Hypothyroidism & Hashimoto's
Does this sound like you?
You wake up feeling like a zombie, needing coffee and already feeling like you're behind. By the afternoon you're running on empty.
You’re the one wearing sweaters or layers when everyone else seems perfectly comfortable in a tee-shirt. Your hands and feet are like ice-blocks to the touch. Your skin is dry, your hair is wiry and your nails seem brittle and weak too.
You've started gaining weight - despite eating and moving much as you always have.
Your brain feels slower. You read the same paragraph over and over and still don't take it in.
You feel flat, low, unlike yourself, but it's difficult to explain exactly why.
You don’t feel like yourself anymore. And you don't understand why your body seems to be working by a completely different set of rules to everyone else’s.
You're tired of being told that your TSH test is "within range’’, even though nothing about how you feel is normal. Maybe you've spent hours reading about thyroid function, comparing your symptoms against lists online, trying to work out for yourself why you feel like this when your results say you shouldn't.
Hypothyroidism is one of the most common endocrine conditions in women, affecting somewhere between 5% and 12% of adults, and up to eight times more common in women than men. And in the vast majority of cases, it's caused by Hashimoto's thyroiditis, an autoimmune process where the body's own immune system gradually affects the thyroid.
FAQ
How serious is Hashimoto’s disease?
That's a hard one to answer. For many women it's very manageable with the right treatment and monitoring, but it's also a condition that's frequently under-treated, under-supported, not monitored properly or dismissed at the "subclinical" stage, which is exhausting when you're the one living with the symptoms.
Hypothyroidism vs hyperthyroidism: what's the difference?
These two are often confused. Both are thyroid conditions, but they affect the body in almost opposite ways.
Hypothyroidism means your thyroid isn't producing enough thyroid hormone for your body's needs. The thyroid mainly produces T4, which is then converted throughout the body into T3, the more biologically active thyroid hormone. When there isn't enough thyroid hormone available, many of the body's processes slow down.
That can show up as persistent fatigue, feeling unusually cold, weight gain or difficulty losing weight, dry skin, hair thinning, constipation, low mood, brain fog, and a general sense that you're moving through life in slow motion.
One of the most common causes of hypothyroidism is Hashimoto's thyroiditis, an autoimmune condition. This means the immune system mistakenly sees the thyroid tissue as a foreign substance or invader and launches an attack against it, gradually damaging the thyroid. Over time, this can impair the thyroid's ability to produce enough thyroid hormone to meet the body's needs.
This process can be slow, years. In the meantime, you might notice that you're more tired than usual, your weight is changing, your hair is thinning, or your mood and concentration aren't what they used to be. Because these symptoms can also be explained by stress, poor sleep, hormonal changes, nutrient deficiencies, or the demands of everyday life, it's easy for them to be dismissed as something else, and for you to start questioning whether you're simply not able to cope as well as you used to.
Hyperthyroidism is essentially the opposite. Your body has too much thyroid hormone circulating, pushing many of its processes into overdrive. You might experience unexplained weight loss, a racing or pounding heart, anxiety or feeling unusually wired, sweating, tremor, difficulty sleeping, and feeling much hotter than everyone around you.
One of the most common causes of hyperthyroidism is Graves' disease, an autoimmune condition in which the immune system stimulates the thyroid to produce too much hormone. One of the distinctive features of Graves' disease is that it can affect the eyes as well as the thyroid, causing dryness, irritation, puffiness, sensitivity to light, or, in some cases, more noticeable bulging of the eyes.
So while hypothyroidism and hyperthyroidism can look very different on paper, the reality isn't always so straightforward. Symptoms can develop gradually, overlap, and vary considerably from person to person.
That's part of why thyroid problems can go unnoticed for so long.
Signs of thyroid issues
Thyroid problems are sometimes described as having up to nineteen recognisable signs, because an underactive thyroid can affect nearly every system in the body. The most commonly recognised include:
Persistent fatigue that doesn't improve with rest
Unexplained weight gain or difficulty losing weight
Feeling cold when others don't
Dry skin and brittle, thinning hair
Constipation
Low mood
Menstrual irregularities and difficulty conceiving
FAQ
How do you lose weight with hypothyroidism?
