Why are so many women told they're depressed or menopausal when it's actually their thyroid? And why are others prescribed drugs for the condition when they don't even need them?

It tin beryllium a communal origin of weight gain, fatigue, arsenic good arsenic unexplained aches and pains – and an underactive thyroid has been linked to superior illness, including an accrued consequence of dementia.

Yet, experts say, it tin return years for nan information to beryllium diagnosed – pinch patients, who are usually women, still not being listened to erstwhile they spell to nan doctor, their symptoms are blamed connected depression aliases menopause instead.

At slightest 1 successful 20 group successful nan UK has a upset of nan thyroid, a butterfly-shaped gland that sits conscionable successful beforehand of nan sound box.

The thyroid produces 2 cardinal hormones — triiodothyronine (T3) and thyroxine (T4) — which thief modulate cardinal assemblage functions, including bosom rate, somesthesia and mood.

An overactive thyroid (hyperthyroidism) is erstwhile levels of these hormones are excessively high, causing symptoms specified arsenic palpitations, accelerated weight loss, sweating and itching.

But overmuch much communal is hypothyroidism, wherever nan gland produces excessively fewer hormones, starring to weight gain, fatigue, emotion nan cold, constipation and barren tegument and hair.

Women are 10 times much apt to beryllium affected than men, though it’s not clear why — and nan astir communal trigger for some thyroid problems is an auto-immune condition, wherever nan assemblage mistakenly attacks nan thyroid tissues.

Other causes see an iodine deficiency, medications specified arsenic amiodarone for bosom hit disorders, and it tin besides beryllium triggered by viral infections, including Covid-19. (However, moreover aft a terrible Covid infection, astir people’s thyroid usability returns to normal by 3 months afterwards, according to a study astatine nan University of Milan, published successful nan European Thyroid Journal successful 2023.)

Left untreated, thyroid conditions tin person a devastating effect connected health. In 2022, investigation successful nan diary Neurology linked having an underactive thyroid successful later life pinch an 81 per cent accrued consequence of processing dementia (although nan reasons for this are unclear).

Yet it takes an mean of 4 ½ years for a thyroid information to beryllium diagnosed, according to a 2023 study of 1,200 patients by researchers astatine nan University of Aberdeen. And often, it’s moreover longer for patients pinch an underactive thyroid.

Part of nan problem is that wide-ranging symptoms of a thyroid upset tin mean they are easy misdiagnosed — often arsenic nan menopause aliases intelligence wellness problems, according to kindness The British Thyroid Foundation.

Patients study needing aggregate appointments earlier a test is made, which takes its toll. As 1 diligent told nan Aberdeen researchers: ‘My self-esteem and intelligence wellness took a battering...it’s really not bully for your caput erstwhile nan expert infers “there is thing physically incorrect pinch you, possibly you’re depressed”, but your assemblage conscionable isn’t moving decently anymore, you cognize it, and you cognize you are not depressed.’

However, nan complexities of nan conditions person led experts to raise concerns that, while immoderate patients are not being diagnosed, worryingly, others are being overdiagnosed and overtreated, pinch perchance superior consequences.

‘Around 25 per cent of nan UK organization will person their thyroid tested via a elemental humor trial successful immoderate fixed year,’ says Dr Peter Taylor, a advisor endocrinologist astatine nan University Hospital of Wales.

A trial typically looks for 2 things successful nan blood: nan levels of T4 and thyroid-stimulating hormone (TSH). Levels of TSH emergence aliases autumn to ‘instruct’ nan thyroid gland to nutrient much aliases little T4 — changes to nan TSH level are often nan first motion of a problem.

‘We are picking up much and much cases, but nan period [of hormone levels] for GPs offering curen for an underactive thyroid has fallen little complete nan years,’ says Dr Taylor.

‘So 1 of nan problems now is that we’re treating group astatine a very debased threshold, but we don’t cognize precisely wherever that trigger constituent [for treatment] should be.’ In different words, immoderate group mightiness beryllium receiving prescriptions for curen they don’t need.

Some experts estimate that arsenic galore arsenic 80 per cent of patients who are prescribed levothyroxine to switch debased levels of T4 person ‘sub-clinical’ hypothyroidism, which intends their results are borderline.

Levothyroxine is 1 of nan astir wide prescribed narcotics successful nan UK; astir 1.36 cardinal group successful England return it and prescriptions roseate by 9 per cent betwixt 2016 and 2022, according to figures published successful The Lancet past twelvemonth [2023]. Potential side-effects see an accrued consequence of osteoporosis and nan bosom hit upset atrial fibrillation.

