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Hypothyroidism in Nigeria

An underactive thyroid — why Nigerian women are most at risk

Hypothyroidism — an underactive thyroid gland — is one of the most commonly missed diagnoses in Nigerian medicine. The thyroid gland, located at the front of the neck, produces hormones that regulate metabolism, energy, mood, and virtually every organ system. When it underproduces, everything slows down. Symptoms develop slowly and are often dismissed as 'stress', 'age', or 'spiritual'. A simple blood test (TSH) diagnoses it, and treatment is cheap and effective.

Signs and Symptoms

✓ Fatigue and sluggishness out of proportion to activity
✓ Weight gain despite no change in diet
✓ Cold intolerance — feeling cold when others are comfortable
✓ Dry skin and brittle hair
✓ Hair loss — diffuse, including the outer third of eyebrows
✓ Constipation
✓ Slowed heart rate (bradycardia)
✓ Depression and cognitive slowing ('brain fog')
✓ Heavy or irregular menstrual periods in women
✓ Infertility or recurrent miscarriage
✓ Puffy face and swollen eyelids
✓ Muscle weakness, cramps, and aches
✓ In severe cases: myxoedema — thickened, dry skin; hoarse voice; slowed reflexes

Risk Factors

When to Seek Help

Unexplained fatigue + weight gain + cold intoleranceThis classic triad in a woman over 30 should always prompt TSH testing.
Infertility or recurrent miscarriageHypothyroidism impairs ovulation and early pregnancy. TSH testing is part of the infertility workup.
Depression not responding to treatmentSubclinical hypothyroidism can cause or worsen depression — always check TSH.
Pregnancy with any thyroid historyHypothyroidism in pregnancy causes miscarriage, preterm birth, and impaired foetal brain development. Tight control is essential.

Tests & Diagnosis

🧪 TSH (thyroid-stimulating hormone)
The single best test for thyroid function. Elevated TSH (above 4.0 mIU/L) indicates hypothyroidism. In early disease, TSH is elevated before T4 falls (subclinical hypothyroidism).
🧪 Free T4 (thyroxine)
Confirms hypothyroidism when TSH is elevated — a low free T4 confirms overt hypothyroidism.
🧪 Anti-TPO antibodies
Elevated in Hashimoto's thyroiditis — the most common cause of hypothyroidism. Confirms the autoimmune aetiology.
🧪 Full blood count
Anaemia (normocytic) is common with hypothyroidism.
🧪 Lipid profile
Hypothyroidism raises LDL — treat the thyroid before attributing dyslipidaemia to diet.

Treatment Options

1
Levothyroxine (L-T4) — the treatment
A synthetic thyroid hormone taken once daily. The dose is individualised (typically 25–200 mcg based on weight, age, and TSH). Take on an empty stomach, 30–60 minutes before food, with water only. Consistent timing is important.
2
Starting dose and titration
Start at 25–50 mcg in the elderly or those with cardiac disease. Increase by 25 mcg every 4–6 weeks based on TSH. Most patients need 100–150 mcg. Avoid starting full replacement doses in older patients with cardiac disease — can precipitate angina or arrhythmia.
3
TSH monitoring
Check TSH 6–8 weeks after any dose change. Once stable, check annually. Target TSH: 0.5–2.5 mIU/L for most adults; 0.5–2.0 in pregnancy.
4
Drug interactions
Calcium, iron supplements, and antacids reduce levothyroxine absorption — take these 4 hours after levothyroxine.
5
Lifelong treatment in most cases
Hashimoto's hypothyroidism is permanent — levothyroxine is needed lifelong. Postpartum thyroiditis may be transient.

Frequently Asked Questions

Can hypothyroidism cause weight gain?
Yes — hypothyroidism slows metabolism, causing modest weight gain (usually 2–5 kg). It is not the cause of severe obesity — but it contributes. Treating hypothyroidism restores metabolic rate but does not automatically cause weight loss; dietary changes are still needed.
Is there a connection between thyroid disease and vitiligo?
Yes — Hashimoto's thyroiditis is an autoimmune condition that is associated with other autoimmune diseases including vitiligo, type 1 diabetes, and rheumatoid arthritis. People with one autoimmune condition have an increased risk of others.
Does iodine deficiency cause hypothyroidism?
Yes — iodine is an essential component of thyroid hormones. Iodine deficiency is the most common preventable cause of hypothyroidism and goitre worldwide. In Nigeria, coastal populations with seafood diets have adequate iodine; inland populations (particularly in the North) may be deficient. Universal salt iodisation has reduced this significantly.
Can I take levothyroxine during pregnancy?
Yes — levothyroxine is safe and essential in pregnancy. Thyroid hormone requirements increase by 30–50% in pregnancy — the dose usually needs to be increased from conception. Poor thyroid control in pregnancy causes miscarriage, premature birth, and reduced IQ in the child. Every pregnant woman with hypothyroidism must have TSH checked each trimester.
If my TSH is 'normal', can I still have thyroid disease?
A normal TSH (0.5–4.0 mIU/L) makes overt thyroid disease unlikely. However, symptoms with TSH in the 'high normal' range (3.0–4.0) may warrant clinical judgement. Anti-TPO antibodies can detect Hashimoto's thyroiditis before TSH rises. If symptoms are strongly suggestive despite normal TSH, repeat testing and anti-TPO are appropriate.

Related Pages

Hyperthyroidism Nigeria GuideGoitre Guide NigeriaThyroid Tests ExplainedDepression Nigeria

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