May 2026 query

Our member asks

I have had a hemithyroidectomy for benign nodules on the left side of my thyroid. The right side is working fine. Could the right side develop nodules in the future?

Our medical advisor replies

Yes, but it is unlikely to. The recent NICE guidance recommends you have an annual thyroid function test if you have had a hemithyroidectomy. This is because you are more likely to develop inadequate thyroid hormone levels in the future. However, it is uncommon to develop a problem on the other side of your thyroid.

March 2026 query

Our member asks

I have positive thyroid peroxidase antibodies but my thyroid function is normal. As I am trying for a baby, do I need to be treated with levothyroxine?

Our medical advisor replies

If you have positive thyroid peroxidase antibodies (TPOab) with TSH and FT4 within the reference range, there is a risk of later developing hypothyroidism, as well as miscarriage, premature birth and thyroid function abnormalities postpartum.

Levothyroxine treatment, however, is not recommended. This is because it does not, unfortunately, reduce these risks if your thyroid function is normal.

It is important that you have your thyroid function monitored every 6 months while planning a pregnancy. If you become pregnant, your thyroid function should be rechecked at 7-9 weeks and again at 20 weeks. It isn't necessary to have your thyroid peroxidase antibodies retested. If you are found to be hypothyroid, you should be treated with levothyroxine.

February 2026 query

Our member asks

Is there any treatment for high antibodies following removal of the thyroid?

Our medical advisor replies

At the moment ‘no’ but there are planned clinical studies in Graves’ disease that will look at this. Essentially once your thyroid is removed your antibodies will slowly decline. And after having radioiodine for Graves', we know there will be a period over the next three to six months when TSH Receptor (TRAb) antibody levels will be higher. But once you get to 12 months or longer after surgery or radioiodine treatment, the level of those antibodies declines. So, we cannot give you anything to take the antibodies away, but having definitive treatment will encourage them to fall and should make the management more straighforward, especially for women planning to conceive or in pregnancy.

January 2026 query

Our member asks

How often will I have check-ups after having radioiodine treatment (RAI) for hyperthyroidism? I’m nervous I will go hypothyroid and it won’t be picked up. 

Our medical advisor replies

Any RAI centre should offer you a treatment plan. This will offer you follow-up tests at set intervals or sooner if there are symptoms or new symptoms. This will typically be at six weeks, three months, six months and one year after RAI. 

December 2025 query

Our member asks

Do higher thyroid antibodies levels determine how severe symptoms are?

Our medical advisor replies

Not always. Higher free thyroid hormones indicate more severe disease but do not always correlate with the severity of symptoms. For example, you can have young people with mild disease who are very symptomatic but older patients who have minimal symptoms despite being much more thyrotoxic*, in terms of their blood results. So, the level of thyroid hormones is not always in keeping with the severity of the symptoms.

Apart from age, there could be a difference in symptoms between men and women. For example, we see men present with less severe symptoms than women in some cases.

The TSH Receptor Antibody (TRAb) doesn’t directly determine the severity of symptoms. A high TRAb is diagnostic for Graves’ disease and the higher the TRAb level, the greater the immune attack going on in the thyroid.

So it is more likely you would have more severe thyrotoxicosis. It may also mean you are more likely to take longer to respond to anti-thyroid medication or require a much higher dose of anti-thyroid medication to achieve remission. Also, the higher the TRAb level, the greater the likelihood of developing Thyroid Eye Disease (TED). So, it’s fair to say that the TRAb level can indicate whether you are more likely to develop TED but it does not determine the severity of thyrotoxic symptoms. 

*Thyrotoxicosis – too much thyroid hormone in the body. Thyrotoxic = relating to the condition thyrotoxicosis

November 2025 query

Our member asks

What causes a goitre?

Our medical advisor replies

A goitre is a swelling of the thyroid gland that you can see at the front of the neck. Most nodules and swellings are harmless and do not mean you have abnormal thyroxine levels but it is always important to have them checked promptly. There are several possible causes, including an underactive thyroid, an overactive thyroid, a temporary thyroid disorder (known as thyroiditis) or a diet which hasn’t included enough iodine.