Weight gain here isn't a discipline problem, it's a metabolic one, driven by how thyroid hormone regulates your metabolic rate. That's exactly why generic calorie-cutting advice so often fails and leaves you feeling like the problem is you, when it was never that simple to begin with.
Signs that often go missed
Hypothyroidism can show up in places that don't obviously look "thyroid-related," which is a well-documented reason it's so often misattributed to other causes. Clinically reported signs include:
Hoarse or gravelly voice, vocal fatigue, or a change in vocal range
Carpal tunnel syndrome, tingling, numbness, or pain in the hands and wrists caused by fluid retention pressing on the median nerve
Puffy face or eyelids, and swelling in the hands, ankles, or feet
Brittle, ridged nails
Brain fog or word-finding difficulty
Joint pain or muscle cramps
If a cluster of these has crept in alongside fatigue and weight changes, it's worth naming all of them to whoever is investigating your thyroid. They're often part of the same clinical picture, even when nothing about them feels connected, and even when you've been the only one joining the dots so far.
The Conventional Approach
Hypothyroidism is usually diagnosed with blood tests, rather than symptoms alone. TSH (thyroid-stimulating hormone) is typically the starting point. When there isn't enough thyroid hormone circulating in the body, the pituitary gland responds by producing more TSH in an attempt to stimulate the thyroid to produce more hormone.
A raised TSH can therefore indicate that the thyroid isn't keeping up with the body's demands. Free T4 (FT4) is usually measured alongside it to assess how much circulating thyroxine is available to the body. Depending on the results and clinical picture, your GP may also test Free T3 (FT3) and thyroid antibodies, particularly thyroid peroxidase antibodies (TPO antibodies), which can support a diagnosis of Hashimoto's thyroiditis.
Diagnosis isn't based on a single number in isolation. Your symptoms, medical history, examination and blood results all form part of the picture, and your clinician will interpret the results according to the laboratory's reference ranges and your individual circumstances.
Levothyroxine (thyroid hormone replacement) is the established, evidence-based first-line treatment for hypothyroidism. Regular TSH monitoring and dose adjustment by your GP or endocrinologist remain essential, as this medication is often used long-term.
Medication is often an essential part of this picture. But it's not unusual to be correctly medicated and still not feel like yourself, and that gap between "your levels are fine" and "you still feel awful" is exactly where a lot of women get stuck, with nowhere obvious to take that feeling next.
FAQ
What are Hashimoto’s treatments?
Hashimoto's treatments follow a similar core approach, since levothyroxine addresses the resulting low thyroid hormone regardless of the autoimmune cause behind it, though ongoing monitoring tends to matter even more here, as thyroid function can continue shifting over time as the autoimmune process progresses.
A whole-body, personalised approach
I don't believe your thyroid can be understood by looking at one number on a blood test, or by handing you a list of foods to eat and avoid.
My approach starts with understanding you, your symptoms, health history, thyroid function, nutrition, sleep, stress, nervous system, gut health, medications, lifestyle and the changes you've noticed in your body. From there, we can start to understand how the different pieces might be connected and where it makes sense to focus our attention.
Nutrition is an important part of my work, but I don't believe a "hypothyroidism diet" is the whole answer. Your thyroid needs the right nutrients to make and metabolise hormones, but there are many other things that can influence how you feel and function.
Understanding what's happening is one thing. Knowing what to do about it, and actually being able to make those changes within your real life, is another.
My way of working is not to replace your medical care. It's to help you understand the bigger picture, identify what may be worth exploring, and give you practical support as you work towards feeling better.
Once we understand what you need, there are different ways we can work together, whether you want a light programme like the Functional Hormone Assessment to get clarity and a practical plan, or more ongoing support to work through the changes with someone alongside you.
You don't need to have it all figured out before you reach out. You just need to be ready to stop carrying it alone.