Thyroid Disorders: 6 Symptoms, Causes & Treatment Options Explained

How the Thyroid Works

The thyroid makes two main hormones, thyroxine (T4) and triiodothyronine (T3), using iodine from food. The pituitary gland in the brain monitors levels and sends thyroid-stimulating hormone (TSH) to tell the thyroid how much to make. If thyroid hormone is low, TSH rises; if it is high, TSH falls. This is why TSH is the most important screening test.

Types of Thyroid Disorders

Hypothyroidism (underactive thyroid). The gland makes too little hormone, slowing the body's processes. It is the most common thyroid problem. The leading cause worldwide is Hashimoto's thyroiditis, an autoimmune condition. Other causes include iodine deficiency, previous thyroid surgery or radioiodine treatment, certain medicines and congenital hypothyroidism in newborns.

Hyperthyroidism (overactive thyroid). The gland makes too much hormone, speeding up the body. Causes include Graves' disease (autoimmune), toxic nodules or multinodular goitre, thyroiditis and excess iodine or thyroid medicine.

Goitre. An enlarged thyroid, which may happen with underactive, overactive or normal function.

Thyroid nodules. Lumps within the thyroid, most of which are benign. A small proportion are cancerous, and they are evaluated with ultrasound and sometimes a needle biopsy.

Thyroid cancer. Less common and, in its most common forms, highly treatable.

Six Key Symptoms

Hypothyroidism

1. 1Fatigue and sluggishness: constant tiredness despite sleep.
2. 2Weight gain and cold intolerance: a modest increase in weight and feeling cold when others are comfortable.
3. 3Dry skin, hair thinning and brittle nails: along with a puffy face, hoarse voice and swelling at the front of the neck.
4. 4Constipation, slow heart rate and muscle aches: sluggish bowel, cramps and joint stiffness.
5. 5Menstrual and fertility problems: heavy or irregular periods and difficulty conceiving.
6. 6Low mood, poor memory and concentration: sometimes mistaken for depression.

Hyperthyroidism

1. 1Weight loss despite a good appetite and frequent bowel movements.
2. 2Palpitations and rapid heartbeat, sometimes an irregular rhythm.
3. 3Heat intolerance and excessive sweating.
4. 4Anxiety, irritability, tremor and trouble sleeping.
5. 5Muscle weakness and tiredness, with thinning hair and light periods.
6. 6Eye symptoms in Graves' disease: bulging, gritty or red eyes and double vision.

Who Is at Risk?

• Women, especially after pregnancy and around menopause.
• People over 60.
• Those with a family history of thyroid disease or autoimmune conditions such as type 1 diabetes, vitiligo or rheumatoid arthritis.
• People with a history of neck radiation or thyroid surgery.
• Those taking medicines such as amiodarone or lithium.
• Women who are pregnant or planning pregnancy.

Thyroid Disease and Pregnancy

Thyroid hormones are essential for the baby's brain development, particularly in early pregnancy. Untreated hypothyroidism increases the risk of miscarriage, anaemia, high blood pressure, premature birth and developmental problems in the child. Women with known thyroid disease should plan pregnancy with their doctor, as the dose of thyroxine often needs to be increased early in pregnancy. TSH should be checked soon after pregnancy is confirmed and monitored regularly.

How Thyroid Problems Are Diagnosed

• Blood tests: TSH is the first test, with free T4 and sometimes free T3. A high TSH with low T4 means hypothyroidism; a low TSH with high T4 and T3 means hyperthyroidism.
• Thyroid antibodies: anti-TPO antibodies indicate Hashimoto's thyroiditis, and TSH receptor antibodies point to Graves' disease.
• Ultrasound of the neck: looks at the size and texture of the gland and any nodules.
• Fine needle aspiration cytology: a thin needle samples suspicious nodules.
• Thyroid scan: shows how active different parts of the gland are, which helps in hyperthyroidism.

Blood tests should ideally be done in the morning, and you should tell your doctor about biotin supplements, which can interfere with results.

Treatment

Hypothyroidism is treated with daily levothyroxine, a synthetic thyroid hormone, taken on an empty stomach, typically 30 to 60 minutes before breakfast, with water, and separated by at least four hours from iron, calcium and antacids. The dose is adjusted based on TSH levels checked every six to twelve weeks at first and then once or twice a year. Most people need treatment lifelong, and stopping medicine without advice leads to relapse.

