Hypothyroidism – Diagnosis and Treatment
Diagnosis
Doctors don’t just look for tiredness, weight gain, or things like dry skin, hair loss, or feeling cold when they check for an underactive thyroid.
Symptoms like muscle weakness, depression, constipation, joint pain, slow heart rate, or a goiter often show up in other health issues, too. Because of that, doctors rely mostly on blood tests.
The main test measures thyroid-stimulating hormone (TSH) in your blood. If TSH is high, your body is probably trying to make your thyroid work harder.
When TSH goes up, doctors also check thyroid hormones like T-4 (and sometimes T-3) to see if those are low. High TSH and low T-4 make hypothyroidism pretty clear.
Sometimes, TSH is high but T-4 and T-3 look normal. This is subclinical hypothyroidism. You might not notice any symptoms with this, but regular monitoring still matters.
Doctors might run other tests for thyroid antibodies if they think you have an autoimmune issue like Hashimoto’s disease or silent thyroiditis. Imaging, like ultrasound or a thyroid scan, checks for an enlarged thyroid, nodules, or signs of chronic thyroiditis.
Medicines or supplements (like biotin) can mess with blood test results. Always let your healthcare team know what you’re taking before any tests.
| Common Tests | What They Measure |
|---|---|
| TSH | Thyroid-stimulating hormone |
| T-4 (Thyroxine) | Main thyroid hormone |
| T-3 (Triiodothyronine) | Active thyroid hormone |
| Thyroid Antibodies | Autoimmune thyroid issues |
Doctors keep checking TSH to help manage your treatment and keep your thyroid levels where they should be.
Treatment
Adjusting the Medication Amount
Most people manage hypothyroidism by taking a thyroid hormone replacement, usually synthetic T-4 hormone. Your provider will figure out the right dose for you and keep a close eye on it.
At first, they’ll check your TSH every 6 to 8 weeks. Later on, they might only need to check every 6 to 12 months, just to make sure things are still on track.
If your hormone dose is too high, you might feel extra tired, eat more than usual, have trouble sleeping, get shaky hands, or notice your heart pounding. Sometimes, switching medicine brands means you need a new dose, too.
People with heart problems or very low thyroid hormone often start with a smaller dose, giving their bodies time to adjust. This careful checking helps you avoid side effects and keeps symptoms under control.
Synthetic T-4 hormone copies the hormone thyroxine (T4), and it usually works well when taken at the right amount.
How to Take Thyroid Hormone Medicine
Take synthetic T-4 hormone by mouth, once a day, on an empty stomach. It works best if you take it at the same time every morning.
If you eat too soon after the pill, your body might not absorb as much medicine. Most doctors say to wait 30–60 minutes before eating or taking other meds.
If you forget a dose, just take it the next day with your usual dose. Try not to skip or stop doses, even if you feel better—hypothyroid symptoms can sneak back.
Some foods and supplements can lower how much medicine your body absorbs. Watch out for:
| Items that may affect levothyroxine absorption |
|---|
| Iron supplements or multivitamins with iron |
| Calcium supplements |
| Antacids with aluminum hydroxide |
| High-fiber diet or lots of soy products |
Make sure you talk with your provider about all meds and supplements you’re taking to avoid any problems.
Managing Mild Thyroid Problems
Subclinical hypothyroidism means your TSH is just a bit high, but you probably don’t feel any different. Treatment depends on your blood tests and symptoms.
Not everyone with a mild TSH change needs medicine. Sometimes, your provider will just watch and check your thyroid levels regularly.
If your TSH goes up more or you start having symptoms, they might recommend thyroid hormone therapy.
Other Treatment Options
Some people want to try something besides standard thyroid medicine. One option is desiccated thyroid extract, which comes from pig thyroid glands.
It contains both T-4 and T-3 hormones, but the amounts can change from batch to batch. Pregnant people shouldn’t use it because it can harm the baby.
Iodine deficiency can also cause thyroid problems, but you should only use iodine supplements if your doctor says so.
Getting Ready for Your Medical Visit
Before your appointment, check with the clinic about any steps you need to take, like fasting or stopping certain meds. Write down all your symptoms, even the small ones, and bring that list with you.
Note any recent life changes, stress, or family history of thyroid or pituitary problems.
A checklist like this can help you stay organized:
| Task | Done? |
|---|---|
| Note all symptoms | ☐ |
| Record all medicines and supplements | ☐ |
| List major life events/stress | ☐ |
| Ask about appointment instructions | ☐ |
| Write down questions | ☐ |
| Bring a friend or family member | ☐ |
Bring a detailed list of your medicines, including vitamins and supplements, so your provider can spot anything that might interact with thyroid treatment.
Having a family member or friend there can help—they might remember things you forget.
Questions you might want to ask include:
- What’s causing my symptoms?
- Which tests will help figure this out?
- Is this temporary or will it last?
- What treatment options do I have?
- How will this affect my daily life?
- How do I manage my other health issues at the same time?
- Should I see a hormone specialist?
If your family has a history of autoimmune diseases or thyroid problems, let your provider know. Genetics can play a big role in thyroid health.
Questions Your Doctor Might Ask
Your doctor or endocrinologist will probably ask when your symptoms started. They might want to know if your symptoms stick around or come and go.
They’ll likely ask how much these symptoms mess with your daily life. You might also get questions about what makes things better or worse. If you’ve thought about these ahead of time, your visit will go a lot smoother.
Doctors usually ask if anyone in your family has had thyroid issues or autoimmune diseases. They want to get a sense of possible genetic risks.
They’ll also want to know about your overall quality of life.
You can expect to talk about:
- When your symptoms began and how they’ve changed
- Family history of thyroid or pituitary problems
- Any medicines or supplements you take
- How symptoms affect your daily routine
Giving clear, honest answers helps your provider figure out the best next step for you.
