Quick answer
Hypothyroidism, or an underactive thyroid, happens when your thyroid gland doesn’t make enough thyroid hormone, so many of your body’s processes slow down. Common symptoms include tiredness, feeling cold, weight gain, dry skin, constipation and low mood. The most common cause is Hashimoto’s disease, an autoimmune condition. A simple blood test diagnoses it, and a daily hormone tablet usually keeps it well controlled.
| Key takeaways |
|---|
| •Symptoms come on slowly and are easy to blame on stress, ageing or a busy life. |
| •Women and people over 60 are the most likely to develop it. |
| •A TSH blood test is the main way to diagnose it. |
| •Treatment is a daily tablet, usually for life, with regular blood tests to get the dose right. |
| •With treatment, most people start to feel like themselves again within a few weeks. |
It starts with a tiredness that doesn’t lift, no matter how much you sleep. Your jeans feel a little tighter, your skin is drier than usual, and you’re reaching for a jersey while everyone else is fine. Because these changes creep up over months or even years, many people put them down to stress, getting older or a new baby.
Sometimes, the real cause is an underactive thyroid. Hypothyroidism is common, especially in women, and the good news is that it’s easy to test for and very treatable. Here’s what you need to know about the symptoms, causes and treatment.
What is hypothyroidism?
Your thyroid is a small, butterfly-shaped gland at the front of your neck. It makes hormones, mainly T4 and T3, that control your metabolism: the speed at which your body uses energy. These hormones affect almost every part of your body, from your heart rate and body temperature to your digestion, skin and mood.
Your thyroid takes its instructions from the pituitary gland in your brain, which releases thyroid-stimulating hormone (TSH). When your thyroid doesn’t make enough hormone, many of your body’s processes slow down. This is hypothyroidism.
There are a few types (Cleveland Clinic):
| •Primary hypothyroidism: the most common type, where the problem is in the thyroid itself. |
| •Subclinical hypothyroidism: a mild form picked up on blood tests, often with few or no symptoms. |
| •Congenital hypothyroidism: present from birth, and checked for in newborn screening. |
Hypothyroidism vs hyperthyroidism
These two conditions are easy to mix up, but they are opposites:
| Hypothyroidism (underactive) | Hyperthyroidism (overactive) | |
|---|---|---|
| Thyroid hormone | Too little | Too much |
| Energy | Tired and sluggish | Restless, anxious, trouble sleeping |
| Weight | Tends to go up | Tends to go down |
| Temperature | Often feel cold | Often feel hot and sweaty |
| Heart rate | Slow | Fast or irregular |
| Bowels | Constipation | More frequent |
| Most common cause | Hashimoto’s disease | Graves’ disease |
Hypothyroidism symptoms
Hypothyroidism affects everyone differently. The most common symptoms include (Mayo Clinic):
| •Tiredness and low energy |
| •Feeling cold when others don’t |
| •Weight gain without eating more |
| •Constipation |
| •Dry skin, and coarse or thinning hair |
| •Muscle aches, stiffness or weakness |
| •Heavier or irregular periods |
| •Low mood, poor memory or “brain fog” |
| •A puffy face or a hoarse voice |
| •A slower heart rate |
Good to know: symptoms usually develop slowly, and you may only have a few of them. Many also overlap with other conditions, such as anaemia, depression or menopause, so a blood test is the only way to know for sure.
Symptoms in babies and children
Babies with an underactive thyroid may have feeding problems, yellowing of the skin (jaundice), constipation, a hoarse cry or floppy muscles. In children and teenagers, signs can include slow growth, late adult teeth and delayed puberty. If you notice any of these, speak to your GP or read our guide on when your child needs a paediatrician.
When to get help urgently
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In rare cases, severe untreated hypothyroidism can lead to a life-threatening condition called myxoedema coma. Call 082 911 straight away if someone with a thyroid problem becomes extremely drowsy or confused, feels very cold to the touch, or has slow, shallow breathing. |
What causes hypothyroidism?
There are several possible causes:
| •Hashimoto’s disease: the most common cause, where the immune system attacks the thyroid by mistake. |
| •Thyroid surgery: removing part or all of the thyroid gland. |
| •Radioactive iodine treatment: used to treat an overactive thyroid. |
| •Radiation therapy: to the head or neck, for example to treat cancer. |
| •Thyroiditis: inflammation of the thyroid, which can happen after an infection or after pregnancy. |
| •Some medicines: such as lithium and amiodarone. |
| •Pituitary problems: a rare cause, where the brain doesn’t send enough TSH. |
| •Being born with it: known as congenital hypothyroidism. |
| •Too little or too much iodine: your thyroid needs iodine to make its hormones. |
Iodine in South Africa
South Africa has required table salt to be iodised for decades, which has greatly reduced iodine deficiency (Bulletin of the World Health Organization). Most people get enough iodine from iodised salt. Too much iodine, for example from kelp or seaweed supplements, can also cause thyroid problems, so check with your doctor before taking an iodine supplement (NIDDK).
