Main symptoms
- •**Hypothyroidism**: fatigue, cold intolerance, weight gain, constipation, dry skin, brittle hair, bradycardia, mental slowing
- •**Hyperthyroidism**: nervousness, weight loss despite appetite, sweating, tachycardia, tremor, insomnia, goitre (Graves' disease: exophthalmos)
- •Goitre (thyroid enlargement)
- •Thyroid nodules (monitor)
- •Menstrual disturbances
- •Infertility, miscarriages
Risk factors
- ⚠️ Female sex (5-8× more common)
- ⚠️ Family history of thyroid disease
- ⚠️ Comorbid autoimmune diseases
- ⚠️ Recent pregnancy (postpartum thyroiditis)
- ⚠️ Age > 60 (hypothyroidism)
- ⚠️ Drugs: amiodarone, lithium, interferon
- ⚠️ Neck irradiation
Management and treatments
**Hypothyroidism**: lifelong levothyroxine (Levothyrox), dose adjusted by TSH. 50-200 μg/day. Generics available (40-100 MAD/month). 80% reimbursed by CNOPS. **Hyperthyroidism**: synthetic antithyroid drugs (carbimazole, propylthiouracil) for 18 months then taper. **Radioactive iodine** (I-131) or **surgery** (thyroidectomy) if relapse. **ALD** recognition if treatment > 6 months or severe autoimmune disease.
Prevention
Use iodised salt (mandatory in Morocco since 1995). TSH screening in pregnant women at the first antenatal visit. Thyroid panel if suggestive symptoms, family history, or after age 60. Neck ultrasound if a nodule is palpable.
Frequently asked questions
Does TSH suffice for diagnosis?+
Yes as first-line. Normal: 0.4-4 mIU/L. If abnormal: add free T4 ± free T3 ± antibodies (anti-TPO, anti-TG for Hashimoto/Graves).
Lifelong levothyroxine?+
Yes in most definitive hypothyroidism. Dose adjusted every 6-12 months via TSH. Take fasting 30 min before breakfast.
Pregnancy with dysfunction?+
Yes but increased risk of miscarriage, prematurity, developmental issues. Pre-conception TSH check essential, levothyroxine often increased during pregnancy.
Diet and thyroid?+
Iodine (fish, seafood, iodised salt) is essential. Avoid excess soy with levothyroxine (absorption). No validated restrictive diet.