Thyroid Problems: Symptoms, Tests (TSH) and Treatment

The thyroid is a small butterfly-shaped gland at the front of your neck. It makes hormones that control how your body uses energy, so when it works too slowly or too quickly, you can feel it almost everywhere. Thyroid conditions are common, especially in women, and most are easy to diagnose and treat.

Underactive thyroid (hypothyroidism)

This happens when the thyroid makes too little hormone. Common symptoms include:

• Feeling tired and sluggish
• Weight gain or difficulty losing weight
• Feeling cold when others are comfortable
• Constipation
• Dry skin and hair thinning
• Low mood or poor concentration
• Heavy or irregular periods

Overactive thyroid (hyperthyroidism)

This happens when the thyroid makes too much hormone. Common symptoms include:

• Weight loss despite a normal or increased appetite
• Fast or irregular heartbeat (palpitations)
• Feeling hot, sweating a lot
• Trembling hands, nervousness or irritability
• Trouble sleeping
• Frequent bowel movements
• Sometimes, a swelling in the neck (goitre) or bulging eyes

Which tests are used?

• TSH is usually the first test. It is high in an underactive thyroid and low in an overactive one.
• Free T4 (and sometimes free T3) show how much thyroid hormone is in the blood.
• Anti-TPO antibodies can show whether the immune system is attacking the thyroid, which is the most common cause of hypothyroidism.
• Ultrasound of the neck may be advised if there is a lump or swelling.

Reference ranges differ slightly between laboratories, so results should always be read by a doctor together with your symptoms.

How is thyroid disease treated?

Hypothyroidism

It is treated with daily thyroid hormone tablets (levothyroxine). The tablet is usually taken on an empty stomach, about 30 to 60 minutes before breakfast, and your TSH is rechecked every few months until the dose is right. Treatment is often long-term.

Hyperthyroidism

Options include anti-thyroid medicines, radioactive iodine, or surgery. Beta-blocker tablets may be used for a short time to control palpitations and tremor. The best choice depends on the cause, your age and your health.

Thyroid problems and pregnancy

Thyroid hormone is important for a baby's development. If you are planning pregnancy, are pregnant, or have had thyroid problems before, ask your doctor to check your thyroid levels. Doses of thyroid medicine often need adjusting during pregnancy.

When to see an endocrinologist

See a specialist if your tests are abnormal, you have a neck lump, your symptoms continue despite treatment, you have thyroid disease along with diabetes or PCOS, or you are pregnant or planning pregnancy.

Frequently asked questions

This article is for general information only and is not a substitute for personal medical advice, diagnosis or treatment. Always speak to a qualified doctor about your own health.