March 4, 2026
Symptoms and signs of hypothyroidism and hyperthyroidism
On this episode of Docs in a Pod, host Carmenn Miles sits down with Dr. Sundas Ahmed to break down the key symptoms and signs of hypothyroidism and hyperthyroidism—two common thyroid conditions that are often overlooked or mistaken for everyday fatigue, weight changes, or mood shifts.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-host Dr. Tamika Perry and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Tamika Perry.
CARMENN MILES
Hello, everyone, and thank you so much for joining us today on the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles and I'm excited to jump into another great conversation centered around health and wellness topics that really matter, especially for our senior listeners. On this podcast, we share practical health information that helps all of us live healthier, happier lives. So, we're thrilled that you are tuning in with us today. With that said, our special guest today is Dr. Sundas Ahmed. A little bit about Dr. Ahmed. She's an internal medicine specialist at WellMed at Great Northwest in San Antonio, my hometown, where she provides comprehensive, patient centered care with the focus on long term wellness and chronic disease management. Dr. Ahmed earned her medical degree from Shifa College of Medicine in Pakistan, where she developed a strong foundation in clinical excellence. Dr. Ahmed completed her residency in internal medicine at Nassau University Medical Center in East Meadow, New York, gaining extensive experience in acute care, complex case management and multi-disciplinary collaboration. She's known for her attentive approach and commitment to patient education. Dr. Ahmed strives to empower her patients to take an active role in their health. We are absolutely thrilled to have her with us today. Dr. Ahmed, welcome to the show.
DR. SUNDAS AHMED
Thank you, Carmenn. Thank you for having me. I'm really excited to be here.
CARMENN MILES
Yes, I'm excited about our conversation as well. With all of these accolades and accomplishments that I just listed out, I'm curious to know, since it is your first time with us, what do you do outside of medicine? Or maybe there's a little known fact or surprising fact that you can share with us today so that the listeners and I can get to know you a little better.
DR. SUNDAS AHMED
Outside of medicine, I like to enjoy time with my family. I have two sons. One is 22 months old, so he keeps me really busy with him. Other than that, I love to decorate my house. Every few months, I will change everything. I would get new stuff and replace it with new things. So, that's one of the things I really enjoy doing other than work.
CARMENN MILES
Making a house a home. I love it. I cannot imagine how busy you are between work and home and a 22 month old. Thank you for sharing that. I won't delay any further today. We are exploring a very important topic and that is hypo and hyperthyroidism. Hypo and hypothyroidism. The symptoms, the signs and the differences between the two. Dr. Ahmed, before we jump right into this important subject matter, I think it's important to first start with a thyroid. A lot of people don't know the function of the thyroid. I've heard doctors refer to it as the body's thermostat, and I have family members who have thyroid issues, and most complain about either being extremely hot or extremely cold. There's more to it than just body temperature, I'm sure. So, help us out. What is the thyroid and what is its function?
DR. SUNDAS AHMED
Thyroid is a small butterfly shaped gland that is present in front of our neck. It plays a huge role in metabolism. It controls your body's metabolism, meaning how fast or slow your body functions is controlled by the thyroid gland. It affects your energy level, your heart rate, weight, digestion and even your menstrual cycles. So, if your thyroid gland isn't working properly, every part of your body can feel it.
CARMENN MILES
Absolutely. And it can go either direct either way, hyper or hypo. We're going to get into that in just a second. But I love that you said that it affects your metabolism. I think you said heart rate, body temperature, your mood and digestion. I hear skin and hair and maybe even nails as well.
DR. SUNDAS AHMED
That's correct. Yes. If your thyroid isn't functioning properly, we can go over in detail as well later, but you can have hair loss, people can develop constipation or diarrhea depending on whether it's hypo or hypo active. It definitely effects your mood as well. So, if it's hypo, like it's not functioning properly, you can have mood changes, you can be depressed, you can feel low. It definitely affects your mood as well, like you said.
CARMENN MILES
Very good. Let's just take a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. I'm your host, Carmenn Miles, and this podcast is available wherever you listen to your podcast. We're also available on the radio on several Texas and Florida markets. We're talking with our special guest today, Dr. Sundas Ahmed, about hypo and hypothyroidism. The symptoms, the signs and the differences between the two. We spoke a little bit about the thyroid and its function and how it influences the body. It influences your metabolism, heart rate, your body temperature, your mood, your digestion, skin, hair and so many other things. Let's start, doctor, if you will, with hypothyroidism, because they're very different. Hypothyroidism and hypothyroidism. Let's start with hypothyroidism. What exactly does that mean to the listener?
