Hypothyroidism (Underactive Thyroid) Care in Hilo & Across Hawaiʻi — Medicaid (QUEST) Accepted

Hypothyroidism means the thyroid gland does not make enough thyroid hormone, which slows the body’s metabolism and can cause fatigue, weight gain, cold intolerance, and low mood. It is common, especially in women and with age, and it is one of the most straightforward conditions to treat once it is found. At Ohana Care Clinic in Hilo, we test for it, treat it, and follow it over time.

What hypothyroidism is

The thyroid is a small gland in the neck that sets the pace of your metabolism. When it is underactive, nearly every system slows down. The most common cause is an autoimmune condition called Hashimoto’s thyroiditis, in which the immune system gradually reduces the thyroid’s output. Because the change is slow, symptoms often creep in over months and are easy to mistake for stress, aging, or simply being tired.

Signs you might notice

Common signs include persistent fatigue, weight gain, feeling cold when others are comfortable, dry skin, constipation, thinning hair, and trouble concentrating. Low mood and depression are common too, which is one reason thyroid testing is part of a thorough evaluation when someone feels persistently down or worn out. Many of these symptoms overlap with other conditions, which is exactly why a simple blood test is so useful.

How we diagnose it

Hypothyroidism is diagnosed with a blood test, primarily the thyroid-stimulating hormone (TSH) level, sometimes with additional thyroid hormone and antibody tests. This makes diagnosis clear and objective, and it also lets us tell true hypothyroidism apart from the many other causes of fatigue.

How we treat and manage it

The American Thyroid Association recommends levothyroxine, a daily replacement of the hormone your thyroid is missing, as the standard treatment. We start at an appropriate dose, recheck your TSH after several weeks, and fine-tune until your levels and your symptoms are where they should be, taking extra care with older adults and during pregnancy. Once you are stable, this is an easy condition to follow by telehealth with periodic lab work.

The mind-body connection

Thyroid problems and mental health are closely linked. An underactive thyroid can mimic or worsen depression, and people sometimes spend a long time treating low mood without realizing the thyroid is part of the story. Because we integrate primary care and behavioral health, we look at both together, so you are not left guessing which is which.

Culturally grounded care

We care for the whole person, in the spirit of lōkahi — balance and harmony among the connected parts of life: the body, the mind and emotions, the spirit, the ʻohana (family), and our relationship with the ʻāina (land) and community. In a Native Hawaiian understanding of health, these are not separate, and neither is our care. To mālama (care for and protect) your wellbeing and to live pono (in balance and rightness), we listen to your whole story, welcome your ʻohana into the process, and honor the values and traditions that ground you. Offering kōkua (help given freely, with aloha) in a way that respects who you are is at the heart of how we practice.

Insurance and how we see you

We accept Medicare and Medicaid, including the Hawaiʻi QUEST Integration plans (AlohaCare, the Hawaiʻi Medical Service Association (HMSA), ʻOhana Health Plan, and UnitedHealthcare Community Plan), along with most commercial insurance, and we are accepting new patients in Hilo. Primary care works best as a partnership. Your first visit is in person at our Hilo clinic. We see patients in person for physical exams, vitals, and lab work, and we use telehealth for follow-up visits, medication management, and chronic-disease check-ins whenever it is clinically appropriate.

Common questions about hypothyroidism

What are the symptoms of an underactive thyroid?

Common symptoms include fatigue, weight gain, feeling cold, dry skin, constipation, thinning hair, trouble concentrating, and low mood. They develop slowly and overlap with other conditions, so a blood test is the way to know for sure.

Is hypothyroidism treated for life?

Often, yes. Most people take a daily thyroid hormone (levothyroxine) long term, but it simply replaces what your body is missing and, once your dose is right, lets you feel like yourself again. We monitor periodically and adjust as needed.

Can hypothyroidism be managed by telehealth?

Yes. Once diagnosed, dose adjustments and follow-up are easy to handle by video, with periodic lab work to check your thyroid levels.

What insurance do you accept?

We accept Medicare and Medicaid, including the Hawaii QUEST Integration plans (AlohaCare, HMSA, Ohana Health Plan, and UnitedHealthcare Community Plan), along with most commercial insurance. We are accepting new patients in Hilo.

References

Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., et al. (2014). Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid, 24(12), 1670–1751. https://doi.org/10.1089/thy.2014.0028

American Thyroid Association. (n.d.). Hypothyroidism treatment guidelines. Retrieved June 29, 2026, from https://www.thyroid.org/new-hypothyroidism-treatment-guidelines-from-american-thyroid-association-published-in-thyroid-journal/

Papa Ola Lōkahi. (n.d.). Native Hawaiian health. Retrieved June 29, 2026, from https://www.papaolalokahi.org/

This page is general health education from Ohana Care Clinic, written by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a medical condition, reach out to us or another licensed provider. In an emergency, call 911.

George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner