Understanding Hypothyroidism: A Simple Guide

Your thyroid is a small, butterfly-shaped gland in your neck that helps control how your body uses energy. If your thyroid doesn’t make enough hormones, it’s called hypothyroidism. This can make your body slow down and cause all sorts of problems. Let’s take a closer look!

Hypothyroidism is very common. Women are much more likely to get it than men, and the risk goes up after age 60. Because it comes on slowly, many people blame their symptoms on getting older, stress, or a busy life for years before anyone checks. The good news is that it’s easy to test for and very treatable.

What Causes Hypothyroidism?

Hypothyroidism can happen for different reasons, like:

• Hashimoto’s disease: This is when your immune system attacks your thyroid by mistake. It’s the most common cause in the United States, and it often runs in families.
• Not enough iodine: Your thyroid needs iodine to work properly. This is the top cause worldwide, but it’s less common here because of iodized salt.
• Thyroid surgery or radiation: Removing part or all of the thyroid, radioactive iodine treatment, or radiation to the neck can cause it to stop making enough hormone.
• Pregnancy: Some women develop thyroid problems during or after pregnancy.
• Other issues: Some medicines, like lithium and amiodarone, and other illnesses can also affect your thyroid.

You’re at higher risk if you’re a woman, over 60, have a family member with thyroid disease, or have another autoimmune condition like type 1 diabetes, celiac disease, or rheumatoid arthritis.

What Are the Symptoms?

When your thyroid isn’t working well, you might feel:

• Tired all the time
• Cold, even when it’s warm
• Sad or moody
• Forgetful or slow to think
• Gaining weight easily
• Dry skin or hair loss
• Constipation
• Muscle aches, stiffness, or joint pain
• Heavier or irregular periods
• A puffy face, hoarse voice, or slow heart rate

Sometimes these symptoms are hard to notice, but it’s important to pay attention if they don’t go away. An untreated thyroid can also raise your cholesterol, so it’s worth checking your thyroid if your cholesterol is high.

How Is It Diagnosed?

A simple blood test is all it takes to get started:

• TSH (thyroid stimulating hormone): This is the main screening test. When your thyroid is slow, your brain sends out more TSH to push it harder, so a high TSH usually means an underactive thyroid.
• Free T4: This measures the main hormone your thyroid makes. Low free T4 with a high TSH confirms hypothyroidism.
• Free T3: This is the active form of thyroid hormone your cells actually use. It can help us see the full picture, especially if you still don’t feel well on treatment.
• Thyroid antibodies (TPO): These tell us if Hashimoto’s is the cause.

Some people have a mildly high TSH with a normal T4. This is called subclinical hypothyroidism. Not everyone with it needs medicine right away, and we’ll decide together based on your symptoms, your numbers, and whether you’re pregnant or planning to be.

Tip: Biotin (found in many hair, skin, and nail supplements) can throw off thyroid blood tests. Stop it for 2 to 3 days before your lab draw.

What Happens If It’s Not Treated?

If hypothyroidism isn’t treated, it can lead to:

• Heart problems, including high cholesterol and heart failure
• Infertility (trouble having a baby) and problems during pregnancy
• Goiter (a big lump in your neck from a swollen thyroid)
• Depression and memory problems
• Myxedema, a rare but serious condition that makes you very sick

How Is It Treated?

Doctors treat hypothyroidism with a pill called levothyroxine, liothyronine, or both, which replaces the hormone your thyroid isn’t making. Levothyroxine (T4) is the standard starting point. Liothyronine (T3) is the active hormone, and some people who still don’t feel right on T4 alone feel better when we add it. Taking it every day helps your body feel better and work like it should.

How you take your thyroid pill matters a lot:

• Take it at the same time every day, on an empty stomach with a full glass of water, 30 to 60 minutes before breakfast or coffee. Some people do well taking it at bedtime, at least 3 hours after eating. Just be consistent.
• Keep it at least 4 hours away from calcium, iron, multivitamins with minerals, and antacids. These block absorption.
• Tell us if you start acid reflux medicine, birth control, or estrogen, since these can change how much you need.
• We usually recheck your TSH about 6 to 8 weeks after starting or changing a dose, then about once a year once you’re stable.
• Don’t switch brands or stop on your own. If you become pregnant, call us right away, because most women need a higher dose early in pregnancy.

Most people need treatment for life, but once the dose is right, many feel like themselves again.

Are There Natural Ways to Help?

While medicine is the most important treatment, some natural things can help support your thyroid:

• Eat iodine-rich foods like seafood, eggs, and dairy, and use iodized salt in moderation. Avoid high-dose iodine or kelp supplements unless we recommend them, because too much iodine can make some thyroid problems worse.
• Get selenium from nuts, like Brazil nuts, and fish. One or two Brazil nuts a day is plenty, since too much selenium can be harmful.
• Stay active with light exercise like walking. It helps with energy, mood, and weight.
• Manage stress with relaxation techniques like deep breathing or yoga, and get good sleep.
• Avoid foods that block iodine, like too much soy or raw cabbage, unless cooked. Cooking cabbage, broccoli, kale, and similar vegetables takes care of most of the problem, so you don’t need to give them up.
• Check your vitamin D, B12, and iron. Low levels are common in people with thyroid disease and can add to the fatigue.

When to See a Doctor

If you think you might have hypothyroidism, talk to your doctor. A simple blood test can check your thyroid levels and help you get the right care. If you’re already on thyroid medicine and still feel tired, cold, or foggy, come in. It may just be a dose that needs adjusting.

Taking care of your thyroid helps your whole body feel its best! Don’t wait—check in with your doctor if you’re not feeling like yourself.

This information is brought to you by Minuteman Medicine. Our team is here to help you stay healthy every step of the way!

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