Dr Salman Razvi, a advisor endocrinologist and a elder objective teacher astatine Newcastle University, says nan problem is partially down to nan truth that nan meaning of ‘normal’ thyroid usability is simply a ‘minefield’. While location is simply a wide ‘reference range’ for ‘normal’, it isn’t a nationally agreed modular and testing labs sometimes usage somewhat different ranges — meaning that, theoretically, results and diagnoses whitethorn alteration depending connected wherever you person nan test.

In addition, ‘conventionally, nan reference scope to diagnose a thyroid upset and perchance prescribe thyroid hormone medicine has been wished by a mathematical equation — it’s not wished connected objective grounds’, says Dr Razvi.

This mostly involves asking a ample number of patient group pinch nary known thyroid problem aliases family history, who aren’t taking immoderate medication, to springiness humor samples and past mounting nan limits of ‘normal’ based connected wherever 95 per cent of their readings fall.

‘So if you had 100 people, for example, 5 mightiness beryllium classed arsenic having an abnormal humor trial — 2.5 group will beryllium classed arsenic having a borderline underactive thyroid and 2.5 arsenic having a borderline overactive,’ explains Dr Razvi.

‘Whether aliases not they really person an underactive aliases overactive thyroid is simply a different question.’

Another problem is that nan samples utilized to create these reference ranges are often taken from healthy, young volunteers, whereas successful existent life ‘we’re treating older group and group connected different medications which mightiness impact results’, he adds.

In different words, what’s normal aliases abnormal for each diligent mightiness not beryllium successful statement pinch nan reference scope — and based connected their property aliases wide health, immoderate mightiness use from curen astatine a little threshold, while others mightiness not request curen astatine all, says Dr Razvi.

Recent investigation seems to backmost this up. A study published successful nan diary Plos One successful 2022, which analysed humor samples for TSH and T4 successful 100,000 people, concluded that ‘thyroid hormone levels alteration during a person’s life and alteration betwixt sexes’.

High TSH and debased T4 levels propose an underactive thyroid — but ‘when you’re successful your 80s, having a TSH level that’s somewhat precocious doesn’t look to beryllium associated pinch immoderate harm’, says Dr Razvi.

It’s known that having a precocious TSH level becomes much communal arsenic we property — but alternatively than being a aesculapian problem, this slowing down of our metabolism could beryllium a earthy portion of ageing and, adds Dr Razvi, ‘may successful truth beryllium beneficial as, hypothetically, it could promote longevity’.

Patients who are older whitethorn besides beryllium much susceptible to unintended side-effects of excessively overmuch levothyroxine, specified arsenic osteoporosis and atrial fibrillation.

What’s more, a 2017 study published successful nan New England Journal of Medicine, involving 700 over-65s pinch borderline hypothyroidism, recovered levothyroxine curen did not amended cardinal symptoms specified arsenic fatigue.

Indeed, 92 per cent of nan patients pinch thyroid conditions surveyed by nan Aberdeen researchers past twelvemonth [2023] reported that astatine slightest immoderate of their symptoms endured, moreover aft they started treatment. (See container below).

‘We mightiness request to dainty younger group a spot much than we are doing — and older group a spot less,’ says Dr Taylor.

‘For younger group — successful their 40s and 50s — location is grounds that treating this borderline aliases sub-clinical thyroid usability mightiness amended cardiovascular outcomes, for example.’

But until much large-scale tests are done, it is difficult to cognize wherever nan cut-offs for curen should be, he adds.

Complicating matters further is nan truth that, though location is rather a wide scope considered ‘normal’ for thyroid usability crossed nan population, ‘individuals look to person a constrictive group constituent for their thyroid function’, says Dr Taylor — i.e. what’s normal for them.

Theoretically, it intends personification could person a alteration successful thyroid usability that causes problems but still falls wrong nan ‘normal’ parameters connected a trial — truthful they would beryllium told they don’t person a upset and person to strengthen nan symptoms regardless.

There are immoderate situations wherever it’s much important to dainty moreover nan astir marginal changes successful thyroid function, specified arsenic during a pregnancy.

In 2021, investigation by UK doctors, published successful The Lancet, suggested that women who acquisition recurrent miscarriage — 3 aliases much gestation losses successful a statement — should person their thyroid usability tested, moreover if they person nary different symptoms of hypothyroidism.

‘There’s now grounds to propose that sub-clinical hypothyroidism increases nan consequence of miscarriage and adverse gestation outcomes, specified arsenic preterm commencement and pre-eclampsia arsenic well,’ says Rima Dhillon-Smith, 1 of nan researchers and a master successful obstetrics and gynaecology astatine Birmingham Women’s and Children’s Hospital NHS Foundation Trust. Currently, thyroid testing isn’t routinely done during pregnancy.

