TALES OF THYROID

A Spectrum Of Symptoms

Most people are unaware of the tiny butterfly-shaped gland in the neck, called the thyroid. Many others are oblivious to the role it plays in maintaining overall health.

The endocrine system is a vast network of glands, of which the thyroid is an integral part. The thyroid gland produces hormones, like Thyroxine (T4) and Triiodothyronine (T3), that regulate metabolism, heart rate, and body temperature and aid growth and development in children.

However, when the thyroid gland does not function effectively—either producing too much thyroid hormones or too little—it can disrupt various bodily processes, leading to a wide range of signs and symptoms associated with hypothyroidism, underactive thyroid, and hyperthyroidism, an overactive thyroid.

Fertility and conception issues

Delhi-based Aarti Singh, a 48-year-old housewife, struggled to conceive for 12 years. When the doctor advised her to undergo several tests, that’s when she discovered she had a thyroid condition.

"At the time, my weight was very low, and I faced many health issues. I started taking regular thyroid medications as prescribed by my doctor, and once my thyroid levels normalised, I was able to conceive," she told OnlyMyHealth.

During pregnancy, Aarti had to take great care to follow her medication routine, as the doctor warned that irregularity could harm her baby. Since then, she has been taking medicines on time and feels completely fine.

Just like Aarti, 36-year-old Suchitra could not conceive even after trying for a year. When she and her husband consulted a doctor, they were recommended several tests, including a painful tube test, which didn’t provide clear answers. However, a thyroid screening revealed that she suffered from a disorder. Suchitra recalled, sharing that it has been seven years since, and she continues to take her tablets regularly.

A 2020 study published in the Best Practice & Research Clinical Endocrinology & Metabolism revealed that thyroid disorders, particularly hypothyroidism, can significantly impact a woman's fertility. Studies show that hypothyroidism affects 2-4% of women of reproductive age, often due to autoimmune issues. Data reveals that women with specific thyroid antibodies like Thyroid Peroxidase Autoantibodies (TPO-abs) along with thyrotropin, a Thyroid Stimulating Hormone (TSH), have a 2.25 times higher risk of infertility and up to 25% of recurrent miscarriages.

Dr Hema Vaithianathan, Senior Consultant - Fertility Specialist, Oasis Fertility, Chennai, said, "Thyroid problems, particularly hypothyroidism, can affect fertility in women by causing hormonal imbalances that disrupt the menstrual cycle. Also, heavy bleeding or irregular cycles can happen, which might interfere with the release of an egg from the ovaries, which might make it harder to conceive. Also, with pregnancy, there is an increased risk of miscarriage and premature birth with thyroid problems in women."

Weight changes

Thyroid dysfunctions can cause weight changes in people. While hypothyroidism is often associated with obesity and weight gain, hyperthyroidism is linked to being underweight.

A study published in the International Journal of General Medicine revealed that out of the 34 patients—17 with hypothyroidism and 17 with hyperthyroidism—weight changes were common in both groups before treatment. After thyroid functions were normalised, hypothyroid patients lost weight and went from approximately 71-69kg, whereas hyperthyroid patients gained weight, increasing from roughly 65-68kg.

Speaking with OnlyMyHealth, Delhi-based Ruchika Bansal, 37, revealed that her thyroid journey began at 33, after her second pregnancy. In addition to low energy and changes in hair texture, she suffered from significant weight changes too, which only stabilised after taking regular medications.

"I’ve adopted a healthier lifestyle. I walk 10,000 steps daily, include green vegetables in my diet, and start my mornings with coriander water. These changes with regular medication, have helped me stay on track," she shared.

Swelling and puffiness

Facial swelling, particularly around the eyes, is a common symptom of thyroid dysfunction, especially when the thyroid is underactive, which can lead to fluid buildup in the tissues, causing puffiness on the face and sometimes in the neck, called goitre.

Geeta Gupta, a 60-year-old housewife, shared that in 2006, she started noticing swelling on her face every morning. Although she took medication for 15-20 days, it didn’t help. By evening, the swelling would subside, only to return the next morning.

"I consulted another doctor, who suggested stopping the medicines for a few days and undergoing tests, including thyroid tests. The results revealed a thyroid issue, and I started medication immediately," she recalled.

Research suggests that people with thyroid issues can start feeling better within 1-2 weeks of starting thyroid treatment, although for severe symptoms, it may take several months to recover.

Thyroid In Men

Several studies suggest that thyroid disorders are more prevalent among women than in men. However, men who develop the condition can experience unique symptoms.

67-year-old Ashok Kumar from Faridabad was diagnosed with thyroid problems in 2015. His treatment began with a prescription for a 50 mcg tablet. "Unfortunately, my condition wasn’t under control, so I consulted another doctor who increased my dosage to 62.5 mcg and then 75 mcg. Despite this, I didn’t see much improvement, so I consulted another doctor who prescribed an 88 mcg tablet, which I am still taking today," Kumar shared.

Thyroid issues paved a difficult path for Ashok, wherein he experienced day-to-day challenges like balance problems, knee pain, hair loss, and swelling in his feet. He also had a dramatic weight loss and added that his bones felt weak, and he often felt cold and fatigued.

