Thyroid Disorders in Women: Signs, Tests, Care

The thyroid is a small butterfly-shaped gland in the front of your neck. It makes hormones that control how fast your body uses energy. When it makes too little or too much, you can feel tired, anxious, cold or hot, and your periods can change.

Thyroid problems are much more common in women than in men, but they are easy to test for and usually well controlled with treatment. Here is what to know.

Underactive and Overactive Thyroid

• Underactive thyroid (hypothyroidism): the gland makes too little hormone. The body slows down.
• Overactive thyroid (hyperthyroidism): the gland makes too much hormone. The body speeds up.

According to the US Office on Women's Health, about one in eight women will have a thyroid problem in her lifetime. The risk rises after pregnancy and after menopause. The NIDDK notes that women are much more likely than men to develop an underactive thyroid.

Symptoms of an Underactive Thyroid

The NHS says these signs usually develop slowly and get worse over time, so you may not notice them at first:

• Tiredness and low energy
• Feeling cold when others do not
• Weight gain
• Constipation
• Dry skin, dry or thinning hair and hair loss
• Low mood and trouble concentrating
• A hoarse voice
• Heavy or irregular periods

Symptoms of an Overactive Thyroid

• Nervousness, anxiety, irritability and mood swings
• Trouble sleeping and constant tiredness
• Feeling too hot and sweating
• A fast or irregular heartbeat and shaky hands
• Weight loss
• A swelling in the neck (goitre)
• Lighter periods

Many of these signs can come from other things, such as stress, anaemia or menopause, so symptoms alone cannot confirm a thyroid problem. A blood test is needed. You can read about another common cause of tiredness in our article on anemia in women.

Why Does It Happen?

The NHS says the most common cause of an underactive thyroid in the UK is Hashimoto's disease, an autoimmune condition in which the immune system attacks the thyroid. It is most common in women. Other causes include thyroid surgery, radiotherapy, some medicines and a family history of thyroid disease. For an overactive thyroid, the most common cause is Graves' disease, another autoimmune condition, followed by thyroid lumps (nodules) that make extra hormone.

Iodine is needed to make thyroid hormone. The Indian Council of Medical Research (ICMR) dietary guidelines advise using iodised salt and keeping total added salt to no more than 5 grams a day. Ask your doctor before taking any iodine supplement.

How Thyroid Problems Affect Women's Health

Periods

The Office on Women's Health says too much or too little thyroid hormone can make periods heavy, light or irregular, or stop them for months. If your cycle has become unpredictable, see our guide on irregular periods.

Fertility

Thyroid problems can interfere with ovulation and make it harder to get pregnant. The NIDDK says that women who have trouble conceiving are often tested for thyroid problems. If you are having difficulty conceiving, see our article on when couples should seek help.

Pregnancy

Your baby depends on thyroid hormone for brain development. The NHS says an untreated underactive thyroid in pregnancy can raise the risk of pre-eclampsia, premature birth and miscarriage, and untreated overactive thyroid has similar risks. The NIDDK says thyroid medicine is considered safe in pregnancy and many women need a change in dose, so tell your doctor as soon as you know you are pregnant. See more in thyroid problems in pregnancy.

After birth and menopause

About one in ten women develop postpartum thyroiditis, according to the Office on Women's Health, and it is often mistaken for the baby blues. Thyroid symptoms can also be confused with menopause symptoms, so testing helps.

Tip: Write down your symptoms, when they started, your periods, any medicines and any thyroid problems in your family before your visit. It helps your doctor decide which tests you need.

Tests and Treatment

The doctor will ask about your symptoms and family history and examine your neck. The main test is a blood test for thyroid-stimulating hormone (TSH), often with thyroid hormone levels. Sometimes a scan or other tests are used. The Office on Women's Health says routine screening is not recommended for most women, but you should discuss testing if you have had a thyroid problem, thyroid surgery or neck radiation, a goitre, anaemia or type 1 diabetes.

• Underactive thyroid: treated by replacing the missing hormone with tablets, usually for life. Blood tests check that your dose is right. The NIDDK says to retest about 6 to 8 weeks after starting, and not to stop without talking to your doctor.
• Overactive thyroid: your doctor may prescribe medicine that reduces hormone production. Other options include radioiodine treatment or surgery, and a hormone specialist often helps choose.
• Thyroid lumps or goitre: may be watched, treated with medicine or removed, depending on the cause.

When to be cautious: Do not buy thyroid tablets or herbal "thyroid boosters" yourself, and do not change or stop your prescribed tablets. The NIDDK warns that too much medicine can cause serious problems such as an irregular heartbeat or weak bones.

When to See a Doctor

• Ongoing tiredness, weight change, hair loss or low mood without a clear reason
• Periods that have become heavy, light, irregular or have stopped
• A swelling or lump in the front of the neck
• A racing or irregular heartbeat, tremor or heat intolerance
• Trouble conceiving, or recurrent miscarriages
• You are pregnant or planning a pregnancy and have a known thyroid problem
• Palpitations, chest pain or severe breathlessness (seek urgent care)

If you are planning a pregnancy, a reproductive care consultation can include a review of your overall health.

Talk to a Doctor

If you think a thyroid problem may be behind your symptoms, book an appointment at Chaitanya Hospital, Kadapa, or call +91 944 103 0587. Teleconsultation is also available. This article is for general awareness and is not a substitute for a doctor's advice.