The thyroid is a gland in your neck, right below the voice box, that controls the way your body uses and stores energy. By producing a molecule called thyroid hormone, your body’s metabolism and temperature is constantly regulated. When there is too little thyroid hormone, or not enough is being made, physicians call this hypothyroidism. When there is too much thyroid hormone, physicians make a diagnosis of hyperthyroidism. In both cases, it can be difficult to make a diagnosis because patients can have little to no symptoms. However, the clinical picture can change drastically depending on how your thyroid hormone levels are.
In hypothyroidism, or an underactive thyroid, many patients feel tired. Fatigue is a difficult symptom to treat, because there are many, many diseases that can make a patient tired. However, patients with hypothyroidism also tend to get cold easily, and they may also have changes with increased hair loss or more brittle hair. More frustratingly, some patients can have problems with constipation as well.
As a physician, I get worried about hypothyroidism because patients can get slower heart rates and weakened heart muscles, which worsens fatigue. These heart problems can lead to swelling, or what physicians call edema, in the legs. It can even raise your blood pressure and your cholesterol, putting more strain on an already at-risk heart.
Just as patients with too little thyroid hormone can have no symptoms, patients with too much thyroid hormone can also be asymptomatic. However, when patients do have hyperthyroidism, I expect them to have problems with irritability, anxiety, and insomnia. Such patients can also sweat too much, making sensitivity to hot weather common as well. And while people may appreciate the weight loss you can get in hyperthyroidism, the concurrent diarrhea and palpitations in these patients can raise one’s risk of abnormal heart rhythms. Since thyroid hormone is constantly being produced, it’s also not uncommon for an enlarged thyroid, or a “goiter” to form as well.
Both hypothyroidism and hyperthyroidism can disrupt one’s reproductive health as well. Hypothyroidism can make it difficult for some women to get pregnant, and if they do manage to get pregnant, it can increase the chances of having a miscarriage. Hyperthyroidism can disrupt monthly periods, making it tough to get pregnant as well. In men, hyperthyroidism can also cause breast growth or lead to sexual issues. Fortunately, these problems can improve or even resolve once the thyroid dysfunction is treated.
Of course, the type of treatment changes depending on the disorder. To help determine the diagnosis, do blood work on patients to monitor their TSH, or thyroid stimulating hormone, which can help me decide whether their thyroid gland is underproducing or overproducing hormone. I usually do these labs outpatient every 4 to 8 weeks, and titrate the prescriptions based on the results.
Treatment for hypothyroidism is straightforward based on labs. By taking thyroid hormone pills every day, we can replace the hormone that the body cannot make on its own. Of course, it is important to keep in mind that thyroid hormone pills have many different formulations and brands. While they all have the same efficacy, it’s important to stay with the same prescription and not trade pills with other patients who take thyroid hormone. It’s never a bad idea to talk to a physician if you wish to change medications for any reason, and you should never change the dosage of medication you’re taking on your own.
Treatment for hyperthyroidism is somewhat more complicated. In terms of medications, physicians can use anti-thyroid medications to calm down the thyroid and decrease how much hormone it makes. Doctors also use medications called beta blockers that treat symptoms alone and make it easier to live with elevated thyroid levels. However, if these measures are not enough, some physicians may recommend using radioiodine to destroy overactive parts of the thyroid using radiation. The amount of radiation used in this treatment is low and targeted, which reduces the likelihood of side effects.
If these options aren’t available or appropriate, hyperthyroidism can also be treated definitively with surgery to remove parts or all of the thyroid gland. This is not usually the first-line treatment for hyperthyroidism, but for some patients this may be the best choice based on the severity of symptoms or the size of their goiter, if present.
In either case, you should see your doctor if you have any symptoms that are suggestive of thyroid problems. By monitoring labs and doing a physical examination, establishing a diagnosis is an uncomplicated process, and doctors can prevent long-term problems from ever presenting.