September 2025 query

Our member asks

Can I still drive with TED?

Our medical advisor replies

If your sight reached the minimum standard for driving you are still able to drive providing you don’t have double vision. If you have uncontrolled double vision, it’s crucial to see the orthoptist because they’d be able to manage the double vision by either some form of occlusion or a prism. And providing you have single vision, and the right level of vision, you should be able to drive.

August 2025 query

Our member asks

I have had a hemithyroidectomy for benign nodules on the left side of my thyroid. The right side is working fine. Could the right side develop nodules in the future? 

Our medical advisor replies

Yes, but it is unlikely to. NICE guidance recommends you have an annual thyroid function test if you have had a hemithyroidectomy. This is because you are more likely to develop inadequate thyroid hormone levels in the future. However, it is uncommon to develop a problem on the other side of your thyroid. 

July 2025 query

Our member asks

Do women who are receiving transdermal oestrogen, or vaginal oestrogen only, need their thyroid function reassessed like those women taking oral HRT?

Our medical advisor replies

The evidence for this is not that clear but I think that with local application of oestrogen it is unlikely that there are significant enough amounts absorbed to affect levothyroxine. I think with transdermal preparations, there may actually be some absorption issues that may affect it.

I think if a patient were on levothyroxine and was fine and suddenly starts feeling unwell, that is sufficient reason to check thyroid function just to make sure that things are ok. The symptoms may not be related to the thyroid but it is a simple, inexpensive test. And often a simple adjustment (to levothyroxine dose) can make a big difference. So, that would be my pragmatic approach to that.

June 2025 query

Our member asks

My child's behaviour is sometimes very erratic. I'm not sure whether it's due to their thyroid condition or now. How does having a thyroid disorder affect your behaviour?

Our medical advisor replies

As well as causing physical symptoms, young people with thyroid disorders can often have emotional symptoms. A thyroid disorder can make people feel more emotional than they felt before diagnosis and different from their friends.

These feelings may include:

• sudden or unpredictable mood changes, or ‘moodiness’
• anxiety - a feeling of nervousness, or worrying that they can’t manage the things they have to do, perhaps their heart will be racing and their hands will be trembling
• depression - low mood and difficulty enjoying things, tearfulness, loss of appetite and sleeping difficulties
• difficulties with concentration or remembering things

Having these symptoms may make it seem to them, and their family, friends or teachers, that their behaviour has changed. And they can also affect the way you cope with their  school work and out-of-school activities.

The important thing is for child to talk to with you about how they are feeling. You may wish to make a GP appointment to see whether their medication needs adjusting. 

It’s important to remember however that from time to time lots of people (including those who don’t have a thyroid disorder) will experience these symptoms and their may not be caused by their thyroid.

May 2025 query

Our member asks

I have a benign multinodular goitre. Should it be monitored to check whether it is getting worse? Is it permanent?

Our medical advisor replies

Lumps in the thyroid are permanent. They rarely go away by themselves. The exception to that is if you have a cyst (fluid-filled sac) in your thyroid or a lump that is mixed solid and cystic. Sometimes the cyst can actually burst, for whatever reason, and the fluid just leaks away. This can cause the lump to shrink. By and large, if you have a multinodular goitre, you will always have a multinodular goitre.

If you have had an ultrasound scan that says the goitre is benign and looks reassuring, then any further scans may not be necessary for the reasons I gave earlier. Generally, we do recommend that you have your thyroid blood tests done every one to two years to ensure your thyroid hormone levels are not changing. Obviously,  if you notice any change in the feel or the look of the goitre then by all means discuss this with your GP but it is not an absolute that this will need follow-up.

April 2025 query

Our member asks

Why can’t my thyroid eye disease be treated yet?

Our medical advisor replies

Essentially, if your disease is mild, then you do not need any specific medical or surgical treatment.

Conservative methods like lid hygiene and using artificial teardrops will help your eyes feel more comfortable. We tend to offer surgery once we know your condition is stable. So, for example, if your eyes are still getting more and more bulgy, and your vision is stable, we tend to wait until the condition has stablised because otherwise we would be trying to fix a problem that was either going to get worse or get better on its own. So, surgery isn’t going to be as effective during those periods of instability.

