The thyroid is a small, butterfly-shaped gland at the front of the neck. Its hormones affect metabolism, heart rate, body temperature and energy levels. When the thyroid works too little or too much, the signs can look like everyday tiredness, stress or the effects of age, so they are often not linked to it straight away.
At Aura Medical Clinic in Tirana, thyroid problems are assessed by endocrinologist Dr. Sara Zavalani, the clinic’s founder. This article explains the difference between hypothyroidism and hyperthyroidism, the main signs and the tests that show how the thyroid is working.
The main differences
| Point | Hypothyroidism (underactive thyroid) | Hyperthyroidism (overactive thyroid) |
|---|---|---|
| What happens | The thyroid makes less hormone than the body needs. | The thyroid makes more hormone than the body needs. |
| Energy | Tiredness, slowing down, sleepiness. | Nervousness, restlessness, trouble sleeping. |
| Weight | Weight gain without eating differently. | Weight loss even with a good appetite. |
| Heart | A slower heartbeat. | A fast or irregular heartbeat. |
| Temperature | Feeling cold. | Feeling hot and sweating. |
| Tests | TSH usually high; free T4 low or normal. | TSH usually low; free T4 or free T3 high or normal. |
| Most common cause | Hashimoto’s thyroiditis, an autoimmune disease. | Graves’ disease, also autoimmune, or nodules that produce hormone. |
The table summarises the usual differences. Not everyone has all the signs, and only a medical assessment shows what is really happening.
Hypothyroidism: when the thyroid works too little
Besides tiredness, weight gain and feeling cold, there may be constipation, dry skin, hair loss, a puffy face, low mood and heavier or irregular periods. The most common cause is Hashimoto’s thyroiditis, an autoimmune disease in which the immune system gradually damages the thyroid. Treatment is usually thyroid hormone in tablet form, at a dose the doctor sets after the tests, with regular check-ups.
Hyperthyroidism: when the thyroid works too much
Besides weight loss and a fast heartbeat, there may be shaking hands, sweating, nervousness, insomnia, muscle weakness, more frequent bowel movements and lighter periods. The most common cause is Graves’ disease; hyperthyroidism can also come from thyroid nodules or from a temporary inflammation of the gland. Treatment depends on the cause and can include medicines that reduce hormone production, as well as other treatments decided after the assessment.
The tests that show how the thyroid is working
- TSH: the hormone that signals to the thyroid. It is usually the first test.
- Free T4 and free T3: the thyroid’s free hormones, which show how much hormone the gland is making.
- Antibodies, such as anti-TPO: they help show whether the cause is autoimmune.
- Thyroid ultrasound: it shows the size and structure of the gland, as well as any nodules.
Normal ranges vary a little from one laboratory to another, so the results should be read by a doctor, together with the symptoms. If you take biotin (vitamin B7) or hair and nail supplements, mention it before the test, as they can change the result. Thyroid tests can be done at Aura’s laboratory, and a thyroid ultrasound in our ultrasound service.
Thyroid nodules
Nodules are small lumps inside the thyroid. They are common and most are benign, but they need to be assessed. An ultrasound shows their size and features, and the doctor decides whether regular check-ups are enough or further tests are needed. Tell your doctor if a lump in your neck grows quickly, if you have difficulty swallowing or breathing, or if your voice changes.
Who should be checked
- Anyone with the signs described above.
- Anyone with family members who have thyroid disease.
- People with other autoimmune diseases, such as type 1 diabetes.
- Women who are planning a pregnancy, are pregnant or have recently given birth.
- Anyone who has had neck surgery or radiation to the neck in the past.
- Anyone taking medicines that can affect the thyroid; ask your doctor about your medicines.
The thyroid matters especially in pregnancy, because its hormones affect the baby’s development. If you have a thyroid problem and are planning a pregnancy, talk to your doctor first.
When to seek help straight away
A very fast or irregular heartbeat, chest pain, shortness of breath, a high temperature with agitation or confusion, or severe drowsiness need immediate medical help. In these cases, do not wait for an appointment: go to an emergency department.
Questions for your consultation
- Are my thyroid results normal, borderline or outside the normal range?
- Do I need other tests, such as antibodies, or an ultrasound?
- What could be causing my problem?
- Do I need treatment now, or is monitoring enough?
- How should I take my medication, and what should I avoid?
- Does this affect a future pregnancy?
- How often should I repeat the tests?
Read more about endocrinology at Aura Medical Clinic and about the early signs of type 2 diabetes. A consultation with Dr. Sara Zavalani sets out your individual plan.