Who is at risk of hypothyroidism?
Anyone can develop hypothyroidism, but you are more likely to if you (NIDDK, Mayo Clinic):
| •Are a woman |
| •Are over 60 |
| •Have a family history of thyroid disease |
| •Have another autoimmune condition, such as type 1 diabetes, coeliac disease, rheumatoid arthritis or lupus |
| •Have had thyroid surgery, treatment for an overactive thyroid, or radiation to the neck or upper chest |
| •Are pregnant or have given birth in the past year |
Read more about the most common women’s health problems and the early signs of rheumatoid arthritis.
How is hypothyroidism diagnosed?
If your GP suspects an underactive thyroid, they will ask about your symptoms and family history and check your neck for swelling (a goitre). They will then send you for blood tests:
| •TSH test: the main test. When your thyroid is underactive, your pituitary gland makes more TSH to try to push it into action, so your TSH level goes up. |
| •Free T4 test: measures how much thyroid hormone is in your blood. |
| •Thyroid antibody test: checks whether Hashimoto’s disease is the cause. |
| TSH | Free T4 | What it may mean |
|---|---|---|
| High | Low | Hypothyroidism (underactive thyroid) |
| Slightly high | Normal | Subclinical (mild) hypothyroidism, which your doctor may monitor |
| Normal | Normal | Your thyroid is working normally |
| Low | High | Hyperthyroidism (overactive thyroid) |
Labs use slightly different reference ranges, so your doctor will explain what your own results mean. On every Health4Me option, a Hello Doctor or Network GP can refer you for blood tests according to the Health4Me pathology list.
Hypothyroidism treatment
The standard treatment is levothyroxine, a daily tablet that replaces the hormone your thyroid can’t make. It is a synthetic version of T4, and most people need to take it for life.
| •Finding the right dose: your doctor will check your TSH about 6 to 8 weeks after you start and after each dose change. Once your dose is right, you’ll usually have a blood test every 6 months, then once a year (NIDDK). |
| •How soon you’ll feel better: hormone levels respond quickly, but symptoms usually take a few weeks to improve (Cleveland Clinic). |
Tips for taking your thyroid tablet
| 1 | Take it at the same time every dayMost people take it first thing in the morning on an empty stomach, before breakfast. |
| 2 | Keep it apart from certain supplementsCalcium, iron and antacids can stop your tablet from being absorbed properly. Ask your pharmacist how long to wait between them. |
| 3 | Don’t stop or change your dose on your ownEven if you feel well, keep taking your tablet as prescribed and speak to your doctor before making any changes. |
| 4 | Tell your doctor if you’re pregnantMany women need a higher dose during pregnancy, so let your doctor know as soon as you find out (NIDDK). |
| 5 | Check before taking supplementsAsk your doctor before taking iodine, kelp or other supplements that could affect your thyroid. |
Does subclinical hypothyroidism need treatment?
Not always. Mild cases can settle on their own, so your doctor may recheck your blood test after a few months before deciding whether you need medication (Cleveland Clinic).
Living well with hypothyroidism
Once your treatment is working, most people with hypothyroidism live full, healthy lives. These habits help:
| •Eat a balanced diet. There’s no special thyroid diet, but try to keep high-fibre foods and soy consistent around the time you take your tablet. |
| •Stay active to boost your energy and help manage your weight. |
| •Look after your mood. Low mood and anxiety are common with thyroid problems, so talk to someone if you’re struggling. Read why it’s important to take care of your mental health. |
| •Keep up with your check-ups, including cholesterol, as an underactive thyroid can raise LDL (“bad”) cholesterol. Our guide to what your health check numbers mean explains your results. |
Complications of untreated hypothyroidism
Left untreated, hypothyroidism can lead to (Mayo Clinic):
| •An enlarged thyroid gland (goitre) |
| •High cholesterol and a higher risk of heart disease |
| •Nerve damage, causing tingling or numbness in the hands and feet |
| •Fertility problems |
| •Problems during pregnancy |
| •Myxoedema coma, which is rare but life-threatening |
With the right treatment and regular check-ups, these complications are largely preventable.
