Eight hours of sleep and still feeling exhausted. Hands are cold while everyone else in the office is in T-shirts, and the pants are tight even though nothing has changed in the diet. Each of these complaints has a hundred harmless explanations. However, together they can indicate hypothyroidism, a condition that starts gradually and often remains undetected for a long time.
What the Thyroid Controls in the Body
The thyroid gland is located below the larynx and weighs only a few grams. It produces the hormones thyroxine (T4) and triiodothyronine (T3). These hormones determine how quickly cells work: how much energy they consume, how fast the heart beats, how warm the body stays, and how quickly digestion occurs.
It is regulated by the pituitary gland through the hormone TSH. If there is too little thyroid hormone in the blood, the pituitary gland releases more TSH to stimulate the thyroid. A high TSH level is therefore the first signal that the thyroid is not keeping up.
How to Notice a Hypothyroid Condition
The symptoms develop over months to years. Many affected individuals get used to their fatigue and consider it normal. Commonly mentioned are:
- Persistent fatigue and lack of energy, even after sufficient sleep
- Sensitivity to cold, cold hands and feet
- Weight gain of a few kilos without changes in diet
- Dry skin, brittle hair, hair loss, brittle nails
- Constipation
- Concentration problems, forgetfulness, low mood
- Hoarse voice, swelling in the face or eyelids
- In women, irregular or heavier menstrual bleeding
No single symptom is definitive. If you recognize three or four of these in yourself, you do not necessarily have a thyroid disorder, but you should not let the issue go unchecked for years. A blood test usually clarifies it quickly.
Causes of Hypothyroidism
In countries with sufficient iodine supply, which includes Germany to a large extent, the most common cause is Hashimoto’s thyroiditis. The immune system attacks thyroid tissue until it can gradually produce less hormone. Women are significantly more affected than men, and the tendency occurs more frequently in some families.
Other reasons include:
- Surgery on the thyroid or treatment with radioactive iodine, for example, due to hyperthyroidism
- Radiation in the neck area
- Certain medications, such as iodine-containing preparations or lithium. Whether a medication plays a role for you will be determined by your doctor; do not stop taking anything on your own.
- Rarely: a congenital disorder or a disease of the pituitary gland
What the Blood Test Shows
It usually starts with the TSH level. If it is above the reference range of the laboratory, the free T4 is usually also measured. The combination provides a clear picture:
- TSH elevated, free T4 low: manifest hypothyroidism.
- TSH elevated, free T4 normal: latent or subclinical hypothyroidism. The body is still compensating, and the symptoms are often mild or absent altogether.
If Hashimoto is suspected, antibodies against the thyroid are also checked, especially TPO antibodies. An ultrasound examination shows whether the tissue is altered. The exact reference values differ from lab to lab, so do not rely on numbers from the internet, but read your results with the range indicated on the lab sheet.
By the way, a single slightly elevated TSH level is not a death sentence for the thyroid. It can occur due to a cold, after an illness, or due to fluctuations. Professional societies therefore recommend checking abnormal values after a few weeks before making any decisions.
How laboratory values should generally be interpreted is also shown in the article about HbA1c value: A value is always just one piece of the puzzle, never the whole diagnosis.
How Treatment Looks
In the case of manifest hypothyroidism, the missing hormone is replaced: with levothyroxine, a thyroid hormone in tablet form. It usually needs to be taken permanently. The doctor determines the dosage individually and adjusts it based on TSH checks; this may take several attempts. It is important to take the tablets as discussed, usually on an empty stomach and spaced out from certain meals and preparations, and not to change the amount on your own.
In the case of subclinical hypothyroidism, the decision is more nuanced. Here, the TSH level, symptoms, age, desire for children, and the presence of antibodies play a role. Sometimes, only observation is done initially, and the value is rechecked after a few months.
Supplementing with selenium or iodine does not replace treatment. Additional iodine can even be unfavorable in Hashimoto, so you should only take such preparations after consulting.
Hypothyroidism or Normal Fatigue?
Fatigue, weight gain, and low mood are among the most common complaints. Not every weight gain is due to the thyroid, and the thyroid alone rarely explains significant weight. Sleep deprivation, stress, elevated blood sugar, or the onset of insulin resistance can also have similar effects. Sleep and stress are topics in their own right; more on this in the article about sleep disorders.
Therefore, when someone comes to the practice due to fatigue, several values are usually determined: blood count, blood sugar, iron status, and TSH. This way, the thyroid is not prematurely suspected but also not overlooked.
When to See a Doctor Quickly
A pronounced hypothyroidism can, in rare cases, become critical. Call emergency services at 112 if the following occurs with known or suspected hypothyroidism: severe drowsiness leading to confusion or unconsciousness, significantly slowed pulse, noticeably low body temperature.
You should make an appointment with your general practitioner in the coming weeks if:
- Fatigue, sensitivity to cold, and weight gain persist together for weeks
- You notice swelling in your neck or your voice changes
- You are pregnant or want to become pregnant and a thyroid disorder is known or occurs in your family
- You are being treated for hypothyroidism and the symptoms do not improve
Frequently Asked Questions
Can you have hypothyroidism without symptoms?
Yes. Especially the subclinical form is often only discovered accidentally during a blood test. Whether treatment is necessary depends on the individual case.
Can hypothyroidism go away?
It depends on the cause. In the case of Hashimoto, it usually remains. After an inflammation of the thyroid or due to a triggering medication, it can, however, regress. Therefore, have your values checked regularly.
How often are the values checked?
After starting or changing treatment, usually after a few weeks, later at larger intervals, often once a year. Your practice determines the rhythm.
Also Read
- Understanding HbA1c: What Long-Term Blood Sugar Reveals
- Insulin Resistance: How to Recognize It
- Sleep Medicine: Ways to Restful Sleep
This article is for informational purposes only and does not replace medical advice.
Sources
- Chaker L., Bianco A. C., Jonklaas J., Peeters R. P.: Hypothyroidism. The Lancet 2017;390(10101):1550–1562.
- Jonklaas J. et al.: Guidelines for the Treatment of Hypothyroidism. Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid 2014;24(12):1670–1751.
- Pearce S. H. S. et al.: 2013 ETA Guideline: Management of Subclinical Hypothyroidism. European Thyroid Journal 2013;2(4):215–228.