What you need to know about hypothyroidism

Created date

June 13th, 2018
An annotated drawing of a Thyroid Gland

An annotated drawing of a Thyroid Gland

Your thyroid gland is a two-inch long organ that can become underactive and result in a disease called hypothyroidism. This condition becomes more common with age, especially among women. It can be caused by a number of reasons, including removal or atrophy of the gland, radiation, or treatment for hyperthyroidism (overactive thyroid).

Sometimes there is no obvious cause. “For some people, the thyroid gland may simply wear out due to the aging process,” says John Marcelis, M.D., regional medical director for Erickson Living and medical director at Ann’s Choice, an Erickson Living community in Bucks County, Pa.

The essential hormones secreted by the thyroid gland, triiodothyronine (T3) and thyroxine (T4), have a complex role in regulating how the body uses energy (metabolism). Untreated hypothyroidism can have a negative effect on many bodily functions.

Can be a hidden disease

The symptoms of hypothyroidism are nonspecific (see sidebar), and as you get older, signs of the disease may become indistinguishable from regular everyday problems or symptoms of other chronic conditions. “The onset of thyroid disease can be so gradual, people may not know they have it,” says Sally Pinkstaff, M.D., director of diabetes programs at Sinai Hospital in Baltimore, Md. “Many people do not realize it until their doctor tests the levels of thyroid hormones in the blood or the disease becomes advanced.”

Sometimes a blood test will show only an increased level of the hormone that stimulates production of thyroid hormones (thyroid stimulating hormone, or TSH) without corresponding low levels of T3 or T4. “In the absence of symptoms, this condition is called subclinical hypothyroidism,” Marcelis explains. “Depending on their health status, I typically monitor these patients to see if there are changes that necessitate treatment, because a fair percentage of them can progress to symptomatic hypothyroidism.”

Hypothyroidism does not always need to be treated—your doctor will determine that based on your symptoms, blood test results, and other health conditions. Typical treatment is with pure synthetic thyroxine (L-T4, levothyroxine) taken once daily. This medication helps make up for the thyroid gland’s dysfunction and treats symptoms in most people. Your doctor may start you slowly on this medication in order to allow your heart and nervous system to become accustomed to it, and you may need periodic tests to determine your blood levels. “Tell your doctor about other medications you take. They may affect how levothyroxine works,” Pinkstaff says.

As you begin treatment, be aware of signs of stress on the heart such as chest pain, shortness of breath, or confusion, and let your doctor know.

A potentially dangerous treatment

Another treatment for hypothyroidism is a form of thyroid hormone developed from pigs. It can be called nonsynthetic thyroid hormone, desiccated thyroid, or levothyroxine-liothyronine (porcine) thyroid hormone. Common brand names include Armour Thyroid, Nature Throid, and WP Thyroid. According to the American Thyroid Association, nonsynthetic thyroid is rarely prescribed, but it can still be obtained as a dietary supplement. There is no evidence, however, that it is superior to levothyroxine in safety or effectiveness.

“This drug has been determined by the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults as potentially harmful for older patients because of possible adverse effects on the heart,” Marcelis says.   

Living with hypothyroidism

If the disease is properly treated, it usually has little effect on people’s lives. Because of natural everyday body changes, however, you may notice symptoms periodically. Having a healthful diet and exercising can help you feel better. Managing stress has also been shown to be important—a 2011 study showed that women with hypothyroidism who participated in yoga reported noticeable improvements in their quality of life.

Symptoms of hypothyroidism


Weight gain

Muscle or joint aches, weakness, cramps, or stiffness

Sensitivity to cold


Pale, dry skin

Facial puffiness



Fast fact

Thyroid hormones are carried to every tissue in the body.

Source: American Thyroid Association