Thyroid Disease: The Vague Symptoms Indian Patients Attribute to Other Things

Thyroid disease is one of the commonest conditions in Indian women and one of the commonest missed diagnoses. The symptoms — fatigue, weight change, hair thinning, feeling cold or hot, low mood, irregular periods — are non-specific enough that they get attributed to age, stress, work, or 'life' for years before somebody thinks to check a TSH. The record that catches thyroid disease earlier is one that notices patterns.

Hypothyroidism vs hyperthyroidism, in plain terms

• Symptom: Weight · Hypothyroid (under-active): Gaining despite normal eating · Hyperthyroid (over-active): Losing despite normal eating
• Symptom: Energy · Hypothyroid (under-active): Tired, sluggish · Hyperthyroid (over-active): Restless, anxious, tremor
• Symptom: Body temperature · Hypothyroid (under-active): Cold intolerance · Hyperthyroid (over-active): Heat intolerance, sweating
• Symptom: Bowel · Hypothyroid (under-active): Constipation · Hyperthyroid (over-active): Loose stools
• Symptom: Mood · Hypothyroid (under-active): Low, foggy · Hyperthyroid (over-active): Anxious, irritable
• Symptom: Heart rate · Hypothyroid (under-active): Slow, sometimes < 60 · Hyperthyroid (over-active): Fast, > 90 at rest
• Symptom: Skin/hair · Hypothyroid (under-active): Dry skin, hair thinning · Hyperthyroid (over-active): Warm skin, hair loss
• Symptom: Periods (women) · Hypothyroid (under-active): Heavier, irregular · Hyperthyroid (over-active): Lighter, sometimes absent

When to test

• Any woman with unexplained fatigue lasting more than 6 weeks.
• Any change in periods that cannot be otherwise explained.
• Any weight change of more than 4-5 kg without dietary change.
• Any new-onset hair thinning.
• Any first-degree relative with thyroid disease.
• At the first pregnancy check, and pre-pregnancy if trying.
• Once at 30, 40, 50 as part of general health checks.

The single test that matters first

TSH (thyroid stimulating hormone). If TSH is normal, the thyroid is almost certainly working. If TSH is elevated, the thyroid is under-active. If TSH is suppressed, over-active. Free T4 and Free T3 add nuance but are secondary. A TSH-only screen costs under ₹300 at most Indian labs.

The Indian iodine story

India moved from iodine-deficient to iodine-sufficient over decades of salt iodisation, but Hashimoto's autoimmune thyroiditis is now the commonest cause of hypothyroidism — not iodine deficiency. Iodine supplements are not a treatment; they can worsen autoimmune thyroid disease. Treatment is levothyroxine, taken empty-stomach in the morning, with TSH monitored 6-weekly until stable then annually.

What the record should hold

• TSH values across years — the trend detects gradual under-treatment.
• Current dose and any changes with dates.
• Any symptom notes correlated with test values.
• Weight over time.
• Menstrual pattern (women), especially around dose changes.

Thyroid treatment is often lifelong. A record spanning years tells the specialist whether the dose has kept up with slow gland decline or whether adherence has been the issue. Both matter; both need the record to answer.

References

• ITS — Indian Thyroid Society guidelines
• American Thyroid Association guidelines
• PMC — hypothyroidism prevalence India