Thyroid problems in Malaysia: overactive and underactive thyroid, goitre and the thyroid blood test

Thyroid problems in Malaysia

Thyroid disorders are the second most common hormone (endocrine) disorder in Malaysia after diabetes. In a nationwide study of more than 2,200 adults, reported when Malaysia launched its first clinical practice guidelines on thyroid disorders in 2020:

• about 3.4% had an overactive thyroid and 2.1% an underactive one, including mild (subclinical) cases
• 9.3% had a goitre (an enlarged thyroid) and 3.6% had nodules (lumps)
• most of those with an abnormal thyroid had never been diagnosed

Thyroid problems are much more common in women, and often start between the ages of 20 and 40, or after pregnancy.

Overactive thyroid (hyperthyroidism)

Symptoms:

• weight loss despite a good appetite
• fast or irregular heartbeat (palpitations)
• shaky hands, sweating and feeling hot
• anxiety, irritability and poor sleep
• loose stools, lighter or fewer periods
• a swelling in the neck (goitre)
• gritty, red or bulging eyes, or double vision (thyroid eye disease)

Causes: about 4 in 5 cases are due to Graves’ disease, an autoimmune condition. Others are caused by overactive thyroid nodules, or by inflammation of the thyroid (thyroiditis), which is often temporary, including after pregnancy.

Treatment:

• Beta-blockers to ease palpitations and shaking while other treatment takes effect.
• Anti-thyroid tablets (carbimazole, methimazole or, in early pregnancy, propylthiouracil), usually for 12 to 18 months.
• Radioactive iodine, a drink or capsule that shrinks the thyroid. It isn’t used in pregnancy or breastfeeding, and can worsen thyroid eye disease.
• Surgery to remove the thyroid, for example for a large goitre.

Smoking makes thyroid eye disease worse, so it is especially important to stop.

Underactive thyroid (hypothyroidism)

Symptoms come on slowly and are easy to blame on stress or age:

• tiredness and sluggishness
• feeling cold
• weight gain, usually modest
• constipation
• dry skin and hair, hair thinning
• low mood, poor memory
• heavier or irregular periods, and difficulty getting pregnant

Causes: most often the autoimmune condition Hashimoto’s thyroiditis. Others include previous thyroid surgery or radioactive iodine, some medicines (such as lithium and amiodarone), and iodine deficiency.

Treatment is a daily levothyroxine tablet, which replaces the missing hormone:

• Take it at the same time each day, on an empty stomach, 30 to 60 minutes before breakfast.
• Keep it at least 4 hours apart from calcium, iron and antacids, which stop it being absorbed.
• Your TSH is rechecked 6 to 8 weeks after starting or changing the dose, then usually once a year once it is stable.

Subclinical hypothyroidism, a raised TSH with normal thyroid hormone, is common and often settles without treatment. Doctors usually repeat the test before deciding on treatment.

The thyroid blood test

You don’t need to fast. Stop biotin supplements, found in many hair and nail products, 2 days before the test, as biotin can give falsely abnormal results.

Ask for a thyroid test if you have symptoms above, a goitre, a family history of thyroid disease, other autoimmune conditions such as type 1 diabetes, irregular periods or difficulty conceiving, or are planning a pregnancy with a past thyroid problem. See also our guide to blood test results.

Goitre, thyroid lumps and iodine

A goitre is an enlarged thyroid, seen as a swelling at the front of the neck. A nodule is a lump within the thyroid.

• Thyroid nodules are very common: about half of people have one by age 60, and more than 9 in 10 are harmless. They are checked with an ultrasound, and if needed a fine-needle biopsy.
• See a doctor promptly for a lump that is growing, or a lump with a hoarse voice, difficulty swallowing or breathing.
• Thyroid cancer is the 8th most common cancer in Malaysian women. Most are the papillary type, which, found early, has a 10-year survival of nearly 100%.

Iodine: the thyroid needs iodine to make its hormones. Iodine deficiency has long caused goitre in parts of Malaysia, especially interior Sabah and Sarawak. A national survey found nearly half of children aged 8 to 10 were iodine deficient, so since the end of 2020, table and fine salt sold in packs of up to 20 kg must be iodised. In Sarawak, goitre in children fell from 2.9% in 2008 to 0.1% in 2018 after salt iodisation. Use iodised salt at home, but don’t take extra iodine supplements unless advised, as too much can also upset the thyroid.

Thyroid problems and pregnancy

• Untreated thyroid problems raise the risk of miscarriage, pre-eclampsia and premature birth, and an underactive thyroid can affect the baby’s brain development.
• If you take levothyroxine, the dose usually needs to go up by 20 to 30% as soon as you are pregnant. Tell your doctor straight away and have your TSH checked, then about every 4 weeks in the first half of pregnancy.
• If you have an overactive thyroid, your doctor may switch your medicine before or early in pregnancy. Radioactive iodine must not be used.
• Newborn screening: babies born in Malaysia are tested for congenital hypothyroidism using blood from the umbilical cord, so that it can be treated before it affects development.

See our pregnancy week-by-week guide.

Thyroid and weight

An underactive thyroid usually adds only a few kilograms, much of it fluid, and this tends to come off with treatment. If you have gained a lot of weight, the thyroid is rarely the only cause. Thyroid hormone shouldn’t be used for weight loss: it can cause heart rhythm problems and bone loss, and the weight returns. See our BMI calculator and guide to weight-loss injections.

Where to get your thyroid checked

A GP can examine your neck, order a thyroid blood test, start treatment for an underactive thyroid and refer you to an endocrinologist or for an ultrasound if needed. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states.

Browse the clinic directory

Frequently asked questions