Always tired, always cold, putting on weight and blaming your age? A small gland in your neck might be the culprit. Here’s what to look for and how to get tested.
You’re shattered by mid-afternoon. You’ve got the heating on when your partner has the window open. The trousers have shrunk, your mood has gone flat and you’ve put it all down to being the wrong side of 50.
Maybe it is your age. But there’s another suspect worth ruling out, and it costs nothing more than a blood test: your thyroid. It’s a small, butterfly-shaped gland at the front of your neck, and when it goes wrong it can make you feel like a slower, colder, grumpier version of yourself.
Your thyroid makes hormones that set the pace for almost everything your body does. Think of it as the thermostat and the accelerator rolled into one. It affects your heart rate, how warm you feel, how quickly you burn energy, your digestion and even how sharp you feel.
If it makes too little hormone, everything slows down. That’s an underactive thyroid, or hypothyroidism. If it makes too much, everything speeds up. That’s an overactive thyroid, or hyperthyroidism.
Both are much more common in women, which is partly why men tend to miss them. You’re not going to hear about it in the pub, and you probably won’t think of it yourself. That’s exactly the problem.
The awkward thing about an underactive thyroid is that it creeps up slowly, and its symptoms sound like a list of complaints about middle age. NHS guidance lists the usual suspects:
Tiredness that sleep doesn’t fix. Feeling the cold more than other people. Weight gain without eating more. Constipation. Dry skin and thinning hair. Aching muscles. Low mood or feeling depressed. A slow, foggy feeling, as if your brain is running on old software.
For men, it can also show up below the belt. Low sex drive and erection problems can both come with a sluggish thyroid, which is a good reason not to assume it’s all down to testosterone, or to put off a chat with your GP.
Any one of these on its own means very little. Lots of them together, especially if they’ve built up over months, is worth mentioning to a doctor.
If you feel like you’re running on half power and nobody can tell you why, a simple blood test is a far better next step than another espresso.
An overactive thyroid is the opposite. You might lose weight without trying, feel anxious or irritable, have a racing or pounding heart, sweat more, struggle with heat, have shaky hands or find it hard to sleep. Some people notice a swelling in the neck, called a goitre.
Don’t ignore palpitations. An overactive thyroid can lead to an irregular heartbeat, which matters for your heart health. If you have chest pain, severe breathlessness or feel faint, call 999. If your heart is racing and you’re worried but it isn’t an emergency, call NHS 111.
Any new lump or swelling in your neck should also be checked by your GP. Most turn out to be harmless, but that’s for a doctor to decide, not Google.
Make a GP appointment and describe your symptoms honestly. If the doctor thinks your thyroid could be involved, they’ll arrange a thyroid function test. It’s an ordinary blood test that usually measures thyroid stimulating hormone (TSH) and often thyroxine (T4).
It’s worth knowing that the free NHS Health Check, offered every five years to adults aged 40 to 74 in England, is designed to look at your risk of heart disease, stroke, diabetes and kidney disease. It isn’t a thyroid test, so a clean bill of health from that doesn’t rule your thyroid out. Scotland, Wales and Northern Ireland run their own versions of health checks, so ask your GP practice what’s available where you live.
One practical tip: tell your GP or the nurse about any supplements you take before the test. High-dose biotin, which turns up in plenty of hair, skin and nail products, can skew thyroid blood results.
What about home testing kits? Private finger-prick thyroid tests are widely sold. They can be a starting point, but they’re not a diagnosis. If a result comes back outside the normal range, take it to your GP rather than treating yourself.
Here’s the good news. An underactive thyroid is usually treated with a daily tablet called levothyroxine, which replaces the hormone your gland isn’t making. You’ll have regular blood tests at first so your doctor can get the dose right, then less often once you’re settled. Many people feel much better once the dose is right, although it can take a few weeks or months.
The usual advice is to take it at the same time each day, often on an empty stomach, as some foods, drinks and other medicines can affect how well it’s absorbed. Your pharmacist is a good person to ask about timing, especially if you take other tablets.
An overactive thyroid is treated differently, with medicines to calm the gland down, radioactive iodine or, sometimes, surgery. A specialist will usually be involved, and the choice depends on the cause and your circumstances.
Sometimes the blood test is only slightly off and you don’t have obvious symptoms. Doctors may simply repeat the test later rather than starting treatment straight away. That’s normal, not a brush-off.
It depends where you live. Prescriptions are free for everyone in Scotland, Wales and Northern Ireland.
In England, an underactive thyroid that needs hormone replacement is one of the conditions that qualifies for a medical exemption certificate. That covers all your NHS prescriptions, not just the thyroid ones, which is handy if you’re also on something for blood pressure or cholesterol. Your doctor applies on your behalf, and the certificate usually lasts five years. Keep an eye on the renewal date, because claiming free prescriptions with an out-of-date certificate can land you a penalty charge. And once you turn 60 in England, your prescriptions are free anyway.
Search online and you’ll find plenty of “thyroid support” pills, iodine drops and kelp tablets promising to boost your energy. There’s no good evidence they help if you have a thyroid problem, and too much iodine can actually upset the gland. Some products sold online have even been found to contain thyroid hormone, which is the last thing you want unsupervised.
If you think your thyroid’s playing up, the boring answer is the right one: see your GP, get the blood test, and talk to your doctor or pharmacist before taking anything that claims to fix it.
If you’re constantly tired, cold, gaining weight or feeling low, don’t just blame your age, because an underactive thyroid can cause all of these and is easy to check with a GP blood test. Palpitations, weight loss and feeling anxious or shaky can point to an overactive thyroid instead. Both are treatable, and in England an underactive thyroid on hormone replacement qualifies you for free NHS prescriptions, which are already free in Scotland, Wales and Northern Ireland.
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