Caring For an Underactive Thyroid

The thyroid is a tiny, but mighty gland located inside your neck, right below the voice box. It acts as the engine of your body, governing every major metabolic function and regulating how cells perform their respective tasks. Every cell has receptors for its hormones. But if for any reason the thyroid starts struggling with its daily duties, your health can begin to roll downwards.

Considering the modern lifestyles, the thyroid is one of the most abused parts of our bodies.

Most days, cells that are nutrient-starved due to latest diet fads or no-idea-what-that-was meals, oxygen-starved due to 8+ hours of seated shifts progressing into seated home relaxation, are forced to work beyond their capabilities by endless cups of coffee that essentially make them forget they are tired.

The thyroid is well-aware and is working hard to dampen the crisis.

Most days, our thyroids have to keep up with massive temperature fluctuations to maintain the constant optimal internal temperature. We struggle through freezing winters with overheated buses, shops and offices just to transition to boiling hot summers with freezing air conditioning indoors. Some brave souls would not give up their daily runs even when the temperature is soaring, and sadly, believe it benefits their health.

Most days, stress levels are through the roof and require more thyroid hormone output to prepare the body to fight stronger or run faster. The body’s manual of stress response has no directions as to what to do when the stress lasts for days, weeks, and let alone years. It was never designed to sustain itself for longer than a few hours and was mostly meant to handle lions, wolves and other things that pose an immediate threat to life.

No wonder that under such conditions even the best of the best eventually start struggling.

How it works

The thyroid produces two hormones: thyroxine (T4) and triiodothyronine (T3).

The process starts at the hypothalamus, a small region at the base of the brain which acts as a messenger between your nervous and hormonal systems and located close to the pituitary gland. The hypothalamus releases thyrotropin-releasing hormone (TRH), which sends a message to the pituitary about how much thyroid stimulating hormone (TSH) it should send out to let the thyroid know how much of T4 and T3 it should produce to cover the body’s needs.

Once the T4 and T3 are produced, they attach to the carrier proteins, thyroid binding globulin (TBG), and travel through the bloodstream. When they arrive at their destination, thyroid hormones detach from the carrier proteins and start performing their intended metabolic work.


Due to the nature of its regulatory work, the thyroid is a very sensitive gland. It must work with extreme precision. Yet, this sensitivity to the surrounding environment also makes it vulnerable.

Since almost every system in your body depends on your thyroid doing its work correctly, when it can’t keep up with the necessary output requirements, anything can go awry. Symptoms vary by individual and can include:

  • fatigue
  • weakness
  • dry skin and brittle nails
  • hair loss
  • weight gain
  • difficulty to lose weight
  • cold hands and feet, cold intolerance
  • constipation
  • muscle cramps
  • difficulty remembering recent events
  • irritability
  • the blues and mood fluctuations for no significant reasons
  • irregular menstrual cycle
  • decreased libido
  • getting ill frequently

While having any of these symptoms does not necessarily indicate that your thyroid is underactive, it is always a good idea to ask your doctor to investigate where they are coming from.

Tests that may be prescribed

The general blood tests to assess thyroid function include TSH, free T4 (free thyroxine) and free T3 (free triiodothyronine).

TSH (thyroid stimulating hormone) is released by pituitary gland as a signal hormone that stimulates the release of other thyroid hormones by the thyroid gland. TSH’s main job is to ensure that the thyroid gland produces exactly the necessary amount. In case your body doesn’t receive enough thyroid hormones, the hypothalamus will pick up on the situation, and the pituitary gland will release more TSH to inform the thyroid to increase its output. Increased levels of TSH may suggest that the thyroid is struggling to keep up with the demands.

TSH reference ranges (if you are on thyroid replacement therapy, these may be different) are 0.4 – 4.0 mIU/L.

Since there is a higher risk of mental retardation in children whose mothers were hypothyroid during pregnancy, notify your doctor immediately if you discover that your TSH during pregnancy is 3.0 (or higher) mlU/L.


Free T4 (free thyroxine) is the form of the hormone thyroxine that is not bound to a carrier protein (thyroid binding globulin), and thus is the biologically active form of the hormone. Thyroxine makes up about 90% of the entire thyroid’s production line, yet the concentration of free T4 is only about 0.1% of the total T4. Thyroxine is mostly inactive but is converted into a much more active T3 (triiodothyronine) in needed amounts.

When thyroxine concentration increases, TSH levels decrease, but should it decrease, TSH levels will rise to stimulate production. Decreased levels of free T4, therefore, suggest that the thyroid is not able to produce sufficient amounts either due to lack of thyroid stimulating hormone (if levels are low) or due to inability to do so despite persistent demands put by high levels of TSH. It may also indicate an iodine deficiency.