DR. SUNDAS AHMED
The easiest way to think about it is slow versus fast. So, when we say hypo meaning slow, hyper means fast. So, hypothyroidism means that your thyroid is underactive. It's not performing how it should be. It's underactive. Hypothyroid means that it's overactive. So, itÕs as if you are anxious. You are panicky when it's overactive. First I'm going to go over the symptoms of hypothyroidism, like when you have hypothyroidism how you feel. So, you would feel fatigued and tired. You will have difficulty losing weight. You'll weight gain. You will feel more cold as compared to the normal people. Everybody would be feeling cold, but you will be feeling it more than them. You will be constipated. You will have dry skin. You can start having hair loss. You could have a low mood. You will feel depressed. You can have poor concentration. The ladies could have heavy or irregular menstrual period. You can have brain fog. All these symptoms, you can see with hypothyroidism. If somebody has hypothyroidism, it doesn't mean that they're going to show all of these symptoms. You could have either of them or one or the other, but mostly these are the symptoms that the patients present with when they have hypothyroid.
CARMENN MILES
I love the way that you explained it. Hypo means it's slowing. Things are slowing down. Hyper means things are accelerating. Based on what you've said, hypothyroidism when I think about it, means basically metabolism brakes. Like the brakes on a car. It can make you slow down.
DR. SUNDAS AHMED
Right.
CARMENN MILES
I'm curious to take a step back because obviously this all comes from the thyroid. Less hormones are generated which means your thyroid slows down or more hormones are generated that makes your thyroid the process or the function of your thyroid speed up. Is that accurate?
DR. SUNDAS AHMED
It's less thyroid hormones that are generated that's causing you hypothyroid symptoms. There can be multiple causes of getting hypothyroidism. So, if somebody had thyroid cancer and they have their thyroid removed, they would have deficiency of the thyroid hormone, and they would present with symptoms of hypothyroidism. Iodine is a very important component in the formation of the thyroid hormones. If somebody has iodine deficiency, they're going to start having symptoms of hypothyroidism because they won't be producing much thyroid hormone. Similarly, autoimmune disorders. There are many autoimmune disorders. One of them is where your own antibodies start fighting against or attacking your thyroid gland and destroys it. Obviously, if the thyroid gland is destroyed, you cannot produce enough thyroid hormone. That's also when you will develop hypothyroidism, and you can start showing all of these symptoms and signs.
CARMENN MILES
You had a long laundry list of symptoms. Let me see if I can recount some of them. Fatigue, uncontrollable weight gain, cold intolerance on hypothyroidism. Is that accurate?
DR. SUNDAS AHMED
Yes, thatÕs correct.
CARMENN MILES
Constipation, brain fog, low mood, low energy, almost like depression or anemia. Just running on a low battery. Muscle aches, and you also mentioned dry skin and changes with your hair, your skin, your nails, and also changes within your menstrual system. As I'm thinking about all of those symptoms, it seems like those are symptoms that overlap with other conditions.
DR. SUNDAS AHMED
ThatÕs correct.
CARMENN MILES
How does a medical professional like yourself decipher? I come in and say, Dr. Ahmed, I'm just I'm really tired. I feel like the brakes are constantly on. I can't accomplish what I used to accomplish. I've got a lot of brain fog going on. How do you decipher whether that is hypothyroidism or any other condition?
DR. SUNDAS AHMED
We diagnose title disorders by checking the TSH level. This is a test that we routinely order. At least in my clinic, I order it routinely on anybody who comes in for an annual physical. When there is a patient that comes in and they're complaining of things that make us think that it's thyroid, and if we haven't ordered it, I order a TSH test. So, I would go into further detail how, based on the search results, we determine whether a patient has hypo or hypo. The TSH is basically it secretes from our brain, and it acts on our thyroid gland and tells it to start producing thyroid hormone. When our thyroid hormone is produced from the thyroid gland it goes back up to the brain and tells the pituitary gland in the brain to stop producing the TSH as feedback. So, when the TSH level is high, this means that there is not enough thyroid hormone to go back up and stop the secretion of TSH. That's why it's high. That's how we determine that this patient is going towards hypothyroidism. If TSH levels come back normal, this means that patient does not have any thyroid disorder. First of all, I want everybody to understand this. If the TSH is high, this means that they have hypothyroidism. The other tests that we do, if the DSH comes back high, we check their T4, which is the thyroid hormone itself. So, we check that to determine the degree of hypothyroidism that the patient has.
