Hypothyroidism: symptoms, lab tests and telehealth follow-up
Hypothyroidism happens when the thyroid does not make enough hormone. It causes fatigue, weight gain, trouble tolerating cold and dry skin, and it is confirmed with blood tests such as TSH. It is controlled with a daily thyroid hormone pill. By video, the doctor can review your labs, give you follow-up lab orders and, if appropriate, renew your prescription.
Can we help by telehealth? Yes, we can help by telehealth.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Extreme drowsiness, confusion or being hard to wake
- A very low body temperature, or feeling very cold with a swollen face
- A very slow heartbeat, fainting or shortness of breath
- Strong palpitations or chest pain after a dose change
Help lines:
- 911 — Emergencies
- 1-800-981-0023 — Línea PAS (mental-health crisis line)
- 988 — Suicide & Crisis Lifeline
- 1-800-222-1222 — Poison Help
Hypothyroidism symptoms
Hypothyroidism develops slowly, so you may not notice symptoms for months or even years. The most common are:
- Fatigue
- Weight gain
- Trouble tolerating cold
- Joint and muscle pain
- Dry skin or dry, thinning hair
- Heavy or irregular periods, or fertility problems
- Slowed heart rate
- Depression
Who is more likely to get it?
Nearly 5 in 100 Americans aged 12 and older have hypothyroidism. Women are much more likely than men to develop it, and the risk rises after age 60. The most common cause is Hashimoto's disease, an autoimmune disorder. Other causes include thyroiditis, thyroid surgery or radiation, and some medicines.
Lab tests: TSH
The main test is TSH, a hormone the pituitary gland makes to push the thyroid to work. When thyroid hormone in your blood is low, TSH goes up, so a high TSH usually points to an underactive thyroid. If TSH is abnormal, other tests such as T4 are usually added.
One test does not explain the cause. The doctor reads your results together with your symptoms and can give you a lab order.
Treatment and dose adjustments
Treatment is levothyroxine, a hormone identical to the one a healthy thyroid makes. It is usually taken once a day on an empty stomach, before breakfast. If you take calcium or iron, ask how far apart to keep them from your levothyroxine.
About 6 to 8 weeks after you start or change your dose, a blood test is repeated to adjust it. Do not stop taking it without talking to the doctor, and it must never be used for weight loss: too much can cause serious problems such as an irregular heartbeat or bone loss.
Hypothyroidism follow-up by telehealth
If you are physically in Puerto Rico, in a US$79 online doctor visit the doctor can:
- Review your symptoms and your TSH results.
- Give you the order for your next blood test, at no extra charge, and go over the result with you.
- Adjust your dose when the results call for it.
- Renew your prescription if appropriate. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances.
Pregnancy and your thyroid
Untreated hypothyroidism during pregnancy can affect both mother and baby, and many women need a higher dose while pregnant. If you are pregnant or planning a pregnancy, your thyroid should be managed in person by your obstetrician or an endocrinologist. Tell them as soon as you know you are pregnant.
Your treatment during hurricane season
In Puerto Rico hurricane season runs from June 1 to November 30. Because levothyroxine is taken every day, it helps to have a supply on hand and your prescription up to date before a storm. See medications and hurricanes.
Hypothyroidism in children
An underactive thyroid in children and teens affects growth and development, so diagnosis and treatment should be handled by a pediatric specialist or pediatric endocrinologist.
Video visit: US$79 · Pay by card · See the price and what is included
Before you book
- You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
- We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
- Real-time video only; we do not do phone-call visits.
- We do not prescribe controlled substances.
Frequently asked questions
- What are the symptoms of an underactive thyroid?
- Fatigue, weight gain, trouble tolerating cold, muscle aches, dry skin and hair, irregular periods, a slow heart rate and depression. Because they come on slowly, many people do not notice them for months.
- What does a high TSH mean?
- When the thyroid makes too little hormone, the pituitary makes more TSH to stimulate it. A high TSH usually points to hypothyroidism, but the doctor reads it together with other tests and your symptoms.
- Can you refill my thyroid medication by video?
- Yes, if your condition is stable and the doctor judges it appropriate. A recent TSH helps; if you do not have one, she can give you the lab order.
- Is hypothyroidism permanent?
- It can almost always be fully controlled with thyroid hormone taken at the recommended dose. In most cases treatment is long-term.
Sources
- NIDDK (NIH): Hypothyroidism (accessed 2026-09-30)
- MedlinePlus (NIH): TSH test (accessed 2026-09-30)
- MedlinePlus (NIH): Levothyroxine (accessed 2026-09-30)
- NOAA National Hurricane Center: tropical cyclone climatology (accessed 2026-09-30)