What Is Hypothyroidism and How Do We Treat It?

Nearly one person in every 20 over the age of 12 have hypothyroidism. What is this condition, how do I know if I have it, and how is it treated?

Sabrina Stierwalt, PhD
5-minute read
Episode #296

How Is Hypothyroidism Diagnosed?

Because of all of the interwoven symptoms and risk factors, having any one of the signs or causes above does not mean you necessarily have an underactive thyroid. A proper diagnosis of hypothyroidism must take into account a full physical and family history.  

A diagnosis will also include a blood test that measures the body’s level of TSH, the thyroid-stimulating hormone produced by the pituitary gland, and the levels of hormones produced by the thyroid like triiodothyronine (T3) and thyroxine (T4). If the level of TSH is adequate—in other words, the thyroid is being properly stimulated to produce hormones—but the thyroid hormone levels are low, the thyroid is likely underactive. Blood tests can also reveal unusually high levels of the thyroid-attacking antibodies produced in those with Hashimoto’s disease.

How Is Hypothyroidism Treated?

The treatment for hypothyroidism may seem simple: if the body does not produce enough thyroid hormones, fill in the gap with medicine that provides the missing hormones. And in fact, the main treatment for hypothyroidism is daily doses of the synthetic hormone levothyroxine.

But returning your body to the status quo is not always straightforward. For example, finding the right dose of the synthetic hormone can be a long dance with trial and error. Too small of a dose won’t fix the problem but too large of a dose can lead to insomnia and heart palpitations. Your ability to absorb the synthetic hormone and put it to work also depends on your diet which can thus vary over time. And unfortunately, not all cases of hypothyroidism can be treated with levothyroxine. For example, in a study of over 700 patients over the age of 65, doctors found no difference in improvement of the condition on average whether they took the synthetic hormone or not.

Your thyroid uses iodine to produce its hormones, so it may seem like a clear solution to increase the iodine in your diet by taking a supplement or, say, eating more kelp or iodized salt. However, those whose hypothyroidism is linked to an autoimmune disorder, like those with Hashimoto’s disease, may be prone to harmful side effects of increased iodine that actually worsen hypothyroidism, according to the National Institute of Health.

There is also very limited evidence that opting for a gluten-free diet can help control hypothyroidism. But that evidence is so far anecdotal and more controlled research is needed to determine whether it is really the reduction in gluten intake that improves thyroid function in these cases, and not, for example, the fiber in wheat or other lifestyle changes that commonly accompany the switch to a gluten-free diet.

There is some suggestion that rates of hypothyroidism are increasing, although that could be more of a result of an increase in our ability to properly diagnose the condition than an increase in its occurrence. The best first steps to maintaining your own thyroid health are to pay attention to the range of symptoms and related bodily systems and to understand how they are all interconnected thanks to the little butterfly-shaped gland near the front of your neck.

Until next time, this is Sabrina Stierwalt with Ask Science’s Quick and Dirty Tips for helping you make sense of science. You can become a fan of Ask Science on Facebook or follow me on Twitter, where I’m @QDTeinstein. If you have a question that you’d like to see on a future episode, send me an email at everydayeinstein@quickanddirtytips.com.

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About the Author

Sabrina Stierwalt, PhD

Dr Sabrina Stierwalt earned a Ph.D. in Astronomy & Astrophysics from Cornell University and is now a Professor of Physics at Occidental College.