I see patients with this complaint almost every day: they have been dieting strenuously for months, they exercise, yet the weight won't come off. They arrive frustrated and often already blaming themselves. Yet in many cases, there is a clear medical explanation: the thyroid gland is not working optimally.
What Is the Thyroid Gland and Why Does It Matter?
The thyroid gland — located at the front of the neck — is your body's "engine speed regulator." Thyroid hormones (mainly T3 and T4) control your basal metabolic rate, i.e. how quickly your body burns calories at rest. If production is insufficient (hypothyroidism), every metabolic process slows down — including fat burning.
Hypothyroidism Symptoms Often Dismissed as "Normal"
What makes hypothyroidism hard to detect is that its symptoms closely resemble everyday complaints:
- Weight gain or extreme difficulty losing weight despite calorie restriction
- Chronic fatigue — not refreshed even after 8 hours of sleep
- Excessive cold intolerance — often feeling cold when others are comfortable
- Persistent constipation with no clear cause
- Hair loss and dryness, brittle nails
- Dry, rough skin
- Depression or a cognitive feeling of being "slowed down"
- High LDL cholesterol that doesn't respond to dietary changes
- In women: irregular or heavier menstrual cycles
Subclinical Hypothyroidism: More Common Than You Think
Often the TSH (Thyroid-Stimulating Hormone) result is slightly above normal while T3 and T4 are still within normal limits — this condition is called subclinical hypothyroidism. Many patients with this condition already experience real symptoms, but are often told "your lab results are still normal."
Proper evaluation requires comprehensive clinical interpretation, not just checking whether numbers fall within the reference range.
Hashimoto's Thyroiditis: The Most Common Cause
In countries with adequate iodine intake such as Indonesia, the most common cause of hypothyroidism is Hashimoto's thyroiditis — an autoimmune disease in which the immune system slowly attacks the thyroid tissue. Symptoms often develop over many years before hormone levels truly drop significantly.
The diagnosis is established with thyroid antibody tests (Anti-TPO and Anti-Tg), which are not always included in a standard thyroid panel.
Hyperthyroidism: The Opposite — Racing Heart and Drastic Weight Loss
Conversely, if the thyroid gland is overactive (hyperthyroidism), the symptoms flip 180°:
- Heart palpitations, even at rest
- Trembling hands (tremor)
- Drastic weight loss despite an increased appetite
- Excessive sweating and feeling hot all the time
- Restlessness, insomnia, and irritability
- In severe cases: bulging eyes (exophthalmos), characteristic of Graves' disease
Untreated hyperthyroidism can lead to cardiac arrhythmias and osteoporosis in the long term.
When Should You Have Your Thyroid Hormones Checked?
I recommend a TSH test as screening if you experience:
- Weight gain of ≥5 kg in 6 months without dietary changes
- Chronic fatigue that doesn't improve with adequate rest
- A family history of thyroid disorders (mother, sisters)
- Another autoimmune disease (such as type 1 diabetes, lupus, rheumatoid arthritis)
- Women planning pregnancy or currently pregnant
- Age >60, on a routine basis
A Lump in the Neck: When Should You Be Concerned?
Not every lump in the neck is cancer — in fact, most are benign conditions. However, some signs warrant further evaluation:
- A lump growing quickly over weeks or months
- Hard texture that doesn't move when swallowing
- Accompanied by unexplained hoarseness
- Enlarged lymph nodes in the neck
Evaluation starts with a thyroid ultrasound as the first step, and if needed, an FNAB (Fine Needle Aspiration Biopsy) to assess the type of cells in the nodule.
"The thyroid is a small gland with a huge influence. Don't let its symptoms be dismissed as 'normal' — one simple TSH test can answer the question that has been troubling you for years."
— dr. Sebastianus Jobul, Sp.PD-KEMD, FINASIM