Hypothyroidism: symptoms, lab tests and telehealth care in Puerto Rico

Your thyroid is a gland in your neck that makes hormones controlling how your body uses energy. With hypothyroidism (an underactive thyroid) it does not make enough, and your body slows down.

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.

The opposite problem is hyperthyroidism, when the thyroid makes too much hormone and causes a racing heart, nervousness and weight loss. The two thyroid problems can be confused; a blood test tells them apart.

It works the same from anywhere in Puerto Rico:

A doctor visit has the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the clinic can’t see you. A doctor's note after your visit is included at no extra charge. See all prices.

If you already take thyroid medication and only need a refill, choose a follow-up visit: anyone can book it. A review of lab results is also a follow-up visit, for existing patients. If a follow-up or forms visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.

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 (see thyroid-related hair loss)
• Heavy or irregular periods, or fertility problems
• Slowed heart rate
• Depression or low mood

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. The doctor reads your results together with your symptoms and gives you a lab order when one is needed.

Treatment is levothyroxine, a hormone identical to the one a healthy thyroid makes. According to MedlinePlus, it is sold as a generic and under brand names such as Synthroid, Levoxyl, Unithroid and Tirosint. It is usually taken once a day on an empty stomach, before breakfast. If you take calcium or iron, ask the doctor 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. Once your dose is stable, the NIDDK says the test is usually repeated at 6 months and then once a year. Do not stop taking it without talking to the doctor. MedlinePlus warns that levothyroxine must not be used to treat obesity: too much can cause serious problems such as a rapid or irregular heartbeat.

A high TSH usually means your thyroid is making too little hormone. According to MedlinePlus, when thyroid hormone in your blood is low, the pituitary gland makes more TSH to stimulate it: the typical pattern of hypothyroidism. A low TSH usually points the other way, to a thyroid making too much hormone; read about hyperthyroidism.

What is the normal TSH range? There is no single number for everyone: each lab prints its reference range next to your result, and that is the one that counts (see how to read lab results). MedlinePlus also explains that TSH may be higher in people over 80 who have no thyroid problem, is often a little low in the first three months of pregnancy, and can drop for a short time with some serious illnesses unrelated to the thyroid.

TSH alone also can’t say why it is high or low, so doctors usually add other tests such as T4. If your thyroid test came back out of range, the doctor goes over the result with you by video, asks about your symptoms and, if needed, gives you an order to repeat or complete it. Book your visit.

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, tell the doctor as soon as you know: she orders a TSH check and helps you coordinate your treatment with your obstetrician.

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.

We see children of all ages. An underactive thyroid in children and teens can affect growth and development, so if your child has symptoms, the doctor evaluates them by video and, if needed, gives you a lab order for a TSH test.

For your safety, call 911 or go to the nearest emergency room if you have any of these signs. See also when to go to the ER.

• Extreme drowsiness, confusion or being hard to wake
• A very slow heartbeat, fainting or shortness of breath
• Strong palpitations or chest pain after a dose change