the baby.
• Kidney problems: Can affect kidney function and water balance.
• Anaemia: Lower red blood cell count.
• Sexual dysfunction: Decreased libido and erectile dysfunction in men.

Managing hypothyroidism effectively can significantly improve your quality of life. Here are five practical tips:

• Take your medication consistently and correctly: This is the most important tip. Take your levothyroxine at the same time every day, ideally on an empty stomach, 30-60 minutes before food, coffee, or other medications/supplements (especially iron and calcium).
• Attend regular follow-up appointments: Regular blood tests (TSH, and sometimes Free T4) are crucial to ensure your medication dose is optimal. Don't skip these appointments, even if you feel well.
• Listen to your body and communicate with your doctor: Pay attention to persistent symptoms (fatigue, weight changes, mood issues) even if your blood tests are "normal." Your optimal TSH level might be different from someone else's. Don't hesitate to discuss concerns with your doctor.
• Maintain a healthy lifestyle: A balanced diet rich in whole foods, regular moderate exercise, and adequate sleep can significantly help manage symptoms like fatigue and weight gain, and support overall well-being.
• Manage stress effectively: Chronic stress can potentially exacerbate autoimmune conditions. Incorporate stress-reducing activities like meditation, yoga, mindfulness, or hobbies into your routine.

“Hypothyroidism will make you gain a lot of weight and you’ll never lose it.”
Reality: Hypothyroidism may cause modest weight gain (usually 2–4.5 kg), mostly from water retention. With proper treatment and healthy habits, most people can lose the extra weight and manage it effectively.

“You can cure hypothyroidism with diet or supplements.”
Reality: There’s no cure for most types of hypothyroidism. Medication (like levothyroxine) is essential. While diet and supplements can support overall health, they can’t replace thyroid hormones.

“Once your TSH is normal, all your symptoms should go away.”
 Reality: TSH normalization helps, but some symptoms like fatigue or brain fog may persist. This can be due to other factors or individual needs. Keep discussing symptoms with your doctor to fine-tune treatment.

See a doctor if you experience:

• Persistent fatigue and tiredness: Especially if unexplained by other factors.
• Unexplained weight gain or difficulty losing weight.
• Increased sensitivity to cold.
• Dry skin, brittle nails, or thinning hair.
• Constipation that is new or worsening.
• Muscle aches, joint pain, or stiffness.
• Changes in your mood, such as persistent sadness or depression.
• Swelling in your neck (goitre) or puffiness in your face or hands.
• Heavy or irregular menstrual periods.
• A family history of thyroid disease.
• You have another autoimmune condition.

If you are already diagnosed with hypothyroidism, see your doctor if:

• Your symptoms return or worsen despite being on medication.
• You experience new or concerning symptoms.
• You are pregnant or planning to become pregnant, as thyroid hormone requirements often change.
• You want to start any new medications or supplements, as they can interact with levothyroxine.
• You are having difficulty remembering to take your medication or adhering to your treatment plan.

• What type of hypothyroidism do I have, and what is its likely cause?
• What is my specific TSH target range, and what are my current TSH and Free T4 levels?
• How long will I need to take levothyroxine, and what are the potential side effects?
• Are there any foods, supplements, or medications I should avoid or take separately from my levothyroxine?
• How often will I need blood tests to monitor my thyroid levels?
• What specific symptoms should I watch out for that might indicate my dose needs adjusting?
• What are the long-term implications of hypothyroidism, and how can I best manage my condition to prevent complications?

• Educate yourself about the condition: Learn about hypothyroidism, its symptoms, and its impact. This will help you understand what your loved one is going through and respond with empathy rather than frustration.
• Offer practical support: If they are experiencing fatigue or "brain fog," offer to help with tasks that might be overwhelming for them, such as errands, cooking, or managing appointments.
• Be patient and understanding: Symptoms like fatigue, mood changes, and weight struggles can be frustrating for the individual. Avoid judgmental comments and remember that their symptoms are real, even if invisible.
• Encourage adherence to treatment: Gently remind them about medication timing and importance of regular check-ups. Offer to accompany them to appointments if they wish, or help them remember questions to ask their doctor.

Hypothyroidism is a lifelong but manageable condition. With proper diagnosis, regular medication, and healthy lifestyle choices, most people can lead a full, healthy life. Staying informed and working closely with your doctor is key to effective management.