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Hypothyroidism (Underactive Thyroid) in Nigeria

Recognising and treating a slow thyroid in Nigeria

Hypothyroidism — insufficient production of thyroid hormone — is common in Nigeria but frequently underdiagnosed because its symptoms (fatigue, weight gain, feeling cold, constipation, depression) are often attributed to other causes or dismissed as 'normal tiredness'. Hashimoto's thyroiditis (autoimmune destruction of the thyroid) is the most common cause in adults. It is highly treatable with a daily tablet — patients who receive appropriate treatment live completely normal lives.

Signs and Symptoms

✓ Fatigue and sluggishness — profound, out of proportion to activity
✓ Weight gain despite no change in diet
✓ Cold intolerance — feeling cold when others are warm
✓ Constipation
✓ Dry skin and hair; hair loss; brittle nails
✓ Slow heart rate (bradycardia), puffy face and hands
✓ Depression, difficulty concentrating, slowed thinking
✓ Menstrual irregularities, heavy periods, fertility problems in women
✓ Hoarse voice, muscle aches and cramps
✓ In severe/untreated cases: myxoedema coma — life-threatening

Risk Factors

When to Seek Help

InvestigateAny combination of unexplained fatigue, weight gain, cold intolerance, constipation, dry skin, or depression — request TSH blood test; a simple blood test diagnoses or excludes hypothyroidism
PregnancyUndiagnosed hypothyroidism in pregnancy causes miscarriage, preterm birth, and irreversible fetal brain damage; thyroid function should be tested in early pregnancy, especially in women with fatigue or history of thyroid disease
UrgentMyxoedema coma (extreme hypothyroidism) — hypothermia, confusion, coma; a medical emergency requiring IV levothyroxine treatment in ICU

Tests & Diagnosis

🧪 TSH (thyroid stimulating hormone)
The most sensitive and specific test — TSH is elevated when thyroid hormone is low (the pituitary compensates by secreting more TSH); TSH >4.5 mIU/L = hypothyroidism in most laboratory reference ranges
🧪 Free T4
Confirms the severity — low free T4 with high TSH = overt hypothyroidism; normal free T4 with high TSH = subclinical hypothyroidism
🧪 Anti-TPO antibodies
Positive in Hashimoto's thyroiditis — confirms the cause; predicts progression in subclinical hypothyroidism
🧪 Lipid profile
Hypothyroidism causes hypercholesterolaemia — treat the thyroid disease first before statins for hypothyroid-related high cholesterol
🧪 Blood glucose
Associated with type 2 diabetes — screen in all hypothyroid patients

Treatment Options

1
Levothyroxine (L-T4)
The treatment — synthetic T4 taken once daily; 25-100 mcg starting dose (lower in elderly and cardiac patients); taken on an empty stomach 30-60 minutes before food or other medications; dose adjusted based on TSH at 6-8 week intervals until normalised
2
Target TSH
TSH 0.5-2.5 mIU/L for most non-pregnant adults; 0.1-2.5 mIU/L in pregnancy (stricter); TSH checked every 6-12 months once stable
3
Drug interactions
Calcium supplements, iron tablets, omeprazole, antacids — all reduce levothyroxine absorption; take levothyroxine at least 4 hours apart from these; soy formula and high-fibre diets also reduce absorption
4
Subclinical hypothyroidism
TSH mildly elevated with normal T4 — treat if TSH >10; if 4.5-10: treat if symptomatic, or if pregnant, or if anti-TPO antibodies positive and wanting to conceive
5
Levothyroxine in pregnancy
Dose needs increase in pregnancy (by 25-30%); TSH target <2.5 mIU/L in the first trimester; check TSH monthly in first trimester then every 3 months

Frequently Asked Questions

Will I take levothyroxine for life?
Usually yes — most hypothyroidism (from Hashimoto's disease) is permanent and requires lifelong treatment. A small proportion (from temporary thyroiditis) may resolve. Never stop levothyroxine without consulting your doctor.
Will levothyroxine cause weight loss?
Levothyroxine corrects the metabolic slowdown from hypothyroidism — any weight gained from hypothyroidism may gradually reduce once TSH is normalised. However, levothyroxine is not a weight-loss drug and does not cause weight loss in people without hypothyroidism.
Is generic levothyroxine as good as branded?
Levothyroxine is one of the drugs where consistent formulation matters — switching between brands can cause minor fluctuations in TSH. Ideally, stick with the same brand or generic formulation once stabilised; if a change is made, check TSH 6 weeks later.
Can hypothyroidism cause depression?
Yes — thyroid hormone affects mood and brain function. Depression, anxiety, and cognitive slowing are well-recognised features of hypothyroidism. Antidepressants alone will not work if the underlying hypothyroidism is untreated — check TSH in any patient presenting with depression.
Is hypothyroidism different from adrenal insufficiency?
Yes — both can cause fatigue, but from different causes. Adrenal insufficiency (Addison's disease) additionally causes low blood pressure, salt craving, and skin darkening. Both are diagnosed with blood tests. Adrenal insufficiency must be treated before starting levothyroxine to avoid precipitating adrenal crisis.

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