February 2025 query

Our member asks

Graves’ disease patients more susceptible to having dental problems?

Our medical advisor replies

The literature suggests that hyperthyroidism is associated with increased risk of caries (decay and crumbling of a tooth or bone) and periodontal (gum) disease. When attempting to find the primary sources for these opinions, there is very little/reliable evidence, apart from the association of Graves’ disease with another autoimmune condition called Sjogren’s syndrome. Sjogren’s causes reduction of salivary secretions and it is well established that Sjogren’s causes significant dental problems. So, I am rather sceptical about the connection between Graves’ disease and dental problems. For what it’s worth, during my 40-odd years of treating patients with Graves’ disease I cannot recall encountering anyone with serious dental problems. 

January 2025 query

Our member asks

I am 20 weeks pregnant. What is the likelihood of my baby inheriting a thyroid condition from me?

Our medical advisor replies

Sometimes women with a thyroid condition are concerned about their baby developing a thyroid condition. We know that thyroid conditions are more common in women because they’re usually autoimmune conditions, but they’re not single-gene inherited conditions. For this reason, I reassure women that the vast majority of babies are not born with a thyroid problem.

If you have a family history of autoimmune conditions, and thyroid conditions are one of the most common autoimmune conditions, your baby is likely to have inherited a pattern of genes that mean they too, as they progress through life, are at some increased risk of developing an autoimmune condition. 

If you have received antithyroid drugs for Graves’ disease during pregnancy, or if your thyroid hormone levels have been abnormal during pregnancy, we can check thyroid function when your baby is delivered. We do this on blood from the cord, so it doesn’t involve the baby having a blood test.

December 2024 query

Our member asks

I have just been told I've got thyroid eye disease (TED). Should I be receiving treatment for it?

Our medical advisor replies

Inflammation is generally what causes the problems in thyroid eye disease. So the main forms of treatment aim to dampen the  inflammation and bring it under control.

If your disease is mild, then you probably just need lubricants for your eyes to make the eyes feel comfortable. If you have more moderate disease, however, then you can have non-steroidal anti-inflammatories.

If your disease is quite active we tend to give something to suppress your immune system and this is usually in the form of steroid treatment, either intravenously or with tablets. If you are getting a lot of side effects from steroids, there are steroid-sparing agents like mycophenolate, cyclosporine or methotrexate. We also use orbital radiotherapy and, in some cases, you might even need surgery for your eyes in thyroid eye disease.

November 2024 query

Our member asks

What are the long-term effects of being on a low dose of carbimazole to treat my overactive thyroid?

Or medical advisor replies

There are no long-term complications or ill effect of carbimazole if you are tolerating it well without any side effects. Having said that, if you choose to take the carbimazole for long-term instead of having definitive therapy you need to bear in mind that carbimazole has the ever-present risk of causing agranulocytosis or lowering lower your white blood cells. And this is a condition where it could happen at any time point as long as you’re on carbimazole. 

So we always advise people to look out for symptoms such as very high fever, severe sore throat or having lots of ulcers in their mouth. If this happens, you will have to stop the medication and get a blood test done to make sure you do not have a suppressed white blood cell count. So, this is basically one of the precautions people have to remember they are on carbimazole.

The other thing to bear in mind is if you choose to have long-term carbimazole rather than definitive therapy then there’s a risk of intermittent, uncontrolled thyrotoxicosis in the context of hyperthyroidism. And there are studies proving that patients on long-term antithyroid drugs with intermittent control have worse outcomes in terms of cardiovascular health and also premature death as well.

September 2024 query

Our member asks

My child's teacher has noticed a change in their behaviour since they've been treated for hypothyroidism. Why would that be? 

Our medical advisor replies

A young person with a very underactive thyroid gland may be very quiet and subdued in a classroom before treatment. And after treatment some teachers notice that the young person becomes more animated and sometimes this can cause them to question what’s changed. For this reason, it’s always worth parents or young people telling the school that the student is being treated for a thyroid issue so that the teachers can be aware of any change in behaviour.

August 2024 query

Our member asks

July 2024 query

Our member asks 

Can thyroid disorders affect men's fertility?