Free T3 (free triiodothyronine) is the form of the hormone triiodothyronine that is, likewise, not bound to a carrier protein and is the biologically active form of triiodothyronine. T3 is more metabolically active and is mostly converted from T4. If your levels of free T3 are low, you are likely to experience multiple symptoms from the list above.


If these three tests come up with suspicious results, your doctor will likely order more blood tests and ultrasonography to assess the state of your thyroid. Some of these blood tests may include:

TPO and TBG (thyroglobulin) antibodies — their elevated levels generally suggest an autoimmune condition.

Iodine and Selenium — both are required for proper thyroid function. Iodine is the primary building block for the synthesis of T4 and T3. Selenium plays a crucial role in the conversion of T4 into T3. While reasonable amounts of selenium are not that difficult to obtain even from a somewhat decent diet, unless you don’t consume fish, seaweed and iodised salt on a regular basis and don’t live close to the sea or ocean, there is a good chance you are not getting enough iodine. Iodine deficiency alone can cause decreased production of thyroid hormones, but it is very important to do the testing and verify the proper dosage with your doctor before reaching out to supplements — iodine and selenium levels above necessary can be toxic and can damage your thyroid.

Prolactin — if levels of thyroid hormones are low, your doctor may want to rule out a prolactinoma – a benign tumour in the pituitary gland that produces too much prolactin. In most cases, it’s a “just in case” measure, and you shouldn’t worry if the test was ordered.

Calcitonin — calcitonin is a hormone produced by the parafollicular cells (C-cells) of the thyroid gland and is involved in the regulation of calcium and phosphate in the blood. If you are known to have a growing thyroid nodule, this test may also be prescribed as a precaution. There is a rare type of cancer called medullary thyroid cancer that arises from C-cells in the thyroid. Patients with this type of cancer have elevated levels of calcitonin in their bloodstream. If the levels are elevated, it suggests a further need for investigation, usually requiring a biopsy.


If based on the gathered data, you were diagnosed as hypothyroid (having a depressed thyroid function), depending on the severity of your condition, your doctor will decide whether you need a hormone replacement therapy, or it can be managed by improving your lifestyle (usually, in cases of subclinical hypothyroidism, where levels of T4 and T3 are optimal, with TSH being only slightly elevated).

If you were prescribed hormone replacement therapy, it is extremely important to follow your doctor’s directions precisely. You will need to take your pills precisely at the same time, never forget them and never skip your follow-up appointments and testing even if everything seems fine. Your dosage needs require regular monitoring and adjustment and will be changing depending on your life situations. Failing to do so may lead to very gruesome consequences.

The role of lifestyle

Whether you were prescribed thyroid replacement therapy or lifestyle modifications only, chances are that even a few improvements in this department will make you feel much better.

Many people assume that swallowing a thyroxine pill will magically erase all symptoms and decrease the body fat. If only it were this easy… Usually, changes are subtle and come gradually, and still, require you to improve working conditions for your beaten up and very necessary engine.

Here are a few areas that you may want to address:

Avoid temperature extremes

The weather, heating systems and air conditioning expose us to massive temperature fluctuations that constantly require our internal temperature regulating functions to react. In a matter of moments, we shiver to preserve the body heat, only to be drenched in sweat just a few minutes after… and back to shivering again.

Although it may not seem so, temperature control is one of the crucial functions in the body, and it is not shy to utilise resources to maintain its constant values. After all, life itself depends on it.

Helping your body with this task will also ease things up for your thyroid.

While, in most cases, it’s impossible to control the ambient temperature indoors of public places, you can experiment a little with the way you dress.

— What clothes at what temperature make you entirely comfortable?
— If you need to migrate from one climate setting to another, how can you layer your clothes so you can easily add or remove them fast, so you remain entirely comfortable?
— At what temperature and with what clothes are you comfortable when you are at home?
— Are there any body parts that freeze easily even if temperature seems otherwise comfortable? Your feet, maybe?

Don’t be shy to tell others that you would prefer not to sit directly under the air conditioner and if they can either switch it off or reseat you (if you are in a restaurant, for example). It will harm you more than it will make them uncomfortable.

Explore stress

“You should just stress less!”

I’m sure you’ve heard it. We all heard it, more times than we wish we would. It is as banal as it is useless. I invite you to try something different.

Take your favourite pen, a nice piece of paper and write down everything you can think of that stresses you – both physically and mentally.

