Thyroid Problems: Fluctuating Weight, Hair Loss and More

A small, butterfly-shaped gland tucked right underneath your Adam’s apple can have a huge impact on your health.

The thyroid gland is a small, squishy, butterfly-shaped gland located in the front of your neck above your collarbone. This unobtrusive little gland can have a huge impact on your health, says Trevor Angell, MD, an endocrinologist with Keck Medicine of USC. 

Your thyroid produces two main hormones: thyroxine (T4) and triiodothyronine (T3). Together, these hormones influence the regulation of cellular activity for everything from digestion and heart function to muscle control, metabolism and body temperature. When the thyroid produces too much or too little of these hormones, you can experience a wide range of health issues.  

There are many types of thyroid conditions, but the two most common are hypothyroidism and hyperthyroidism. Both conditions can affect various bodily systems, including brain function, heart rate, metabolism, menstrual cycle and fertility. Hair loss is also common in both conditions.  

What is hypothyroidism? 

Hypothyroidism is having an underactive thyroid and not having enough thyroid hormone. This can slow your metabolism and cause many problems, including: 

• Constant fatigue or depression: Low thyroid levels potentially cause fatigue, sadness or depression. 
• Dry skin and hair loss: Hair follicles naturally go through phases of growing, shedding and resting, but with hypothyroidism new hair grows more slowly and normal shedding continues, resulting in overall thinning. Your hair may also become brittle or coarse. 
• Low energy and frequently feeling cold: A slow metabolism can make you feel sluggish, and you may struggle to stay warm. 
• Muscle or joint pain: When the thyroid is underproducing hormones, you may experience swelling and inflammation in your joints and muscles, which can cause aches and pains, plantar fasciitis in the feet or carpal tunnel syndrome in the wrists. 
• Weight gain and constipation: You haven’t been eating more or exercising less yet find yourself gaining weight due to your underactive thyroid suppressing your metabolism. This slower metabolism also affects digestion, contributes to high cholesterol and can lead to constipation. 

Hypothyroidism has several causes. They include: 

• Hashimoto’s disease: An autoimmune disorder where your immune system attacks your thyroid. This is the most common cause. 
• Thyroiditis: Inflammation of the thyroid 
• Congenital hypothyroidism: Hypothyroidism that is present at birth 
• Surgical removal of part or all the thyroid 
• Radiation treatment of the thyroid 
• Certain medicines 
• In rare cases, a pituitary disease or too much or too little iodine in your diet can cause hypothyroidism. 

What is hyperthyroidism? 

In hyperthyroidism, the thyroid is overactive and produces too much of the thyroid hormones, which speeds up your metabolism and cause many different symptoms, including: 

• Anxiety, irritability and insomnia: Excess thyroid hormone may make you feel nervous, jittery, anxious and irritable, and it can disrupt your sleep patterns. 
• Constant hunger and/or weight loss: Hyperthyroidism increases your metabolic rate, causing weight loss and constant hunger even if you’re eating as you always have. This type of weight loss is not healthy, Dr. Angell says, because it involves the loss of muscle mass and not just fat. Additionally, faster gastrointestinal function may cause more frequent bowel movements or diarrhea. 
• Fewer or lighter periods: Women with hyperthyroidism may have fewer or lighter menstrual periods, potentially affecting ovulation and leading to infertility.  
• Hair loss: The whole hair-growth cycle speeds up, and though new hair is growing, a faster growth cycle is causing more shedding than usual, producing the overall result of hair loss despite ongoing hair growth. 
• Rapid or irregular heartbeat: Your heart may feel like it is pounding, and you may have trembling in your hands and fingers. You may also feel hot and sweat more. 
• Thyroid trouble may also lead to low sex drive or miscarriage. 

Hyperthyroidism has several causes. They include: 

• Graves’ disease, an autoimmune disorder in which your immune system makes antibodies to your thyroid that cause it to make too much hormone. This is the most common cause. 
• Thyroid nodules, which are growths on your thyroid. They are usually benign (not cancerous). But they may become overactive and make too much thyroid hormone. Thyroid nodules are more common in older adults. 
• Thyroiditis, or inflammation of the thyroid. It can cause stored thyroid hormone to leak out of your thyroid gland. 
• Too much iodine. Iodine is found in some medicines, cough syrups, seaweed and seaweed-based supplements. Taking too much of them can cause your thyroid to make too much thyroid hormone. 
• Too much thyroid medicine. This can happen if people who take thyroid hormone medicine for hypothyroidism (underactive thyroid) take too much of it. 

Who is at risk of thyroid problems? 

Women are significantly more likely than men to develop thyroid disorders, with rates about four times higher in women overall, Dr. Angell explains. The disparity is even more pronounced for hypothyroidism, which affects nearly 5 out of 100 Americans ages 12 years and up but affects women as much as nine times more frequently than men. These risks increase particularly after pregnancy and during menopause. Both hyperthyroidism and hypothyroidism are typically caused by autoimmune dysfunction, in which your body’s immune system attacks itself. 

Diagnosing and treating thyroid conditions 

All the symptoms mentioned above are rather nonspecific, even when taken together, Dr. Angell cautions. This means that a mild thyroid condition can be difficult to diagnose based on symptoms alone. For this reason, your most effective approach is a medical evaluation and a thyroid stimulating hormone (TSH) lab test, which can detect thyroid issues. 

If you suspect you may have thyroid problems — especially if someone in your family has previously been diagnosed with thyroid or other autoimmune conditions — your primary care physician can use a simple blood test to diagnose thyroid function. The TSH test provides a highly accurate measurement. When autoimmune disorders of the thyroid are suspected, antibody tests may also be ordered.  

Fortunately, many of the effects of thyroid dysfunction are often treatable by properly addressing the underlying thyroid imbalance. Depending on the patient’s reporting of symptoms and test results, several treatment options are available, from standard T4 hormone replacement to newer interventions.  

Dr. Angell notes that recent advances have changed treatment approaches. “What’s particularly new is the recognition that some patients who don’t feel well on T4 alone might benefit from adding T3 supplementation, an approach that wasn’t recommended in the past,” he says. “On the hyperthyroid side, what is in development now are agents to block the antibody that actually causes Graves’ disease.” 

Experts at Keck Medicine, including Dr. Angell, are continually researching new treatments and therapies for thyroid conditions. Unlike today, where T3 pills must be taken daily on an empty stomach, extended-release forms of T3 and subcutaneous delivery of T4 are in development, Dr. Angell says. Stay tuned. 

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