Thyroid problems are common but often overlooked. Learn the signs of hypothyroidism and hyperthyroidism, and why early detection matters for your overall health.
The Thyroid: Your Body's Master Controller
Tucked at the base of your neck, the thyroid gland may be small—only about 5 centimeters across—but its influence on your health is enormous. This butterfly-shaped gland produces hormones that regulate virtually every cell in your body, controlling metabolism, energy production, body temperature, heart rate, and even mood.
Thyroid disorders are remarkably common, affecting an estimated 200 million people worldwide. In the Philippines, thyroid problems—particularly goiter and thyroid nodules—have historically been prevalent, especially in mountainous regions where iodine deficiency was common. While iodized salt has reduced goiter rates, other thyroid disorders remain significant health concerns.
The challenge with thyroid disorders is that symptoms often develop gradually and can mimic other conditions. Many people live with thyroid dysfunction for years without realizing that a simple blood test could identify the problem and lead to effective treatment.
"The thyroid affects so many body systems that thyroid disorders can masquerade as depression, heart disease, digestive problems, or simply 'aging.' If you have unexplained symptoms, thyroid testing should be part of your workup." — Philippine Society of Endocrinology, Diabetes and Metabolism
How Your Thyroid Works
The thyroid gland produces two main hormones: thyroxine (T4) and triiodothyronine (T3). These hormones are released into the bloodstream and travel to every tissue in the body, where they regulate how cells use energy.
The thyroid is controlled by the pituitary gland through thyroid-stimulating hormone (TSH). When thyroid hormone levels drop, TSH rises, signaling the thyroid to produce more. When levels are adequate, TSH decreases. This feedback loop normally keeps hormone levels stable.
📊 Normal Thyroid Hormone Levels
- TSH: 0.4-4.0 mIU/L (most labs)
- Free T4: 0.8-1.8 ng/dL
- Free T3: 2.3-4.2 pg/mL
Note: Reference ranges may vary slightly between laboratories.
Hypothyroidism: The Underactive Thyroid
Hypothyroidism occurs when the thyroid doesn't produce enough hormones. It's the most common thyroid disorder, affecting women far more often than men. The most common cause worldwide is Hashimoto's thyroiditis, an autoimmune condition where the immune system attacks the thyroid.
Symptoms of Hypothyroidism
Symptoms typically develop slowly over months or years:
- Fatigue and sluggishness: Feeling tired despite adequate sleep, lacking energy for daily activities
- Weight gain: Gaining weight despite eating normally, difficulty losing weight
- Cold intolerance: Feeling cold when others are comfortable, needing extra layers
- Constipation: Slower digestive function leads to infrequent bowel movements
- Dry skin and hair: Skin becomes coarse and dry; hair may become brittle or fall out
- Depression and mood changes: Low mood, difficulty concentrating, memory problems
- Muscle weakness and aches: Joints may be stiff and painful
- Menstrual irregularities: Heavy or irregular periods, fertility problems
- Slow heart rate: Bradycardia (heart rate under 60 bpm)
- Elevated cholesterol: Thyroid affects lipid metabolism
- Puffy face and swelling: Especially around eyes and in hands and feet
- Hoarse voice: Due to thyroid enlargement or tissue changes
Hyperthyroidism: The Overactive Thyroid
Hyperthyroidism occurs when the thyroid produces too much hormone, speeding up the body's metabolism. Graves' disease, another autoimmune condition, is the most common cause. Toxic nodules and thyroiditis can also cause hyperthyroidism.
Symptoms of Hyperthyroidism
- Unexplained weight loss: Losing weight despite normal or increased appetite
- Rapid heartbeat (tachycardia): Heart rate over 100 bpm, palpitations, irregular heartbeat
- Heat intolerance: Feeling hot when others are comfortable, excessive sweating
- Nervousness and anxiety: Feeling restless, irritable, or on edge
- Tremor: Fine trembling of hands and fingers
- Sleep disturbances: Difficulty falling or staying asleep
- Frequent bowel movements: Sometimes diarrhea
- Menstrual changes: Lighter, less frequent, or absent periods
- Muscle weakness: Especially in thighs and upper arms
- Skin changes: Warm, moist, velvety skin
- Hair changes: Fine, thinning hair
- Eye problems: In Graves' disease, bulging eyes (exophthalmos), vision changes
⚠️ Thyroid Storm: A Medical Emergency
Severe, untreated hyperthyroidism can lead to thyroid storm—a life-threatening condition. Symptoms include: very high fever (over 40°C), rapid heart rate, confusion, agitation, vomiting, and diarrhea. This requires immediate emergency care.
