Woman's years of cold hands, brittle nails ended after Hashimoto's diagnosis; experts urge simple blood test

A Bristol civil servant who endured lifelong cold hands, brittle nails and growing fatigue was diagnosed with Hashimoto’s disease after a routine blood test prompted by a sudden five-month absence of her period.

Emily Measures, 31 at the time of diagnosis, said she had long assumed her symptoms were down to weather or low iron levels until she developed extreme tiredness and "brain fog" and her menstrual cycle stopped. A blood test arranged by her general practitioner identified the autoimmune thyroid disorder that causes hypothyroidism, and a letter informed her she would need lifelong medication.

Hashimoto’s disease occurs when the immune system attacks the thyroid gland, reducing its ability to produce hormones that regulate metabolism. Common signs include fatigue, weight gain, dry skin, hair loss, muscle weakness and feeling cold; less common symptoms can include brittle nails, constipation, a slow heartbeat, hoarse voice and inappropriate breast milk production.

"The standard treatment is a daily tablet of thyroxine — also known as T4 — taken in the morning on an empty stomach," said Professor Ashley Grossman, a consultant endocrinologist. He added that a small percentage of patients may not feel fully better on T4 alone and that studies have suggested that the other thyroid hormone, T3, can help some people, though access and prescribing practices vary.

Experts say the disorder is common and often underdiagnosed because symptoms are non-specific and develop gradually. Estimates cited by clinicians and charities in recent studies suggest hypothyroidism affects around two in 100 adults in the UK and that disorders of the thyroid gland may be present in at least one in 20 patients nationally. Research published in 2019 estimated that as much as 4.7% of people in Europe could have undiagnosed hypothyroidism, and the American Thyroid Association has said up to 60% of people with thyroid conditions may be undiagnosed.

"Once you or your doctor consider hypothyroidism, then a simple blood test to measure thyroid-stimulating hormone (TSH) is enough to make the diagnosis in most cases," said Dr. Simon Pearce, professor of endocrinology at Newcastle University. He cautioned that symptoms such as tiredness, constipation or aching are often attributed to busy lives, parenting or poor sleep, which can delay testing and diagnosis.

The exact cause of Hashimoto’s is unknown, though it often runs in families and may be triggered by environmental factors such as infection, medications or hormonal changes. Left untreated, hypothyroidism can increase the risk of cardiovascular problems and elevate cholesterol.

Clinicians emphasise the importance of diagnosing and treating thyroid dysfunction for women who are trying to conceive or who are pregnant. Research has linked thyroid antibodies, such as those present in Hashimoto’s disease, with higher miscarriage risk. A study from the University of Birmingham cited by specialists found that the presence of thyroid antibodies can substantially increase miscarriage risk. Thyroid dysfunction can also affect ovulation and sex hormones, making conception more difficult, and elevated TSH in early pregnancy has been associated with worse outcomes.

Measures said treatment improved her symptoms: her nails strengthened, hair loss stopped and her sensitivity to cold eased. She became pregnant less than two years after starting medication and has since had a child. She said her dosage has required adjustment since childbirth, reflecting clinicians’ advice that thyroid hormone requirements can change with life events.

Clinicians and patient groups advise people, particularly women with persistent fatigue, cold intolerance, brittle nails, hair changes or menstrual irregularities, to discuss a TSH blood test with their GP. Early detection allows for straightforward hormone replacement and monitoring to restore normal metabolism and reduce risks associated with untreated hypothyroidism.