In nan future, familial testing whitethorn beryllium capable to pinpoint an individual’s ‘normal’ thyroid range. However, location is simply a booming marketplace successful DIY thyroid usability tests — pinch High Street retailers including Superdrug, Holland & Barrett and Boots now trading them.

Typically, these tests impact taking a finger-prick humor trial and posting nan sample to a laboratory to beryllium analysed for TSH and T4 levels (the trial offered by nan NHS). A report, sometimes written by a doctor, is past sent to you. But Dr Razvi and Dr Taylor person doubts astir really adjuvant these DIY tests are.

‘It’s an costly measurement of having your thyroid checked,’ says Dr Taylor, fixed really commonly it is done connected nan NHS anyway.

Although Good Health recovered immoderate DIY tests costs arsenic small arsenic £7, different companies complaint arsenic overmuch arsenic £136 for a azygous study (and urge you execute nan humor trial much than once).

And location are different factors worthy base successful mind.

Unwanted weight summation is simply a communal trigger for suspecting an underactive thyroid. But while hypothyroidism tin origin nan pounds to heap on, location is immoderate proposal that nan narration goes some ways; that, successful immoderate cases, it’s weight summation that disrupts thyroid function.

Test results tin besides beryllium affected by a caller viral infection, which DIY testers whitethorn not beryllium alert of. ‘When we’re unwell, nan assemblage goes into a small spot of a shutdown because it wants to conserve energy, truthful TSH levels and T3 thin to beryllium low,’ says Dr Razvi. ‘During recovery, nan assemblage goes into a transient overdrive, and you could person a play erstwhile nan TSH is higher. Then, successful a fewer months’ time, it would spell backmost down to normal.’

TSH levels tin moreover alteration passim nan time — aliases alteration pinch nan seasons, he adds. ‘They thin to beryllium higher successful wintertime and little successful summer. People mightiness think: “If my TSH is high, past I must person an underactive thyroid and truthful I request thyroxine” — but it’s not arsenic easy aliases straightforward arsenic that.

‘That’s why clinicians wouldn’t usually diagnose a thyroid rumor from conscionable 1 humor test. You’d want to repetition it successful astatine slightest six weeks, but ideally successful 3 months’ time,’ he says.

BOX: WHEN YOUR THYROID PILLS DON’T WORK

Symptoms of an underactive thyroid, specified arsenic weight summation and fatigue, don’t ever amended connected levothyroxine — a synthetic type of nan earthy thyroxine hormone, T4 — moreover erstwhile humor tests propose hormone levels person returned to normal.

For some, this whitethorn beryllium because their information is borderline and possibly they don’t request to beryllium connected levothyroxine successful nan first place, says advisor endocrinologist Dr Salman Razvi.

However, different mentation is that they whitethorn besides request supplementary T3 — nan different hormone produced by nan thyroid. Normally, T4 accounts for 75 per cent of nan hormones produced by nan thyroid gland, T3 nan different 25 per cent. The assemblage past converts T4 into nan much progressive T3 arsenic required.

Treating group pinch other T3 is controversial, arsenic truthful acold location has been constricted grounds arsenic to really good it works.

However, successful 2023, nan British Thyroid Association [CORR] and nan Society for Endocrinology issued a associated connection advising doctors that ‘for a mini number of patients who stay symptomatic’ it tin beryllium due to prescribe T3.

‘We deliberation immoderate group mightiness not beryllium capable to person T4 into T3 arsenic well,’ says advisor endocrinologist Dr Peter Taylor.

‘In session we find that a 3rd of group don’t announcement immoderate quality connected T3 arsenic good arsenic T4, a 3rd consciousness a spot amended and a 3rd consciousness overmuch better,’ adds Dr Taylor, who believes it’s worthy considering T3 curen if personification doesn’t spot betterment connected T4 alone. But investigation connected T3’s semipermanent information mixed pinch T4 is still successful its early stages.

And, arsenic Dr Taylor acknowledges, ‘if you’re not emotion correct connected T4, it whitethorn person different origin speech from nan thyroid — and it tin beryllium rather difficult to find a expert who will support an oculus connected your T3 connected nan NHS’.

There person besides been proviso issues for T3, pinch galore NHS commissioning bodies restricting its usage aft manufacturers hiked up nan value by 4,600 per cent, arsenic antecedently reported by Good Health.

· For much information, visit: btf-thyroid.org