How do you recognise and treat thyroid problems, and when are you in a grey area?
Blood tests give a clear picture of thyroid problems, and levothyroxine works effectively when there are clear abnormalities. With mild abnormalities and no symptoms, treatment offers little benefit for most people.
Fatigue, weight gain, feeling cold, dry skin and constipation are characteristic complaints of an underactive thyroid, but they are not specific enough to establish the diagnosis on their own. Symptoms alone are insufficient. The diagnosis stands or falls with blood tests: TSH (thyroid-stimulating hormone) and free T4 together provide a reliable picture. Around half of all thyroid problems in Europe go undetected; an underactive thyroid is by far the most frequently undiagnosed.
Once the diagnosis of hypothyroidism has been established, levothyroxine is the standard treatment. The usual starting dose is 1.5 to 1.8 micrograms per kilogram of body weight per day. If you are older than 60 or have a heart condition, treatment is started at a lower dose (12.5 to 50 micrograms per day) because of the risk of heart rhythm problems. Driving TSH too low increases the risk of atrial fibrillation and bone loss, so over- or underdosing is something to avoid.
The grey area lies with a mildly abnormal TSH in the absence of clear symptoms, also known as subclinical hypothyroidism. Most people with such a mild abnormality do not benefit from treatment. Treatment is only worthwhile when TSH exceeds 10 mIU/L, or when certain thyroid antibodies (TPO antibodies) are elevated. If levothyroxine is nonetheless started because of possible symptoms, it should be stopped if there is no improvement. Adding T3 to the treatment also does not help people who still have symptoms despite a normal TSH; other causes should then be investigated.
For an overactive thyroid there are three treatment options: inhibiting medication (thionamides), radioactive iodine, or surgery. All three work, but with each there is a chance that the thyroid will subsequently become underactive, which requires lifelong monitoring. If you use amiodarone (a widely used heart rhythm medication), your thyroid deserves periodic monitoring regardless: approximately 14% of long-term users develop hypothyroidism as a result.
Hashimoto's thyroiditis, the most common thyroid disease, causes not only fatigue and weight-related complaints but also local symptoms that are less well known: throat discomfort (in twenty to nearly 44% of patients), shortness of breath (in nearly half), swallowing difficulties and sleep apnoea. Neck pain and a feeling of fullness in the throat are still too rarely recognised in practice as thyroid-related complaints. Finally, if you have hypothyroidism and become pregnant, increase your weekly levothyroxine dose immediately by 30% (two extra doses per week) and have your thyroid function checked monthly. Discuss this with your doctor straight away.
This answer draws on several review studies and two analyses that pool the results of many individual studies. The prevalence figures for Europe come from one such summary of existing literature. The treatment standards for levothyroxine and hyperthyroidism are based on broad clinical reviews. The findings on amiodarone come from two separate literature summaries, one of which focuses specifically on amiodarone-induced hypothyroidism; the estimate of 14% is assessed there as reliable. The data on Hashimoto's and local symptoms come from a single review study and are more modestly supported: the researchers themselves note that the percentages vary considerably between studies and that the evidence in this particular area is still limited.
How do I know whether my fatigue is caused by my thyroid?
Thyroid blood tests can rule out or confirm whether your thyroid is the cause, but a mildly abnormal TSH alone does not explain fatigue and treating it often does not help. In Hashimoto's, symptoms can persist even when your values are normal.
What are the symptoms of an underactive thyroid and when should you see a doctor?
An underactive thyroid produces vague complaints such as fatigue, weight gain and cold intolerance, but the diagnosis can only be made through a blood test. If you have recognised several complaints for a while, discuss them with your general practitioner.
How do you recognise gum recession early, and which habits can inadvertently make the problem worse?
Gum recession is widespread and often present without being noticed; the main habit that worsens it is abrasive horizontal brushing with a hard toothbrush, although cause and effect have not been conclusively proven here. Have it checked regularly by your dentist, especially if your teeth become more sensitive or appear to be getting longer.
How do I keep my kidneys healthy as I age?
The two best-supported steps to limit kidney damage as you age are keeping your blood pressure under control and exercising regularly. Moderate salt intake and a healthy weight demonstrably contribute to both.
How do I keep my eyes healthy and prevent cataracts or macular degeneration?
Protect your eyes with UV-filtering glasses, a diet rich in vegetables and fruit, good diabetes management and regular eye check-ups. If cataracts have advanced significantly, surgery is the only proven solution.
How do I keep my joints supple and prevent osteoarthritis?
Exercise and maintaining a healthy weight are the best-supported ways to prevent osteoarthritis and manage symptoms; however, no treatment stops the disease once it has begun.