Our medical advisor replies

Although it is well recognised that thyroid disorders can affect men's fertility, it often receives less attention than fertility in women with thyroid conditions. But we know that men with overt hypothyroidism or hyperthyroidism do have a potential impact on their sperm parameters, and this can then lead to reduced chances of conceiving a pregnancy with their partner. 

If your thyroid condition is treated, sperm parameters should return to normal and your chances of conceiving should return to your baseline. When we talk about sperm parameters we mean a number of different things, but this is typically sperm mobility. Ensuring you have normal thyroid function is the best way to reduce your chances of encountering any problems and helping you to conceive normally. 

June 2024 query

Our member asks

Do thyroid antibodies ever go away? 

Our medical advisor replies

For Graves’ disease, if you've had successful treatment with antithyroid drugs your TSH receptor antibodies will disappear towards the end of treatment, and that will be an indicator for your doctor to stop your antithyroid drug treatment.

For thyroid peroxidase antibodies they don’t really correlate very well with the disease activity. They’re just a marker that you have the disease and there’s no value to repeating the measurements.

May 2024 query

Our member asks

I am 70 and have recently been told I have subclinical (borderline) hyperthyroidism. Will it need treating?

April 2024 query

Our member asks

How can scans be used to distinguish between Graves’ disease and postpartum thyroiditis?

Our medical advisor replies

We don’t commonly use thyroid ultrasound to determine the cause of hyperthyroidism nowadays. This is because, first of all, an ultrasound scan is not very sensitive in diagnosing these conditions. Secondly, blood thyroid autoantibodies and thyroid uptake scans are more sensitive and specific diagnostic tests.

We only do ultrasound scans, for example, if a patient with hyperthyroidism is found to have a thyroid nodule. Even then we would defer the ultrasound until after the thyrotoxicosis is treated. This is because if you have an overactive thyroid gland, there is a high chance that an ultrasound scan will show some indeterminate features.

This could lead to unnecessary investigations, such as a biopsy. So, we tend to wait until thyroid function is normal and then we do the scan, unless the thyroid nodule has increased in size or the patient has  obstructive symptoms from a large nodule.

The best test to distinguish between Graves’ disease and postpartum thyroiditis is a blood test. If you have very high TRAb levels then this is Graves’ disease and not postpartum thyroiditis. If the TRAb level is negative, then we would do a thyroid uptake scan.

We can also predict the likelihood of Graves’ disease or thyroiditis by judging the thyroid hormone levels. We know that thyroid follicles produce/store more T4, so when we look at the ratio between T4 and T3 we will have an idea of whether it is more likely to be Graves’ disease as opposed to thyroiditis.

February 2024 query

Our member asks

Can people with thyroid disease start perimenopause/menopause earlier?

Our medical advisor replies

Treated hypothyroidism is not explicitly associated with early menopause. However, Premature Ovarian Insufficiency (POI) is associated with autoimmune thyroid disease. Thyroid problems can occur in 14–27% of women with POI, so these women should be tested for thyroid peroxidase antibodies and screened for thyroid-stimulating hormone levels at presentation.

Hyperthyroidism does not specifically cause an earlier menopause. Uncontrolled hyperthyroidism can cause stress across your hormone system. For this reason, it can affect, and even stop, menstrual periods in fertile women and increase perimenopausal symptoms in women who are already nearing, or in, the menopause transition. Once the overactive thyroid is treated, these effects may subside. They may also continue if your body was already heading towards perimenopause before the thyroid problem began.

January 2024 query

Our members asks

I have Graves' disease and the endocrinologist has confirmed I do not have any signs of thyroid eye disease. I would like to have laser eye surgery for my short-sightedness however I am not sure whether I would be a suitable candidate?

Our medical advisor replies

Laser eye surgery is not recommended due to possible dry eye and exposure issues. It is not an absolute contraindication; however, you would need to accept the risks if you decided to proceed.  

December 2023 query

Our member asks

What is the link between thyroid blood tests and symptoms? For example, do higher thyroid antibodies levels determine how symptomatic patients are?