— Does the mountain of dishes in the sink drive you nuts?
— Are you worried about your financials?
— Do you spend most of your day sitting and your body could use some extra oxygen?
— Is your apartment so cluttered that you have nightmares of people opening the door and seeing… this?
— Does your boss shout at everything he sees so loud that even office plans wilt?
— Does someone close to you struggle and you don’t seem to be able to do anything to help?
— Did someone or something force you to go against your values?

Have a good look at the list. Now circle anything that can be eliminated under a week if you concentrate on it. Choose one thing that is the fastest to eliminate and tackle it without further delay.

Now you have one item less to stress about. You’ve successfully decreased your stress, even if a little bit. Trust me, it matters. And now you can think about how you will eliminate the next stress-provoker.

This method puts you in a problem-solving mode. When you approach stressful conditions with the belief that you have the means to tackle them, you change the way your body responds to them and thus eliminate the biochemical harm.

Improve sleep

Modern culture makes it a virtue to be overworked and sleep-deprived. Especially in the big cities, an increased amount of social activities are shifting to later and later in the evening, and getting to sleep early now seems like an impossible task. But even if we do, our heads are often so full of information to be processed that we can’t fall asleep even if we try to.

Sleeping well is a challenge. It is also a factor that can make or break us.

As impossible as it may seem, going to bed early and getting sufficient amount of zzzzz most nights will nevertheless significantly improve your energy levels and will also strengthen your immune system — a pretty good deal, especially if it seems like you already catch every germ around.

While there are a lot of ways to improving your sleep hygiene and it’s beyond this article to discuss them in detail, I will share one easy way to fall asleep that you can try without much hustle or financial investments.

About one hour before your sleep time, switch off all the artificial light. You may use a candle or other dim relaxing light as you do all the usual things to prepare for sleep. Low light exposure will naturally and gradually relax the buzzing brain and let your body prepare for the shut-down.

It will likely take a few days into this routine to get your first night of proper deep sleep, so don’t be lured by the “it’s not working” rationalisation to quit. Once you adjust, it feels like a SPA.

Stay hydrated

There are many great benefits to staying sufficiently hydrated, but it’s especially important for people whose thyroids are struggling.

Among other unpleasant side effects, having an underactive thyroid puts you at a higher risk of developing gallstones. When you are dehydrated, your bile becomes thicker and its flow can become more difficult than usual. Problems usually appear when the gallbladder doesn’t empty its bile on a regular basis, and drinking an adequate amount of liquids per day will help your whole digestion process run a little bit smoother.

If you often forget to drink when you are too concentrated on the work you are doing, find that your mouth is dry, your lips are chapped and you are not going to the loo as often as you should, there is a way to keep yourself reminded: take two bottles (or any other vessels that are suitable to drink from) of approximately 1 litre capacity each, and write AM on the first, and PM on the second. For insulated water bottles, you can stick a piece of masking tape on each and write on the tape instead. The goal is to finish the bottles’ contents in the appropriated time slots.

You may notice that you happen to be awake for fewer hours in the AM than in the PM and wonder why the litres are not distributed equally. One reason is that you need more water in your first waking hour to rehydrate after sleep. Another reason is that if you drink most of your water in the evening, you may find yourself needing to pee multiple times a night. Besides, it’s pretty hard to get decent sleep if you need to wake up all the time.

Avoid drastic changes in eating habits or exercise

When we don’t feel well, it’s understandable when patience is not something we are willing to exercise. When reading this post, you may have already developed the internal resolve to fix every single thing that you consider wrong with your lifestyle. Drastic overhauls rarely last, but even if you manage to pull it off, it may actually be counterproductive.

Any change creates stress on the body. Unlike being “stressed out”, the stress in this context is not good or bad, it is synonymous with “adaptation”. When it comes portion-sized, it is a very healthy thing for the body to have and stimulates it to work better. But if you try to stuff more adaptation than your thyroid can chew (and, if issues are already present, it can chew way less than it could when it was healthy), then you can expect your symptoms getting worse.

Confusing information on the internet is also not helping. You can find claims about miracle thyroid cures and nearly instant stubborn fat blasting by way of diets, supplements and exercise plans, but I strongly advise against any drastic measures.

Don’t exclude entire nutrient groups — for the reasons mentioned above, drastically decreasing or completely obliterating carbohydrates, fat, sugar, go high-protein, carb-cycling or attempting any other massive change that your body is not used to will create conditions your thyroid might not be able to deal with. It would be better to brainstorm how you can improve your current diet by including the things you know should appear on your plate more than they currently do.

Don’t drastically decrease calories — you may want to get rid of unwelcome fat as soon as you can, but it’s there for a reason. Since your body can’t generate as much heat to maintain internal body temperature, it added some thermal isolation tissue. And it is going to hold onto it for dear life if it feels like your internal systems are in danger. Trying to restrict calories at this point will likely result in loss of lean mass, rather than fat, and may damage your thyroid function even further, as one of the primary responses to starvation is the reduction of thyroid hormone secretion.

