Hiding in Plain Sight: Diagnosing Hypothyroidism

An important part of being a family doctor is getting to know my patients. Starting with the first visit, I want to build ongoing, caring relationships with them over time. When I meet with new patients, I take time to find out about their current and past health care issues or concerns. Sometimes, patients don’t even realize that they are having symptoms of a health problem. In these cases, listening carefully and asking the right questions is especially important. This helps me make a diagnosis or decide if the patient needs any lab tests.

Recently, a 40-year-old new patient named Emily (not her real name) came in for a complete physical exam. When I asked Emily if she had any health concerns, she said that she was worried about infertility. She and her husband had been trying to conceive for more than a year.

At first, Emily told me she wasn’t having any other health issues. But as I asked more questions about possible symptoms, I found out that she had been having mood swings and that she felt cold most of the time. She had also been gaining weight even though her diet and physical activity hadn’t changed much. Emily had noticed these symptoms for several years but never mentioned them to a doctor. She thought they were probably just part of getting older.

Based on Emily’s symptoms and her infertility concerns, I suspected that she might have hypothyroidism. Hypothyroidism (also called underactive thyroid) is a condition in which the thyroid gland does not make enough thyroid hormones. Thyroid hormones control how your body uses energy. They affect your heart rate and how well your other organs work. They also affect your muscles, bones, and menstrual cycles (for women). Women who don’t have enough thyroid hormones may have a hard time getting pregnant. Learn more about common symptoms of hypothyroidism, what causes it, and how it is treated.

When I gave Emily a physical exam, I carefully felt her thyroid gland. The thyroid gland is located in the lower front of the neck and is shaped like a butterfly. Emily’s thyroid gland felt normal. Her overall physical exam was also normal.

The U.S. Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians (AAFP) do not recommend routine screening for thyroid disorders in patients who are not pregnant and don’t have any symptoms. However, because of Emily’s ongoing symptoms and her concerns about infertility, I ordered a blood test to check her thyroid function. This test measured the amount of thyroid hormone and thyroid-stimulating hormone (TSH) in her blood. TSH is a hormone that tells the thyroid gland how much thyroid hormone to make.

Emily’s blood test results confirmed the diagnosis of hypothyroidism. I immediately started her on a synthetic thyroid hormone. This medicine replaces the hormones the thyroid gland is supposed to make. I also made sure that Emily had regular blood tests to closely monitor her thyroid hormone levels. Treating hypothyroidism can improve a woman’s chances of conceiving, so Emily is hoping that she will be able to get pregnant soon. If not, I will refer her to an infertility specialist.

During a follow-up visit, Emily told me she was surprised she had never thought to mention her symptoms during any previous doctor’s appointments. She was very grateful that I took the time to find out about her health history and concerns. With treatment, she has noticed an overall improvement in her hypothyroidism symptoms.

Quick Tip

Synthetic thyroid hormone is taken daily in pill form. Doctors recommend taking this medicine in the morning, 30 minutes before eating. It’s important to follow your doctor’s instructions for how to take this medicine. If you don’t, your hormone levels may go up and down. This can cause complications such as heart palpitations (the feeling that your heart is racing), anxiety, trouble concentrating, or changes in body temperature. Be sure to let your family doctor know if you have any side effects while taking synthetic thyroid hormone.