Our medical advisor replies

Not always. Higher free thyroid hormones indicate more severe disease but do not always correlate with how severe symptoms are. For example, you can have young people with mild disease who are very symptomatic but older patients who have minimal symptoms despite being much higher thyroid levels, in terms of their blood results. So, the level of thyroid hormones does not always correspond with the severity of the symptoms.

Apart from age, there could be a difference in symptoms between men and women. For example, we see men present with less severe symptoms than women in some cases.

The TSH Receptor Antibody (TRAb) doesn’t directly determine the severity of symptoms. A high TRAb is diagnostic for Graves’ disease and the higher the TRAb level, the greater the immune attack going on in the thyroid. In these patients, we may see more severe thyrotoxicosis*. It may also mean you are more likely to take longer to respond to anti-thyroid medication or require a much higher dose of anti-thyroid medication to achieve remission.

Also, the higher the TRAb level, the greater the likelihood of developing Thyroid Eye Disease (TED). So, it’s fair to say that the TRAb level can indicate whether you are more likely to develop TED but it does not determine the severity of thyrotoxic symptoms.

*Too much thyroid hormone in the body

November 2023 query

Our member asks

I have a multinodular goitre; does it mean you have to remove the whole thyroid or just some 
of it?

Our medical advisor replies

With a small multinodular goitre you may need to do nothing at all. If it is causing discomfort, 
you may be offered Radioactive Iodine (RAI) therapy. Where surgery is needed for a multinodular 
goitre affecting just one of the thyroid lobes, then you may be offered a partial thyroidectomy
(hemithyroidectomy). If is on both sides of the neck, then it is best to remove the entire thyroid
(thyroidectomy). This is because if some tissue is left behind it may regrow. Repeating surgery on the 
same spot increases the risk of damaging the thyroid.

October 2023 query

Our member asks

How often will I have check-ups after RAI? I am worried I will go hypothyroid and it won't be picked up.

Our medical advisor replies

Any RAI centre should provide you with a treatment plan.This will offer you follow-up tests at set intervals or sooner if there are symptoms or new symptoms. This will typically be at six weeks, three months, six months and one year after RAI. These appointments are often held virtually. You will be given a series of blood test forms and we monitor them. We may need to see you face-to-face in our clinics though. 

August 2023 query

Our member asks

Why does TSH sometimes stay persistently low? For example, in someone who has Graves’ disease whose T4 levels are now in range but their TSH remains suppressed?

Our medical advisor replies

This is an unusual phenomenon. The truth is we do not exactly know why the TSH stays chronically suppressed.

I can give you two possibilities:
1. When we measure the thyroid hormones in the blood, it is a snapshot in time. It is not the T3 level throughout the 24 hour period. So, it is possible that in that Graves’ disease patient the snapshot measurement of T3 is ok but over a 24 hour period the thyroid gland is producing just a little too much T3. And this is what accounts for the persistently suppressed TSH.

2. Another explanation, for which there is also good evidence, is that the receptor to which TSH receptor antibodies bind is, strangely enough, also expressed on the TSH producing cells of the pituitary. So, there is a suggestion that the Graves’ antibody cells – the Thyroid Stimulating Hormone Receptor Antibodies (TSHR Ab, also known as TRAb) – is what binds to the pituitary and shuts off the TSH for a long time. I think Prof Moran and I would agree that when we see this in clinical practice we observe this as a
phenomenon that when we treat a patient with Graves’ disease, the TSH can remain suppressed for months. As things get better, it then flips.

July 2023 query

Our member asks

Can the surgical use of iodine cause goitres?

Our medical advisor replies

There is no evidence that iodine uptake scans nor surgical iodine cause nodules or goitres. If anything it is iodine deficiency that causes goitres or nodule, not excess iodine as such. In someone who has Graves’ disease and borderline overactivity, if they took a lot of iodine (i.e. seaweed) this could make their thyroid more overactive in the short term.

Other than that, surgical iodine does not get absorbed into the skin in any meaningful amount. In iodine contrast medium used in x-rays, the amount of iodine is trivial; much, much less than is in a normal diet.

