metaboliq
Anjali is 36, an architect in Lucknow, and she has felt tired for most of the year. Her hair comes out in clumps in the shower. She has put on nine kilos over three years without eating more, and she wears socks to bed in September. Her mother, who has taken thyroid treatment for fifteen years, recognised the pattern over tea one Sunday before Anjali did. Anjali is a composite of the readers who ask this, not a real patient.
An underactive thyroid usually causes tiredness, feeling cold, weight gain, dry skin, hair fall, constipation and heavier periods. An overactive one causes weight loss, a racing heart, shaky hands, heat intolerance and anxiety. The symptoms are vague and overlap with everyday life, so a TSH blood test is the only reliable way to know.
What does the thyroid do?
It is a small gland at the front of the neck that sets the pace of the body. Its hormones affect how fast the heart beats, how warm you feel, how quickly food moves through the gut, how the skin and hair grow, and how much energy you have. When it makes too little or too much, almost every system notices.
Thyroid problems are common in Indian women. An eight-city Indian survey found high rates of underactive thyroid and of thyroid antibodies, many of them in people who had never been diagnosed. Anjali's mother found out at 47, after years of being told her tiredness was the menopause. That family history is one of the strongest reasons for Anjali to get tested now.
In India today, the most common cause of an underactive thyroid is Hashimoto's thyroiditis, in which the immune system slowly damages the gland. It runs in families and is far more common in women, often appearing in the thirties and forties. Iodine deficiency, once the main cause of goitre in the Himalayan foothills and parts of Uttar Pradesh, is much rarer since salt was iodised nationwide.
Sources: [2]
What are the symptoms of an underactive thyroid?
Tiredness that sleep does not fix, feeling cold when others are comfortable, weight gain, dry skin, hair thinning, constipation, a puffy face, heavier or irregular periods, low mood and slow thinking. Layal Chaker's review in The Lancet points out that none of these is specific, which is why the condition is so easy to miss.
Anjali has five of them. She had explained each one away. The tiredness was the new project, the hair fall was hard water in her new flat, the weight was the office biscuits, and the cold was the air-conditioning. Seen together, and with her mother's history, they make a strong case for a simple blood test rather than another month of guessing.
Sources: [1]
What are the symptoms of an overactive thyroid?
Mostly the opposite set. Weight falls even though appetite is good or bigger than usual. The heart races or pounds, sometimes at rest, and the hands tremble enough to rattle a cup on its saucer. The person feels hot and sweaty in rooms others find comfortable, sleeps badly, and may have loose stools and lighter, less frequent periods. Anxiety and irritability are common enough to be mistaken for a personality change. The American Thyroid Association guideline led by Douglas Ross covers how it is diagnosed and treated.
Anjali's colleague Farah, 31, lost six kilos last spring without trying. Her heart raced in client meetings and she put it down to nerves over a big pitch. A TSH far below the range showed an overactive thyroid. It is less common than the underactive kind, and it needs treatment promptly. A heart that races for months can tip into an irregular rhythm, and the bones thin while it lasts.
Sources: [5]
Can thyroid problems affect periods and fertility?
Yes. An underactive thyroid often makes periods heavier, longer or more irregular, and can make it harder to conceive. An overactive one tends to make periods lighter and less frequent. Thyroid hormone also matters in early pregnancy, when the baby depends on the mother's supply for brain development.
Anjali and her husband would like a child in the next year or two. Her gynaecologist in Hazratganj asked for a TSH before anything else, which is routine for women planning pregnancy in India. Untreated hypothyroidism is linked with miscarriage and with problems for the baby, and it is simple to correct before conception. Women who already take thyroid treatment usually need their treatment reviewed as soon as pregnancy is confirmed.
Sources: [1]
Which tests show a thyroid problem?
TSH is the first and most useful test. It is high when the thyroid is underactive and low when it is overactive. Free T4 confirms the picture, and anti-TPO antibodies show whether the cause is autoimmune. The American Thyroid Association's guideline sets out how TSH, free T4 and antibody status are read together, and when a raised TSH calls for treatment rather than monitoring.
Anjali's report came back with a TSH of 9.8 and a free T4 at the low end of normal, with positive anti-TPO antibodies. That pattern is called subclinical hypothyroidism. The consensus review led by Martin Surks advised repeating a mildly abnormal result after some weeks before acting, because some settle on their own. Her doctor repeated it after six weeks, found it higher, and started treatment.
Why are thyroid symptoms easy to miss in women?
Because each symptom has a ready everyday excuse. Tiredness gets blamed on work or children. Hair fall gets blamed on hard water, weight on age, low mood on stress, and heavy periods on fibroids or the menopause. Layal Chaker's review in The Lancet stresses how non-specific the symptoms are, and in the eight-city Indian survey about a third of the people found to have an underactive thyroid had never been told.
The year after childbirth is the hardest time to spot it. Anjali's cousin Ritu developed an overactive thyroid three months after her daughter was born, then swung into an underactive phase. She took the racing heart, and later the exhaustion, as normal parts of having a newborn. Her gynaecologist only caught it at the six-month check because Ritu mentioned her hair coming out in handfuls. A TSH for any new mother who feels wrong in that first year would catch most of these.
How do thyroid symptoms change after 40 and around menopause?
They blend into the menopause, which is why so many are missed in women in their forties and fifties. Tiredness, poor sleep, low mood, dry skin, thinning hair and a thickening waist belong to both. An overactive thyroid can mimic hot flushes, with sweating and palpitations at night. Chaker's review notes that older adults often show fewer and milder symptoms, so a slow drift can pass for ageing.
Anjali's mother was diagnosed at 47, after three years of being told her exhaustion was "just the change". The test that would have settled it costs a few hundred rupees at any lab. Women in this age group who feel unwell for months should ask for a TSH alongside any menopause discussion, rather than one instead of the other. It is also worth repeating every few years once there is a family history.
Sources: [1]
How much weight does an underactive thyroid add?
Usually a few kilos, not ten or twenty. Peter Laurberg's review describes the link as two-way, with modest weight changes in most people. Jesper Karmisholt's study found that when adults were treated for overt hypothyroidism, most of the weight they lost afterwards was excess body water rather than fat.
That surprised Anjali. She had hoped treatment would take off all nine kilos. Her doctor explained that it would lift her energy and take off some fluid, and that the fat would need the same food and activity changes as for anyone else. Two months into treatment, she has her energy back, she has lost about a kilo and a half, and she is walking to her site visits again.
What helps with weight once the thyroid is treated?
Energy usually returns first, and that is the moment to start. Months of tiredness meant months on the sofa and in the car, and Anjali's muscle quietly shrank. Now she walks with her mother round the colony park every evening, and on Sundays she does squats, lunges and wall push-ups in the living room while the cricket is on. Rebuilding that muscle matters as much as losing the fat, because muscle is what keeps the weight from creeping back.
Her lunch box has changed too. The office biscuits have given way to roasted chana, and her dal now comes with a bowl of curd or some paneer, which keeps her full until dinner. She weighs herself every Saturday morning and writes it on the calendar in the kitchen. Nine kilos will take months, and the line on that calendar wobbles, but it is heading the right way.
For readers in Anjali's position, we should be clear about our own part. Metaboliq is a doctor-led weight programme, and the aim we set with members is "Lose up to 20% of your body weight — and keep your muscle". Results vary; your doctor decides what is right for you. The first step is a home blood test that a doctor reads, thyroid included, so the plan starts from her actual results.
Sources: [7]