Hypothyroidism
An underactive thyroid is common and treatable, but not every mildly raised TSH needs a tablet for life. The honest approach is to test properly, not to assume.
Medically reviewed by the RIIMS medical team · Last updated: June 2026
Go to hospital now
- Severe tiredness with confusion, slowed breathing or a very slow pulse (a rare emergency called myxoedema coma, more common in the elderly with untreated severe hypothyroidism)
- Chest pain or fainting
See a doctor soon (not an emergency)
- Symptoms not improving despite treatment
- A new pregnancy while on or being evaluated for thyroid medicine
- A TSH result far outside the expected range on a routine test
What does hypothyroidism mean, and does it always need lifelong treatment?
Hypothyroidism means the thyroid gland is not making enough hormone, and the standard treatment, levothyroxine, replaces that hormone rather than repairing the gland itself; for most people who need it, treatment continues long-term. An eight-city Indian study found hypothyroidism in 10.95% of adults screened. But lifelong treatment for everyone is not accurate, and a milder form called subclinical hypothyroidism, a mildly raised TSH with a normal thyroxine level and often no clear symptoms, is treated far too often. A 2019 BMJ Rapid Recommendations panel issued a strong recommendation against giving thyroid hormone for subclinical hypothyroidism in most adults, based on a review of 21 trials covering 2,192 patients that found no meaningful improvement in quality of life, mood or energy from treatment. Treatment remains clearly appropriate in specific situations: pregnancy or planning a pregnancy, a TSH above 10, a positive anti-TPO antibody test together with symptoms, and in children. Outside these situations, the honest and useful step is not to stop a tablet abruptly on your own, but to have your TSH properly reviewed with your doctor to see whether the medicine is actually needed at your current dose, or at all.
Symptoms to watch for
- Tiredness and low energy
- Unexplained weight gain
- Feeling cold when others do not
- Dry skin and hair thinning
- Constipation
- Slowed thinking or low mood
When to consult a doctor
Get tested if you have persistent tiredness, unexplained weight gain, or a family history of thyroid disease, or if you are pregnant or planning a pregnancy. If you are already on levothyroxine and unsure whether you still need it, ask for a TSH-based review rather than stopping it yourself.