The tiroid (thyroid) is a small butterfly-shaped gland in the front of the neck that makes hormones controlling your heart rate, body temperature and energy. Thyroid problems are common and much more likely in women. An overactive thyroid (hyperthyroidism) speeds the body up, causing weight loss, a fast heartbeat, anxiety and feeling hot, while an underactive thyroid (hypothyroidism) slows it down, causing tiredness, weight gain, feeling cold and irregular periods. A swollen thyroid is called a goitre (tiroid bengkak). Both conditions are diagnosed with a simple blood test and are usually treatable; with the right treatment, most people live a normal life.
Tiroid itu apa? What the thyroid gland does
The thyroid (kelenjar tiroid) is a small, butterfly-shaped gland in your neck, just in front of the windpipe. It makes thyroid hormones that affect things such as your heart rate, body temperature and how your body uses energy.
Penyakit tiroid (thyroid disease) usually means one of these:
- the thyroid makes too much hormone: overactive thyroid, or hyperthyroidism (hipertiroid);
- the thyroid makes too little hormone: underactive thyroid, or hypothyroidism (hipotiroid);
- the thyroid becomes swollen (goitre) or develops lumps (nodules).
Hipertiroid vs hipotiroid: overactive or underactive?
According to the NHS, the two main thyroid conditions cause almost opposite symptoms:
| Overactive (hipertiroid) | Underactive (hipotiroid) | |
|---|---|---|
| Hormone level | Too much | Too little |
| Weight | Weight loss | Weight gain |
| Temperature | Sensitive to heat | Feeling cold more than usual |
| Heart | Fast or irregular heartbeat (palpitations) | Increased risk of heart problems if untreated |
| Mood and energy | Nervousness, anxiety, irritability, mood swings, poor sleep, tiredness and weakness | Extreme tiredness, low mood, difficulty concentrating |
| Other signs | Trembling or twitching, neck swelling (goitre), eye problems in Graves' disease | Constipation, dry skin, dry hair or hair loss, hoarse voice, irregular or heavy periods |
| Most common cause | Graves' disease (about 4 in 5 cases) | Hashimoto's disease (in the UK) |
| Main treatment | Antithyroid medicine, radioiodine or surgery | Daily levothyroxine tablets |
Underactive thyroid symptoms often develop slowly and can be mild, so they are easy to miss or blame on stress or ageing.
Simptom tiroid pada perempuan
Thyroid conditions are much more common in women. According to the NHS:
- an overactive thyroid is about 10 times more common in women than in men, and usually starts between 20 and 40;
- Hashimoto's disease, the main cause of an underactive thyroid in the UK, is most common in women and usually starts between 30 and 50.
Thyroid problems can show up in ways women may not link to the thyroid:
- Periods: an underactive thyroid can cause irregular or heavy periods; see our guides to period lambat and kurang darah (heavy periods can lead to anaemia).
- Hair: dry hair or hair loss can be a sign of an underactive thyroid; see our guide to rambut gugur.
- Sleep and mood: an overactive thyroid can cause anxiety and poor sleep (see our guide to susah tidur), while an underactive thyroid can cause low mood.
- Weight: unexplained weight gain or weight loss.
- Pregnancy: untreated thyroid disease can increase the risk of pre-eclampsia, premature birth or miscarriage, and the dose of thyroid medicine often needs to change in pregnancy.
- Menopause: tiredness, poor sleep, mood changes and feeling hot can overlap with menopause symptoms, so a blood test can help tell them apart.
Tiroid bengkak: goitre, lumps and thyroid cancer
A goitre is a lump or swelling at the front of the neck caused by a swollen thyroid. According to the NHS, it is usually painless, may look smooth or lumpy, and may be on just one side. It can also cause:
- a cough that does not go away;
- a hoarse voice or voice changes;
- a feeling that something is stuck in the throat;
- wheezing, or difficulty swallowing or breathing.
Most goitres are small, not serious and sometimes need no treatment, but they should be checked. Tests may include blood tests, an ultrasound scan and sometimes a small needle biopsy. Goitres caused by an overactive or underactive thyroid can usually be treated with medicine; large goitres that affect breathing or swallowing may need surgery.
Thyroid cancer is uncommon. See a doctor if you have a new lump in the front of the neck, or an existing lump that is getting bigger, a hoarse voice, sore throat or cough lasting more than 3 weeks, or pain or pressure in the front of the neck. These symptoms usually have other causes, but finding cancer early makes it easier to treat. A sore throat that comes with a cold is more likely to be an infection; see our guide to sakit tekak.
Punca tiroid: what causes thyroid problems?
Overactive thyroid causes, according to the NHS, include:
- Graves' disease, an autoimmune condition where the immune system makes the thyroid produce too much hormone (about 4 in 5 cases);
- lumps (nodules) on the thyroid that produce extra hormone;
- some medicines, such as amiodarone for heart rhythm problems.
Underactive thyroid causes include:
- Hashimoto's disease, where the immune system attacks the thyroid;
- other thyroid conditions such as thyroiditis (an inflamed thyroid);
- surgery or radiotherapy to the neck, or treatment for an overactive thyroid;
- not getting enough iodine in your diet;
- certain medicines.
Having family members with a thyroid condition also makes an underactive thyroid more likely.