Scientific evidence also reveals that thyroid disorders can impact sexual health. A 2005 study published in the Journal of Clinical Endocrinology & Metabolism found that 50% of men with hyperthyroidism experience premature ejaculation, whereas 64.3% of the participants with hypothyroidism had low sexual desire and delayed ejaculation.

As per a more recent review, more than 50% of men with thyroid disorders report sexual dysfunction, with a higher prevalence in hypothyroidism cases compared to hyperthyroidism.

In India, the self-reported prevalence of thyroid disorders in men aged 15-49 was less than 1%, according to the National Family Health Survey (NFHS) (2015-2016).

Impact Of Thyroid On Mental Health

Thyroid symptoms are not just physical; they also affect a patient's mental and emotional health.

Nidhi shared that her condition caused mood swings and sleep issues, leaving her feeling dizzy and unproductive throughout the day.

Although taking medications regularly and following a disciplined lifestyle helped her manage her condition better, it did not ease the burden on her mind.

According to a review published in the journal Cureus, thyroid problems can harm people’s mental health. Researchers highlighted that both underactive and overactive thyroid can lead to an increased risk of dementia, especially in the ageing population. The review also found an association between hypothyroidism and depression/mania and hyperthyroidism and dementia/mania.

In a conversation with OnlyMyHealth, Dr Sreystha Beppari, Psychologist, Apollo Clinic, Viman Nagar, Pune, explained, "Since the thyroid gland produces hormones that regulate metabolism and play a crucial role in brain function, any imbalance can impact mood, behaviour, and cognitive abilities."

Common Mental Health Issues in Thyroid Patients

Thyroid disorders are often linked to:

But in addition to the direct impact thyroid disease has on people's minds and their mental well-being, the treatment and management process can also take a toll.

The Emotional Toll of Thyroid Treatment

Beyond the direct impact of thyroid disease, the treatment process itself can impact a patient's mental and emotional health.

For 36-year-old Shaikh Uzma Jamal, thyroid management had a serious impact on both her physical and mental health. She was surprised by her thyroid diagnosis, which started with a skin rash and led to a thyroid test that revealed elevated TSH levels, with T3 and T4 within the range.

She shared that the thought of being on lifelong medication was overwhelming.

Similar to Uzma’s situation, Reema Gupta, a 39-year-old teacher, opened up about her journey, discussing how her thyroid condition was more than just physical struggles. "It has been a mentally and physically exhausting journey," she recalled, sharing that it all started after the birth of her second child. She experienced several symptoms ranging from puffiness and hair fall to weight gain and persistent fatigue.

"Despite wanting to stay active, simple tasks became difficult," she added.

On Managing Mental Health Alongside Thyroid Disorders

Dr Mahesh D M, Consultant Endocrinologist at Aster CMI Hospital, Bengaluru, explained that thyroid problems can cause depression, which may be worsened by the condition itself or its treatment. "Healthcare providers must recognise the psychological impact of thyroid management and adopt a holistic approach that addresses both physical and mental health," he said.

Speaking with OnlyMyHealth, Dr Bhawna Attri, Consultant – Endocrinology at Sarvodaya Hospital, Faridabad, emphasised that mood disorders, irritability, and anxiety are common in thyroid patients. She advised that the first step in management is to normalise thyroid function through medications and regular follow-ups. She also recommended timely tests to ensure medication effectiveness and to keep thyroid levels in check.

Can Thyroid Medications Have Side Effects?

For thyroid disorders, medication is the first line of treatment.

Dr Vyankatesh Shivane, Consultant - Diabetology and Metabolic Physician, Jaslok Hospital & Research Centre, Mumbai, shared that the underactive thyroid (hypothyroidism) is treated with thyroxine, which is taken early morning on an empty stomach. On the other hand, overactive thyroid (hyperthyroidism) is treated with tablets to reduce the extra production of thyroid hormone from the thyroid gland. According to the United Kingdoms National Health Services (NHS), hyperthyroidism is often treated with medications like thionamides, carbimazole, and propylthiouracil.

But while thyroid disorders can be treated and managed with regular medications, health experts advise watching out for potential side effects, particularly with higher dosages.

Low Calcium Levels Due to Thyroid Medication: Myth or Fact?

In the initial phases of her treatment, Geeta was prescribed a high dose of thyroid medication (150 mcg tablets), which was later reduced to 50 mcg. While her thyroid symptoms improved, she suspected the medication contributed to low calcium levels, a mineral that helps keep the bones and teeth strong.

A 2011 study published in The BMJ suggested that older adults taking levothyroxine, which is a common medication to treat hypothyroidism, have a higher risk of fractures, especially with higher doses. This was more prominent among women, the study authors noted.

However, Dr Shivane believes that thyroid medicines don't directly reduce calcium levels in the body. “We have to keep in mind that in thyroid illnesses, especially in overactive thyroid, the calcium levels in the bone go down. The turnover of our bones in hyperthyroidism is very fast, due to which the bones may become weak. However, the medications for thyroid problems don't have a direct impact or effect on calcium levels,” he emphasised.

Additionally, postmenopausal women and elderly thyroid patients require calcium and vitamin D supplementation to prevent bone loss, he said, adding that in such cases, the patients with hyperthyroidism are supplemented with calcium plus vitamin D in the adequate dose as per the age of the patient.

Common Side Effects of Thyroid Medication

According to Dr Shivane, thyroid medications generally do not have side effects if taken in the correct dose. However, if taken in excess, it may cause: