Thyroid health, Johannesburg
Hypothyroidism assessed and treated properly.
A careful, evidence-based approach to underactive thyroid: correct testing, appropriate levothyroxine treatment and specialist escalation when the picture is complex.
In short
Hypothyroidism means the thyroid is not producing enough thyroid hormone for the body's needs. In typical primary hypothyroidism, TSH is the key first test and free T4 is measured when TSH is abnormal; thyroid peroxidase antibodies can help identify autoimmune thyroid disease but usually do not need repeated monitoring. Levothyroxine is the standard first-line treatment. Persistent symptoms deserve reassessment, but they do not automatically mean higher doses, routine T3 treatment or natural thyroid extract are required.
Medically reviewed by Dr Arnav Kapur, MBBCh Cum Laude
The approach
Understand first. Then treat.
Fatigue, weight change, constipation, cold intolerance, dry skin, hair change, low mood and menstrual changes can occur with hypothyroidism, but none is specific. Anaemia, sleep disorders, menopause, depression, medication and metabolic disease can produce similar symptoms.
The aim is therefore to confirm thyroid dysfunction correctly, understand the cause and treat to restore appropriate thyroid hormone status without pushing replacement into overtreatment.
What thyroid assessment may include
- TSH as the first-line test in most adults with suspected primary thyroid disease
- Free T4 when TSH is outside the reference range or pituitary disease is suspected
- Free T3 selectively, particularly when TSH is low or hyperthyroidism is being evaluated
- Thyroid peroxidase antibodies when autoimmune hypothyroidism is suspected
- Medication and supplement review, including biotin
- Iron, vitamin B12 or other contributors where symptoms overlap
- Pregnancy or fertility context where relevant
- Review of previous thyroid blood tests and treatment
- Specialist endocrinology when the pattern is complex, discordant or suggests pituitary disease
Symptoms are not the diagnosis
Hypothyroidism can cause fatigue, cold intolerance, constipation, dry skin, hair change, menstrual disturbance and weight gain, but these symptoms overlap with many other conditions. Diagnosis rests on the clinical picture plus correctly interpreted thyroid function tests rather than on symptoms alone.
Testing should be targeted
For most adults where primary thyroid disease is suspected, TSH is the appropriate first test, with free T4 added if TSH is high and free T4/free T3 considered if TSH is low. Both TSH and free T4 are appropriate when pituitary or secondary thyroid dysfunction is suspected. TPO antibodies can help establish autoimmune thyroid disease but generally do not need serial repetition.
Levothyroxine remains first-line treatment
Levothyroxine is the standard first-line treatment for primary hypothyroidism. Dose is individualised according to age, cardiovascular history, body size, pregnancy status and the severity of deficiency, then adjusted using symptoms and thyroid function. The goal is replacement, not thyroid-hormone excess.
Persistent symptoms need a broader review
Some patients continue to feel unwell after TSH has normalised. The answer is not automatically more thyroid hormone. Adherence, timing, drug interactions, sleep, iron deficiency, menopause, metabolic health and other diagnoses should be reviewed. Routine liothyronine or natural thyroid extract is not recommended by major guidelines, while complex or unusual cases can be escalated to specialist endocrinology.
Common questions
Answers before you book.
Do I need T3 and reverse T3 testing?
Free T3 is useful in selected settings, especially when hyperthyroidism is suspected, but it is not routinely required to diagnose typical primary hypothyroidism. Reverse T3 is not part of standard diagnostic assessment for hypothyroidism.
Should thyroid antibodies be repeated?
Usually not. TPO antibodies can help identify autoimmune thyroid disease when TSH is elevated, but repeating the antibody level generally does not guide treatment or monitor response.
Can hypothyroidism make it hard to lose weight?
It can contribute to modest weight gain and lower energy when untreated, but substantial or persistent weight difficulty often has additional metabolic, nutritional, sleep or lifestyle contributors that should be assessed separately.
What if I still feel unwell on levothyroxine?
First confirm the diagnosis, dose, adherence, timing and absorption, then look for other causes of the symptoms. Some complex cases warrant endocrinology review rather than simply escalating thyroid hormone.
This page provides general health information and does not replace individual thyroid assessment. Thyroid medication should be prescribed and monitored according to clinical findings and laboratory results.
Clinical references
Ready to start properly?
- Specialist Endocrinology
- Specialist Endocrinology Consultation
- Hyperthyroidism & Graves' Disease
- Thyroid Nodules
- Why Am I Always Tired?
- Menopause & Perimenopause
- Longevity & Preventative Medicine
Centre of Advanced Medicine, 13 Scott St, Waverley, Johannesburg
Monday to Friday, 07:40 to 17:00
011 440 8721