Fatigue, weight gain, and brain fog? These may point to hypothyroidism

Often mistaken for stress or ageing, hypothyroidism can quietly harm health. Here's what to know about its symptoms, risks, and treatment

Feeling tired all the time? Gaining weight without changing your diet, or struggling with brain fog? You’re not alone. These could be signs of hypothyroidism - a condition in which the thyroid gland does not produce enough thyroid hormones.

 

These hormones help regulate metabolism, energy, and many body processes. When levels drop, the body slows down.

 

Symptoms of hypothyroidism

 

Hypothyroidism is actually one of the commonest endocrine issues we see. It occurs when the thyroid gland, a small, butterfly-shaped gland located at the base of the neck, just below the Adam’s apple, fails to produce enough hormones to meet the body’s needs.

 

 

"When the hormone deficiency is more severe, the signs are quite obvious. People may feel extremely sensitive to cold. They may often complain of tiredness that doesn’t improve with rest, muscle cramps, constipation, dry skin, or a change in the voice, usually becoming hoarse," Dr Kalyan Kumar Gangopadhyay, endocrinologist at The Calcutta Medical Research Institute (CMRI), told Business Standard.

 

When the hormone levels are only mildly low, the picture is less striking - people may simply describe general weakness, fatigue, or sometimes tingling in the hands, which we call carpal tunnel syndrome, he explained.

 

"In advanced cases, blood sodium may drop as well. These are fairly similar in both men and women, but in women we also see disturbances in the menstrual cycle —periods can become irregular, or sometimes the bleeding is much heavier than usual," he added.

 

Underdiagnosis and its consequences

 

Hypothyroidism is very often underdiagnosed because initial symptoms are vague and non-specific, said Dr Ankur Gahlot, additional director - diabetes and endocrinology, CK Birla Hospitals, Jaipur. "Early symptoms could easily be mistaken for normal aging. There is a lack of awareness among the public regarding the same and it contributes to missed diagnoses and delays in seeking treatment," he added. 

 

"Underdiagnosis poses significant health challenges, including an increased risk of heart problems, high cholesterol, infertility. In children, it can lead to severe mental and physical developmental issues. Without timely treatment, severe, life-threatening complications like heart failure and coma (myxedema) can occur," shared Dr Hetashvi Gondaliya, associate consultant - diabetes and endocrinology at CK Birla Hospitals, Jaipur.  “Sometimes, new-borns are born with a condition called congenital hypothyroidism. In such cases, the thyroid gland may be absent, not properly formed during intrauterine life, or present but non-functional. The prevalence is around 1 in 1,700 births, making it relatively common. This is why it is crucial to screen all new-borns for hypothyroidism on the third day of life. Each day without treatment can result in the loss of one IQ point, and if therapy is not started promptly, affected babies may suffer from permanent intellectual disability,” said Dr Sweta Budyal, Senior Consultant – Diabetology & Endocrinology, Fortis Hospital, Mumbai.

 

Adding to the point, Dr Gangopadhyay said, "In adolescents and young adults, the picture is usually more about fatigue, weight changes, or irregular menstrual cycles in women. These symptoms are often blamed on lifestyle or stress, so the thyroid problem can be missed. In older people, the presentation can be quite vague—low mood, memory problems, or slowing down physically—and it may be confused with ageing or depression." 

 

In severe cases, especially in the elderly, the condition can also affect the heart. So across all age groups, early recognition makes a big difference, he added.

 

Causes and underlying mechanisms

 

According to Dr Gangopadhyay, the most common cause of hypothyroidism worldwide is still iodine deficiency, though in countries where iodised salt is widely used, we tend to see more of the autoimmune type.

 

"In auto-immune disorder, the body produces antibodies against its own thyroid gland, and the gland slowly stops working properly. This is why you often find hypothyroidism in people who also have other autoimmune problems, like type 1 diabetes or Addison’s disease," he explained, adding that there are drug-related causes where medicines such as amiodarone, lithium, or interferon interfere with thyroid function.

 

Adding to the point, Dr Gahlot said, "Genetic causes of hypothyroidism include those passed down to you from your parents, hereditable factors, and those related to acquired genetic mutations. Some genetic components in congenital hypothyroidism result in absent or underdeveloped thyroid gland. This may increase the risk of hypothyroidism in childhood or later life."

 

"Environmental and lifestyle factors which can disrupt thyroid gland function include smoking, alcohol consumption, micronutrient deficiencies, obesity, exposure to pollutants," added Dr Gondaliya.

 

Diagnosis and tests

 

The most common diagnostic indicator is the Thyroid Stimulating Hormone (TSH) test, which checks hormone levels in the blood. If the TSH is abnormal, further tests such as Free T4, Free T3, and anti-thyroid antibodies may be ordered, experts said.

 

Approximate cost

 

TSH test: ₹200–₹500 (depending on the lab and city)

Complete thyroid profile (TSH, T3, T4): ₹400–₹800

Antibody tests (if needed): ₹700–₹1,500  “All pregnant women should be screened for thyroid disorders, ideally during the prenatal period. In fact, thyroid hormone levels should be checked even before planning a pregnancy. Additionally, it is recommended that all individuals undergo at least one thyroid function test after the age of 35,” said Dr Budyal.

 

Treatment options

 

The main treatment still remains thyroid hormone tablets, usually levothyroxine, which is the T4 hormone, shares Dr Gangopadhyay. "We put emphasis on how the medicine is taken, because the absorption is affected by food. So ideally, it should be taken first thing in the morning on an empty stomach, and patients should wait at least half an hour, preferably an hour, before eating," he explained.

 

"Researchers are now looking at formulations that are not so dependent on food. There are liquid and soft gel versions being studied, and these may be better absorbed. Another area of interest is T3. Traditionally, we have replaced only T4, but now T3 tablets are also available, and in some cases, especially where patients don’t feel fully well on T4 alone, a combination may give better results," he added.  "One of the most important factors when it comes to treatment of hypothyroidism is to be disciplined. The treatment of is lifelong - patients have to take thyroxine forever," emphasised Dr Budyal.

 

Managing life with hypothyroidism

 

Lifestyle adjustments can support treatment: taking medication consistently, eating a balanced diet with sufficient iodine and iron, exercising regularly, and keeping stress under control.

 

"A balanced, nutrient-rich diet with sufficient iodine and selenium supports thyroid function, while regular, moderate exercise boosts energy and metabolism. Lifestyle adjustments like managing stress through meditation, avoiding smoking and excessive alcohol, getting adequate sleep, and taking medication consistently as prescribed are crucial for maintaining well-being and thyroid health," said Dr Gondaliya.

 

"For patients with hypothyroidism, it is extremely important to comply with prescribed medications along with lifestyle changes. Regular follow-up with your doctor and maintaining TSH/T4 values in target range can ensure proper growth and development of children and good quality of life in adults," added Dr Gahlot. 

 

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This report is for informational purposes only and is not a substitute for professional medical advice.