• Hypothyroidism (underactive thyroid) is a condition in which the thyroid gland is not able to produce the required amount of thyroid hormones
  • It may not cause significant symptoms in the initial stages but over a period of time, untreated hypothyroidism results in a number of health problems such as obesity, joint pain, infertility and heart disease
  • Thyroid function tests accurately diagnose hypothyroidism
  • The condition is treated with synthetic thyroid hormones which are safe and effective. The key factor is to find the appropriate dose which varies with each patient

The signs and symptoms of hypothyroidism vary, depending on the severity of thyroid hormone deficiency. As symptoms develop slowly, initially you may not notice the mild symptoms like tiredness and weight gain


Hypothyroidism signs and symptoms may include:

  • Weight gain inspite of loss of appetite/hunger
  • Fatigue, Muscle weakness
  • Increased sensitivity to cold
  • Constipation, Dry skin, Thinning hair
  • Puffy face, Hoarseness of voice
  • Elevated blood cholesterol level
  • Muscle aches, Pain, stiffness or swelling in your joints
  • Heavier than normal or irregular menstrual periods
  • Slowed heart rate
  • Depression, Impaired memory
  • Enlarged thyroid gland (goiter)

Hypothyroidism results when the thyroid gland fails to produce sufficient thyroid hormones. Hypothyroidism may be caused by:

  • Iodine deficiency
  • Pregnancy
  • Autoimmune diseases like hashimoto’s thyroiditis
  • Over-response to hyperthyroidism treatment with radioactive iodine or anti-thyroid medications
  • Thyroid surgery
  • Radiation therapy used in the treatment of head and neck cancers
  • Medications like lithium
  • Congenital diseases
  • Tumors of Pituitary gland

Although anyone can develop hypothyroidism, the risk is increased if you:

  • Are a woman
  • Older than 60years of age
  • Have a family history of thyroid disease
  • Are pregnant or have delivered a baby within the past six months
  • Are suffering from autoimmune diseases, such as type 1 diabetes
  • History of treatment with radioactive iodine or anti-thyroid medications
  • Received radiation to neck or upper chest area
  • History of thyroid surgery (hemi thyroidectomy)

Untreated hypothyroidism can lead to a number of health issues:

  • Enlargement of thyroid known as goiter
  • Infertility
  • Mental health issues like slowed mental functioning and Depression
  • Peripheral neuropathy
  • Cardiac diseases
  • Myxedema

Blood tests

Diagnosis of hypothyroidism is based on symptoms and the results of blood tests that measure the level of TSH and sometimes thyroid hormone T4. A high level of TSH with low T4 indicates an underactive thyroid

Synthetic thyroid hormone levothyroxine is the standard treatment. Levothyroxine is to be taken orally on empty stomach every day in the morning. This restores adequate hormone levels and reverses the signs and symptoms of hypothyroidism. Treatment with levothyroxine will likely be lifelong, but the dosage may have to be changed over time

Right dosage of levothyroxine is determined based on the levels of TSH in the blood. Hence, to ensure the right dosage it is important to repeat TSH tests at regular intervals as advised by the thyroid specialist

No. Your TSH levels have become normal as your taking levothyroxine in the appropriate dosage, but if you stop taking the drug, the symptoms of hypothyroidism will gradually return. Levothyroxine dose should never be skipped or stopped without medical supervision

Levothyroxine is best taken on an empty stomach at the same time every day. Ideally, it is to be taken in the morning and wait an hour before eating or taking other medications. If you miss a dose of levothyroxine, take two pills the next day

Certain medications, supplements and some foods may decrease the absorption of levothyroxine:

  • Supplements like calcium supplements, Iron supplements or multivitamins that contain iron interfere with levothyroxine absorption. A minimum of 4 hours gap should be present between intake of levothyroxine and intake of these supplements
  • Foods like cabbage, cauliflower and soya are to be avoided


  • Hashimoto’s thyroiditis is an autoimmune disorder where antibodies are produced against the thyroid resulting in thyroid inflammation and damage
  • The thyroid damage results in decreased production of thyroid hormone (hypothyroidism)
  • The constant attack of the immune system on the thyroid leads to chronic inflammation of the thyroid
  • There is no direct relationship between thyroid cancer and thyroiditis
  • Hashimoto’s thyroiditis can sometimes become inflamed and large causing compressive symptoms
  • Although thyroid surgery is not commonly needed for Hashimoto’s thyroiditis, in select symptomatic patients, expert thyroid surgery can be tremendously beneficial



  • An autoimmune condition
  • Effects women more commonly than men
  • Often appears between 40-60 years of age
  • Appears to have some hereditary component
  • Risk Increases risk in the presence of other autoimmune disorders
  • May show pseudonodules on ultrasound
  • Diagnosed by high TSH, low Free T4 and detection of anti-thyroid antibodies

Early in the course of the disease, symptoms may not appear as the condition progresses slowly. Over time, the following symptoms may arise:


1. Thyroid hormone deficiency that may cause

  • Weight gain inspite of loss of appetite/hunger
  • Cold intolerance
  • Fatigue, Joint/muscle pain
  • Constipation
  • Irregular menstrual periods
  • Thinning hair, dry skin
  • Depression, Memory problems
  • Slowed heart rate

2. Large thyroid or goiter

3. Neck/thyroid tenderness

Hashimoto’s thyroiditis is an autoimmune disorder where antibodies are produced against the thyroid. The exact reason why antibodies are produced against thyroid is unknown. These antibodies are called thyroid peroxidase antibodies and anti-thyroglobulin antibodies

The following are a list of tests that are required in the evaluation of a patient with Hashimoto’s thyroiditis:

  • Complete medical history and physical examination
  • Thyroid profile : TSH, T3, T4
  • Thyroid antibody profile : Thyroid peroxidase antibody, Anti thyroglobulin antibody
  • Ultrasound of neck (Thyroid and lymph nodes)

1. Thyroid Hormone ReplacementThis medication compensates for the lack of hormones that the thyroid is actually producing


2. Anti-inflammatory drugs- In severe inflammation, a short duration of steroid therapy may be considered


3. Thyroid Surgery- Medical management of Hashimoto’s thyroiditis should be considered in patients prior to considering thyroid surgery. Thyroid Surgery may be recommended in patients with:

  • Symptomatic thyroiditis
  • Thyroid goiter
  • Symptoms due to increase in size of thyroid
  • Thyroid nodule suspicious for thyroid cancer on FNAC


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