Hyperthyroidism can be treated with:

• Antithyroid medicines such as carbimazole or methimazole, which lower hormone production, usually for 12 to 18 months in Graves' disease.
• Beta-blockers for quick relief of palpitations and tremor.
• Radioactive iodine, which gradually destroys overactive thyroid tissue.
• Surgery (thyroidectomy), for large goitres, suspicious nodules, cancer or when other treatments are not suitable.

Nodules and cancer. Benign nodules may only need monitoring. Cancers are usually treated with surgery, sometimes followed by radioiodine and hormone therapy. Outcomes are excellent for most common types.

Diet and Lifestyle for Thyroid Health

1. 1Get enough iodine through iodised salt, but avoid excess iodine from supplements such as kelp.
2. 2Eat a balanced diet with selenium and zinc sources such as nuts, seeds, eggs, fish, whole grains and pulses.
3. 3Cruciferous vegetables such as cabbage, cauliflower and broccoli are safe in normal cooked amounts. Soy products and high-fibre meals should be spaced from medicine.
4. 4Take medicine consistently and at the same time each day.
5. 5Exercise regularly to manage weight, mood and energy.
6. 6Avoid crash diets and unproven "thyroid detox" supplements.
7. 7Manage stress and sleep.
8. 8Do not self-adjust doses, and recheck TSH after any change in weight, pregnancy or other medicines.
9. 9Examine your neck: look for swelling or lumps in the mirror with a glass of water, and tell your doctor about any change.

Myths About Thyroid Disease

• "Hypothyroidism causes big weight gain." It often causes modest weight gain, mostly from fluid and slowed metabolism, which improves with treatment.
• "Thyroid tablets are addictive." They replace a hormone your body lacks, just as insulin replaces missing insulin.
• "Only women get thyroid disease." Women are affected more often, but men and children can develop it too.
• "Thyroid nodules are always cancer." Most are benign.
• "You can stop medicine once you feel better." Feeling better means the dose is working.

Thyroid Disease in Children and Older Adults

Newborns are screened for congenital hypothyroidism soon after birth because early treatment prevents intellectual disability. In older children, thyroid problems can cause slow growth, delayed puberty or poor school performance. In older adults, symptoms are often subtle or mistaken for ageing: fatigue, constipation, memory problems or low mood in hypothyroidism, and weight loss, atrial fibrillation or weakness in hyperthyroidism. Doses of levothyroxine in older adults and people with heart disease are started low and increased slowly. Anyone over 60 with unexplained changes in energy, mood or weight benefits from a TSH test.

Tips for Taking Thyroid Medicine Correctly

• Take your tablet at the same time every day, ideally first thing in the morning on an empty stomach.
• Wait 30 to 60 minutes before eating, or take it at bedtime at least three hours after the last meal if your doctor agrees.
• Keep iron, calcium, multivitamins and antacids at least four hours apart.
• If you miss a dose, take it as soon as you remember the same day; do not double up the next day without advice.
• Always tell your doctor if you change brands, since small differences may need monitoring of TSH.
• Repeat TSH six to eight weeks after any dose change, and annually when stable.

Care at Trustmed Hospital

At Trustmed Hospital in Badshahpur, Gurugram, our general medicine and gynaecology teams diagnose and manage thyroid disorders, including in pregnancy, with in-house diagnostics and surgical support from our surgery department if a procedure is needed. Book an appointment for a thyroid check.

Key Takeaways

• An underactive thyroid causes tiredness, weight gain, cold intolerance and constipation, while an overactive thyroid causes weight loss, palpitations and anxiety.
• A simple TSH blood test diagnoses most thyroid problems.
• Levothyroxine is taken on an empty stomach and the dose is adjusted with regular tests.
• Thyroid control is especially important before and during pregnancy.

Quick Checklist

1. 1Take your thyroid tablet at the same time every morning.
2. 2Keep iron, calcium and antacids at least four hours away from it.
3. 3Repeat TSH as advised, and after any dose change.
4. 4Tell your doctor immediately if you become pregnant.

Frequently Asked Questions