Hypothyroidism

Hypothyroidism means the thyroid gland is producing too little hormone, slowing down the body's metabolism. It is common, easily diagnosed with a single blood test, and straightforward to treat.

Symptoms

Not everyone gets every symptom, and the pattern can differ in older people, in people with diabetes and in children. These are the ones most often reported.

• Persistent tiredness and sleepiness
• Weight gain despite no change in diet
• Intolerance of cold
• Dry skin, hair fall and brittle nails
• Constipation
• Heavy or irregular periods, and difficulty conceiving
• Puffiness of the face, low mood and slowed thinking

When to see a doctor

• Unexplained tiredness, weight gain or hair fall lasting several weeks
• Any woman planning pregnancy or newly pregnant should have thyroid function checked
• A visible swelling in the front of the neck
• Severe drowsiness, very low body temperature or confusion in an elderly patient — attend the emergency department

Tests that may be advised

Your consultant will order only the investigations that change the plan. Most of the following are available on the SIMS campus, so results usually come back the same visit.

• TSH and free T4
• Thyroid antibody testing where autoimmune thyroiditis is suspected
• Haemoglobin, lipid profile and blood sugar
• Ultrasound of the neck if there is a swelling or nodule
• Periodic repeat testing after a dose change

How it is treated

Treatment is decided case by case — by how advanced the problem is, what else you are being treated for, and what you can realistically sustain. Broadly, it involves the following.

• Daily thyroid hormone replacement taken on an empty stomach, well before food
• Periodic blood tests so the dose can be titrated rather than guessed
• Separating the tablet from calcium and iron supplements by several hours
• Closer monitoring during pregnancy, when requirements usually rise
• Treatment is generally lifelong; stopping when symptoms improve causes relapse