An underactive thyroid gland (hypothyroidism) can be very difficult to diagnose because the symptoms can also be associated with other conditions, and deciding whether to have therapy is a serious decision best discussed with an expert. For women of childbearing age planning to embark on a cycle of ovulation induction, IVF or embryo transfer, it’s imperative that the thyroid function is working as well as possible.

Sub-clinical hypothyroidism, which occurs when levels of thyroid-stimulating hormone (TSH) are above the normal range, is often – but not always – associated with women of childbearing age. We offer advice and guidance on how to manage it, particularly during pregnancy.

An overactive thyroid is also known as hyperthyroidism or thyrotoxicosis. The most common cause is Graves’ disease, an autoimmune disease that affects the thyroid. Hyperthyroidism is most common in – but is not restricted to – younger patients. We can help to make your diagnosis and decide on the right treatment for you.

Some people make antibodies that can stimulate the thyroid, causing hyperthyroidism. This is known as Graves’ disease. Hyperthyroidism must be treated, and there are many options available. For most patients, medicine is prescribed to get things under control, but for others, radio-iodine or surgery may be more appropriate. Often a 12-to-18-month course of medicine will be enough to allow the production of antibodies to fall and put Graves’ disease into remission, with no further treatment needed. Graves’ disease often causes a swelling of the thyroid – known as thyroid eye disease or Graves’ ophthalmopathy – and much more rarely it can affect the skin, nails or joints.

Thyroid eye disease (TED) can only be identified through a detailed ophthalmological assessment. We work in a small team alongside specialist ophthalmology, radiology and neurosurgery colleagues to manage both TED and Graves’ ophthalmology, making us uniquely placed to consider treatments ranging from the use of selenium, steroids and immunosuppressants through to cosmetic surgery and orbital decompression.

Hyperthyroidism can also be caused by a multi-nodular thyroid gland – a condition that becomes more common as we get older and causes swelling to the neck. Like all hyperthyroidism, it has to be treated and the options available include medicine, radio-iodine and/or surgery. Unlike Graves’ disease, where the antibodies can go away, the nodularity usually persists and, even after 12-18 months of tablets, toxic multinodular goitre is rarely cured or put into remission. Patients can still have tablet treatment, however, and together we can consider what is the best ongoing treatment for you.

A single nodule – a toxic adenoma – can also cause thyrotoxicosis. Its treatment can be quite different to other forms of hyperthyroidism so it is particularly important to get an accurate diagnosis.

Viruses can inflame the thyroid for a short time and cause dramatic hyperthyroidism, often followed by a period of calm and then either transient or permanent hypothyroidism. This can often come and go within 6 months. The condition must be recognised because the treatment is completely different to other causes of hyperthyroidism: often a nuclear medicine uptake scan is needed for diagnosis, followed by blood tests while the inflammation is treated.

While thyroid nodules are very common, thyroid cancer is rare, and most cases are curable if treated promptly. We work closely with a multidisciplinary team including ultrasonographers, pathologists, cytologists, doctors of nuclear medicine and specialist nurses so that the best decisions can be made about your treatment. Very often this is to exclude cancer, but sometimes it is to give a prompt diagnosis and work out who is best placed to help you.

Pregnancy is a natural process, and we avoid making any medical intervention unless it is absolutely necessary. Keeping the thyroid functioning perfectly is particularly important during the first twelve weeks of pregnancy and in the time preceding conception. However, it can also be more difficult to treat at this time; in the second and third trimesters it is usually easier. Most women don’t need routine testing before or during pregnancy, but if your thyroid is abnormal, was abnormal in a previous pregnancy and/or you need it to be functioning perfectly for assisted conception, ovulation induction, embryo transfer or IVF, we can help manage this for you. The thyroid often changes during pregnancy, and we can readjust things for you after delivery to help you and your baby, however you are nursing.

Just as the immune system changes after pregnancy, so the thyroid function can also change. Patients can become unwell and attribute their feelings of exhaustion or depression to becoming a new mother. The risk of post-partum thyroiditis is higher for some women, and for those patients we would consider arranging a blood test and routine reviews rather than waiting for you to become unwell. We will advise you on what is best for your individual case.