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Hypothyroidism vs. Hyperthyroidism: How to Figure Out Your Thyroid Issue

When your energy is thrown off, your thyroid is often to blame. Here's how to sort through the symptoms to solve your problems.


There are a lot of things that contribute to your energy levels: diet, exercise, medications. Those are all things you can control. But sometimes the answer lies within. In your neck, actually.

Your body goes as your thyroid goes. This little gland in your neck controls your metabolism — how your body uses energy. It can slow you down and tire you out or speed you up and make you restless.

You may be quick to blame your issues on something else but thyroid issues like this are quite common, especially in women. While about 20 million Americans live with a thyroid problem, women are five to eight times more likely to have one.

An underactive or overactive thyroid can lead to a number of issues.

There are a variety of thyroid disorders but they all relate back to two main problems: hypothyroidism or hyperthyroidism. The first means you have an underactive thyroid, the second that it’s overactive.

Either way, your body is not producing the right level of thyroid hormones, known as T3 and T4. These are the hormones that control your metabolism and a number of other processes in your body.

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Feeling Sluggish or Restless?

Those may be thyroid symptoms. Talk to your primary care provider about your issues.

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Hypothyroidism Symptoms

Of the two thyroid conditions, hypothyroidism is much more common, affecting 1 in 20 people in the United States. As your metabolism slows, so do you.

Tiredness and fatigue are the hallmarks of hypothyroidism. Since there are many things that can contribute to those issues, it can be hard to identify that your thyroid is the problem. When hypothyroidism progresses to these more serious symptoms, it becomes easier to diagnose:

  • Feeling slow mentally
  • Poor memory
  • Weight gain
  • Depression
  • Constipation
  • Slow, weak heartbeat
  • Sensitivity to cold
  • Enlarged thyroid
  • Muscle weakness
  • Dry, thickened or puffy skin

Hyperthyroidism Symptoms

Since hyperthyroidism is the opposite problem — your thyroid is producing too many hormones — your symptoms are on the other end of the spectrum. Instead of feeling run down, you’re bursting with energy to the point of restlessness.

You may still have an enlarged thyroid and muscle weakness, but every other sign of hyperthyroidism is a direct opposite to hypothyroidism:

  • Sleeplessness
  • Weight loss
  • Anxiety
  • Diarrhea
  • Quick, irregular heartbeat
  • Sensitivity to heat
  • Hand or finger tremors

Symptoms vary from person to person. To make things more confusing, you can swing back and forth from their extremes, switching between hypothyroidism and hyperthyroidism. The best way to find out whether your thyroid is overactive or underactive is by getting a TSH blood test to check your thyroid function.

Your TSH level can tell you which thyroid problem you have.

It’s simple. TSH stands for thyroid-stimulating hormone. It’s produced by the pituitary glands and controls your thyroid function, telling it when to produce its own hormones.

Your TSH levels go in the opposite of your thyroid hormones — the T3 and T4. When your thyroid hormones are low, as in hypothyroidism, your body creates more TSH to produce more T3 and T4. When thyroid hormones are higher due to an overactive gland, TSH production slows down until your body is more balanced.

Because the thyroid-stimulating hormone is so closely linked to your thyroid function, TSH levels are a good indicator of thyroid health. But they change over the course of your life or even the course of a day.

Stress, diet, medication, pregnancy and menstruation all have an effect on your TSH levels on a day-to-day basis. But there are still normal ranges that differ depending on your age, sex or stage of pregnancy. When you fall outside those ranges, you likely have a thyroid issue.

Group

Age/Stage

Low TSH

Normal TSH

High TSH

Women

18 – 29 Years

< 0.40

0.40 – 2.34

> 4.50

30 – 49 Years

< 0.40

0.40 – 4.00

> 4.10

50+ Years

< 0.46

0.46 – 4.68

4.10 – 7.00

Pregnant Women

1st Trimester

< 0.20

0.20 – 2.50

2.50 – 10.00

2nd Trimester

< 0.30

0.30 – 3.00

3.01 – 4.50

3rd Trimester

< 0.80

0.80 – 5.20

> 5.30

Men

18 – 30 Years

< 0.50

0.50 – 4.15

> 4.50

31 – 50 Years

< 0.50

0.50 – 4.15

> 4.15

51 – 70 Years

< 0.50

0.50 – 4.59

> 4.60

71+ Years

< 0.40

0.40 – 5.49

> 5.50

Children

Premature Birth

< 0.70

0.70 – 27.00

> 28.00

0 – 4 Days

< 1.00

1.00 – 29.00

> 30.00

2 – 20 Weeks

< 1.70

1.70 – 9.10

> 9.20

20 Weeks – 18 Years

< 0.70

0.70 – 64.00

> 64.00

TSH tests are the gold standard for evaluating thyroid health. But since they measure thyroid-stimulating hormones instead of the thyroid hormones themselves, sometimes additional testing of your T3 and T4 levels is necessary.

Even with all these tests, sometimes the results are conflicting. For example, up to 20 percent of adults have subclinical hypothyroidism, a mild form of hypothyroidism that’s especially common in women and older adults. Your TSH levels may be normal but you still show symptoms or you could have high TSH and normal T4 levels. Thyroid antibody tests can show if there’s an autoimmune issue with your thyroid and help you and your doctor decide if treatment is needed for milder thyroid problems.

Thyroid issues require lifelong management and treatment.

Neither hypothyroidism or hyperthyroidism can be cured. In fact, when surgery is needed to remove an overactive thyroid, you just end up with hypothyroidism and have to treat that condition instead.

Medications help with the management of both thyroid conditions and get rid of the side effects. For hypothyroidism, synthetic hormones eliminate your T4 deficiency as if your thyroid was functioning normally.

On the flip side, you have to stop the production of T4 with hyperthyroidism. Antithyroid medications that block the production of new thyroid hormones and radioactive iodines that destroy the cells that make T4 are often used.

So whether you’re full of energy or out of it, gaining weight or losing it, you have to talk to your primary care provider about your symptoms and get a TSH blood test. From there, you can balance out your hormones and feel like your old self again.

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