Thyroid disorders (hypothyroidism and hyperthyroidism)

The thyroid is a butterfly-shaped gland at the front of the neck. It makes hormones that control how fast your body uses energy. When the gland makes too little (hypothyroidism) the whole body slows down — fatigue, weight gain, cold intolerance, dry skin, hair loss, depression. When it makes too much (hyperthyroidism) the body runs hot — palpitations, weight loss despite normal eating, anxiety, heat intolerance, fine tremor. Thyroid disease affects women about 5 times more than men. In Indian women aged 30-50 the prevalence of hypothyroidism is around 8-12%.

Why it gets missed

The symptoms of hypothyroidism look like "modern life" — tired, gaining weight, low mood. So many patients spend years writing it off as overwork or post-pregnancy tiredness before someone orders a thyroid test. The blood test is cheap (₹350-500), takes a single venous sample, and gives the answer in a few hours. There is essentially no good reason for an Indian woman with the symptoms above not to have been tested.

How we diagnose

The basic thyroid panel is:

• TSH (Thyroid Stimulating Hormone) — the first screening test. High TSH = hypothyroidism, low TSH = hyperthyroidism.
• Free T4 — adds confidence to the picture when TSH is abnormal.
• Free T3 — used when hyperthyroidism is suspected.
• Anti-TPO antibodies — used when we suspect Hashimoto's thyroiditis (autoimmune hypothyroidism, the most common Indian cause).

Sometimes an ultrasound of the neck is ordered — particularly when there is a goitre (visible thyroid swelling) or a palpable nodule.

Treatment

Hypothyroidism is the simpler scenario. We give synthetic thyroid hormone (levothyroxine) as a once-daily tablet, taken on an empty stomach 30-60 minutes before breakfast. We start at a low dose and titrate up over 6-8 weeks based on follow-up TSH. Once the right dose is found, most patients stay on it for life — TSH is checked annually. Side-effects are minimal at correct doses; problems usually mean the dose is too high.

Hyperthyroidism is more complex. Three treatment options:

• Antithyroid medication (carbimazole or methimazole) — slows hormone production. Often the first-line. Used for 12-18 months and sometimes leads to permanent remission.
• Radioactive iodine — destroys the overactive gland tissue. One-time treatment, often leads to permanent hypothyroidism that is then treated with levothyroxine.
• Surgery — total or near-total thyroidectomy. Used for very large goitres, when medication doesn't work, or when there is a suspicious nodule.

Thyroid in pregnancy

This is the highest-stakes scenario. Untreated hypothyroidism in pregnancy is associated with miscarriage, pre-eclampsia, and developmental issues in the baby. Every pregnant woman at Asian Hospital is screened for thyroid in the first trimester (TSH + T4). If hypothyroid, we start treatment immediately and recheck every 4-6 weeks until delivery. Levothyroxine is safe in pregnancy at correct doses; the danger is in not treating, not in treating.