Hypothyroidism Symptoms
In This Chapter
- Understanding hypothyroidism symptoms
- Checking off your symptoms
- True tales of hypothyroid patients
- Conditions with similar or parallel symptoms
Hypothyroidism is often hard to identify because it can create any of dozens of seemingly unrelated symptoms, ranging from abrupt weight gain to fatigue to hair loss to depression. Even excellent physicians who don’t happen to be thyroid experts might not recognize when you’re hypothyroid.
While Chapter 2 covered all thyroid diseases, this chapter focuses squarely on hypothyroidism. It begins with a checklist of symptoms to help you decide if you’re hypothyroid. It then provides some real-life stories about patients who thoroughly overcame hypothyroid problems with inexpensive medication.
In addition, it briefly describes other common conditions that resemble and/or overlap with hypothyroidism, which will help you both clarify what your symptoms are and decide what tests to request when you see your doctor.
Once you’re done reading, you’ll have a checklist of symptoms you can take to your doctor for testing, diagnosis, and possible treatment.
Throat Quote
I was so exhausted I couldn’t figure out what was going on in my life. I ended up going to Africa and spent a month with my beautiful daughters there, was still feeling really tired, really tired, going around from doctor to doctor trying to figure out what was wrong.
—Oprah Winfrey on her hypothyroidism
Acknowledging Symptoms
Your thyroid regulates your energy levels by producing hormones that allow your cells to stay “powered up” and active, and to grow and generate new cells. Since every part of your body requires energy, if your thyroid starts underproducing these hormones you may experience any number of issues involving your skin, your hair, your brain, your sexual organs, and more.
Some symptoms may be obvious, such as sudden weight gain or severe tiredness. Others may be so subtle—such as feeling confused or less interested in sex—that you’re unlikely to immediately recognize them as the results of an illness.
Diagnosing hypothyroidism is tricky for doctors as well. Different patients can have completely different symptoms, combinations of symptoms, and severities of symptoms, all stemming from an off-kilter thyroid. While most hypothyroid issues aren’t immediately serious, they can become dangerous over time. And either way, they have a significant negative impact on quality of life.
There are millions of people who suffer with debilitating problems simply because neither they nor their doctors have recognized the root cause as insufficient thyroid hormones. It’s a tragedy, because you can easily make up for any lack of T4 and T3 with inexpensive pills … but not until your hypothyroidism has been identified.
Too often we rationalize changes in our bodies, altering our perception of what’s normal instead of acknowledging there’s something wrong. This chapter will empower you to listen to your body when it’s saying your thyroid is underperforming.
Hypothyroidism Symptoms Checklist
Because thyroid hormones affect every cell, in theory an underactive thyroid can result in any of hundreds of symptoms. In general, though, certain symptoms are more likely to occur than others. These frequent clues to hypothyroidism appear in the checklist that follows.
Take a few minutes to go over the list and check off any symptom that applies to you. If you aren’t sure whether you have a particular symptom, find the description of it in Chapter 2 and use the additional information to make your decision.
Hypothyroidism Symptoms Checklist
- ❑ Gaining weight for no apparent reason
- ❑ Frequent exhaustion
- ❑ Sluggishness
- ❑ Slowed thinking
- ❑ Memory problems
- ❑ Depression
- ❑ Lowered interest in sex
- ❑ Menstrual problems
- ❑ Infertility
- ❑ Insomnia
- ❑ Constipation
- ❑ Hair loss
- ❑ Thinning or dry hair
- ❑ Dry, brittle nails
- ❑ Rough, itchy, and/or thinning skin
- ❑ Acne
- ❑ Puffy skin
- ❑ Cold skin
- ❑ Feeling unusually cold
- ❑ Sweating too little
- ❑ Numbness in the hands and feet
- ❑ Weak muscles
- ❑ Hoarse voice
- ❑ Enlarged neck
If you have six or more of these common symptoms, there’s a strong chance you’re hypothyroid. Get your thyroid checked out—typically via blood tests for TSH, free T4, free T3, and antibodies—as soon as possible.
If you have two to five of these symptoms, that’s still reason enough to get your thyroid tested. Either the results will be positive, putting you on the path to treatment, or negative, which will inform your doctor to explore other potential problem sources. (Before accepting a negative result, though, see Chapter 7.) But even if you have only one of these symptoms and your doctor isn’t providing a satisfying explanation for its cause, you should seriously consider getting tested. That’s especially true if you’re a woman 30 to 50 years old, as that’s the gender and age range most often struck by hypothyroidism.
