hypothyroidism diagnosis and treatment

Understanding Hypothyroidism: Diagnosis and Treatment

Dr. Jolene BrightenPublished: Last Reviewed: Thyroid & Hormone Balance Leave a Comment

More than 12% of Americans will develop a thyroid condition during their lifetime, and up to 60 percent won't even know it. These disorders typically manifest as either an overactive thyroid (hyperthyroidism) or an underactive thyroid (hypothyroidism). Of these two conditions, an underactive thyroid, or hypothyroidism, is the more common type that affects people in the U.S., especially women.

If you often feel exhausted, even after getting enough sleep, and experience difficulty concentrating, feelings of coldness, and issues with your weight and mood, you might be dealing with hypothyroidism.

When you experience thyroid dysfunction, it can significantly affect your overall well-being and quality of life. That's because the thyroid — a butterfly-shaped gland located at the front of the neck — acts as your body's metabolic thermostat, regulating your metabolism, weight, body temperature, and heart rate. It's also a key player in your fertility and menstrual cycle. 

Below, we'll cover the most common causes of hypothyroidism, tips for receiving a proper hypothyroidism diagnosis, and treatment options for managing this condition, often which involves a holistic approach to improving your overall health. 

Recognizing Hypothyroid Symptoms

Hypothyroidism can lead to a range of symptoms, often varying in intensity depending on the severity of the case. Because thyroid hormones are considered “homeostasis-maintaining hormones,” symptoms of an underactive thyroid can be widespread and affect many different aspects of your life, including your weight, mood, and mental performance.

In the early stages of hypothyroidism, when the condition first develops, symptoms can be subtle and easily overlooked. Over time, however, symptoms are likely to become more noticeable.

Symptoms including fatigue, brain fog, unexplained weight gain, and feeling unusually cold can be your body's way of whispering that your thyroid might need attention. These are among the first hypothyroidism symptoms you might notice. It's crucial to listen to these whispers before they become roars.

Common hypothyroidism symptoms can include:

  • Fatigue and lethargy
  • Brain fog and memory issues
  • Constipation
  • Dry skin
  • Thinning hair or loss of the outer portion of eyebrows
  • Unexplained weight gain
  • Joint pain or stiffness
  • Mood swings and depression
  • Sensitivity to cold temperatures
  • Irregular menstrual cycles
  • Infertility

What Causes Hypothyroidism?

Hypothyroidism is a condition that occurs when your thyroid gland doesn't produce enough hormones, including triiodothyronine, or T3, and thyroxine (T4). In other words, it's when the thyroid is “underactive.”

For many women, the root cause of hypothyroidism is Hashimoto's thyroiditis, an autoimmune condition where the body attacks its own thyroid tissue. This leads to a gradual reduction in thyroid function, including decreased output of important thyroid hormones that affect many bodily functions.

While Hashimoto's is a common root cause of hypothyroidism, it's not the only cause; this condition can arise for various other reasons — such as genetics and poor nutrient intake. It can also manifest as subclinical hypothyroidism, a more subtle form that isn't always easy to diagnose.

Hypothyroid causes can include:

  • Autoimmune disease
  • Surgical removal of the thyroid (thyroidectomy)
  • Radiation exposure as a treatment for hyperthyroid (overactive thyroid)
  • Exposure to radiation in your environment (like at your job)
  • Certain medications
  • Environmental toxins
  • Infections
  • Too much or too little iodine
  • Congenital disease
  • Pituitary gland conditions

Risk Factors for Hypothyroidism

When it comes to the development of hypothyroidism, it's not just about what's happening inside your thyroid gland; various factors and aspects of your lifestyle, such as your diet and stress levels, can increase your risk of developing this condition. 

Because so many different components of your health affect thyroid function, it can sometimes be hard to diagnose hypothyroidism accurately and to pinpoint exactly why it's occurring.

Below are important risk factors for hypothyroidism to be aware of.

Autoimmune Conditions

One of the most significant risk factors for hypothyroidism, particularly Hashimoto's thyroiditis, is the presence of autoimmune conditions. Autoimmunity occurs when your body's immune system, which usually guards against invaders, mistakenly attacks your own tissues. 

