Hypothyroidism
Sources consulted
This article is original patient-education content.
- WHO—Health topics A–Z(2024)
- NHS—Health A to Z(2024)
- CDC—Health topics(2024)
Based on international clinical guidelines
Overview
Hypothyroidism is a condition where your thyroid gland does not produce enough thyroid hormone. This is a small, butterfly-shaped gland in your neck. Thyroid hormone helps control how your body uses energy. When you don't have enough, many body functions slow down.
Key facts
- The thyroid gland is located at the front of your neck, just below your Adam's apple.
- Thyroid hormone affects your heart rate, body temperature, and metabolism.
- Hypothyroidism is common and can be treated with daily medicine that replaces the missing hormone.
Yes, it is quite common. In the UK, about 2 in every 100 people have hypothyroidism. It is more common as you get older and in women.
Hypothyroidism can affect anyone, but it is most common in women over the age of 60. People with a family history of thyroid problems or other autoimmune conditions, such as type 1 diabetes, are also at higher risk.
Symptoms
- Confusion or feeling very drowsy
- Very slow heart rate or trouble breathing
- Fainting or passing out
- ⚠Extreme tiredness that does not get better
- ⚠Rapid swelling in the face, hands, or legs
- ⚠Severe constipation that does not go away
Common symptoms
- Feeling very tired all the time
- Unexplained weight gain
- Feeling cold when others are warm
- Dry skin and hair
- Constipation
- Depression or low mood
- Slow heart rate
- Muscle aches and weakness
Symptoms in children
- Slow growth and short height
- Delayed puberty
- Poor performance in school
- Tiredness and low energy
Symptoms in older adults
- Memory problems that seem like dementia
- Depression
- Slow movements and stiffness
- Hoarse voice and thickened skin
Causes
Main causes
- Hashimoto's thyroiditis: an autoimmune disease where your immune system attacks your thyroid gland.
- Treatment for an overactive thyroid: for example, radioactive iodine therapy or thyroid surgery.
- Radiation therapy to the neck area for cancer.
- Some medicines, such as lithium used for bipolar disorder.
- Iodine deficiency, though this is rare in countries like the UK where iodine is added to salt.
Risk factors
- Being female
- Being over 60 years old
- Having a family history of thyroid disease
- Having another autoimmune condition, such as type 1 diabetes, celiac disease, or rheumatoid arthritis
- Having Turner syndrome (a genetic condition in females)
When to see a doctor
See a doctor urgently if:
- If you have symptoms like confusion, very slow heart rate, or trouble breathing – call your local emergency number right away.
- If you have sudden severe swelling in your face or tongue, or feel like your throat is closing.
Book a routine appointment if:
- If you have been feeling very tired for no clear reason, gaining weight, feeling cold, or have dry skin and constipation.
- If you notice a change in your mood, like feeling depressed or having trouble concentrating.
- If you have a family history of thyroid problems and are feeling unwell.
Diagnosis
Hypothyroidism is diagnosed with a simple blood test. Your doctor will check the level of thyroid stimulating hormone (TSH). A high TSH level means your thyroid is not working hard enough. Sometimes they also check the amount of T4 hormone.
Tests that may be done
- Blood test for TSH (thyroid stimulating hormone)
- Free T4 test
- Thyroid antibody test to check for autoimmune causes
What to expect at your appointment
Your doctor or a nurse will take a small sample of blood from your arm. This only takes a few minutes. The results usually come back in a few days. If hypothyroidism is confirmed, your doctor will explain treatment options and what to expect.
Treatment
Treatment is simple and effective. You take a tablet every day that replaces the missing thyroid hormone. The dose is tailored to you and is checked with regular blood tests. Most people feel much better after starting treatment.
Self-care at home
- Take your thyroid medicine at the same time each day, usually first thing in the morning on an empty stomach.
- Do not skip doses or change your dose without talking to your doctor.
- Keep a regular routine and take your medicine consistently – it works best that way.
Medical treatments
The main treatment is a daily tablet containing a synthetic version of thyroid hormone. Your doctor will start with a low dose and increase it slowly based on your blood test results. You will need to continue this treatment for life. Regular blood tests will be done to make sure the dose is right for you.
When is surgery considered?
Surgery is not normally used to treat hypothyroidism. It may be needed if the thyroid gland becomes very large and causes pressure on your windpipe or esophagus, but this is rare.
Living with this condition
Most people with hypothyroidism live a full and normal life. The key is to take your medicine every day and have regular check-ups with your doctor. You will have a blood test about once a year to check your levels.
Lifestyle tips
- Take your medication at the same time every day, ideally on an empty stomach.
- Avoid taking your medicine with high-fiber foods, calcium or iron supplements, or antacids – separate them by at least 4 hours.
- Manage stress with relaxation techniques like deep breathing or gentle exercise.
Diet and exercise
No special diet is needed, but a balanced diet with enough iodine is important. Good sources include fish, dairy, and iodized salt. Avoid eating large amounts of raw cruciferous vegetables like broccoli or kale, as they can affect thyroid function if eaten in huge amounts. Regular exercise, like walking or swimming, can help improve your energy and mood.
Mental health and emotional wellbeing
Hypothyroidism can cause depression, brain fog, and anxiety. Getting the right treatment usually improves these symptoms within weeks. If you are still feeling low or worried even after treatment begins, talk to your doctor. You are not alone, and help is available.
Prevention
There is no known way to prevent hypothyroidism. However, if you have a family history or are at high risk, being aware of symptoms and getting tested early can help you start treatment before complications occur.
Vaccines
There are no vaccines for hypothyroidism.
Screening programmes
Routine screening is not recommended for everyone. However, your doctor may suggest a blood test if you have symptoms or are at higher risk due to family history or other autoimmune diseases.
Complications
If left untreated
- Heart problems, such as an enlarged heart or heart failure
- Severe depression and other mental health issues
- Peripheral neuropathy – nerve damage causing numbness or tingling in your hands and feet
- Myxedema coma – a rare but life-threatening emergency with low body temperature, confusion, and loss of consciousness
- Infertility and problems during pregnancy
Long-term outlook
With proper treatment, the outlook is excellent. Most people feel back to normal within a few weeks of starting medication. By taking your medicine every day and having regular check-ups, you can expect to live a long and healthy life. There is hope and effective treatment available.
Find support
International organisations
Local organisations
- NHS Choices – Underactive Thyroid ↗ · United Kingdom
Helplines
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.