The checklist is by no means comprehensive; you can definitely experience other symptoms. However, the odds are that along with the unlisted symptoms you’ll have at least a few of the ones on the checklist.
If you’re successfully treated, you’ll soon experience improvement regarding all your hypothyroidism symptoms.
Throat Quote
I was depressed, I kept gaining weight, and I had no interest in sex. My doctor sent me to a psychiatrist, but that didn’t help at all. Then my hair started falling out.
—Patient who fully recovered after going on thyroid medication
Hypothyroid Patient Stories
It can be easier to understand symptoms when they’re viewed within the context of people’s lives. The following are true stories of people struggling with medical problems that turned out to be the results of hypothyroidism. Most of these patients had been misdiagnosed before they turned to me for help. They were all restored to full health via inexpensive thyroid medication.
Memory Problems
JoAnne was a delightful woman in her early 70s who abruptly began suffering from impaired mental functioning. JoAnne used to enjoy moderating Civil War discussion groups and traveling to historic battlegrounds, but her memory suddenly became so poor that she gave up all such activities. JoAnne’s children were concerned she was experiencing dementia or early Alzheimer’s, and had made an appointment for her to see a neurologist. She came to me first in hopes of discovering a more treatable cause.
When I started asking JoAnne questions, it became clear that she wasn’t only losing her memory but her enthusiasm for life. She told me her best friend had switched from calling her a spitfire to calling her an old dishrag. Thyroid testing was definitely called for.
JoAnne proved to be very clearly hypothyroid. Medication quickly turned things around. It’s fortunate we caught the problem relatively early; in cases where memory loss lasts for more than 18 months, full function often doesn’t return even after treatment.
Fatigue and Depression
Susan was a kind woman under my care for chronic fatigue syndrome. The most prominent aspect of her illness was a dark, foreboding depression. After she grew to trust me, Susan described how the depression felt in painful detail. She then added she saw no reason to subject others to it, so she put on a “public face” when she was with family and friends. I deeply wanted to cure her, but months went by with no significant progress.
One day Susan mentioned reading that depression was sometimes caused by hypothyroidism. “Thyroid disease was one of the first things I tested for,” I said, “but your lab results showed nothing unusual. If you’re willing to risk temporary hyperthyroid side effects, though, I can give you a low dose of thyroid hormones to see whether they do any good.” Susan agreed; and to my surprise, the medication made a substantial improvement in how she felt. I was also surprised that Susan’s next series of blood tests showed no significant change in her thyroid hormone levels.
I ended up increasing Susan’s dosage four times before her levels clearly went up; and when they did, they were still within the “normal” range. Susan was a prime example of a patient for whom the numbers didn’t tell the whole story.
After a couple of months on the medication, Susan’s fatigue and depression entirely lifted. Susan responded by happily throwing away her antidepressant drugs … which had never helped her because they didn’t address her real problem, which was hidden hypothyroidism.
Jason was a professional flamenco guitarist who normally loved his job, but over the past year had lost his motivation to compose and perform music. He rationalized his lack of energy as career burnout and old age—but he was only in his late 20s!
When I started questioning Jason, he casually mentioned that his fingernails had become a problem. His style of guitar playing depends on long, well-manicured nails. But at around the same time his enthusiasm went downhill, his nails became brittle and kept breaking when picking guitar strings. Jason’s manicurist applied increasingly greater levels of protectant, but it didn’t help. To be thorough, I tested Jason’s zinc and protein levels as well as his thyroid levels. The lab results clearly showed hypothyroidism.
After a year of treatment, Jason’s nails were in top shape again. And more importantly, his passion for music and performing had been completely restored.
Thyroid Factoid
Famous people who have had thyroid disease and thrived after treatment include rock star Rod Stewart, movie critic Roger Ebert, comedian Joe Piscopo, Olympic track and field champion Carl Lewis, pro golfer Ben Crenshaw, Nobel Prize–winning doctor Rosalyn Yalow, best-selling author Isaac Asimov, and former President George H. W. Bush and his wife Barbara.
Feeling Unusually Cold
Caroline came to see me in the middle of the summer wearing heavy pants and a very heavy sweater. When we shook hands, I felt that she was freezing. When I mentioned this, she replied, “All offices keep their temperatures much lower than they ought to.” She added, “My husband tries to do the same thing at home, but I won’t let him.”
Caroline was already on thyroid medication, but on a low dosage. I gradually raised it, and after a few months Caroline was dressing normally and enjoying warmth again.
