Thyroid Disorders in Lebanon: Hypothyroidism, Hashimoto's & Nodules

Thyroid disease is common in Lebanon, particularly autoimmune hypothyroidism (Hashimoto's). Many people are over-tested and over-treated — knowing what a normal panel looks like helps avoid both extremes.

The right tests to start

• TSH — the single best screening test.
• Free T4 — added if TSH is abnormal or symptoms are strong.
• Anti-TPO antibodies — to confirm autoimmune cause.
• Thyroid ultrasound — only for a palpable lump, abnormal blood tests, or pre-pregnancy planning in known patients.

When TSH is high (hypothyroidism)

Levothyroxine is the standard treatment, taken on an empty stomach 30–60 minutes before food, away from coffee and calcium/iron supplements. Re-check TSH 6 weeks after any dose change.

When TSH is low (hyperthyroidism)

Graves' disease, toxic nodule, or thyroiditis are the main causes. Treatment options include anti-thyroid drugs (methimazole), radioactive iodine, or surgery — the choice depends on age, plans for pregnancy, eye involvement, and nodule size.

Thyroid nodules

Most are benign. Ultrasound classifies them (TI-RADS); fine-needle aspiration is reserved for higher-risk patterns or nodules >1 cm with suspicious features. Don't accept a "watch and wait" with no follow-up plan — re-image at the interval the endocrinologist sets.

Pregnancy

Untreated maternal hypothyroidism affects fetal brain development. Target TSH in pregnancy is trimester-specific (typically <2.5 mIU/L in the first trimester). Levothyroxine dose usually rises 25–50% during pregnancy — confirm dose at positive pregnancy test.