In the case of Hashimoto's, it's your thyroid gland that becomes the target of immune responses. As your thyroid experiences damage, it stops functioning properly and becomes underactive.

Gender and Age

Being a woman puts you at a higher risk for thyroid disorders, including hypothyroidism. Women are up to eight times more likely to develop thyroid issues, especially as they age. The risk increases particularly after menopause, highlighting the intricate connection between your hormones and thyroid health.

Family History/Genetics

Your family tree can hold clues to your thyroid health. If thyroid issues or autoimmune diseases run in your family, this can increase your risk of developing hypothyroidism as it indicates that you've inherited a thyroid with greater vulnerability.

Nutritional Factors (Including Iodine and Selenium)

Your diet plays a crucial role in thyroid health. For example, both iodine deficiency and iodine excess can lead to thyroid dysfunction. Selenium, another essential nutrient for the thyroid, is often overlooked. 

Ensuring a balanced intake of essential nutrients is critical to supporting your thyroid. It's also crucial to eat enough in general, especially if you're active, since under-eating and over-exercising can take a toll on your hypothalamic-pituitary-adrenal (HPA) axis and potentially contribute to thyroid issues as well as adrenal fatigue (a term that really means HPA-axis dysregulation).

Environmental Factors

Exposure to certain environmental toxins, including endocrine disruptors, can negatively impact thyroid function. These can include certain chemicals in plastics, pesticides, household cleaners, and cosmetics. 

On the other hand, being mindful of what you're putting inside and on your body on a daily basis can help decrease your exposure to these harmful chemicals.

Radiation and Medication

Having a history of radiation exposure, especially to the neck area, or taking certain medications can also increase the risk of developing hypothyroidism. Discussing these factors with your healthcare provider is essential, as they can provide valuable insights into your thyroid health.

High Amounts of Stress

Never underestimate the power of stress on your thyroid health. Chronic stress can wreak havoc on your hormones, including your thyroid, as well as your HPA axis. Research shows that stress across the lifespan impacts thyroid hormone signaling and can exaggerate symptoms such as anxiety.

Keep in mind that “stress” can come in many forms, including physical, mental, and emotional stress from a hectic and anxiety-producing lifestyle, too little sleep, too little nutrients, and too much exercise.

Other Health Conditions

Having health issues, including a history of goiter (enlarged thyroid), anemia, or type 1 diabetes, increases your risk for hypothyroidism. If you have any of these conditions, talk to your provider about testing your thyroid if you notice any hypothyroidism symptoms emerging.

The Importance of an Accurate Hypothyroidism Diagnosis

Addressing thyroid disorders is about more than losing stubborn weight or feeling more energized; an undiagnosed thyroid disease may put adults at greater risk for certain serious conditions, such as heart disease and infertility. 

For instance, pregnant women with undiagnosed or untreated hypothyroidism have an increased risk of experiencing a miscarriage and preterm delivery. At the same time, their babies are at higher risk of having severe developmental problems.

Diagnosing hypothyroidism will likely require you and your healthcare provider to look beyond the thyroid gland itself. 

A proper diagnosis can involve examining your overall health — including your gut health, exercise and sleep habits, nutrient intake, stress levels, and general lifestyle. All these factors can influence thyroid function and should be part of the diagnostic process. 

Here's more about how to go about receiving an accurate hypothyroidism diagnosis.

Comprehensive Lab Testing

In order to determine if you have hypothyroidism or not, it's important to have testing done that goes beyond the standard Thyroid-Stimulating Hormone (TSH) test. 

TSH is tested by many healthcare providers early on, as it measures hormone levels that stimulate the thyroid to make more thyroid hormone. If TSH is high, it can indicate that the thyroid isn't currently making enough thyroid hormones, so it keeps pumping out more TSH to try and compensate. 

A TSH test is one important piece of the puzzle, but to truly understand what's happening, a range of tests is needed to help paint a complete picture of your thyroid function. 

I recommend having a full thyroid panel done to evaluate levels of:

  • TSH
  • Total and Free T4
  • Total and Free T3
  • Reverse T3
  • Anti-TPO
  • Anti-thyroglobulin

The Role of Antibodies in Diagnosis

Particularly in cases of Hashimoto's thyroiditis, the autoimmune form of hypothyroidism, testing for thyroid antibodies is crucial. 