Don’t hop right back to your old exercise plans — in general, we tend to either underestimate or overestimate our own abilities. There is no shame in that: when it comes to ourselves, we are biased. If you don’t already work long-term with a trainer, who knows how your body will react to a particular exercise better than you do yourself, err on the side of caution and take it very slowly. Slow and steady wins the race here, and your thyroid will thank you for the efforts.

Although the temptation to go all in may be very real and it may feel like your body is against you, this is not the case. Your body is made of about 37.2 trillion cells, and every single one of them cares about nothing, but your wellbeing. They work without holidays, weekends, in less than favourable and often disastrous conditions. It’s time to give them back some love and care.

Improve the quality of your diet

One way to make your cells happy is to provide them with good food. Just as you like your food to be delicious, your cells like it nutritious, and the two concepts don’t have to be mutually exclusive. Snap some photos of your meals and have an honest look: is anything missing?

Is there about a palm-sized amount of protein-rich bites with every meal?
— Is there about a tablespoon of cold-pressed oil, nuts or other fatty goodness with every meal?
— Are the carbohydrate proportions of whole grains to treats look adequate, or do they lean towards treats?
— Does it look like you have five or more recommended daily servings of fruits and vegetables?
— Do those servings of fruits and vegetables look like actual fruits and vegetables or do they come from cardboard boxes and plastic tubs?



Grab a pen and paper. After identifying some potential improvements and jotting them down, circle one or two things that you will be most looking forward to improving.

Do you love apples and ratatouille, but kind of forgot about them lately?

Once you made a habit of enjoying the ratatouille, you can proceed to the next item on the list.

You don’t need an overhaul. Little improvements do matter and go a long way.

Engage in recovery exercise

Another way to make life easier for your cells is to supply them with sufficient oxygen, and there is no better way to increase oxygen supply and delivery than engaging in a regular exercise routine.

Exercise promotes both blood and lymph circulation. The first is responsible for timely delivery of oxygen, nutrients, hormones and elimination of waste products, while the latter is essential for removal of bacteria, abnormal cells and other matter that you don’t want in your body. Sedentary lifestyles are associated with poor circulation of both, and some movement should be incorporated even during the days when it feels like it’s beyond your capabilities.

Consistency is essential.

Think about something you can do daily, even if you are busy, tired, or the weather is not welcoming. It can be as simple as a walk or dancing to your favourite music.

You may have noticed that this section suggests “recovery exercise”. Recovery exercise, in this context, means that all the exercise you should be engaging in if you are hypothyroid must be designed with a purpose of supporting your body, instead of straining it. Sitting down all day is just as straining as trying to force your body to burn off body fat with intensive circuit training.

While every single person is different and you may need to experiment to find a sweet spot with exercise, general recommendations would be:

  • Get as much low-intensity movement in your day as you can (walking, light housework, dog walking, badminton with friends).
  • Shoot for about 5 medium-intensity workout sessions a week, where you break into a sweat but don’t get drenched.
  • Following an exercise session, you should feel better and happier than you did before the session (and have no problem walking on your own).
  • Next morning after an exercise session, it shouldn’t hurt anywhere.

Avoid high-intensity exercise

Nowadays, everyone is rooting for High-Intensity Interval Training (HIIT).

It is intense, it produces adaptation faster, it strengthens muscles and hearts, it burns more calories per minute than most other types of exercise. But if you are either overstressed or hypothyroid, with very few exceptions, it is not for you.

HIIT is effective, but it also demands a lot. It requires your systems to temporary function near their limits to adapt and rise above them. Working at your limits, even temporary, when your thyroid is underactive is not a great idea. HIIT will stimulate the rise of TSH due to increased needs for thyroid hormones, but it is an unnecessary burden on the already overworked gland.

Not to mention, when you perform HIIT, the intensity significantly increases your internal body temperature, thus requiring prompt and efficient cooling. As a result, you are drenched in sweat, and soon after the session is over, you are freezing under the gym’s air conditioner.


If there were only one thing to take away from this article, it would be that you need to take care of yourself. It is not selfish, has way too many benefits to number and will make you enjoy yourself a little more.

While changing your current habits is far from easy, I did my best to arm you with some simple techniques you can implement without delay. Small improvements done consistently will always outperform lifestyle overhauls. Sadly, there are no solutions that would fit all cases and situations, but there always is a solution that will meet your specific needs. You just need to find the one that works specifically for you. Which one of them will you pick to implement today?

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