How to Manage an Overactive or Underactive Thyroid
The thyroid may be small, but it plays a significant role in your overall health and wellness. This butterfly-shaped gland at the base of your throat produces and regulates hormones that influence your metabolism and energy level, cholesterol, heart rate, body temperature, and more.
Balanced thyroid hormones allow your body’s many systems to properly function, and issues with the thyroid can impact many aspects of your health. There are two main types of thyroid imbalances that may occur: hyperthyroidism and hypothyroidism.
- Hyperthyroidism occurs when the thyroid produces too much thyroid hormone, accelerating the metabolism beyond normal.
- Hypothyroidism occurs when an underactive thyroid leads to lower-than-normal levels of thyroid hormone.
Without treatment, both hyperthyroidism and hypothyroidism can lead to more serious complications. Below, we explain how to manage these disorders and maintain a balanced thyroid.
Causes and risk factors
Several conditions or health factors may lead to overproduction of thyroid hormone. Graves’ disease, an autoimmune disorder in which antibodies overly stimulate the thyroid, is the leading cause of hyperthyroidism, accounting for 85% of all cases.
Other contributing factors include:
- The development of thyroid nodules, which are typically benign lumps or growths in the thyroid that produce more hormones than needed
- Thyroiditis, or thyroid inflammation, which most commonly occurs after pregnancy due to an underlying autoimmune disease or unknown cause
- Excess consumption of iodine — a mineral critical to the production of thyroid hormone — through diet or medications
There are also several known factors that may increase your risk of developing the condition, including:
- A family history of thyroid disease
- Health conditions including pernicious anemia, type 1 diabetes, and primary adrenal insufficiency (also known as Addison’s disease)
- A high-iodine diet
Hyperthyroidism is associated with a wide range of signs and symptoms such as the following:
- Unintentional weight loss even with increased food intake
- Increased appetite
- More frequent bowel movements
- Rapid or irregular heartbeat
- Heart palpitations
- Tremors and/or sweating
- Nervousness and anxiety
- Fatigue and muscle weakness
- Increased sensitivity to heat
- Enlarged thyroid gland at the base of your neck
- Irregular menstrual cycles
Symptoms of hyperthyroidism may be subtle for some individuals. In addition, many common symptoms overlap with those of other health conditions. If you have any concerns about your thyroid health, consult with your provider for an evaluation.
Hyperthyroidism and fertility
Hyperthyroidism is associated with irregular menstrual cycles, which can lead to difficulty conceiving. Many people initially learn of a hyperthyroidism diagnosis after experiencing fertility challenges. The treatment options described in more detail below can help restore hormone levels and ovulation.
Related health complications
The thyroid affects so many areas of your health and wellness, and untreated hypothyroidism can lead to other health issues such as the following.
An underactive thyroid can increase levels of LDL cholesterol, leading to a greater risk of heart disease and heart failure.
Mental health disorders
Hypothyroidism is also linked to depression.
An underactive thyroid can affect ovulation, or the release of a mature egg from the ovaries during a menstrual cycle. Treatment for hypothyroidism may address fertility issues by restoring hormone levels and ovulation.
In the long term, untreated hypothyroidism can damage the peripheral nerves, which carry information from your brain and spinal cord to other parts of your body. This can lead to pain, numbness, and tingling.
There are several ways to diagnose hyperthyroidism, including a physical exam, blood tests, and imaging tests.
Your healthcare provider may check your thyroid, eyes, heart, hands, and skin during a physical exam to confirm a diagnosis of hyperthyroidism.
Your provider may recommend thyroid function testing, which consists of measuring your thyroid hormone levels via blood samples. Hyperthyroidism is characterized by elevated levels of the thyroid hormones triiodothyronine (T3) and thyroxine (T4) and lower-than-normal levels of thyroid-stimulating hormone (TSH).
Your provider may also use one or more imaging tests to more closely examine your thyroid, including a radioactive iodine uptake (RAIU) test, a thyroid scan, and a thyroid ultrasound.
There are a variety of treatment options for hyperthyroidism. Your provider will make individualized recommendations based on the cause of your hyperthyroidism and your overall health history.
The following types of medications are commonly used in the treatment of hyperthyroidism.
- Anti-thyroid medications including methimazole (Tapazole®) and propylthiouracil (PTU) reduce symptoms by preventing over-production of thyroid hormones. These medications are typically taken for at least a year, though symptoms may improve within weeks or months.
- Radioactive iodine is an oral medication that targets overactive thyroid cells, causing the thyroid to shrink and lowering hormone levels within a few weeks. This treatment approach permanently affects thyroid function, so symptoms of hyperthyroidism will not reappear. In most cases, the use of thyroid hormone medications is necessary after this treatment to maintain balanced hormone levels.
- Beta blockers can control associated symptoms such as a rapid heartbeat, nervousness, or tremors. These medications cause the heart to beat more slowly and less forcefully. They will not change hormone levels and are typically used in tandem with anti-thyroid medications or radioactive iodine therapy. Commonly prescribed beta blockers include atenolol (Tenormin®), bisoprolol (Zebeta®), metoprolol tartrate (Lopressor®), metoprolol succinate (Toprol-XL®), acebutolol (Sectral®), and propranolol (Inderal®).
Some cases of hyperthyroidism require removal of part or all of the thyroid gland in a procedure known as a thyroidectomy. While this is effective at treating hyperthyroidism, it can result in hypothyroidism, which requires ongoing use of thyroid supplements.
Nutrition and diet
Iodine consumption can contribute to the development of hyperthyroidism or worsen symptoms. Managing hyperthyroidism often includes monitoring iodine intake.
If your provider recommends following a low-iodine diet, try to avoid or limit your intake of seafood and seaweed, which have the highest iodine content of all foods. Other high-iodine foods to consume in moderation include milk and dairy products, egg yolk, and iodized salt.
Never make significant changes to your diet without first consulting your provider or a nutritionist.
Causes and risk factors
The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto's thyroiditis.
Other significant contributing factors include:
- Thyroid surgery, which can affect hormone production
- Radiation therapy to treat cancer, if targeting the head or neck
- Medications, such as lithium
Anyone can develop hypothyroidism, but several known factors may increase your risk, including:
- Sex - the condition occurs more frequently in women than in men
- Age - the condition occurs more frequently in those over 60
- A family history of thyroid issues
- Having another autoimmune disorder such as type 1 diabetes or celiac disease
Symptoms of hypothyroidism often develop gradually, over the course of many years. These are among the most common and significant:
- Dry skin
- Weight gain
The following symptoms may also develop:
- Sensitivity to cold
- Muscle weakness, aches, or stiffness
- Joint pain or stiffness
- High cholesterol
- Heavier or irregular menstrual cycles
- Thinning hair
- Slow heart rate
If you have symptoms of hypothyroidism, your doctor will likely use a thyroid stimulating hormone (TSH) test to confirm a diagnosis. This simple blood test measures the levels of thyroid hormones in your blood.
One challenge of diagnosing hypothyroidism is that symptoms frequently overlap with those of other health issues.
Hypothyroidism is manageable. Treatment allows you to control symptoms such as elevated LDL cholesterol levels and weight gain, preventing potential health complications.
The main goal of treatment is to increase your thyroid levels. Levothyroxine (Levo-T®, Synthroid®, Tirosint®), a synthetic thyroid hormone taken orally, is often the starting point.
Another synthetic thyroid hormone, liothyronine (Cytomel®), may also help treat low thyroid levels.
There are formulations that combine levothyroxine and liothyronine.
The majority of individuals with hypothyroidism need to take medication every day on an ongoing basis, though some mild cases are resolved with short-term treatment.
Your dosage may change over time. Your doctor will use the TSH test to measure your thyroid levels and make any adjustments to your treatment plan. In most cases, TSH testing is needed at least once a year.
Dietary and lifestyle considerations
Minimizing your intake of processed sugars and increasing your intake of iron and B vitamins can help reduce fatigue.
Iron-rich foods include:
- Beans and lentils
- Enriched breakfast cereals
Healthy sources of B vitamins include:
- Leafy greens
- Chicken and turkey
While iodine can boost production of thyroid hormone, you shouldn’t necessarily increase your intake of this mineral if you have hypothyroidism. Always speak with your doctor before making any dietary changes.
Staying physically active can support a healthy metabolism and combat fatigue. Aim for about 30 minutes a day five days per week.
Additionally, minimize stress as much as possible, as it can also impact thyroid function.
Your partner in health
Managing hyperthyroidism or hypothyroidism is easier with a reliable pharmacy partner by your side. Our pharmacists can answer any questions you may have about treatment, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.
To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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Editor’s Note: This post was originally published in September 2022 and has been updated for accuracy and completeness.