Why Thyroid Disease Goes Undiagnosed in Women

Metabolic Mysteries

Doctor Examining Patients Thyroid
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It's a common story. After having a baby, you find it unusually difficult to lose the baby weight, despite serious diet or exercise. Or you think you're getting enough sleep, but find yourself waking after eight or more hours of sleep exhausted and then drag around during the day feeling like a nap is the only thing on your mind. Or, conversely, you may find yourself anxious for no apparent reason, losing weight, up all night with insomnia and heart palpitations, and noticing that you're losing hair.

For many of you, the doctor will suggest that these symptoms point to depression, not enough sleep, a need for exercise, premenstrual syndrome, or simply the effects of stress.

The reality is that symptoms such as fatigue, anxiety, unexplained weight gain or loss, hair loss, depression, and palpitations may indicate that you have an undiagnosed thyroid condition. A woman faces as high as a one in five chance of developing thyroid problems during her lifetime. That risk increases with age and for those with a family history of thyroid problems. The majority of women with thyroid disease are, however, undiagnosed.

The thyroid is our body's metabolic engine, controlling the use of energy and foods. A small butterfly-shaped gland, the thyroid is located in the neck behind the Adam's apple and produces key hormones – triiodothyronine (T3) and thyroxine (T4) – that fuel metabolism and help our bodies properly use energy and calories.

Symptoms of Hypothyroidism

How do you know if you have hypothyroidism, the most commonly diagnosed thyroid problem? Your symptoms might include depression, forgetfulness, fatigue, weight gain, hoarse voice, high cholesterol levels, constipation, intolerance to cold, coarse hair, hair loss, dry skin, reduced libido, tingling hands and feet, heavy or irregular periods, and infertility or recurrent miscarriage. 

Undiagnosed hypothyroidism is blamed for many conditions and symptoms in women, including:

  • infertility and recurrent pregnancy loss
  • heart attacks and clogged arteries
  • high cholesterol levels
  • difficulty losing weight
  • exacerbated menopausal symptoms
  • fibromyalgia and chronic fatigue syndrome
  • carpal tunnel syndrome and tendinitis
  • low sex drive
  • mitral valve prolapse

If your doctor suspects hypothyroidism, he or she will order a thyroid stimulating hormone (TSH) test. Most American laboratories have a normal range from around .5 to 5. A TSH level above 5 is usually diagnosed as hypothyroidism.

Doctors usually prescribe the synthetic T4 hormone levothyroxine to treat hypothyroidism. Popular brands include Levoxyl and Synthroid. A number of research studies have shown that a majority of patients may feel better on a combination of hormones. On that basis of that study, more doctors are also adding synthetic T3 (liothyronine). Alternative physicians tend to prefer natural desiccated thyroid drugs like Armour or Naturethroid, drugs that include both hormones.


The thyroid can also become overactive – hyperthyroid – producing excess thyroid hormone. Olympic medal-winning athlete ​Gail Devers testified before Congress regarding her own case of Graves' disease, an autoimmune condition that can cause hyperthyroidism. In Devers' case, doctor after doctor failed to recognize the signs of severe Graves' disease, as the Olympic gold medal-winning athlete dropped from 125 to only 87 pounds, suffered debilitating fatigue, lost nearly all her hair, and suffered other symptoms including rapid heart rate, and dry skin. It was two years before Devers was finally diagnosed and treated.

Common symptoms of hyperthyroidism include rapid weight loss, insomnia, anxiety, irritability, palpitations, fast heartbeat, heat intolerance, sweating, tremors, diarrhea, depression, weakness, eye and vision changes, lighter or infrequent periods, and infertility. Your doctor will typically run a TSH blood test and will look for low, from below .5 to nearly undetectable, TSH levels to diagnose hyperthyroidism. Our Hyperthyroidism Symptoms Checklist features a comprehensive list of symptoms.

If you have a milder case of hyperthyroidism, your doctor may initially prescribe antithyroid drugs such as methimazole (Tapazole) or propylthiouracil (PTU), as these drugs offer some chance of remission. For more advanced hyperthyroidism, doctors prefer radioactive iodine treatment, known as RAI. By partially or fully disabling the thyroid, RAI eliminates hormone overproduction but commonly results in life-long hypothyroidism. Surgery, known as thyroidectomy, is typically only done when you cannot tolerate antithyroid drugs, or are not a good candidate for RAI. A comprehensive overview of hyperthyroidism diagnosis, treatment and options is covered in our Graves' Disease/Hyperthyroidism FAQ.

Thyroid Nodules

Occasionally, symptoms may accompany suspicious thyroid nodules. Nodules are typically evaluated by ultrasound scan and blood tests, and sometimes by an outpatient biopsy called fine needle aspiration (FNA). The vast majority of nodules are benign, and some are treated with levothyroxine. If cancer can't be ruled out, or your thyroid is obstructing breathing or swallowing, your doctor will likely recommend surgery.

A Word From Verywell

There are several things you can do to reduce your chance of thyroid problems.

Be Careful About Too Much Soy: There's evidence that excessive isoflavones, found in popular soy products and supplements, may cause hypothyroidism, goiter or nodules. Going overboard on soy supplements and powders may trigger or worsen thyroid problems. Also, remember that a long-term, steady diet of soy formula may make your baby more vulnerable to developing autoimmune thyroid conditions, due to overexposure to antithyroid isoflavones.

Drink Fluoride-Free Water: Fluoride in water, and a rocket fuel manufacturing by-product known as perchlorate, and other toxic chemicals are among the many substances in water that may trigger or worsen the risk of thyroid problems. Consider drinking filtered, purified, or fluoride-free bottled water.

When It Comes to Iodine, Think Moderation: Too little iodine, an increasing problem in the United States, increases your risk of hypothyroidism or goiter, but excessive iodine intake, including kelp or bladderwrack, can also affect the thyroid.

Stop Smoking: Smoking can damage the thyroid, and actually worsens some existing thyroid conditions . . . yet another reason to quit or never start smoking.

Reduce Your Stress: Reducing stress using effective techniques such as aerobic exercise, yoga, and mind-body techniques can play a part in preventing some autoimmune problems like thyroid disease.

View Article Sources
  • Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 10th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2013.
  • De Groot, Leslie, M.D., Thyroid Disease Manager, Online book. Online