Your Thyroid Might Be the Reason You Feel Off — Here's How to Know

A patient came in last month who'd been exhausted for close to a year. Sleeping eight hours and still dragging through the day. Gaining weight even though she'd cut back on rice and sodas. Hair coming out in the shower. She'd chalked it up to stress, the heat, getting older. She was 38.

Her TSH came back at 9.2. Her thyroid had been failing her for months.

This happens more than most people realize. The thyroid is a small butterfly-shaped gland in your neck, but what it controls is enormous — metabolism, heart rate, body temperature, mood, digestion, fertility. When it's off, everything feels off. And because the symptoms are so ordinary, people live with them for a long time before anyone thinks to check.

There are two main ways the thyroid goes wrong. An underactive thyroid, called hypothyroidism, means it's not making enough hormone. You feel slow, heavy, foggy. You might notice dry skin or constipation. Your period might become irregular or heavier. The cold hits you harder than everyone else — which, given how frigid Central Florida offices and malls keep the AC, can be a real day-to-day problem. Hashimoto's disease, an autoimmune condition, is the most common cause of hypothyroidism in the U.S., and it tends to run in families.

An overactive thyroid, hyperthyroidism, is the opposite — your system is running too hot. Heart racing, hands trembling, sweating even before you've stepped outside. You might eat constantly and still lose weight. Sleep becomes difficult. Anxiety ramps up in ways that feel like nerves but are actually hormonal. Graves' disease drives most cases.

Both can look like a dozen other things. That's exactly why they get missed.

Hispanic women are diagnosed with thyroid disorders at higher rates than the general population, and thyroid conditions cluster in families. If your mother or grandmother had thyroid issues, mention that at your next visit. If you're pregnant or trying to get pregnant, thyroid function matters even more — untreated thyroid problems increase the risk of miscarriage and complications.

The test itself is simple: a blood draw that checks your TSH, or thyroid-stimulating hormone. If that comes back abnormal, we usually add T4 and sometimes T3 to get the full picture. Most insurances cover this, especially when there's a documented symptom. If cost is a concern, say so — there are cash-pay lab options in Orlando that make this genuinely affordable.

A few practical things if you're already being treated for hypothyroidism, or suspect you might need to be.

Levothyroxine, the most common thyroid medication, needs to be taken on an empty stomach — ideally 30 to 60 minutes before coffee or breakfast. Taking it with your morning café con leche every day will blunt how well it works. This is one of the most common reasons I see patients whose levels still aren't right despite being on medication for years.

Calcium supplements, iron supplements, and antacids like Tums can interfere with absorption if taken at the same time. Separate them by at least four hours. And if you're taking biotin for hair and nail growth, stop it about a week before bloodwork — it can artificially skew thyroid lab results and make your numbers look normal when they're not.

Iodine deficiency is rare here since most table salt is iodized, but if you cook mostly with sea salt or pink Himalayan salt, those aren't always iodized. Check the label.

When to see a doctor: Don't wait if you notice unexplained weight gain or loss of more than ten pounds without trying, persistent fatigue that sleep doesn't fix, a visible lump or swelling in your neck, heart palpitations, hair thinning throughout your scalp, or irregular periods. Any one of those is worth a conversation. Several of them together? Come in this week.

You don't need a specialist to start this process. A thyroid panel is something your primary care doctor orders and manages. If something comes back that needs an endocrinologist, I'll tell you and send you with a clear referral. But most thyroid conditions — especially hypothyroidism — are handled right here, long term.

If any of this sounds familiar — if you've been brushing off symptoms for months the way that patient did — I'd like to see you. We're at our Narcoossee Road location in Lake Nona and our Lancaster Road office in Orlando, and we take same-day appointments. Dr. Catherine Arevalo sees patients at both locations and will actually sit down and talk through what you've been experiencing.

Your thyroid might be fine. But if it's not, finding out is a one-blood-draw conversation. That's worth making the call.

This article is for informational purposes only and does not constitute medical advice. Please consult your physician for guidance specific to your health situation.