Hypothyroidism means the thyroid gland does not make enough thyroid hormone, which slows down many of the body's functions.
Overview
The thyroid is a small butterfly-shaped gland in the front of the neck. The hormone it makes sets the pace of the body — how fast you burn energy, how your heart beats, how your digestion works and how you feel.
When the gland is underactive, everything slows down. Symptoms build up gradually and are easy to mistake for stress, ageing or simply being busy.
It is common in India, and considerably more common in women than in men.
It is diagnosed with a simple blood test and treated with one tablet a day. Most people feel substantially better once the dose is right.
Symptoms of Hypothyroidism
- Tiredness that does not improve with rest
- Weight gain without a clear change in diet
- Feeling cold when others are comfortable
- Dry skin and hair fall
- Constipation
- Heavy or irregular periods, and difficulty conceiving
- Low mood, poor concentration and forgetfulness
- Puffiness of the face, especially around the eyes
- A slower heart rate
- Hoarse voice, or swelling at the front of the neck
What causes it
- Hashimoto's thyroiditis — the immune system gradually damages the thyroid. This is the commonest cause.
- Iodine deficiency, which is now much less common in India since salt iodisation
- Surgical removal of the thyroid, or radioactive iodine treatment
- Certain medicines, including lithium and amiodarone
- Some babies are born with an underactive thyroid, which newborn screening detects
Who is at higher risk
- Being female
- A family history of thyroid disease
- Having another autoimmune condition, such as type 1 diabetes or coeliac disease
- The year after childbirth
- Previous thyroid surgery or neck radiation
- Age over 60
Tests and diagnosis
These are the tests doctors commonly use. Which ones you need depends on your symptoms.
- TSH — the main test. A raised TSH suggests the thyroid is underactive.
- Free T4 — a low level alongside a high TSH confirms the diagnosis.
- Anti-TPO antibodies — to check whether the cause is autoimmune.
- Doctors usually check thyroid function in pregnancy, and in anyone with unexplained tiredness, weight change or infertility.
Treatment
- Levothyroxine, a tablet that replaces the hormone the thyroid is not making. It is a replacement, not a stimulant.
- Take it on an empty stomach, usually first thing in the morning, and wait about 30 to 60 minutes before eating or drinking anything other than water.
- Keep a gap of at least four hours from calcium tablets, iron tablets and antacids, which block its absorption.
- The dose is adjusted based on repeat TSH tests, usually six to eight weeks after any change.
- Most people need it lifelong. Never change or stop the dose yourself — both too little and too much cause problems.
Prevention
- Use iodised salt for cooking
- If you are pregnant or planning a pregnancy, ask for a thyroid test — untreated hypothyroidism affects the baby's development
- If a close family member has thyroid disease, mention it to your doctor and get tested if symptoms appear
When should you see a doctor?
See a doctor if you have persistent tiredness, unexplained weight gain, hair fall, constipation or irregular periods — especially together. Ask for a thyroid test if you are planning a pregnancy or are already pregnant.
Frequently Asked Questions
What does a high TSH mean?
A high TSH usually means the thyroid is underactive. The pituitary gland raises TSH to push the thyroid to work harder, so a high level is a signal that the gland is not producing enough hormone.
Why must levothyroxine be taken on an empty stomach?
Food, tea, coffee, calcium and iron all reduce how much of the tablet your body absorbs. Taking it on an empty stomach with water, and waiting 30 to 60 minutes before eating, keeps the dose consistent from day to day.
Is hypothyroidism permanent?
In most cases yes, and treatment is lifelong. Some forms — such as thyroid inflammation after pregnancy or a viral illness — are temporary and recover on their own. Your doctor will tell you which type you have.
Does hypothyroidism cause weight gain?
It can, but usually a modest amount — often a few kilograms, much of which is retained fluid rather than fat. Large weight gain generally has other contributing causes, and treatment alone will not resolve it.
Questions to ask your doctor about Hypothyroidism
Pick the three that matter most to you and write them down before your appointment. Consultations are short, and almost everyone forgets at least one.
- What was my TSH, and what range are we aiming for?
- When will you recheck my TSH after this dose change?
- How long after taking the tablet can I have tea or breakfast?
- Which of my other tablets need a gap from this one?
- Is this lifelong, or could it be temporary in my case?
- What should I do if I am planning a pregnancy?
What this costs, and what is free
Government hospitals and health and wellness centres provide screening and treatment for blood pressure, diabetes and common long-term conditions at little or no cost.
Eligible families are covered up to ₹5 lakh per year for hospitalisation under Ayushman Bharat PM-JAY. Day-to-day medicines are not covered by PM-JAY, but Jan Aushadhi Kendras sell them at much lower prices.
Generic versions are sold at Jan Aushadhi Kendras at substantially lower prices than branded packs of the same medicine.
The main long-term cost is medicines taken daily for years, not the consultation. Asking your doctor to write generic names, and buying at a Jan Aushadhi Kendra, is usually the single biggest saving available.
Source: Ayushman Bharat PM-JAY, National Health Authority, Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP)
Prices and scheme rules change. Confirm current details with the hospital or Kendra before you rely on them.