My colleague Sunita spent three years being told she was fine.
She is 34 years old and works in the same office building as me in Saket. I did not know her well until about eight months ago when we ended up at the same table during a team lunch and she mentioned, almost as an aside, that she had just been diagnosed with Hashimoto’s thyroiditis after three years of going to various doctors with symptoms that none of them had connected into a complete picture.
The symptoms she described during that lunch conversation stopped me from finishing my food.
She had gained approximately nine kilograms over eighteen months despite eating carefully — she had actually reduced her rice portions and started skipping her evening snack. She was sleeping eight to nine hours every night and waking up so tired that she had started setting two alarms because she did not trust herself to get up from the first one. She felt cold constantly — in January she wore a sweater indoors in a heated office where everyone else was comfortable in full sleeves. Her hair had been falling out steadily for a year — she had switched shampoos three times and had spent ₹4,500 on a dermatologist consultation who told her it was stress-related. Her periods had become irregular and heavier. She had been to a gynaecologist who had tested her for PCOS and found nothing significant.
In three years of symptoms across five different doctors she had received diagnoses or near-diagnoses of stress, anaemia (which she did have, separately), possible PCOS, work-related burnout, and perimenopausal changes. Nobody had ordered a complete thyroid panel until she specifically asked for one herself after reading about thyroid disease in a health newsletter.
Her TSH came back at 8.4 mIU/L. Her Anti-TPO antibodies were strongly positive. She had Hashimoto’s thyroiditis — an autoimmune condition in which the immune system attacks the thyroid gland, gradually impairing its ability to produce hormone.
She has been on levothyroxine for six months now. Her TSH is 2.1. She has lost four of the nine kilograms without changing her diet. She wakes up on the first alarm. She is warm enough in the office in January without a sweater.
I am writing this article because of that lunch conversation. And because Sunita’s experience — three years, five doctors, wrong diagnoses, correct diagnosis finally arrived at because she asked for it herself — is not unusual. It is, based on everything I have read and every woman I have spoken to since, the norm rather than the exception.
Why Thyroid Disease Stays Undiagnosed in Indian Women for So Long
The Indian Thyroid Society estimates that approximately 42 million Indians live with some form of thyroid disease. Women are 5 to 8 times more likely to be affected than men. Yet the average time between symptom onset and correct diagnosis in India remains two to four years.
Three factors explain most of this diagnostic delay.
The symptoms of hypothyroidism — the most common presentation — overlap almost completely with the symptoms of stress, overwork, anaemia, and hormonal fluctuation. Fatigue, weight gain, hair loss, irregular periods, feeling cold, low mood — every one of these is common in working Indian women in their 20s and 30s for reasons entirely unrelated to thyroid function. Distinguishing thyroid-related symptoms from background-level life stress requires either a complete thyroid panel or a doctor who thinks to order one.
The standard TSH test — which is the first and often only thyroid test ordered in most Indian clinics — can return within the quoted normal range even when a woman has Hashimoto’s thyroiditis and significant antibody activity against her own thyroid. The TSH reference range of 0.4 to 4.0 mIU/L is debated among endocrinologists, with many preferring to investigate symptoms in women whose TSH is above 2.5. A TSH of 3.8 — technically within range — can coexist with significant autoimmune thyroid damage that would be revealed by antibody testing.
And thyroid testing is not part of routine preventive health checks for most Indian women. It is ordered in response to symptoms, which means it is often ordered after symptoms have been present for months or years — and only when a doctor thinks of it or a patient requests it.
The Thyroid — What It Does and Why Everything Suffers When It Fails
The thyroid is a small, butterfly-shaped gland sitting at the front of the neck. It produces two hormones — thyroxine (T4) and triiodothyronine (T3) — that function as the metabolic regulators for virtually every process in the body. Heart rate, body temperature, digestion speed, hair growth cycle, skin cell turnover, cognitive processing speed, menstrual cycle regulation, fertility, mood — all of these are directly influenced by circulating thyroid hormone levels.
When thyroid hormone production is insufficient — hypothyroidism — everything slows down simultaneously. This is why hypothyroidism produces such a wide range of seemingly unrelated symptoms. It is not a single organ failing. It is the regulator of all organs underperforming, and the effect is felt everywhere at once.
When thyroid hormone production is excessive — hyperthyroidism — everything accelerates. The heart beats faster. The metabolism speeds up. The nervous system becomes hyperactive.
Both conditions are fully treatable. Both are frequently missed. And in Indian women specifically, both are missed far more often than they should be given how common they are.