CARMENN MILES
This is all great information, and I want to talk a little bit more about that before we transition from hypothyroidism to hyperthyroidism. We need to take just a quick break, but please stay with us as we continue this great discussion on hypo versus hypothyroidism. The symptoms and the signs on this podcast, Docs in a Pod presented by WellMed.
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CARMENN MILES
We're back with our guest today, Dr. Sundas Ahmed. I'm your host, Carmenn Miles, and we're discussing the thyroid and what symptoms and signs indicate that there may be issues with what many refer to as the body's thermostat. I'm curious to know Dr. Ahmed, and I'm sure this is just a quick answer, but I need to know. I'm learning along with our listeners. Are thyroid issues hereditary?
DR. SUNDAS AHMED
As I mentioned earlier, there are different causes of getting hypothyroidism. One could be iodine deficiency. If you are having hypothyroidism because of an iodine deficiency, then it's not heritage because it depends on what you are consuming. But there's another kind of hypothyroidism that happens because your own antibodies are fighting against your thyroid gland and destroying it. This is a condition that is hereditary. So, if somebody has it in the family, there are chances of the other family members to have this as well. So, it depends on what kind of hypothyroidism the patient has. But it can be hereditary as well.
CARMENN MILES
Very good. We talked about that long list of symptoms that could indicate that hypothyroidism is in play. There's a difference between symptoms and signs. I know that we talked a little bit about tests, and I know you want to talk about that a little bit later as well, but are there common signs when you're looking at a patient? Or maybe their heart rate when you're measuring their heart rate? I also heard a family member say something about having a puffy face. Are there different signs versus symptoms? Two different things. What are there some common signs that you look for as a medical professional?
DR. SUNDAS AHMED
For hypo, you would see their heart rate being slower as hypo is where everything kind of slows down. So, their heart rate could be on the lower side. For hyper, you would see them tachycardic. Their heart rate would be racing. As a complication of hyperthyroidism, the heart beats so fast that sometimes patients develop atrial fibrillation where the heart starts beating irregularly. So, those are the things that we can look for. If you look at a patient who's thin, you could think of hyperthyroidism because they are losing weight. We're going to go over the symptoms of hyperthyroidism as well. For hypothyroidism, they might have a puffy face like you mentioned, their skin could be dry, they would have hair loss. They may be having a low mood. You would see they're not very active. One of the symptoms is also that they are sleeping a lot. So, you would see that they're tired, fatigued and they're not very active. So, you can tell by looking sometimes, but mostly we go by the symptoms that the patient is telling us.
CARMENN MILES
Great. We've covered hypothyroidism. I want to flip the switch so we have enough time to talk about hyperthyroidism. I'm guessing by just what you've told me today that they're quite the opposite. Hypothyroidism is the slowing down of the thyroid or the hormone production and hyperthyroidism is this speeding up that production.
DR. SUNDAS AHMED
That's correct.
CARMENN MILES
Tell us about it.
DR. SUNDAS AHMED
Almost everything that we said, if you do the opposite of it, that's hyper. So, if somebody has hyperthyroidism, they're going to be anxious. They're going to be telling you that they're they feel like their heart is racing, which is called palpitations. You can see tremors and their hands shaking. They will have heat intolerance. They cannot tolerate heat or sweating more than other people. They'll be having unintentional weight loss. They're not trying to lose weight, but their weight keeps going down. They can have diarrhea. They'll have trouble sleeping. So basically, you can consider hypothyroidism as if you are in a panic situation. Your heart is racing, you are having tremors, you are sweating. These are all the symptoms of hypothyroidism.
CARMENN MILES
Yeah. Like mimicking a panic attack or maybe caffeine. Maybe how you feel when you're overloaded on caffeine or just constantly wired without the ability to kind of turn that off. That's a great way of explaining that. From a doctor's perspective, we talked about some of the symptoms. What are some of the signs or key indicators from a doctor's perspective that indicate that a patient may be dealing with hypothyroidism?
