Thyroid Care: Hypothyroidism, Hyperthyroidism, Goiter, & Thyroid Cancer

Clinically reviewed by Dr. Chhaya Makhija, MD, Triple Board-Certified Endocrinologist, in Sept. 2026.

Hypothyroidism

Hypothyroidism is reduced synthesis or inadequate levels of thyroid hormone. It is more commonly seen in women than in men.

Common Causes

• Autoimmune / Hashimoto's — also called primary hypothyroidism

• Postsurgical (postoperative) hypothyroidism

• Subclinical hypothyroidism

• Secondary hypothyroidism — for example, after pituitary surgery

Common Symptoms

Symptoms of inadequate thyroid hormone range from weight gain, lethargy, fatigue, hair loss, constipation, and water retention, to relatively asymptomatic in some individuals.

Treatment

Treatment is individualized. If a new diagnosis of hypothyroidism needs treatment, the options discussed are levothyroxine — synthetic versions, which can be generic or brand forms like Synthroid, Tirosint, and Levoxyl — versus animal thyroid hormone, which some patients feel better starting in a safe manner with monitoring, such as Armour Thyroid and NP Thyroid.

Synthetic thyroid hormone liothyronine is T4. Armour and NP Thyroid are animal or porcine extracts of the thyroid gland and have different ratios of T4 and T3 hormones. In very rare cases, patients might need support with the prescription form of liothyronine (T3) at low doses — but this must be monitored, individualized, and supervised by a specialist.

Thyroid Symptoms Across a Woman's Life Stages

It is very important to recognize that in women during puberty, the preconception period, postpartum, perimenopause, and menopause, there can be overlapping symptoms of weight changes, temperature intolerance, fatigue, and hair loss, while the thyroid hormone tests (that is, TSH, Free T4, or Total T4) are optimally normal.

That is when, as an endocrinologist, I also assess fluctuations in estrogen and progesterone, along with other causes of fatigue and weight changes, to develop a complete patient evaluation and management plan.

Thyroiditis

Thyroiditis is an acute, transient inflammation of the thyroid. It can be related to infection (subacute thyroiditis), it can be medication-related (amiodarone-induced thyroiditis), or it can have other etiologies.

Hyperthyroidism

Hyperthyroidism is an increased synthesis or excess of thyroid hormone.

Common Causes

• Autoimmune / Graves' disease

• Toxic adenoma or toxic thyroid nodule

• Subclinical hyperthyroidism

The most common cause is Graves' disease, which is autoimmune in origin.

Common Symptoms

• Increased sense of anxiety

• Palpitations

• Weight loss

• Tremors

• Increased appetite

Thyroid hormone ramps up metabolism, which can lead to symptoms — including changes in menstrual cycles — in women.

There are multiple-level symptoms that will not mimic the usual hyperactive symptoms described above. A detailed history is therefore needed, because some of these patients, if left untreated, can develop Graves' ophthalmopathy (Graves' eye disease) or dermatopathy.

Evaluation

Lab work, biochemical evaluation, and follow-ups are essential in these cases, including levels of:

• TSH

• Free T4

• Free T3

• TSI antibodies (thyroid-stimulating immunoglobulins), or thyroid receptor antibodies

I also recommend an ultrasound to understand the heterogeneity and the vascularity of the thyroid gland in such scenarios. This also helps to assess whether there is any thyroid nodule/s.

Treatment

Treatment for Hyperthyroidism includes medical management with methimazole or propylthiouracil, depending on your diagnosis and your plans for pregnancy. Referral to surgery, rather than radioactive iodine ablation, is very seldom used as a first option. At your first visit, if we have a blood test, then treatment is initiated. Depending on that, follow-up is decided between 4-8 weeks, along with blood test coordination. Thyroid ultrasound is also performed at your 1st consultaiton when indicated.

Goiter

Goiter is an enlargement of the thyroid gland. Not everyone with an enlarged thyroid gland has hypo- or hyperthyroidism.

This is an anatomical finding of an enlarged thyroid gland, and it is essential to have blood work and biochemical evaluation in order to diagnose hypo- or hyperthyroidism. An individual can have an enlarged thyroid gland and optimal thyroid hormone function at the same time.

Thyroid Cancer

Please also refer to the evaluation of a thyroid nodule. Once a diagnosis is confirmed with fine needle aspiration and, if needed, genetic testing of the aspirate, thyroid cancers can be papillary or follicular, which are more common; medullary thyroid carcinoma, which is very rare; and anaplastic thyroid carcinoma, which is rarer still.

After a patient has undergone surgical resection or other surgical treatment, endocrinologists help coordinate management and thyroid hormone replacement, along with monitoring of tumor markers and periodic neck ultrasound. Thyroid cancer care is a multi-collaborative approach.

Frequently Asked Questions

Can I fix my hypothyroidism naturally?

This is a very nuanced answer. For patients who have an appropriate biochemical and clinical diagnosis of primary hypothyroidism, it means that they are deficient in thyroid hormone, which is an essential hormone for sustaining our lives. In these situations, treatment with thyroid hormone replacement is lifesaving.

There are also many conditions — such as transient thyroiditis, autoimmune thyroiditis, or postpartum thyroiditis — in which individuals can have short-term hypothyroidism, proven clinically and biochemically. They usually recover within 4 to 8 weeks and need close monitoring. On a case-by-case basis, and based on the root cause of the diagnosis, these patients may not need thyroid hormone replacement.

There is no supplement, nutrition, or diet that can treat or fix a medical condition that is permanent hypothyroidism.

How can I lower my TPO antibodies in Hashimoto's?

There is no single thing that can help your TPO (thyroid peroxidase) antibodies. Many individuals can have elevated TPO antibodies on blood tests (that is, high TPO antibodies) but have very normal and optimal TSH and T4 levels.

We have data from a meta-analysis indicating that in individuals with elevated TPO antibodies and normal or mild elevations in TSH, selenium supplementation may confer some benefit. It is not guaranteed to reduce TPO antibodies or normalize TSH, so monitoring with your endocrinologist is crucial.

• Link to the study

• Video on selenium supplementation: 

• What are the different types of thyroid hormones?

Can I take GLP-1 medications if I have hypothyroidism or Hashimoto's?

Answer: Yes, GLP-1 medications are not contraindicated when you are being treated for hypothyroidism. If you are diagnosed with new-onset hypothyroidism and have experienced weight gain, then treating hypothyroidism with thyroid hormone replacement is the 1st step before discussing GLP-1 medications. Watch the detailed answer in this video

Links and Videos

• https://youtu.be/sSLYTZ8lkNQ?si=CARoDyI0ACcT2ITP

• https://youtu.be/aYw_zT2qnt8?si=wVKvq7Vt-ZutWSsP

• https://youtu.be/tmD3qWgZMLc?si=WKwKedVM3im2o-Mx

• https://unifiedendocrinecare.com/blog/thyroid-labs-and-what-they-mean

A Note on Insurance

Unified Endocrine Care is an out-of-network practice. Practicing outside of insurance networks allows us to give each patient the time and attention their care deserves, and to build treatment plans around clinical need and personal health goals rather than around the limitations insurance coverage places on them.