Hair Loss
One of the symptoms that most strongly motivates people to see me without delay is hair loss. Sally was a patient of mine for years, and had been treated successfully for her hypothyroidism. One day Sally came to see me in a panic. She leaned her head forward and showed me the clear thinning of her hair, with lots of scalp showing.
“We need to raise my thyroid medication right away!” Sally said.
“It could be your thyroid,” I replied, “but it could be something else. Let me take your blood and have the lab test for the likeliest causes.”
The results showed Sally’s instincts were right. She tested negative for everything except her previous problem—she’d again become hypothyroid.
I was puzzled, because Sally’s condition had been stable for years. I asked if she was taking her medication first thing in the morning, and was waiting 30-60 minutes before eating or drinking anything but water. She assured me she was.
I therefore raised Sally’s dosage, expecting her thyroid hormone levels to rise on her next test. A month later, I received another surprise: the levels had gotten even lower.
The situation had become so unusual that I decided to question Sally more carefully about her morning routine. This time she mentioned that a few months ago she’d begun taking her thyroid pills with orange juice instead of water. “But that shouldn’t make any difference,” she added.
“Is it calcium-fortified orange juice?” I asked.
“Yes, it is,” she replied.
I shook my head. “Sally, calcium is one of the strongest binders of thyroid hormones. You aren’t giving the hormones a chance to get into your bloodstream.”
I put Sally back on her original dosage and asked her to take her medication with water only. Sally’s blood levels quickly returned to normal, and within a few months over 90 percent of her hair had grown back.
Throat Quote
How can I control my life when I can’t control my hair?
—Anonymous
Hair brings one’s self-image into focus.
—Shana Alexander
Monica was a 30-year-old who’d tried for years to conceive, with no success. In such cases low progesterone is often the culprit. When I spoke to Monica, however, I learned that she’d been gaining weight over the past few years. She’d chalked it up to “growing older.”
I tested Monica’s blood, and she turned out to be hypothyroid. This should’ve been picked up by Monica’s gynecologist or fertility specialist, but it never occurred to either of them to check her for thyroid disease.
As it turned out, Monica was quite fertile. Within two months of starting on thyroid medication, she became pregnant. A few years later, my wife and I ran into Monica and her two children—the second was conceived shortly after the first was born. Monica proudly showed off her new family and thanked me exuberantly. My wife mentioned friends of hers who I’d also treated successfully for infertility, adding, “Oh yeah, he gets everybody pregnant!” I was quite embarrassed, but the two of them had a good laugh over it.
Muscle Weakness
Janet was diagnosed with debilitating fibromyalgia syndrome when she was 16. She’d been forced to drop out of school due to her unremitting muscle pain and weakness. She needed her mother’s help with such simple things as getting out of bed and dressing. Janet had seen a mob of doctors—rheumatologists, neurologists, and alternative practitioners. They all said her problem was exclusively fibromyalgia syndrome.
Three years later, at age 19, Janet came to see me. The tests I ran showed signs of an old Epstein-Barr viral respiratory infection, thyroid antibodies, and a TSH that was above normal levels. Apparently Janet developed Hashimoto’s as a result of her respiratory infection at age 16 … and had been hypothyroid ever since.
After six months of thyroid medication, Janet regained over 80 percent of her muscular strength, and her pain all but disappeared. I prescribed exercises for her to perform to get the rest of the strength back in her arms and legs.
Similar and Overlapping Conditions
If you’re experiencing hypothyroid symptoms, you shouldn’t hesitate to see a doctor and get your blood tested for TSH, free T4, free T3, and thyroid antibodies. However, that doesn’t mean you should skip other types of testing. There are conditions that cause many of the same symptoms as hypothyroidism, and it’s possible that your problems are actually stemming from one of them. Further, it’s possible that you’re suffering from hypothyroidism and some other condition simultaneously. Certain conditions not only resemble but frequently coexist with hypothyroidism, making normally unpleasant symptoms even worse.
The rest of this chapter briefly describes common conditions that produce many of the same symptoms as hypothyroidism. If you find one or more of these conditions fits closely with the problems you’ve having, don’t hesitate to bring it up when you speak with your doctor. Take care to clearly explain which symptoms make you suspicious—your doctor will be more interested in what you’re feeling and experiencing so she can make her own diagnosis—and then ask if she believes it makes sense to test for some other specific condition in addition to your thyroid testing.
Once your illness has been diagnosed, don’t stop there; discuss with your doctor whether there are any aspects of your diet, environment, and lifestyle that might have contributed to its development. Dealing with not only your symptoms but the underlying causes vastly increases your chances of achieving optimum health.