DR. SUNDAS AHMED
If I see somebody who has tremors in their hand, they're young, and I don't expect them to have some other neurological condition, and they're just having tremors, I would want to check their thyroid to see if they have hyperthyroidism. If each time I do their pulse and they're like over 100, they have atrial fibrillation that just started, a new onset or I feel like their heart rate is irregular, that's one of the indications you would like to check their thyroid to see what may have caused it in them. Similarly, if they keep losing weight and each time they come in you are noticing they've lost so much weight, they are sweating a lot, they seem like they're always in a state of panic, anxious, nervous all the time even though there is no apparent issue going on, you should look for hyperthyroidism in those patients.
CARMENN MILES
You mentioned the TSH agent and how it communicates to the brain when you're when they're suffering from hypothyroidism. Is it the exact opposite effect with hyperthyroidism? The TSH is not communing with the brain as much as often as it should. Is that correct?
DR. SUNDAS AHMED
For the lab, when you want to diagnose hyperthyroidism, you check the first test that we do is always going to be TSH. If somebody has hyperthyroidism they TSH would be low. It's going to be low because you're producing too much thyroid hormone that it's going back up in the brain and telling the pituitary gland, which is in the brain, to produce less TSH.
CARMENN MILES
Got it.
DR. SUNDAS AHMED
You see how we said in hypothyroidism we had it high because there was less thyroid hormone to go back up and telling the brain to not produce TSH. This time there is a lot of thyroid hormone in the blood that it's going back to the brain and telling it to lower the TSH. When you will do bloodwork in a hypothyroid patient, you will have low TSH in them.
CARMENN MILES
You make it so simple and so plain. That's fantastic. I'm wondering if there are common thyroid symptoms that sometimes get overlooked or dismissed.
DR. SUNDAS AHMED
I would say if each time when we have patients come in and they are saying they're anxious, they are nervous, they are having diarrhea, we usually start thinking about them having an anxiety disorder or put them on psych meds or send them to a psychiatrist for evaluation because of the anxiety symptoms that they're describing. I would suggest we should always keep thyroid in our mind as well, and we should make sure that we have ruled out all the medical causes behind their psych symptoms before we label them with having anxiety or depression as well.
CARMENN MILES
Fantastic. What is the fix? When you when you do determine that a patient has hypothyroidism or hypothyroidism, what are the next steps?
DR. SUNDAS AHMED
For hypo it's very easy because we don't have enough thyroid hormone. That's what's going on with hypothyroidism. So, we replace it with a synthetic hormone which is called levothyroxine. So, you have to take that pill usually is once a day. Basically, you are giving yourself that a synthetic thyroid hormone to perform the functions of the thyroid hormone that you are missing or you have less in your body. As far as hyperthyroidism, because you have too much thyroid in your blood, which is making you have all these kinds of symptoms there are different treatments and different options that you can do. Let me let me just give you a little bit about hyperthyroidism. Sometimes, how hyperthyroidism was that our own antibodies were fighting against the thyroid gland and destroying it. Similar conditions can also happen in hypothyroidism, in which the antibodies, instead of destroying it, they are stimulating it more to produce more and more thyroid hormone. So, that's what causes hyperthyroidism. So, if somebody has that condition, the thyroid gland can become enlarged. You might have seen people with a big mass in their neck. There are multiple options. You can just remove the thyroid gland to get rid of all the thyroid hormone that was in excess. There can be radioactive iodine that can be used to destroy the thyroid gland, so it stops producing enough thyroid hormone in case of hypothyroidism. There are also medications that can prevent the thyroid hormone to be formed. That thyroid hormone is being formed in your thyroid gland. So, if you take those medications then inhibit the formation of the gland that would target and they would prevent the thyroid hormone to be formed, those medications can also be used for hypothyroidism.
CARMENN MILES
Dr. Ahmed, you're a wealth of information, and I love just how you make it so simple and so plain and break it down to us and to the audience. I've learned so much, and believe it or not, we're out of time. So, you have got to come back and chat with us again soon. Thank you to our audience for joining us for this episode of Docs in a Pod presented by WellMed. Don't be a stranger. Subscribe to this podcast so you never miss an episode. If today's show helped you, sharing is caring. Tell your friends and your family where to find us, which is on any podcast platform, and you can also catch us on the radio and several Texas and Florida markets. Until next time, stay well!
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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