Iodine in Malaysia. The thyroid needs iodine to make its hormones. In Sarawak, where iodine deficiency was a problem, mandatory iodised salt was introduced in 2008. Ten years later, goitre among schoolchildren had fallen from 2.9% to 0.1%. However, a 2018 survey found that most pregnant women in Sarawak still had inadequate iodine levels, so pregnant women should ask their doctor or clinic about their iodine intake.
Tests and treatment
Thyroid problems are diagnosed with a blood test that measures thyroid-stimulating hormone (TSH) and thyroxine (T4). Your doctor may also examine your neck and ask about your family history.
Overactive thyroid is usually treatable. The main treatments are:
- medicine that stops the thyroid making too much hormone;
- radioiodine treatment, a type of radiotherapy that reduces the thyroid's ability to make hormones;
- surgery to remove some or all of the thyroid.
Each has benefits and drawbacks, and you will usually see a hormone specialist (endocrinologist) to decide which is best.
Underactive thyroid is usually treated with daily levothyroxine tablets that replace the missing hormone. Most people need them for life. You will have regular blood tests to make sure the dose is right; the wrong dose can cause side effects such as feeling sick, diarrhoea, headaches or sleep problems.
Supplements. Thyroid disease needs medical treatment. Some supplements, such as ashwagandha, have been shown in some studies to affect thyroid hormone levels, so speak to your doctor or pharmacist first; see our guide to ashwagandha and medications. Check that any supplement is registered (see how to verify KKM registration).
Living with thyroid disease and when to get urgent help
Jangka hayat (outlook). Most thyroid conditions can be controlled. The NHS says people with an underactive thyroid on the right treatment should be able to live a normal life. Problems are more likely if thyroid disease is untreated or poorly controlled:
- an untreated underactive thyroid raises the risk of heart disease, heart failure and osteoporosis;
- an untreated overactive thyroid raises the risk of atrial fibrillation (an irregular heartbeat), osteoporosis, heart failure and eye problems.
Call 999 or go to the emergency department for:
- thyroid storm, a rare, life-threatening flare-up of an overactive thyroid, with a rapid heartbeat, high temperature, severe agitation or confusion, yellow skin or eyes, or loss of consciousness;
- a goitre that makes it hard to breathe or causes wheezing;
- signs of a very severe underactive thyroid (myxoedema coma), which is very rare and more common in older people.
See a doctor if you have symptoms of an overactive or underactive thyroid, a swelling or lump in your neck, or if you have a thyroid condition and are pregnant or planning a pregnancy.
Frequently asked questions (FAQ)
What is tiroid (tiroid itu apa)?
The tiroid (thyroid) is a small butterfly-shaped gland at the front of the neck, just in front of the windpipe. It makes hormones that affect things such as your heart rate, body temperature and energy levels. Penyakit tiroid usually means the gland makes too much hormone (overactive thyroid) or too little (underactive thyroid), or becomes swollen (goitre).
What are the symptoms of thyroid problems in women (simptom tiroid pada perempuan)?
An overactive thyroid can cause anxiety, irritability, poor sleep, feeling hot, a fast heartbeat, trembling and weight loss. An underactive thyroid can cause tiredness, feeling cold, weight gain, constipation, low mood, dry skin, hair loss and irregular or heavy periods. Thyroid problems are much more common in women than men.
What is the difference between hyperthyroidism and hypothyroidism?
Hyperthyroidism (hipertiroid) means the thyroid makes too much hormone, so the body speeds up, causing weight loss, a fast heartbeat and anxiety. Hypothyroidism means it makes too little, so the body slows down, causing tiredness, weight gain and feeling cold. Both are diagnosed with a blood test and are usually treatable.
What causes a swollen thyroid (tiroid bengkak or goitre)?
A goitre can be caused by an overactive or underactive thyroid, harmless lumps (nodules), hormone changes during puberty, pregnancy or menopause, an inflamed thyroid, Graves' disease, not getting enough iodine, and rarely thyroid cancer. Most goitres are not serious, but they should be checked by a doctor.
What is the life expectancy of someone with thyroid disease (jangka hayat pesakit tiroid)?
Most thyroid conditions are treatable. According to the NHS, people with an underactive thyroid who take the right dose of levothyroxine should be able to live a normal life. Problems such as heart disease and weak bones are more likely if thyroid disease is untreated or poorly controlled, so regular check-ups matter.
Can thyroid problems affect periods and pregnancy?
Yes. An underactive thyroid can cause irregular or heavy periods. If not treated, both overactive and underactive thyroid can increase the chance of pregnancy complications such as pre-eclampsia, premature birth or miscarriage. Tell your doctor if you have a thyroid condition and are pregnant or planning a pregnancy, as your medicine dose may need to change.
Can supplements help thyroid problems?
Thyroid conditions need medical treatment, not supplements. Some supplements, such as ashwagandha, may affect thyroid hormone levels, so talk to your doctor or pharmacist before taking any supplement if you have a thyroid condition or take thyroid medicine.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Overactive thyroid (hyperthyroidism) — NHS
- Overactive thyroid: complications — NHS
- Underactive thyroid (hypothyroidism) — NHS
- Goitre — NHS
- Symptoms of thyroid cancer — NHS
- Kuang Kuay L, et al. A 10-year impact evaluation of the universal salt iodization (USI) intervention in Sarawak, Malaysia, 2008-2018. Nutrients. 2022;14(8):1585.
- Kuay LK, et al. Pregnant women are iodine deficient while school-aged children demonstrate adequate iodine status in Sarawak, Malaysia. Food Nutr Bull. 2021;42(3):406-413.
