January is Thyroid Awareness Month, and hypothyroidism is a common but frequently untreated thyroid condition. Singing River endocrinologist Dr. Arianna Mohiuddin explains hypothyroidism and how to regulate our TSH levels.
Think of your body’s metabolism as an engine and your thyroid as the gas pedal.
With hypothyroidism, it is like having a gas pedal stuck on low. Your body slows down and struggles to keep pace with its usual rhythm.
Dr. Arianna MohiuddinEndocrinologist
A Gulfport native now residing in Ocean Springs, Arianna Mohiuddin, MD, is a triple board certified endocrinologist in diabetes, endocrinology, and metabolism, obesity medicine, and internal medicine. Having overcome personal challenges with thyroid disease and obesity, she brings a depth of empathy and insight to her personalized, non-judgmental care. She sees patients at Singing River Endocrinology Services in Gulfport and Ocean Springs.
Learn more about Dr. Mohiuddin.
What brought you to endocrinology?
Before pursuing a career in endocrinology and obesity medicine, I worked in a variety of healthcare settings, including as a hospital medicine physician and also for a healthcare startup. I saw patients who sadly presented at an advanced stage in their disease process and thus ended up hospitalized. I remember a diabetic patient who had no idea that he had a diagnosis of Type 2 diabetes; he found out about the diagnosis on the way to the operating room for an emergent foot amputation.
These experiences forever changed my perspective, and I decided to switch gears to focus more on preventative care and keeping patients medically optimized so that they can avoid hospital admissions. In fact, patients with uncontrolled diabetes are at higher morbidity and mortality from conditions like COVID, heart disease, stroke, and many others.
I also got diagnosed with a thyroid disorder (Graves’ disease) in my 20’s, so I had a firsthand perspective of things.
What is hypothyroidism?
Hypothyroidism is also referred to as underactive thyroid, and it is a condition where your thyroid gland does not produce enough thyroid hormones. These hormones regulate your metabolism, heart rate, body temperature, and various other functions.
Think of your body’s metabolism as an engine and your thyroid as the gas pedal. When you have hypothyroidism, it is like having a gas pedal stuck on low. Your body slows down, and it is struggling to keep pace with its usual rhythm.
Hypothyroidism is incredibly common and affects approximately five to ten percent of the general population.
What are the common symptoms that indicate you may have hypothyroidism?
Fatigue & Sluggishness
The most common symptom is fatigue—feeling that you’re perpetually tired, drained, and have no energy.
Unexplained Weight Gain
An unexplained weight gain of approximately five to 10 pounds. Even with diet and exercise, your body is just not burning calories efficiently.
Sensitivity to Cold
Your metabolism slows down heat production, making you feel chilly, even in mild temperatures.
Dry Skin and Hair
Your skin might feel rough, and your hair might feel thin or become brittle.
Brain Fog and Mood Changes
Difficulty concentrating, memory problems, and even depression can occur with hypothyroidism.
Do many people have hypothyroidism but not know?
Yes, absolutely. Hypothyroidism is incredibly common and affects approximately five to ten percent of the general population. Levothyroxine, which is the treatment for hypothyroidism, is one of the most commonly prescribed medications in the world.
How do I find out if I have hypothyroidism?
A Thyroid Stimulating Hormone (TSH) Test is the best initial test you can get for the diagnosis of hypothyroidism. It is very easy to order the test from any primary care provider—PCP, physician, physician assistant, or nurse practitioner—and the results come back pretty quickly.
What is a normal TSH level?
It depends on your specific lab, but a normal TSH ballpark estimate is 0.45 to 4.5. For people who are elderly, the upper limit of normal is slightly higher. The recommendation also changes for pregnant patients.
What does hypothyroidism do to your body?
It depends on which stage of hypothyroidism you’re in and how long the process has been going on. Long term effects include:
- Slowing down of your metabolic processes
- Weight gain
- Fluid retention—swelling in the face, ankles and feet
- Significant cognitive deterioration
- Neuropathy symptoms
- Increased cholesterol
- Issues with fertility
One of the most feared complications is Myxedema Coma. This is a comatose state that happens when an individual with severe hypothyroidism has stopped taking their thyroid medication. It requires ICU admission and has a very high mortality rate. It can be easy to think that you don’t need your thyroid medication because for the first few days to two weeks you will not notice any significant change. It takes approximately six to twelve weeks for your dose to equilibrate in your body.
What are the treatments for hypothyroidism?
The mainstay of treatment is levothyroxine. The dose will be adjusted on the basis of a variety of factors such as the patient’s age, their weight, as well as other factors such as a presence of coronary artery disease, aka heart disease. Dosage regimens also change during pregnancy and with significant weight changes.
Are there side effects of levothyroxine?
Levothyroxine is generally very well tolerated. Some people are actually allergic to the dye in levothyroxine, but there is definitely a work-around using a [dye-free] 50mcg pill. Other symptoms can include nausea and vomiting.
Another side effect that can happen, especially whenever you’re first starting the dose, is fatigue and tiredness. Within the first few weeks of taking levothyroxine, some people can experience change in their menstrual periods, diarrhea, insomnia, nervousness, and anxiety.
Are there specific diets that you prescribe to people with hypothyroidism?
Generally, it will be a healthy diet, and I am a believer in the plant-based diet. Now, I know the world of diets is very controversial, because different doctors will tell you different things.
There are people who say to do keto diets, then there’s people who say to do low carb like Atkins, but based on the research that I have reviewed, and based on recommendations from the American Heart Association, a plant-based diet is the way to go, meaning that the majority of your diet is coming from fruits and vegetables as well as legumes and whole-grains.
Studies have shown that plant-based diets can lower your risk of heart disease, stroke, and other cardiovascular issues.
Are GLP-1 medications (such as Ozempic, Wegovy, Trulicity, Rebelsus, Saxenda, etc.) safe for people with hypothyroidism?
Absolutely. However, with GLP-1 agonists there are two main conditions which we’re very concerned about. They’re both rare, but I always like to mention them. The first is any personal or family history of medullary thyroid cancer and second is any prior history of acute pancreatitis. Those would be reasons why we would not do GLP-1 agonists, but otherwise, in most patients, they’re perfectly fine.
Can hypothyroidism be cured, or is it a chronic condition?
It is considered a chronic condition, meaning that it necessitates lifelong treatment.
Should I see my regular doctor or an endocrinologist for hypothyroidism?
It really depends on the patient. Some people want to be seen by a specialist, and in my opinion, that’s perfectly fine. If the option is available to you, go for it. However, because hypothyroidism is such a common condition, it can very well be treated by a primary care provider.
Certain indications to see an endocrinologist if you have hypothyroidism would be:
- People who are pregnant or trying to conceive
- Any history of goiter or thyroid nodules
- Uncontrolled symptoms
- Not responding to levothyroxine
- Health conditions that affect thyroid function such as a history of atrial fibrillation
- History of thyroid cancer