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Endocrine Health

Identifying the Signs and Symptoms of Hypothyroidism and Hashimoto’s Thyroiditis

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Victor J. Bernet, M.D., FACP, FACE

Secretary and Chief Operating Officer, ATA; Chair, Division of Endocrinology, Mayo Clinic Florida

Women experience thyroid problems in far greater numbers than men. It is estimated that 1 in 8 women will develop a thyroid condition in their lifetime. Autoimmune disorders are also more common in women and are related to immune system dysfunction, which leads to inflammation and damage within organs and glands, such as the thyroid. 

The autoimmune disorder Hashimoto’s thyroiditis can lead to hypothyroidism, or thyroid underactivity, as the antibodies react against and damage the thyroid. While not everyone with the thyroid antibodies of Hashimoto’s thyroiditis develops hypothyroidism, research indicates the presence of these antibodies is associated with a 5 percent risk of developing hypothyroidism each year.

The symptoms of hypothyroidism include, but are not limited to, fatigue, feeling cold, unexplained weight gain, dry skin, depressed mood, memory issues, constipation and menstrual changes, and infertility. While being a common disorder, experience indicates some patients may go undiagnosed for long periods of time.

What you should do

If you have the symptoms of hypothyroidism, simple blood tests called a TSH and Free T4 can help determine whether your thyroid is underactive. 

TSH, a hormone secreted by the pituitary, which is part of your brain, provides a measurable signal within the blood to help assess thyroid health. In the most common forms of hypothyroidism, TSH promptly rises when thyroid hormone becomes insufficient. 

If your thyroid blood test results suggest hypothyroidism is present, your healthcare team will advise you whether additional testing is warranted. In regards to management recommendations, sometimes close monitoring with serial thyroid blood tests will be advisable, while in other cases, oral thyroid hormone replacement therapy may be indicated.

As recommended by the American Thyroid Association (ATA), the majority of patients with hypothyroidism can be successfully manage the condition with an oral medication called levo-thyroxine. Choices include either a generic or brand name forms of this medication, which need to be taken once daily. Your healthcare team can advise you further about these options. 

Investigating the issue

If hypothyroidism is the cause of the symptoms, they should gradually resolve once thyroid hormone levels are back in the normal range. However, if symptoms persist despite appropriate thyroid levels, it is possible they are related to another underlying condition and not your thyroid. Further evaluation for other potential causes of the symptoms is then warranted. 

Anemia, obstructive sleep apnea, sleep disruptions, chronic pain, fibromyalgia, and behavioral health concerns like depression, anxiety, and significant stress have been found to be present in hypothyroid patients with persistent symptoms. 

After thyroid hormone replacement therapy beings, thyroid blood tests are typically checked every four to six weeks until the levels are in range and are believed to be stable. The blood tests can then be administered less frequently thereafter, such as every six to 12 months. 

In addition, special attention to managing thyroid levels and thyroid hormone replacement is necessary in women with infertility and during pregnancy. More specific recommendations can be obtained through your OB/GYN, reproductive endocrinologist, or other thyroid specialist. 

Furthermore, patient educational material about these topics is available on the ATA website, as well as published guidelines for clinicians related to the management of thyroid disorders to include those encountered during pregnancy.

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