Hypothyroidism and pregnancy
During pregnancy, your body needs more thyroid hormone. Untreated hypothyroidism can raise the risk of complications for both mother and baby, so it’s important to keep your levels well controlled.
| •If you already take a thyroid tablet, tell your doctor as soon as you know you’re pregnant, as your dose may need to go up. |
| •Your doctor will check your thyroid levels more often during pregnancy. |
| •Some women develop thyroid problems in the months after giving birth, known as postpartum thyroiditis. |
Learn more about the routine antenatal tests all pregnant women need and health insurance maternity benefits.
How Health4Me helps you manage hypothyroidism
Hypothyroidism is one of 27 conditions covered by Health4Me’s chronic benefit, available on the Gold option. Here’s how Health4Me supports you, from your first symptoms to long-term care.
Chronic cover on the Gold option
| •Chronic medication from the network prescribed chronic medication formulary. Rules and protocols apply. |
| •Pathology and radiology to monitor your condition, according to the Health4Me pathology and radiology lists. |
| •Pre-authorisation is required, and waiting periods apply. |
| •For questions about your chronic benefit, call Momentum Health4Me on 0860 10 29 03. |
Specialist visits on the Gold option
Gold members can see a specialist, such as an endocrinologist, for up to two visits a year with a Network GP referral and pre-authorisation. Any shortfall is paid by the member, and waiting periods apply.
Support on every option
| •Unlimited GP visits at a Network GP to talk through your symptoms. |
| •Unlimited Hello Doctor consultations by chat, phone or video call, 24 hours a day. |
| •Basic pathology: blood tests when a Hello Doctor or Network GP refers you, according to the Health4Me pathology list. |
| •A yearly health assessment to keep track of your blood pressure, cholesterol and blood sugar. |
| •The Employee Assistance Programme: free telephonic counselling if you’re finding it hard to cope. |
See everything that’s included on our benefits page or compare the options.
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Cover that supports your long-term health Health4Me Gold includes chronic cover for 27 conditions, including hypothyroidism, while every option gives you unlimited GP and Hello Doctor visits. Find the option that suits your needs and budget. |
Frequently asked questions
What are the first signs of hypothyroidism?
The first signs are often tiredness, feeling cold when others don’t, weight gain, constipation and dry skin. They usually come on slowly over months or even years, so they are easy to put down to stress or getting older.
What is the main cause of hypothyroidism?
The most common cause is Hashimoto’s disease, where the immune system attacks the thyroid gland. Other causes include thyroid surgery, radiation treatment and some medicines. In South Africa, iodised salt means iodine deficiency is far less common than it used to be.
Can hypothyroidism be cured?
Hypothyroidism usually can’t be cured, but it can be controlled very well with a daily thyroid hormone tablet. Some temporary forms, such as thyroid inflammation after pregnancy, can settle on their own.
Does hypothyroidism cause weight gain?
It can cause some weight gain, partly from fluid build-up. Weight often improves once the condition is treated, especially alongside a balanced diet and regular activity.
What should I avoid if I have hypothyroidism?
Avoid taking your thyroid tablet at the same time as calcium, iron or antacids, as they can stop it working properly. Check with your doctor before taking iodine, kelp or other supplements, and don’t stop your medicine without advice.
How long does it take for levothyroxine to work?
Hormone levels start to respond quickly, but most people notice their symptoms improving within a few weeks. Finding exactly the right dose can take a few months of regular blood tests.
Is hypothyroidism more common in women?
Yes. Women are much more likely than men to develop hypothyroidism. It is also more common in people over 60 and in women during or after pregnancy.
What is the difference between hypothyroidism and hyperthyroidism?
Hypothyroidism is an underactive thyroid that slows the body down, causing tiredness, weight gain and feeling cold. Hyperthyroidism is an overactive thyroid that speeds the body up, causing weight loss, a racing heart and feeling hot.
Is hypothyroidism covered by health insurance?
Health4Me covers hypothyroidism under its chronic benefit on the Gold option. This includes chronic medication from the network formulary and tests to monitor your condition. Pre-authorisation is required and waiting periods apply.
Final thoughts
Hypothyroidism is common, easy to miss and very manageable once it’s diagnosed. If you’ve been feeling tired, cold and sluggish for a while, don’t just put it down to a busy life: ask your GP about a thyroid test. With a daily tablet and regular check-ups, most people feel like themselves again. If you’d like to know more about chronic cover, compare our options or ask for a call back and our team will gladly help.
Disclaimer: This article is for general information only and does not replace medical advice. Always speak to your doctor before starting, stopping or changing any medication.
Momentum Health4Me is not a medical scheme product and is not a substitute for medical scheme membership. Benefits are subject to the product terms and conditions, including pre-authorisation, waiting periods and benefit limits.