Other Thyroid Conditions
Goiter
A goiter is an enlarged thyroid gland, visible as a swelling at the base of the neck. Goiters can occur with hypothyroidism, hyperthyroidism, or even normal thyroid function. Causes include iodine deficiency (now rare with iodized salt), Hashimoto's thyroiditis, Graves' disease, and thyroid nodules.
Thyroid Nodules
Thyroid nodules are lumps in the thyroid gland. They're very common—detectable in up to 50% of adults on ultrasound. Most nodules are benign, but about 5-15% may be cancerous, which is why evaluation is important.
Thyroid Cancer
Thyroid cancer is the most common endocrine cancer but has an excellent prognosis in most cases. The most common types (papillary and follicular) have 5-year survival rates exceeding 95%. Warning signs include a rapidly growing nodule, hoarseness, difficulty swallowing, or enlarged lymph nodes.
Getting Diagnosed
Thyroid testing is simple and involves blood tests, sometimes supplemented by imaging:
Blood Tests
- TSH (Thyroid-Stimulating Hormone): The primary screening test. High TSH suggests hypothyroidism; low TSH suggests hyperthyroidism.
- Free T4: Measures the active hormone available to tissues
- Free T3: Sometimes tested, especially in hyperthyroidism
- Thyroid antibodies: TPO antibodies (Hashimoto's), TSI (Graves')
Imaging
- Thyroid ultrasound: Visualizes thyroid size, nodules, and characteristics
- Radioactive iodine uptake scan: Shows how the thyroid is functioning
- Fine needle aspiration (FNA): Biopsy of suspicious nodules
✅ Who Should Get Thyroid Testing?
- Anyone with symptoms of thyroid dysfunction
- Women over 35 (every 5 years)
- Pregnant women or those planning pregnancy
- People with family history of thyroid disease
- Those with other autoimmune conditions
- Patients taking medications affecting thyroid (lithium, amiodarone)
- Anyone with neck swelling or nodules
Treatment Options
Treating Hypothyroidism
Hypothyroidism is treated with synthetic thyroid hormone (levothyroxine), taken as a daily pill. Treatment is typically lifelong but straightforward:
- Take medication consistently at the same time each day
- Take on an empty stomach, 30-60 minutes before breakfast
- Avoid taking with calcium, iron, or antacids (interfere with absorption)
- Regular blood tests to adjust dose as needed
With proper treatment, most people feel significantly better within weeks and can live completely normal lives.
Treating Hyperthyroidism
Several treatment options exist for hyperthyroidism:
- Anti-thyroid medications: Methimazole or propylthiouracil (PTU) reduce hormone production
- Beta-blockers: Control rapid heart rate and tremor while other treatments take effect
- Radioactive iodine: Destroys overactive thyroid tissue; often leads to hypothyroidism requiring replacement therapy
- Surgery: Removal of part or all of the thyroid in certain cases
Living with Thyroid Disease
Diet and Lifestyle
- Iodine: Essential for thyroid function. Most Filipinos get adequate iodine from iodized salt and seafood. Don't take iodine supplements without medical guidance.
- Soy and goitrogens: Large amounts may interfere with thyroid function; moderate consumption is fine.
- Exercise: Important for maintaining metabolism and managing weight
- Stress management: Chronic stress can affect thyroid function
- Sleep: Adequate rest supports hormonal balance
Pregnancy and Thyroid
Thyroid health is crucial during pregnancy. Untreated hypothyroidism can affect fetal brain development. Untreated hyperthyroidism can cause complications for mother and baby. All pregnant women should have thyroid testing, and those with known thyroid disease need close monitoring and dose adjustments.
"Many of my patients tell me they wish they'd been tested sooner. They'd attributed their symptoms to aging, stress, or just 'getting older.' Once treated, they realize how much their quality of life had suffered. A simple blood test can make a tremendous difference." — Dr. Francis Tan, Endocrinologist
When to See a Doctor
Consult an endocrinologist or internist if you experience:
- Unexplained fatigue, weight changes, or mood changes
- Heart palpitations or irregular heartbeat
- Visible swelling in your neck
- Difficulty swallowing or breathing
- Menstrual irregularities or fertility concerns
- Family history of thyroid disease
- Difficulty managing thyroid symptoms despite treatment
Take Action for Your Thyroid Health
Thyroid disorders are common, treatable, and often overlooked. If you're experiencing unexplained symptoms—especially fatigue, weight changes, mood disturbances, or temperature sensitivity—ask your doctor about thyroid testing. A simple blood test could reveal the answer to problems you've been living with for years.
Your thyroid may be small, but its impact on your health is enormous. Don't ignore the signs—get tested and take control of your well-being.