These antibodies can indicate an autoimmune process long before other lab changes become apparent. For example,  thyroid antibodies (which measure autoimmune activity against the thyroid) can start to rise long before TSH goes up; therefore, testing them can be an early sign of the development of hypothyroidism.

Subclinical Hypothyroidism Diagnosis

As mentioned above, basic thyroid panels don't always include all important thyroid measures, so it's possible to have an imbalance or early stages of hypothyroidism even if your levels look mostly “normal.”

With subclinical hypothyroidism, your lab results might hover within the normal range, yet you can still experience symptoms. This is one reason why working with an experienced healthcare provider and discussing your symptoms is essential rather than just reviewing numbers on a lab report. 

If you suspect you have hypothyroidism, but your numbers are subclinical, explain to your provider how you feel, and be sure to have a full panel of tests done. 

Your symptoms are a key part of this puzzle. A TSH level that's considered normal might not be optimal for you. It's about finding that sweet spot where your lab values and your well-being align. 

Hypothyroidism Treatment

Successful treatment of hypothyroidism usually requires a broad look at the body's interconnected systems and a holistic approach to improving overall health. 

For example, lifestyle modifications — including diet, supplements, stress management, and prioritizing sleep — can all help treat hypothyroidism, while medication may also be needed to rebalance thyroid hormone levels.

Here are my suggestions for treating hypothyroidism.

Listen to Your Body

When it comes to understanding and managing hypothyroidism, it's essential to recognize that this journey is as unique as you are. The process begins with tuning into your body's signals and addressing your symptoms, which might not be the same types of issues that someone else with hypothyroidism deals with.

In other words, if something feels “off,” especially if the risk factors for thyroid disorders that I mentioned above apply to you, seek help from a qualified health professional.

Partner with the Right Healthcare Provider

One key to a successful hypothyroidism diagnosis is partnering with a healthcare provider who listens and sees you as a whole person, not just a set of symptoms or lab results. 

Ideally, find a healthcare provider to work with who understands the intricacies of thyroid health and is committed to helping you find balance and wellness. Your need for medication can change over your lifespan, especially if you're pregnant or entering menopause, so be sure to follow up with your provider regularly to monitor your condition.

Improve Your Gut Health

Imbalances in the gut microbiome can impact thyroid function and the production of other hormones. Research suggests that hypothyroidism causes changes in the gut microbiome; in turn, altered gut flora can also affect thyroid function.

Supporting gut function is particularly important among those with autoimmune thyroid conditions like Hashimoto's. In fact, regulating the immune response is as important as managing thyroid hormone levels in autoimmune thyroid conditions because the gut microbiome plays a crucial role in immune system regulation. 

A dysregulated gut microbiome can lead to increased intestinal permeability (often called ‘leaky gut'), which allows particles to enter the bloodstream and potentially trigger autoimmune responses, including those targeting the thyroid gland.

Here's more about the importance of the gut-thyroid connection.

Absorption of Nutrients

The gut is responsible for absorbing nutrients that are critical for thyroid function, including iodine, selenium, zinc, and vitamins. An imbalanced gut microbiome can lead to poor absorption of these nutrients, which can directly affect thyroid hormone production and metabolism.

Conversion of Thyroid Hormones 

The microbiome assists in converting T4 (the inactive form of thyroid hormone) into T3 (the active form). An imbalance in the gut bacteria can hinder this conversion process, leading to symptoms of hypothyroidism even when thyroid gland function is normal.


Systemic or chronic inflammation that impairs thyroid function and exacerbates thyroid disorders can stem from gut dysfunction. Reducing inflammation through gut health often has a positive impact on thyroid health.

Hormone Regulation 

The gut microbiome influences the regulation of various hormones in the body, including those produced by the thyroid gland. It can affect the levels of hormones circulating in the body and how they are metabolized.

Supporting Gut Health for Thyroid Function

  • Probiotics and prebiotics: Incorporating probiotics and prebiotics can help balance the gut microbiome. Probiotics introduce beneficial bacteria, while prebiotics provide the necessary nutrients to feed these bacteria. Eat foods regularly that provide probiotics and prebiotics (found in high-fiber foods), including yogurt, kefir, sauerkraut, and kimchi. Taking a Women's Probiotic supplement can also help support a healthy gut microbiome.
  • Dietary changes: A diet rich in fiber, healthy fats, lean proteins and low in processed foods, sugar, and artificial additives can promote a healthy gut environment.
  • Stress management: Chronic stress can negatively impact the thyroid and gut health due to the effects of stress hormones on inflammation. Techniques such as mindfulness, yoga, and adequate sleep can help manage stress levels.
  • Avoiding gut irritants: Reducing the intake of foods and substances that irritate the gut, such as alcohol, caffeine, and certain medications, can help maintain a healthy gut lining.
  • Regular exercise: Physical activity can promote a healthy digestive system and support the balance of gut bacteria.

Supplements and Nutrition

Alongside medication, a nutrient-rich, balanced diet and appropriate supplements can support thyroid function and hormone activation.

Overall, aim to eat an anti-inflammatory diet that provides plenty of healthy fats, fiber, protein, vitamins, minerals, and antioxidants. Avoid processed foods, sugar, and artificial additives that can take a toll on the gut environment. For help sticking to a healthy thyroid diet, check out this article on creating a thyroid meal plan.

Here are other tips for eating well and supplementing to support your thyroid.

Monitor Your Iodine Intake 

While iodine is crucial for thyroid health, excessive intake can exacerbate autoimmune responses in Hashimoto's. It's best to balance iodine intake carefully. For help determining your iodine level and how much you need, speak with your healthcare provider about testing or supplementation options.

To consume a healthy amount of iodine, it's generally recommended that you incorporate iodized salt into your meals and eat foods like seaweed (such as kelp, nori, kombu, and wakame), seafood eggs, yogurt, beans, and turkey.

Consume Enough Selenium 

Selenium is a vital micronutrient that plays a crucial role in thyroid health for several key reasons, such as by supporting glutathione peroxidase, an important antioxidant enzyme in the body that neutralizes harmful compounds. 

Selenium also assists in the conversion of thyroxine (T4), the inactive form of thyroid hormone, into triiodothyronine (T3), the active form. Additionally, selenium plays a role in the regulation of the immune system, such as decreasing inflammation and oxidative stress. 

To cover your selenium needs, add foods to your diet, including Brazil nuts, eggs, poultry, grass-fed meat, yogurt, legumes, and veggies like broccoli, greens, and mushrooms.

Consider Thyroid Support Supplements: 

My Thyroid Support Kit featured three supplements that together serve as a comprehensive solution designed to enhance thyroid function and overall hormone health. This kit is particularly beneficial for women who are more prone to thyroid diseases, including those with autoimmune conditions, recent mothers, women transitioning into menopause, or those under stress. 

Within my Thyroid Support kit, you'll find:

  • Thyroid Support: Formulated with essential nutrients including vitamins, minerals, and American ginseng for thyroid hormone production and conversion.
  • Adrenal Support: Includes adaptogenic herbs and nutrients aimed at optimizing stress hormone production and balancing cortisol.
  • Omega Plus: Contains EPA/DHA fats (enhanced with lipase for better absorption) to support cellular health, reduce inflammation, and balance the immune system. 

Consider Individualized Medication

Thyroid treatment is not one-size-fits-all. What works for one person may not be effective for another. It's crucial to find the right medication and the right dosage that works for your body.

If your healthcare provider does recommend you take thyroid medication, such as levothyroxine which is typically taken in tablet form once daily, you may need to continue taking it for a long period of time, depending on your individual case. Your dosage might also need to be adjusted based on the stage of life you're in, such as pregnancy or menopause.

Hypothyroidism Diagnosis and Treatment Summary

Hypothyroidism, a condition where the thyroid gland doesn't produce enough thyroid hormones, can be a bit of a chameleon, often presenting with symptoms that can easily be mistaken for other health issues. 

Diagnosing and treating hypothyroidism commonly requires comprehensive diagnostic testing followed by a personalized treatment plan. While lab results are important, they should always be interpreted in conjunction with someone's unique symptoms. By working with experienced healthcare professionals, those with hypothyroidism can achieve better health outcomes and an improved quality of life.

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.