Hypothyroidism — The Condition Sunita Had and What It Actually Feels Like
Hypothyroidism — and specifically Hashimoto’s thyroiditis, its most common autoimmune cause — is the thyroid condition most likely to affect Indian women. Hashimoto’s develops when the immune system mistakenly targets the thyroid gland, gradually damaging its ability to produce hormone. The process is slow, which is why symptoms accumulate gradually rather than arriving suddenly.
The weight gain that nothing fixes
Sunita’s nine kilograms over eighteen months while actively trying to eat less is one of the most characteristic presentations of hypothyroidism. A slowed metabolism burns fewer calories at rest — meaning the same food intake that maintained your weight previously now produces a surplus. Additionally, hypothyroidism causes fluid retention in body tissues, which contributes to the weight increase independently of fat accumulation.
The most important thing to understand about this weight gain is that it does not respond to conventional dietary restriction in the way that normal weight gain does. Sunita was eating less and gaining weight. This is not a willpower failure. It is a metabolic consequence of insufficient thyroid hormone — and it does not fully resolve until the hormone deficiency is corrected.
The fatigue that sleep does not touch
Every cell in the body requires thyroid hormone to produce energy efficiently. Without adequate T3 and T4, mitochondrial function is impaired and cellular energy production is reduced throughout the body. The result is a fatigue that is fundamentally different from being tired after a long day — it is present regardless of how much sleep you get, does not improve with rest, and does not respond to caffeine or willpower.
Sunita’s two-alarm system was her accommodation to this symptom. She had decided she was simply not a morning person and adapted around it. In reality she had been running on insufficient cellular energy for two years.
Feeling cold when nobody else is
Thyroid hormone regulation of body temperature means that hypothyroid women frequently feel cold in situations where others are comfortable. Sunita’s winter sweater in a heated office is a textbook presentation. Cold hands and feet even in summer, needing extra blankets while others sleep with one sheet, feeling chilled after a shower — these are characteristic and often dismissed as individual variation rather than recognised as symptoms.
Hair loss across the whole scalp
The hair loss of hypothyroidism is diffuse — it comes from everywhere across the scalp simultaneously rather than from a specific area — and it affects the hair growth cycle rather than causing immediate hair fall from the root. Hair grows more slowly, the growth phase shortens, and more hairs enter the resting phase and fall out. Sunita spent ₹4,500 on a dermatologist who missed it entirely. The distinctive additional sign — thinning of the outer third of the eyebrows — is specifically associated with thyroid disease and is something to look at in the mirror.
Constipation that dietary changes do not resolve
The digestive system slows when thyroid function is impaired. Persistent constipation that does not respond to increased fibre, water intake, or dietary changes is a consistent hypothyroid symptom. Some women also experience persistent bloating and slow gastric emptying that makes them feel uncomfortably full for hours after eating normal-sized meals.
Depression and brain fog diagnosed as depression
Thyroid hormone influences neurotransmitter activity and brain chemistry. The cognitive and emotional symptoms of hypothyroidism — persistent low mood, slowed thinking, difficulty concentrating, forgetfulness, a mental fogginess that was not previously present — closely mimic the presentation of clinical depression. Many women with undiagnosed hypothyroidism are prescribed antidepressants that provide minimal relief because the underlying metabolic cause is not being addressed. If you have been treated for depression that has not responded adequately to antidepressants, asking for a complete thyroid panel is entirely reasonable.
Irregular periods and unexplained fertility problems
Thyroid hormone interacts directly with reproductive hormones. Hypothyroidism can cause periods to become heavier, arrive more frequently, or become irregular. In some cases it suppresses menstruation altogether. And undiagnosed hypothyroidism is among the more common and more overlooked causes of unexplained infertility and recurrent early miscarriage in India. If you are navigating fertility investigations, a complete thyroid panel including antibody testing is an essential part of that workup.
Hyperthyroidism — When the Thyroid Overproduces
Hyperthyroidism, most commonly caused by Graves’ disease — another autoimmune condition — produces the opposite pattern of symptoms. Everything accelerates.
Unexplained weight loss despite eating normally or more than usual is often the first thing noticed. Rapid or irregular heartbeat — palpitations, a fluttering or pounding sensation, sometimes visible as the heart beating visibly in the chest — is common. Heat intolerance and excessive sweating without obvious cause, hand tremors, anxiety and irritability that feel neurological rather than situational, difficulty sleeping, frequent loose stools.
Graves’ disease specifically may cause exophthalmos — a protrusion or prominence of the eyes that is visually distinctive and has specific implications for treatment choice.
