Do you feel tired even after a full night's sleep? Are you eating healthy foods but still gaining weight? Or does your heart start beating fast while you sit on the couch?
It is easy to blame these feelings on stress, aging, or a busy schedule. But they could be warning signs that your thyroid gland is out of balance.
Thyroid disease affects approximately 5% of American adults, with the prevalence increasing in recent years. Yet many people don't even know they have it. Understanding how your thyroid works can help you get the care you need to feel better.
What is the thyroid?
Your thyroid is a small gland shaped like a butterfly. It sits at the bottom of your neck, just below your Adam's apple. Even though it is small, it has a huge job.
Think of your thyroid as the engine control system for your body. It makes hormones that travel through your blood. These hormones control your metabolism, which is how your body turns food into energy.
When your thyroid works right, your body burns energy at the right speed. Your brain, heart, and muscles get the power they need. But if the thyroid makes too much or too little hormone, your body's "engine" speed changes, which can cause health problems.
Below are some common thyroid diseases and conditions to be aware of to help you and your thyroid stay healthy.
Hypothyroidism: when your engine slows down
Hypothyroidism happens when your thyroid is "underactive." This means it doesn't make enough hormones. When this happens, your body slows down. The most common cause in the U.S. is called Hashimoto’s disease, an autoimmune condition that accounts for up to 85% of hypothyroidism cases in areas with adequate iodine intake.
Because signs of an underactive thyroid happen slowly, many people don't know they have it until they get a blood test. Here are some common symptoms to look for:
- Fatigue: Feeling very tired or slow, even after sleeping. (affects 74-86% of patients)
- Weight Gain: Gaining weight for no clear reason or having trouble losing weight. (affects 24-59% of patients)
- Feeling Cold: Needing a sweater when everyone else feels fine.
- Dry Skin and Hair: Skin feels rough and hair might get thin or break easily.
- Mood Changes: Feeling sad or depressed.
- Body Changes: Constipation (trouble going to the bathroom), weak muscles, or a slow heartbeat.
Treatment options: The good news is hypothyroidism is easy to treat. Most people take a daily pill called levothyroxine. This is a man-made hormone that replaces what your body is missing. Once you and your doctor or advanced practice provider* (APP) find the right amount to take, you will likely feel normal again. Your thyroid levels should be checked 6 to 8 weeks after starting treatment or changing doses, and then annually once levels are stable.
Hyperthyroidism: when your engine races
Hyperthyroidism is the opposite problem. This is when your thyroid is "overactive." It makes too much hormone, causing your body’s engine to race too fast.
Symptoms for hyperthyroidism usually show up faster than they do with an underactive thyroid. They can include:
- Weight Loss: Losing weight even if you are eating the same amount or more.
- Fast Heartbeat: Your heart feels like it is pounding or beating very fast.
- Anxiety: Feeling nervous, grumpy, or shaky.
- Heat Sensitivity: Sweating a lot and feeling like you can't handle the heat.
- Sleep Problems: Trouble falling asleep or staying asleep.
- Shaking: Your hands or fingers might tremble.
Treatment options? Treating an overactive thyroid is a little more complicated than treating hypothyroidism. Your doctor or APP might use antithyroid medication (such as methimazole) to reduce hormone production, radioactive iodine to shrink the gland, or in some instances, surgery may be required. Antithyroid drugs are increasingly preferred as initial treatment, especially for Graves’ disease, which is the most common cause of hyperthyroidism. The choice depends on the underlying cause, your age, other medical conditions, and your preferences.
Lumps and bumps: goiters and nodules
Sometimes the thyroid gland physically changes shape.
A goiter is when the thyroid gets too big. This can cause a cough, a tight feeling in your throat, or trouble swallowing.
Thyroid nodules are lumps inside the thyroid. These are surprisingly common. They are found in up to 68% of adults when examined by ultrasound, though only about 5% are felt during physical examination. While finding a lump can be scary, the vast majority of these nodules are benign (not cancer) and don't cause pain. Only about 7-15% of thyroid nodules are cancerous. If you have nodules, your doctor or APP will likely just want to monitor them to be on the safe side.
Take the “neck check”
You can monitor your thyroid health by checking your neck at home with a simple test called the “neck check.” Here are the steps to perform one:
- Hold a hand mirror and focus on the lower front area of your neck, above your collarbones.
- Tip your head back slightly while keeping the gland in view.
- Take a sip of water and swallow.
- As you swallow, look for any bulges in that area. (Note: Don't confuse your Adam’s apple with your thyroid).
- If you see any bulges, contact your doctor or APP.
Thyroid symptoms look a lot like symptoms for other things, which makes it hard to know if you are sick. You should see your doctor or APP if you have tiredness that won't go away, sudden weight changes, a lump on your neck, or changes in your heart rate. They can check your thyroid with a simple blood test called TSH (Thyroid Stimulating Hormone), which is the most reliable initial test for thyroid dysfunction.
While thyroid problems can be frustrating, they are manageable. If you think you have a thyroid problem, talk with your doctor or APP. A simple check-up can lead to a treatment plan that helps you feel like your best self again.
*An advanced practice provider includes a nurse practitioner or physician assistant.