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The thyroid is a butterfly-shaped gland in the middle of the neck, located below the larynx (voice box) and above the clavicles (collarbones) (figure 1). The thyroid produce two hormones, triiodothyronine (T3) and thyroxine (T4), which regulate how the body uses and stores energy (also known as the body’s metabolism).

Thyroid function is controlled by a gland just below the brain, known as the pituitary. The pituitary produces thyroid-stimulating hormone (TSH), which stimulates the thyroid to produce T3 and T4.


In approximately 95 percent of cases, hypothyroidism is due to a problem in the thyroid gland itself and is called primary hypothyroidism. However, certain medications and diseases can also decrease thyroid function. As an example, hypothyroidism can also develop after medical treatments for hyperthyroidism, such as thyroidectomy (surgical removal of the thyroid) or radioactive iodine treatment (to destroy thyroid tissue). In some cases, hypothyroidism is a result of decreased production of thyroid-stimulating hormone (TSH) by the pituitary gland (called secondary hypothyroidism). (See “Patient education: Hyperthyroidism (overactive thyroid) (Beyond the Basics)”.)

Thyroid problems are more common in women, increase with age, and (in the United States) are more common in white people and Mexican Americans than in African Americans.


The symptoms of hypothyroidism vary widely; some people have no symptoms, while others have dramatic symptoms or, rarely, life-threatening symptoms. The symptoms of hypothyroidism are notorious for being nonspecific and for mimicking many of the normal changes of aging. Usually, symptoms are milder when hypothyroidism develops gradually. Symptoms, when caused by hypothyroidism, generally are related to the degree of hypothyroidism. Many patients with mild hypothyroidism are identified on screening tests for potential hypothyroid symptoms but have few or no symptoms that ultimately are attributed to hypothyroidism or respond to treatment of hypothyroidism. In contrast, patients with moderate to severe hypothyroidism are usually symptomatic and improve significantly with thyroid hormone replacement.

Causes of Thyroid in Female

Insufficient thyroid hormones cause body functions to slow. Symptoms are subtle and develop gradually. Some of them may be mistaken for depression, especially among older people.

Facial expressions become dull.
The voice is hoarse and speech is slow.
Eyelids droop.
The eyes and face become puffy.
The hair becomes sparse, coarse, and dry.
The skin becomes coarse, dry, scaly, and thick.
Many people with hypothyroidism are fatigued, gain weight, become constipated, develop muscle cramps, and are unable to tolerate cold. Some people develop carpal tunnel syndrome , which makes the hands tingle or hurt. The pulse may slow, the palms and soles may appear slightly orange (carotenemia), and the side parts of the eyebrows slowly fall out. Some people, especially older people, may appear confused, forgetful, or demented—signs that can easily be mistaken for Alzheimer disease or other forms of dementia. Women with hypothyroidism may have changes in their menstrual periods.

The following list of symptoms are those that may be present prior to treatment; hypothyroid patients on appropriate treatment should no longer be symptomatic. If symptoms persist, they likely have causes other than hypothyroidism.

General symptoms — Thyroid hormone normally stimulates the metabolism, and most of the symptoms of hypothyroidism reflect slowing of metabolic processes. General symptoms may include fatigue, sluggishness, slight weight gain, and intolerance of cold temperatures.

Skin — Hypothyroidism can decrease sweating. The skin may become dry and thick. The hair may become coarse, lateral eyebrows may disappear, and nails may become brittle.

Eyes — Hypothyroidism can lead to mild facial swelling. People who develop hypothyroidism after treatment for Graves’ disease may retain some of the eye symptoms of Graves’ disease, including protrusion of the eyes, swelling around the eyes, the appearance of staring, and impaired movement of the eyes. (See “Patient education: Hyperthyroidism (overactive thyroid) (Beyond the Basics)”.)

Cardiovascular system — Hypothyroidism slows the heart rate and weakens the heart’s contractions, decreasing its overall function. Related symptoms may include fatigue and shortness of breath with exercise. These symptoms may be more severe in people who also have heart disease. In addition, hypothyroidism can cause mild high blood pressure (the diastolic or second number) and raise blood levels of cholesterol.

Respiratory system — Hypothyroidism weakens the respiratory muscles and decreases lung function. Symptoms can include fatigue, shortness of breath with exercise, and decreased ability to exercise. Hypothyroidism can also lead to swelling of the tongue, hoarse voice, and sleep apnea. Sleep apnea is a condition in which there is intermittent blockage of the airway while sleeping, causing fitful sleep and daytime sleepiness. (See “Patient education: Sleep apnea in adults (Beyond the Basics)”.)

Diagnosis of Hypothyroidism

Measurement of thyroid-stimulating hormone levels in blood
Doctors usually suspect hypothyroidism on the basis of the symptoms and findings on physical examination, including a slow pulse.

Causes of Thyroid in Ladies

Usually hypothyroidism can be diagnosed with one simple blood test: the measurement of TSH. If the thyroid gland is underactive, the level of TSH is high.

In those rare cases of hypothyroidism caused by inadequate secretion of TSH, a second blood test is needed. This blood test measures the level of the thyroid hormone T4 (thyroxine, or tetraiodothyronine). A low level confirms the diagnosis of hypothyroidism.

Treatment of Hypothyroidism

Replacement of thyroid hormone
Treatment involves replacing thyroid hormone using one of several oral preparations. The preferred form of hormone replacement is synthetic T4 (levothyroxine). Another form, desiccated (dried) thyroid, is obtained from the thyroid glands of animals but is no longer used very often. In general, desiccated thyroid is less satisfactory than synthetic T4 because the content of thyroid hormones in the tablets may vary. In emergencies, such as myxedema coma, doctors may give synthetic T4, T3 (triiodothyronine), or both intravenously.

Treatment begins with small doses of thyroid hormone, because too large a dose can cause serious side effects, although large doses may eventually be necessary. The starting dose and the rate of increase are especially small in older people, who are often most at risk of side effects. The dose is gradually increased until the levels of TSH in the person’s blood return to normal. During pregnancy, doses usually need to be increased.

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