Hypothyroidism: Symptoms, TSH Levels and Treatment

Your thyroid is a small, butterfly shaped gland at the front of your neck. Its hormones (T4 and T3) set the pace of your metabolism, influencing energy, weight, heart rate, digestion, periods and mood. In hypothyroidism, the gland is underactive and everything slows down.

A study across eight Indian cities found that about 1 in 10 adults had hypothyroidism, and many were undiagnosed. Women are affected several times more often than men.

Symptoms

Symptoms develop slowly and are easy to blame on stress or age:

• tiredness and sluggishness
• weight gain and puffiness of the face
• feeling cold when others don't
• constipation
• dry skin, brittle nails and hair fall
• heavy or irregular periods, and difficulty conceiving
• low mood, poor memory or "brain fog"
• muscle aches and joint stiffness
• a slow heart rate
• a swelling in the neck (goitre) in some people

Causes

• Hashimoto's thyroiditis: an autoimmune condition where the immune system attacks the thyroid: is the most common cause in India today.
• Previous thyroid surgery or radioactive iodine treatment.
• Iodine deficiency, once widespread in India, is now much less common thanks to iodised salt.
• Some medicines, such as lithium and amiodarone.
• After pregnancy (postpartum thyroiditis).

Tests and TSH levels

The main test is TSH (thyroid stimulating hormone), made by the pituitary gland. When thyroid hormone is low, the pituitary pushes harder, so TSH goes up.

Reference ranges vary by lab and are different in pregnancy. Anti TPO antibodies can confirm Hashimoto's.

Treatment

Hypothyroidism is treated with levothyroxine, a synthetic form of T4. To get the most from it:

1. Take it first thing in the morning on an empty stomach with water.
2. Wait 30 to 60 minutes before tea, coffee or breakfast.
3. Keep a 4 hour gap from calcium, iron supplements and antacids, which block absorption.
4. Take it at the same time every day; don't switch brands without telling your doctor.
5. Recheck TSH 6 to 8 weeks after starting or changing the dose, then every 6 to 12 months once stable.

Most people need treatment for life. Symptoms usually improve within a few weeks of starting the right dose.

Thyroid and pregnancy

Untreated hypothyroidism in pregnancy can affect the baby's brain development. Women planning a pregnancy should get their TSH checked, and those already on levothyroxine usually need a higher dose as soon as pregnancy is confirmed. Read more in our early pregnancy signs guide.

Diet and thyroid

There's no special "thyroid diet". Use iodised salt, eat a balanced diet and don't take iodine or selenium supplements unless advised. Cooked cabbage, cauliflower and soy are fine in normal amounts.