Practice information from Dr Syed Kashif Hussain Kazmi, Consultant Endocrinologist. View professional profile on Top Doctors.
A thyroid disorder means the thyroid gland makes too much or too little hormone, or becomes enlarged or lumpy. A thyroid specialist can explain unclear blood tests, assess nodules and overactive or underactive thyroid, and plan treatment and monitoring. Virtual consultations are available across the UK, with in person appointments in Cambridge.
What is a thyroid disorder?
The thyroid is a small gland at the front of the neck. It makes hormones that help control energy use, heart rate, body temperature and many other body processes. If it makes too little hormone the condition is called hypothyroidism (underactive thyroid); too much is hyperthyroidism (overactive thyroid). The gland can also become enlarged (a goitre) or develop lumps (nodules), most of which are not cancer.
Common causes include autoimmune conditions: Hashimoto’s thyroiditis, which usually causes an underactive thyroid, and Graves’ disease, which causes an overactive thyroid. Some medicines, pregnancy and inflammation of the gland can also affect thyroid function.
What are the symptoms of thyroid problems?
Thyroid symptoms are often non-specific and overlap with many other conditions, which is why blood tests matter. Commonly reported features are:
- Underactive: tiredness, feeling cold, weight gain, constipation, dry skin, low mood, heavy or irregular periods
- Overactive: palpitations, tremor, weight loss despite a normal appetite, heat intolerance, anxiety, loose stools, light periods
- A visible swelling in the neck, hoarseness or difficulty swallowing
- Gritty, red, swollen or bulging eyes (thyroid eye disease, linked to Graves’ disease)
When should you see a thyroid specialist?
Many thyroid conditions are managed in primary care. A specialist assessment may be helpful when:
- Thyroid blood tests are borderline, fluctuating or do not fit your symptoms
- You have an overactive thyroid, a thyroid nodule or a goitre
- You continue to feel unwell despite treatment and your test results look normal
- You are pregnant or planning pregnancy and have a thyroid condition
- Thyroid function has been affected by a medicine such as amiodarone or lithium, or by cancer treatment
- You have eye symptoms that could be related to thyroid disease
How are thyroid problems investigated?
Tests depend on what is suspected and may include:
- Thyroid-stimulating hormone (TSH), free thyroxine (T4) and sometimes free T3
- Thyroid antibodies (TPO and TSH-receptor antibodies)
- Ultrasound scan of the thyroid, and where needed a nuclear medicine thyroid scan
- Fine-needle aspiration of a nodule, arranged through an appropriate imaging service
How are thyroid disorders treated?
Treatment depends on the cause and your circumstances. Broad approaches include:
Underactive thyroid
Daily levothyroxine, with the dose adjusted by blood tests and then reviewed regularly. NICE advises caution about treating borderline (subclinical) results, so decisions are made case by case.
Overactive thyroid
Anti-thyroid medicines, and where appropriate radioactive iodine or surgery. The best option depends on the cause, thyroid size, eye disease, age, pregnancy plans and your preferences.
Nodules and goitre
Risk assessment, imaging and, when necessary, referral to a specialist surgeon or multidisciplinary thyroid team.
Monitoring
Planned follow up so that dose changes are timely and long term risks, such as to bone health or the heart, are kept in view.
When to seek urgent help
Follow the safety instructions from your prescriber and the patient information leaflet, including any instructions to stop a medicine and seek urgent advice for serious side effects. Seek emergency help (999) for a very fast or irregular heartbeat with high temperature, agitation or confusion in someone with an overactive thyroid, for sudden swelling in the neck with difficulty breathing, or for sudden loss of vision or double vision.
Common questions
My thyroid tests are normal but I still feel unwell. Can you help?
A specialist review looks at the whole picture: medicines, other hormone and medical conditions, sleep, iron and vitamin levels, and the timing of tests. Many symptoms have other causes and the aim is to find them rather than assume the thyroid is responsible.
Will I need to take thyroid medicine for life?
It depends on the cause. Underactive thyroid caused by autoimmune disease usually needs long term treatment. Some overactive or inflammatory conditions settle or are treated definitively.
Is a thyroid lump usually cancer?
No. Most thyroid nodules are benign. A lump that is new, growing, hard or associated with voice change should be assessed promptly so the right tests can be arranged.
Related patient guides
- Thyroid blood tests explained: TSH, T4 and what “borderline” means: What each thyroid test measures, why borderline results are often repeated, and when to ask for a specialist opinion.
- When should you see an endocrinologist?: Signs a hormone, thyroid, diabetes or bone problem may need a specialist, and how to prepare.
Further reading
- NHS: Underactive thyroid (hypothyroidism)
- NHS: Overactive thyroid (hyperthyroidism)
- NICE guideline NG145: Thyroid disease, assessment and management
Clinical content awaiting consultant review.