Hypothyroidism - diagnosis of

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Hypothyroidism is extremely common and very badly treated in this country. Its effects are insidious in onset and often mistaken for aging. It should be looked for in every patient with any unremitting symptom. I do thyroid function tests routinely in all my CFS patients.

One could argue that everyone over the age of 60 should be screened every three years for hypothyroidism.

Many of my patients come telling me that their thyroid gland has been checked and found to be normal. This just reflects how inadequate tests can be in picking up thyroid deficiency. Usually doctors simply check a TSH (thyroid stimulating hormone), which will only pick up primary thyroid gland failure. For many of my CFS patients the problem is secondary to pituitary failure and therefore the TSH will be normal. For some the problem is poor conversion of inactive T4 to active T3. Too many doctors treat the laboratory, not the patient. See Thyroid hormone test.

Symptoms of thyroid failure

  • weight gain
  • lethargy, inability to get fit
  • mental sluggishness (can progress to "myxoedema madness")
  • sensitivity to cold
  • heat intolerance
  • tendency to get recurrent infections
  • fluid retention
  • mood swings and depression
  • poor memory and concentration
  • hair loss - classically the outer third of the eyebrows
  • arthralgia (joint pain) and morning stiffness
  • skin problems and furunculosis (boils)
  • headaches
  • vertigo and deafness
  • hypoglycaemia (low blood sugar)
  • constipation
  • menstrual problems
  • pre-menstrual tension
  • digestive problems
  • infertility and loss of libido
  • feeling older than you are.

Signs of hypothyroidism

  • puffy face and/or puffy eyes
  • cold hands and feet
  • dry skin, rashes, eczema and boils
  • enlargement of the tongue
  • hoarse voice or voice change
  • soft pulse or bradycardia
  • goitre (swelling at the base of the neck)
  • slowed Achilles tendon reflex
  • low basal body temperature (measure your body temperature first thing in the morning. If consistently below 36 degrees centigrade, suspect hypothyroidism).
  • and almost anything else!

Suspect hypothyroidism if blood tests show

  • raised cholesterol (or abnormal fats)
  • macrocytosis - i.e. the red cells are too big
  • anaemia.

Look for hypothyroidism with other diagnoses

  • Chronic fatigue syndrome - see Hypothyroidism
  • Arteriosclerosis and heart disease
  • Cancer
  • Depression
  • Dementia
  • Muscle and joint pains.


  • if one member of the family is affected, blood relatives are also at risk. I would screen for thyroid in all elderly patients.
  • Hypothyroidism must not be forgotten in children as a cause of failure to thrive or poor scholastic performance.
  • The test for hypothyroidism is to do Thyroid profile: free T3, free T4 and TSH. I diagnose hypothyroidism on the results of blood tests and clinical examination and confirmed by response to a trial of thyroid hormones. There are a few patients who do not feel well until their T4 is at the top of the normal range. So I find myself using thyroid hormones very often in fatigue syndromes.

Thyroid History is an excellent website with hundreds of experts from medical journals going back to the early 19th Century.

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