How the thyroid gland is working is assessed with blood tests and examination together. Swelling in the neck, hoarseness and difficulty swallowing may relate to the size of the gland, while fatigue, feeling cold, palpitations and weight change may relate to hormone levels. These symptoms do not establish a diagnosis on their own.
The thyroid is a gland in the lower front of the neck that affects many of the body’s functions through the hormones it secretes. The General Directorate of Public Health (opens in a new tab) of the Ministry of Health of the Republic of Türkiye states that iodine is required in the thyroid gland for the production of thyroid hormones, and describes goitre as the best-known consequence of iodine deficiency.
Because some thyroid complaints progress slowly, they may be noticed late. Fatigue is often put down to “working hard” and weight change to “age”. For this reason the symptoms are assessed together rather than one by one.
What is asked about at the examination?
Symptoms relating to the neck. Swelling or a feeling of fullness in the neck, a sensation of catching when swallowing, hoarseness, a shirt collar starting to feel tight.
Symptoms that may be related to hormone levels. Fatigue, feeling cold or excessive sweating, palpitations, trembling of the hands, dry skin, hair loss, constipation or diarrhoea, a change in sleep routine, a change in the menstrual cycle.
Changes in weight. Weight gain or loss despite no change in eating habits is asked about separately.
Family history. Whether there is thyroid disease in the family is asked about.
Previous investigations and treatments. Whether a thyroid test has been done before, whether there is an ultrasound result, and any history of radiotherapy to the neck area.
Current medication and supplements. Some medicines and products containing iodine may affect thyroid tests. For this reason you need to report every product you take.
How does the assessment proceed?
- Medical history. When the symptoms began, how they have developed and whether they occur together are recorded.
- Examination of the neck. The physician examines the thyroid gland by hand, assessing its size and consistency and whether any formation can be felt within it.
- Blood tests. Thyroid function tests are requested. Where necessary, antibody levels are assessed.
- Imaging. Depending on the examination and test results, a thyroid ultrasound may be requested.
- Drawing up the plan. The results are assessed together; the follow-up interval and, where necessary, an adjustment to medication are determined.
In which patients is it assessed differently?
In the situations below, the assessment proceeds differently.
- In patients who are pregnant or planning a pregnancy (the reference limits for thyroid hormones are different and follow-up is arranged separately)
- In breastfeeding patients (the choice of medicine is assessed separately)
- In patients already taking thyroid medication (the medicine is not changed or stopped without consulting a physician)
- In patients with a history of radiotherapy to the neck area (that history is given separate attention in the assessment)
- In patients with a family history of thyroid cancer (any nodule is assessed with particular care)
- In patients with a heart rhythm disorder (because thyroid hormones may affect the rhythm, the two are assessed together)
- In patients under 18 years of age (assessment lies within the field of paediatrics; this content has been prepared for adults)
Points to be aware of
A single test result is not assessed on its own. Results take on meaning together with the complaint and the examination findings. Laboratory reference limits may differ from one institution to another, and they change in pregnancy.
Do not use products containing iodine on your own initiative. Unnecessary or high-dose use of supplements containing iodine may affect thyroid function. Under the salt iodisation programme that has been running in Türkiye since 1994, table salt contains iodine; taking iodine on top of this requires assessment by a physician.
Not every swelling that can be felt in the neck means the same thing. The distinction is made with examination and, where necessary, imaging.
Regularity matters in taking medication. The physician determines when thyroid medicines are taken and the interval between them and other medicines.
Results vary from person to person.
When should you see a physician without delay?
If you notice these symptoms, consult a physician without delay:
- Swelling in the neck that is growing rapidly
- Hoarseness that does not go away
- Difficulty swallowing or a sensation of catching in the throat
- Difficulty breathing that increases over days
- Marked palpitations and trembling of the hands
- Unintentional and rapid weight loss
- A hard, painless mass felt in the neck
In the event of sudden shortness of breath or an inability to swallow, go directly to the emergency department.
Frequently asked questions
Which blood tests are requested for the thyroid?
Assessment generally starts with thyroid function tests; depending on the examination and the results, antibody levels may be added. Which of them are needed is determined according to your complaint. If you have previous results to hand, bringing them allows the course to be assessed.
I have a swelling in my neck but no symptoms; should I still go?
Yes, assessment is advised. Enlargement of the thyroid gland does not always produce symptoms. The nature of the swelling is determined with examination and, where necessary, ultrasound.
Does thyroid disease resolve with diet?
Nutrition matters for thyroid health in terms of iodine intake; however, the management of a diagnosed thyroid disease is planned by a physician. Dietary adjustment does not replace treatment.
My tests came back normal but my symptoms continue; what should I do?
Symptoms such as fatigue, weight change and hair loss may also be related to issues other than the thyroid. Anaemia, iron and B12 status, the course of blood sugar and sleep routine are assessed separately.
Is follow-up needed while I am taking my thyroid medicine?
Yes. While the medicine is being taken, a blood test is repeated at set intervals and the dose is adjusted where necessary. Your physician determines the interval; do not change the dose on your own initiative.
Is thyroid follow-up different in pregnancy?
Yes. In pregnancy the reference limits for thyroid hormones change and follow-up is carried out at closer intervals. If you are planning a pregnancy or are pregnant, mention this at the start of the consultation.
Sources
- Ministry of Health of the Republic of Türkiye, General Directorate of Public Health, Küresel İyot Eksikliği Bozukluklarını Önleme Günü (iodine, thyroid hormones and the salt iodisation programme). https://hsgm.saglik.gov.tr/tr/haberler-cocukergen/kuresel-iyot-eksikligi-bozukluklarini-onleme-gunu.html (opens in a new tab)
- World Health Organization, Noncommunicable diseases fact sheet, 25 September 2025. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases (opens in a new tab)