June 2023 query

Our member asks

I have Graves’ disease but no sign of Thyroid Eye Disease (TED). Will having thyroid surgery
reduce the risk of TED developing?

Our medical advisor replies

The Thyroid Stimulating Hormone Receptor Antibodies (TRAb) antibodies which can trigger TED do decline over time when removing the thyroid. We also know that if someone has TED, giving them RAI can make it worse. I am not aware of any concerns about giving RAI for someone with Graves’ disease who hasn’t yet developed TED. Yes, thyroid surgery can be helpful where people already have TED but I wouldn’t be offering surgery to someone just because of worries about developing TED at a later date.

May 2023 query

Our member asks

I am struggling to get pregnant after several miscarriages. I have a family history of thyroid problems and have tested positive for thyroid antibodies. Would taking levothyroxine improve my chances of having a successful pregnancy?

Our medical advisor replies

There is no evidence that treating women who have positive TPO antibodies but normal thyroid function tests will result in improved pregnancy outcomes even in those with previous pregnancy losses.

If your TSH is above the pregnancy-specific reference range (or greater than 4.0 mU/L where there are no pregnancy ranges available) then treatment with levothyroxine is recommended.

The evidence for treating those with a TSH between 2.5 mU/L and the upper limit of the pregnancy reference range (or 4.0 mIU/L) who are TPO positive and have recurrent miscarriages is less clear and the TABLET trial showed no benefit. A number of fertility clinics and the current American Thyroid Association (ATA) guidelines however would treat someone with a TSH greater than 2.5 mU/L in this situation.

April 2023 query

Our member asks

I believe my son has hypothyroidism as we have a strong family history of thyroid disease. His thyroid function is only showing elevated TSH and a borderline T4. The paediatric endocrinologist has indicated he may develop hypothyroidism in the future but does not currently require treatment. Yet, he is experiencing extreme tiredness, heavy legs, low mood and he has been found to have a low vitamin D. I wish to avoid the problems we had getting his sister’s diagnosis. Is there anything else I should be asking my son’s doctor?

Our medical advisor replies

Firstly, I think it would be good to highlight your concerns with the paediatric endocrinologist.

He or she may make the point that other issues may need to be addressed as well before the picture becomes clear. For example, low vitamin D concentrations can also cause tiredness and heavy legs etc. I imagine your son is on vitamin D now, which may improve his symptoms.

Many studies have shown that subtle TSH increase in isolation (for example, a TSH less than 10mU/l) does not seem to be associated with the kind of profound symptoms that you describe in your son and it would be good to know how high the TSH actually is. If it is persistently elevated in the presence of symptoms, many endocrinologists would consider a trial of thyroxine, particularly if the free T4 is borderline as you suggest. I do think it is important that the team try and understand why the TSH is increased though. Has your son got positive autoantibodies for example? Is he on a diet that does not contain much iodine?

I would just bear in mind that in some individuals mild TSH elevation or mild thyroid dysfunction can actually be the consequence of illness and not the underlying cause. We see this very commonly. If this is the case then the thyroid dysfunction can correct itself spontaneously. Nature and time are sometimes better than a prescription.

Again, this underlines the importance of discussing the specifics with your paediatric endocrinologist who I am sure will be very receptive to your thoughts about the possible way forwards.  

Ultimately, if the TSH continues to rise and the Free T4 continues to fall he will need thyroxine.

March 2023 query

Our member asks:

I was diagnosed with Graves’ disease a few years ago. After taking carbimazole for over a year I became euthyroid and was able to stop treatment. I am now trying to become pregnant and was wondering if I am now completely clear of hyperthyroidism or could the illness come back? 

Our medical advisor replies:

You should have thyroid function tests and thyroid stimulating hormone receptor antibodies (TRAb) checked in the first trimester. Even if you are euthyroid, if the TRAb is positive, you should be referred to a local antenatal clinic during pregnancy. This is precautionary but because thyroid receptor antibodies cross the placenta, monitoring during pregnancy is recommended.

There is a risk of Graves' disease relapse pre-pregnancy or in early pregnancy, or in the postpartum period.Thyroid function tests should be checked if you develop symptoms of hyperthyroidism at any stage, or in early pregnancy. 

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