An underactivity of the thyroid gland that causes lesser production of thyroid hormones is known as hypothyroidism.

The body’s energy usage from food is controlled by the thyroid gland. This process is called metabolism. Metabolism affects the body’s temperature, heartbeat, and the number of calories burnt. In the absence of enough thyroid hormone, – The body processes slow down, the metabolism becomes sluggish, energy levels stoop to a low level, facial expressions become dull, and the eyes and face become puffy.

India has a high percentage (11%) of hypothyroidism cases, which is linked to the long-standing iodine deficiency in the country.

What are the symptoms of Hypothyroidism?

Symptoms of hypothyroidism subtle and develop slowly. They may often be confused with other conditions. The symptoms are:

  • Dull facial expressions, a hoarse voice and slow speech
  • Droopy eyelids and puffy eyes and face.
  • Dry, sparse hair and skin also becomes scaly, and thick.
  • Fatigue
  • Greater sensitivity to cold
  • Joint pain, stiffness, and swelling
  • Problems with memory
  • Muscle aches and stiffness
  • Muscle weakness
  • Puffy face
  • Unexplained weight gain or difficulty losing weight.
  • Changes in the menstrual cycle
  • Constipation
  • Depression

In some people, elevated cholesterol, slower heart rate, swelling of the thyroid gland (goitre), carpal tunnel syndrome (makes the hand tingle).

What are symptoms of hypothyroidism in babies and children?

Babies with hypothyroidism may have no symptoms. If symptoms do occur, they can include cold hands and feet, constipation, extreme sleepiness, hoarse cry, low muscle tone (floppy infant), puffy face, stomach bloating are some of the symptoms. These symptoms may also be due to other medical conditions. Consult the doctor in case these symptoms are observed.

  • Children and teens may show developmental delays such as slow mental development, slower development of permanent teeth, stature, delay in puberty, etc.

What are the causes of hypothyroidism?

Hypothyroidism may be –

  • Primary (owing to thyroid gland directly)
  • Secondary (owing to pituitary dysfunction (TSH levels) affecting thyroid gland indirectly)

The most common primary hypothyroidism disorder is Hashimoto thyroiditis. Hashimoto’s thyroiditis is an autoimmune disorder (a person’s own body produces antibodies that attack and destroy the thyroid gland). Thyroiditis means inflammation of the thyroid gland. Thyroiditis may also be due to a viral infection.

Other causes of primary hypothyroidism include –

  • Lack of iodine: Iodine is required to produce thyroid hormone and if the body gets it through diet. Iodized table salt is rich in iodine. Other food sources of iodine include shellfish, saltwater fish, eggs, dairy products.
  • Radiation to the head and neck (radiation while treating certain cancers may damage the cells in the thyroid, making it difficult hormones production.)
  • Inherited disorders that prevent the thyroid gland from making or secreting enough hormones: This is called congenital hypothyroidism where abnormality of the enzymes in thyroid cells at birth prevents the gland from making or secreting enough thyroid hormones
  • Thyroid surgery: Surgical removal of the thyroid gland leads to a lack of thyroid hormone production.

How is Hypothyroidism diagnosed?

Blood tests are ordered by the doctor to check hormone levels and confirm hypothyroidism. These may include:

  • Thyroid-stimulating hormone (TSH)
  • T4 (thyroxine)

Lower-than-normal T4 levels are indicators of hypothyroidism. People with increased TSH levels with normal T4 levels have a condition called as subclinical (mild) hypothyroidism – an early stage of hypothyroidism. In case of abnormal blood test, doctor may conduct a thyroid ultrasound, or thyroid scan, to check for nodules or inflammation.

How is Hypothyroidism treated?

Treatment involves replacing thyroid hormone using one of several oral preparations (mostly a tablet). A synthetic (human-made) thyroid hormone T4 is the preferred form of replacement. The doctor may need to adjust the dose initially depending on the patient response. The dose is gradually increased until the levels of TSH in the person’s blood return to normal and is continued for life. During pregnancy, doses usually need to be increased.


  1. Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. 2011 Jul;15(Suppl 2):S78-81.
  2. DownToEarth. (November 2023)
  3. Hypothyroidism. (November 2023). WebMD.

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