Thyroid Problems in India: Signs, Tests and What Actually Helps

Tired all the time, putting on weight you can't explain, losing more hair than usual, feeling cold when everyone else is fine. Most people blame stress or age. Sometimes the real cause is a small gland in your neck.

Thyroid problems are common in India. A multi-city study published in the Indian Journal of Endocrinology and Metabolism found hypothyroidism in about 1 in 10 adults, and close to a third of them didn't know they had it. Women are affected about three times as often as men.

What the thyroid does

The thyroid makes hormones (T4 and T3) that set the pace of your metabolism. When it makes too little (hypothyroidism), everything slows down. When it makes too much (hyperthyroidism), everything speeds up. In India, the underactive kind is much more common.

Signs worth paying attention to

An underactive thyroid tends to show up slowly:

• Tiredness that sleep doesn't fix

• Weight gain without a change in diet

• Dry skin, hair fall, brittle nails

• Feeling cold, constipation

• Heavy or irregular periods, or trouble conceiving

• Low mood or slow thinking

An overactive thyroid looks almost like the opposite: weight loss, a racing heart, sweating, shaky hands and anxiety.

None of these prove a thyroid problem on their own. They're a reason to get tested.

The tests to ask for

The usual first test is TSH (thyroid stimulating hormone). A high TSH usually points to an underactive thyroid, and a low TSH to an overactive one. Doctors often add free T4, and sometimes anti-TPO antibodies to check for Hashimoto's thyroiditis, the autoimmune condition behind most hypothyroidism in iodine-sufficient areas.

It's a cheap blood test. It's worth doing if you have symptoms, a family history, are planning a pregnancy, or are a woman over 35.

What actually treats it

If you're diagnosed with hypothyroidism, the treatment is a daily thyroid hormone tablet (levothyroxine) prescribed by your doctor. Take it on an empty stomach, usually 30 to 60 minutes before breakfast or tea, and keep it apart from calcium and iron supplements by about four hours, because they can block absorption. Get your dose rechecked with a TSH test every few months at first.

No herb or supplement replaces this tablet. Be wary of anyone who says otherwise.

Where food and nutrients fit in

Iodine: iodised salt is how most Indians get enough. More iodine isn't better, and high doses from kelp or "thyroid booster" products can make some thyroid conditions worse.

Selenium: some trials suggest selenium may lower thyroid antibody levels in Hashimoto's, but the evidence is mixed. Talk to your doctor before taking it. A couple of Brazil nuts, eggs or sunflower seeds give you some from food.

Vitamin D and B12: low levels of both are common in people with autoimmune thyroid disease, and they're common in India anyway. Testing and correcting a real deficiency is sensible, but it doesn't treat the thyroid itself.

Iron: low iron can make fatigue worse and may affect how your body makes thyroid hormone. This is especially worth checking in women with heavy periods.

Cabbage, cauliflower and soy: normal cooked portions are fine for most people. The bigger soy issue is timing, so keep soy away from your tablet.

Habits that help

Take your tablet at the same time every day. Keep your weight steady through regular walking and strength work. Sleep properly. Don't stop or change your dose on your own when you start feeling better. If you're pregnant or planning a pregnancy, tell your doctor early, because your dose often needs to go up.

The short version

If you're always tired and something feels off, a TSH test costs less than a pizza. Get the diagnosis first, take your medicine properly, and use food and nutrients to support the treatment, not replace it.

Disclaimer: This article is for general information only and is not medical advice. Thyroid conditions need diagnosis and treatment by a qualified doctor. Do not start, stop or change any medication or supplement without speaking to your healthcare provider.

References

• Unnikrishnan AG et al. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab. 2013;17(4):647–652.

• American Thyroid Association. Hypothyroidism patient information.

• Winther KH et al. Selenium in thyroid disorders: essential knowledge for clinicians. Nat Rev Endocrinol. 2017;13:158–170.