Conditions
Hypothyroidism: symptoms, lab tests and telehealth care in Puerto Rico
Hypothyroidism happens when the thyroid does not make enough hormone, and it is controlled with a daily thyroid hormone pill. It causes fatigue, weight gain, feeling cold and dry skin, and it is confirmed with blood tests such as TSH. By video, the doctor evaluates you, gives you a lab order, reviews your results, adjusts your dose and, if appropriate, sends your prescription to your pharmacy.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Extreme drowsiness, confusion or being hard to wake
- A very low body temperature, or feeling very cold with a swollen face
- A very slow heartbeat, fainting or shortness of breath
- Strong palpitations or chest pain after a dose change
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At a glance
Hypothyroidism
Common symptoms
- Fatigue
- Weight gain
- Trouble tolerating cold
- Joint and muscle pain
- Dry skin or dry, thinning hair
- Heavy or irregular periods
- Slowed heart rate
- Depression
- Other names
- Underactive thyroid · Low thyroid
- Usual test
- TSH and, when needed, T4
- Treatment
- Daily thyroid hormone (levothyroxine), with dose adjustments based on blood tests
- Possible complication
- Risks to mother and baby if untreated during pregnancy
On this page(11)
What is hypothyroidism?
Your thyroid is a gland in your neck that makes hormones controlling how your body uses energy. With hypothyroidism (an underactive thyroid) it does not make enough, and your body slows down.
Nearly 5 in 100 Americans aged 12 and older have hypothyroidism. Women are much more likely than men to develop it, and the risk rises after age 60. The most common cause is Hashimoto's disease, an autoimmune disorder. Other causes include thyroiditis, thyroid surgery or radiation, and some medicines.
Hypothyroidism care by telehealth
You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico (verify her license) with several years of emergency-department experience. She sees you in English or Spanish, and we care for adults and children of all ages. We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
As part of our chronic care, the doctor can:
- Review your symptoms and your TSH results.
- Give you the order for your next blood test and go over the result with you.
- Adjust your dose when the results call for it.
- Refill your thyroid hormone. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
How to book your visit in 3 steps
It works the same from anywhere in Puerto Rico:
Request your visit.
Request a visit online 24/7 — we confirm your time by email or text. Choose Doctor visit, or Follow-up visit if you only need a refill of a medicine you already take, and pay by card at secure checkout. Book your visit.
Get your link.
We send you a secure video link. It works on your phone, tablet or computer. You need to be in Puerto Rico during the visit (visitors are welcome). Patients under 21 need a parent or legal guardian on camera with photo ID.
See the doctor.
The doctor evaluates, diagnoses and treats you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If you need a test, we give you a lab order for a lab near you.
Price: a US$79 doctor visit, no membership
A doctor visit costs US$79, the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the visit can't happen. A doctor's note after your visit is included at no extra charge. See all prices.
If you already take thyroid medication and only need a refill, choose a follow-up visit: it costs US$49 and anyone can book it. A review of lab results is also US$49 for existing patients. If a US$49 visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.
Video visit
Doctor visit
US$79
For a new problem, urgent care (non-emergencies), primary care, children, birth control, STIs, skin and acne, and visitors. Includes a doctor's note if you need one.
- You’re charged when you request the visit.
- Full refund if the visit can’t take place
Hypothyroidism symptoms
Hypothyroidism develops slowly, so you may not notice symptoms for months or even years. The most common are:
- Fatigue
- Weight gain
- Trouble tolerating cold
- Joint and muscle pain
- Dry skin or dry, thinning hair
- Heavy or irregular periods, or fertility problems
- Slowed heart rate
- Depression
Treatment, and when a TSH test is ordered
The main test is TSH, a hormone the pituitary gland makes to push the thyroid to work. When thyroid hormone in your blood is low, TSH goes up, so a high TSH usually points to an underactive thyroid. If TSH is abnormal, other tests such as T4 are usually added. The doctor reads your results together with your symptoms and gives you a lab order when one is needed.
Treatment is levothyroxine, a hormone identical to the one a healthy thyroid makes. It is usually taken once a day on an empty stomach, before breakfast. If you take calcium or iron, ask the doctor how far apart to keep them from your levothyroxine.
About 6 to 8 weeks after you start or change your dose, a blood test is repeated to adjust it. Do not stop taking it without talking to the doctor, and it must never be used for weight loss: too much can cause serious problems such as an irregular heartbeat or bone loss.
Pregnancy and your thyroid
Untreated hypothyroidism during pregnancy can affect both mother and baby, and many women need a higher dose while pregnant. If you are pregnant or planning a pregnancy, tell the doctor as soon as you know: she orders a TSH check and helps you coordinate your treatment with your obstetrician.
Your treatment during hurricane season
In Puerto Rico hurricane season runs from June 1 to November 30. Because levothyroxine is taken every day, it helps to have a supply on hand and your prescription up to date before a storm. See medications and hurricanes.
Hypothyroidism in children
We see children of all ages. An underactive thyroid in children and teens can affect growth and development, so if your child has symptoms, the doctor evaluates them by video and, if needed, gives you a lab order for a TSH test.
When to go to the ER
For your safety, call 911 or go to the nearest emergency room if you have any of these signs. See also when to go to the ER.
- Extreme drowsiness, confusion or being hard to wake
- A very slow heartbeat, fainting or shortness of breath
- Strong palpitations or chest pain after a dose change
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
What are the symptoms of an underactive thyroid?
What does a high TSH mean?
Can I get my thyroid medication refilled by video?
Is hypothyroidism permanent?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (4)
- NIDDK (NIH): Hypothyroidism (opens in a new tab) (accessed 2026-09-30)
- MedlinePlus (NIH): TSH test (opens in a new tab) (accessed 2026-09-30)
- MedlinePlus (NIH): Levothyroxine (opens in a new tab) (accessed 2026-09-30)
- NOAA National Hurricane Center: tropical cyclone climatology (opens in a new tab) (accessed 2026-09-30)