Hyperthyroidism can progress to a thyroid storm — a sudden, severe escalation of symptoms including extremely rapid heartbeat, very high fever, and altered consciousness — which is a medical emergency. Anyone with symptoms of hyperthyroidism should see a doctor promptly rather than monitoring at home.
The Tests — What to Ask For and What They Mean
If you recognise yourself in the hypothyroid symptoms particularly — or if you are a woman over 30 with a family history of thyroid disease, PCOS, or any other autoimmune condition — these are the tests worth requesting:
TSH (Thyroid Stimulating Hormone) — The standard first test and the right place to start. A high TSH indicates the pituitary gland is working hard to stimulate an underperforming thyroid — consistent with hypothyroidism. A low TSH suggests hyperthyroidism. The quoted normal range is 0.4 to 4.0 mIU/L, but discuss with an endocrinologist if you have symptoms and your TSH is above 2.5.
Free T3 and Free T4 — Measure the actual active thyroid hormones circulating in your blood. Some women have a technically normal TSH but low free hormone levels — a pattern that would be missed by TSH testing alone. These are important to test when symptoms are present and TSH is borderline.
Anti-TPO and Anti-TG antibodies — These tests confirm the presence of autoimmune thyroid disease. Significantly elevated antibodies indicate Hashimoto’s or Graves’ disease even when TSH and hormone levels are still within normal range — because autoimmune damage to the gland may be occurring before TSH rises sufficiently to be flagged. Sunita’s TSH of 8.4 combined with strongly positive Anti-TPO antibodies confirmed Hashimoto’s unambiguously.
Thyroid ultrasound — Not a blood test but an imaging study that evaluates the physical structure of the gland. Identifies nodules, enlargement, inflammation patterns, and other structural changes. Often ordered alongside or after blood tests when a diagnosis is being confirmed.
A full thyroid panel — TSH, Free T3, Free T4, and antibodies — costs approximately ₹800 to ₹1,500 at major pathology labs including Dr Lal PathLabs, Metropolis, and SRL. No doctor’s referral is required at most labs. You can walk in and request it yourself, as Sunita ultimately did.
Treatment — What Managing Thyroid Disease Actually Looks Like
Hypothyroidism is treated with levothyroxine — a synthetic version of the T4 hormone the thyroid is not producing adequately. It is taken as a single small tablet every morning on an empty stomach, at least 30 to 45 minutes before food or other medication. The dose is adjusted based on follow-up TSH testing — typically every 6 to 8 weeks initially until the dose is stable, then every 6 to 12 months.
Levothyroxine is inexpensive — a month’s supply costs under ₹100 at most pharmacies in India. It is safe for long-term use including throughout pregnancy — in fact, adequate thyroid hormone is particularly important during pregnancy for foetal brain development, making thyroid testing and management critical for pregnant women.
Sunita’s experience — TSH falling from 8.4 to 2.1, four kilograms lost without dietary change, energy restored, temperature regulation normalised — is what adequate treatment typically looks like within three to six months.
Hyperthyroidism management depends on severity and cause and should always be guided by an endocrinologist — options include antithyroid medications, radioactive iodine therapy, or surgical removal of part or all of the thyroid gland.
A Final Word
Sunita told me recently that she had shared the information about thyroid testing with her mother after her own diagnosis. Her mother — 58, in Jaipur — got tested. Her TSH was 6.2. She is now on levothyroxine.
Two women in one family. Years of symptoms in both. One lunch conversation that led to both of them being treated.
If you have been feeling the kind of tired that sleep does not fix, gaining weight despite eating carefully, losing hair without explanation, feeling cold when others are not, or cycling through diagnoses that have not fully explained how you feel — please ask your doctor for a complete thyroid panel. Ask specifically for TSH, Free T3, Free T4, and Anti-TPO antibodies.
If your doctor tells you everything is normal based on TSH alone and you still feel the symptoms described here — ask for the full panel. Or walk into a pathology lab and order it yourself.
You are allowed to advocate for your own health. Sunita did. Her mother did. It changed both their lives.
Medical Disclaimer: This article is for educational and informational purposes only. It does not constitute medical advice, diagnosis, or treatment. The personal experiences described are real but individual symptoms and health circumstances vary significantly. Always consult a qualified endocrinologist or physician for any thyroid-related concerns.
Alen is a Delhi-based writer covering personal finance, health, and career topics for Indian audiences. He has been writing about practical financial and lifestyle topics since 2020 and believes that clear, honest information should be accessible to every Indian regardless of background