The ins and outs of hypothyroidism

March 22, 2019
A man and woman stand on a bridge while pausing during a hike.
Hypothyroidism can come on gradually as it takes time for hormone levels to decrease. Photo by Getty Images.

If you’re feeling tired or down, or struggle to lose weight, you might be dealing with hypothyroidism, a condition in which the thyroid does not make enough thyroid hormone. The disease, which has a wide range of symptoms, impacts as many as five out of 100 people in the U.S.

Dr. Jessica Devin, an endocrinologist with UCHealth Endocrinology Clinic in Steamboat Springs, outlines must-knows about the condition below.

Why too little?

The most common cause of hypothyroidism is Hashimoto’s disease, an autoimmune disorder in which the immune system attacks the thyroid and prevents it from making enough hormone. Lab tests can confirm the presence of the thyroid antibodies involved.

Thyroid surgery or radiation may also be culprits.

Regardless of the cause, blood work will show low levels of thyroid hormone when there is an issue.

Common symptoms

Hypothyroidism can come on gradually as it takes time for hormone levels to decrease. And with its range of symptoms, such as weight gain, fatigue, sleep issues and mood problems, the condition may not be diagnosed right away.

“We can all usually offer an explanation for why we might be gaining weight or be fatigued, so someone may not get checked right away,” Devin said. “The symptoms of thyroid disease are so non-specific, the thyroid is definitely one of those things that should be checked when these symptoms are present.”

If thyroid levels are normal, however, the thyroid gland is unlikely to be the cause of the symptoms.

What to do

The good news is that the condition can be successfully treated with thyroid hormone replacements. The bad news: it can take time to find the right type and dosages.

“One of the biggest reasons I see patients with hypothyroidism is that they’re on thyroid replacement and still not feeling great,” Devin said.

Devin uses hormone replacements that are FDA approved, including generic and brand name medications.

“Some people experience a lot of fluctuations with generic replacements because there are batch-to-batch variations among manufacturers,” Devin said. “If you’ve had your thyroid removed or are susceptible to fluctuations, it may be worthwhile to go to a brand name therapy.”

The thyroid makes two main hormones – thyroxine, or T4, and triiodothyronine, or T3. Most patients only need to replace T4, as the body naturally makes T3 out of T4.

However, some patients prefer to use a natural hormone that’s a combination of the two. But since T3 is very potent, Devin may prescribe each hormone separately, so levels can be carefully calibrated.

When taking a hormone replacement, be sure to take it at the same time and in the same way, every day. As with hyperthyroidism, this condition must be treated to avoid long-term issues. Hormone levels should be checked regularly to be sure they’re in range.

“I always caution all my patients against over-replacement,” Devin said. “I’ve seen patients dealing with osteoporosis and heart issues due to years of too much thyroid hormone.”

Watch those supplements

Iron and calcium supplements can decrease absorption, so be sure those are taken at least four hours before or after thyroid replacements. And be wary of biotin: this supplement for hair and nail strength can make thyroid levels appear off in lab work.

Give it time

Finding the right thyroid replacement therapy takes time. But the effort is worth it.

“You don’t get started on replacement therapy, and then the next week, you’re a brand new you,” Devin said. “It’s more like six months later you realize, ‘I felt really bad then, and now I feel so much better.’

“I always tell people to hang in there and be patient. There are lots of options to try. It will get better.”


This article first appeared in the Steamboat Pilot & Today on March 18, 2019.

About the author

Susan Cunningham lives in the Colorado Rocky Mountains with her husband and two daughters. She enjoys science nearly as much as writing: she’s traveled to the bottom of the ocean via submarine to observe life at hydrothermal vents, camped out on an island of birds to study tern behavior, and now spends time in an office writing and analyzing data. She blogs about writing and science at