Hypothyroidism: Common, Treatable, Often Missed

• Persistent fatigue
• Cold intolerance
• Weight gain or difficulty losing weight
• Dry skin and brittle hair
• Constipation
• Low mood and slowed thinking

Diagnosis

TSH measurement is the cornerstone. A high TSH with low free T4 confirms overt hypothyroidism; high TSH with normal T4 indicates a subclinical form.

Treatment

Daily levothyroxine on an empty stomach, with TSH monitoring at 6-8 weeks and after each dose change. Most patients return to full function within 2-3 months.

Special situations

Pregnancy increases thyroxine needs by 25-50% from early gestation; close monitoring is essential.

Avoid taking levothyroxine with calcium, iron or coffee: absorption can drop by 40%.