Hypothyroidism – popularly called a “lazy thyroid” – means the thyroid gland is underactive and thyroid hormone levels in the blood fall. Early symptoms are mild, but recognising them in time makes treatment much easier.
What is hypothyroidism?
Hypothyroidism is the most common thyroid disorder: the gland works less than normal or stops functioning altogether, so the body does not get the hormones it needs. Blood tests show a TSH above normal, with T3 and T4 normal or low.
The most common cause of hypothyroidism is Hashimoto’s thyroiditis – the immune system turning against its own thyroid gland.
Hypothyroidism can also develop after surgical removal of the thyroid, after radioactive iodine treatment or against a background of iodine deficiency.
Which symptoms should you watch for?
Hypothyroidism often progresses silently and slowly, and its signs are mistaken for ordinary tiredness or stress. Do not ignore unexplained fatigue – these are the most common signs of hypothyroidism:
- chronic fatigue, low energy, waking up as if you had not slept at all;
- intolerance to cold – hands and feet are always cold;
- weight gain despite dieting;
- dry, pale skin and hair loss;
- mood changes, mild depression, loss of motivation;
- poor memory, a deeper, hoarser voice;
- swelling of the hands and feet, constipation, menstrual irregularities.
What does TSH show?
TSH (thyroid-stimulating hormone) is the thyroid’s “manager”: it is released by the pituitary gland in the brain and tells the thyroid to produce T3 and T4. In adults TSH is usually between 0.4 and 4.0 mIU/L; some laboratories use 4.5 mIU/L as the upper limit. In children the range varies with age, while in pregnancy it is lower and assessed by trimester.
A high TSH indicates that the gland is underactive (hypothyroidism); a low TSH, that it is overactive (hyperthyroidism). If your TSH is outside the normal range, do not self-medicate – see an endocrinologist.
How to take levothyroxine correctly
Hypothyroidism is treated with levothyroxine – a synthetic form of the T4 hormone. Euthyrox and Thyroxine contain the same active substance (levothyroxine sodium); they differ in excipients and available doses. The dose is individual for each patient and is set by the doctor according to TSH. Treatment should be continued with the same product; always consult your doctor before switching from one to another.
In the stomach, calcium and iron bind to levothyroxine and form a large complex that the gut cannot absorb. As a result TSH stays high and symptoms persist even when the dose is increased.
- take it as soon as you wake up, on an empty stomach, without crushing, with a glass of water;
- do not eat or drink tea or coffee for at least 30–45 minutes afterwards;
- take it at the same time every day;
- take iron supplements at least 2 hours and calcium supplements at least 4 hours later; also leave a gap before stomach-protecting medicines;
- do not change the dose on your own – on a neighbour’s or the internet’s advice;
- on the day of a blood test, give the sample before taking the tablet;
- do not keep the medicine in the fridge.
Do you have to take it for life?
That depends on the cause of hypothyroidism. In hypothyroidism caused by Hashimoto’s, if treatment is indicated, the medicine is taken for life – the idea that it can be taken “temporarily” is wrong. After a transient thyroid problem, or when it arises only during pregnancy, lifelong medication may not be needed.
It is important to repeat TSH, T3 and T4 tests every 3–6 months and to follow up with ultrasound when needed. Pregnancy, weight changes and other medicines can affect the dose. Fatigue, hair loss, palpitations or a changed sensitivity to heat or cold may indicate that the dose is not right.
Thyroid medicines do not make you gain weight – weight gain is caused by the hormone deficiency itself, often by an insufficient dose. Do not stop the medicine for fear of putting on weight.
Levothyroxine should be taken only on a doctor’s prescription, at the right dose and under regular monitoring.
Dr. Samir Shukurov
This article is for general information only and does not replace a medical examination.