Autoimmune Diseases
Hashimoto’s is by no means the only common autoimmune disease. Others range from rheumatoid arthritis to lupus to scleroderma. And especially in the early stages, many autoimmune disorders produce the same symptoms, including fatigue, dry skin, and hair loss. So even if you have autoimmune disease, it isn’t necessarily Hashimoto’s.
Then again, if you do have Hashimoto’s, that doesn’t mean you don’t also have other autoimmune diseases. Once your body demonstrates a tendency to attack itself in one area, there’s a greater chance it’ll do so in other areas. It’s therefore wise to get tested annually for other autoimmune disorders.
Anemia
If you don’t have enough healthy red blood cells distributing oxygen from your lungs to the rest of your body, you’ll develop anemia. Resulting hypothyroid-like symptoms can include feeling fatigued and weak; mental fogginess; depression; insomnia; developing dry, brittle nails; and feeling cold (especially in the hands and feet). And, like hypothyroidism, women in their 40s and older are especially susceptible.
Anemia is easy to detect via a routine blood test.
Hypoglycemia
Low blood sugar, or hypoglycemia, will make you experience hypothyroid-like symptoms such as fatigue, insomnia, depression, and even anxiety. These problems can be severe, but quickly lessen or go away after you eat something to raise your blood sugar.
Hypoglycemia is easy to detect via a routine blood test.
PMS
Premenstrual syndrome (PMS) is estimated to affect over 85 percent of women between the ages of 20 and 40. The symptoms shared with hypothyroidism include fatigue, mental fogginess, memory problems, depression (and/or anxiety), insomnia, lowered interest in sex, and constipation.
Given its monthly cycle, no one’s likely to confuse PMS for hypothyroidism. However, the opposite often occurs—that is, ignoring signs of hypothyroidism by attributing them to PMS. It’s actually common to have both; and when this happens, hypothyroidism will make a tough time substantially worse. To learn more, see Chapter 17.
CFIDS
Chronic fatigue immunodeficiency syndrome (CFIDS) results in fatigue so severe that it’s debilitating—lasting for over six months, and forcing you to make major adjustments to your work and lifestyle. In addition to exhaustion, symptoms echoing hypothyroidism include insomnia, memory and concentration problems, weak muscles, and throat pain.
CFIDS is a syndrome, meaning it’s a collection of conditions rather than just one disease. So while you might have CFIDS instead of hypothyroidism, it’s just as likely that low-level hypothyroidism is one of the conditions contributing to your CFIDS. In the latter case, thyroid medication won’t cure you, but it’ll definitely help.
Fibromyalgia Syndrome
Fibromyalgia syndrome is essentially CFIDS plus persistent and unexplained muscle pain. The latter is believed to be the result of a malfunction in how the body processes cellular waste—the acids that build up when you exercise.
As with CFIDS, you might have fibromyalgia syndrome instead of hypothyroidism, but it’s just as likely that low-level hypothyroidism is one of the conditions contributing to your illness … in which case thyroid medication will help.
Polycystic Ovarian Syndrome
Polycystic ovarian syndrome affects around 5 million women of childbearing age in the United States alone. It shares a number of symptoms with hypothyroidism, including weight gain, fatigue, depression (or anxiety), acne, thinning hair, irregular periods, and infertility.
This syndrome can usually be distinguished from hypothyroidism by its other symptoms, which include facial hair, and one or more ovarian cysts.
Clinical Depression
Standard clinical depression and depression from hypothyroidism are indistinguishable in their effects—they both result in feelings of immense sadness or emptiness, loss of interest in activities that were previously enjoyable, low energy, etc.
The main difference is that the cure for depression from hypothyroidism is quick and easy: thyroid medication, and particularly T3.
However, standard clinical depression is a much longer and more difficult problem to solve. Treatment usually involves talk therapy combined with antidepressants—and, increasingly, T3, even for patients without apparent hypothyroidism. To learn more, see Chapter 16.
Adrenal Gland Disease
You can become hypothyroid even if your thyroid is functioning normally. This paradox stems from a pair of endocrine glands called adrenals that your thyroid relies on to be effective. Your adrenal glands produce cortisol, which helps convert T4 into T3. That’s a vital function, because it’s T3 that does the work of “powering up” your cells. In addition, cortisol gives T3 the ability to penetrate a cell’s membrane. Once inside a cell, the T3 charges the cell’s storage batteries, called mitochondria, providing your body with the energy it needs.
If your adrenal glands are underperforming, then you probably won’t have enough T3; and more importantly, the T3 you have won’t be able to do its job because it’ll be blocked from penetrating cells. As a result, you’ll quickly become hypothyroid. However, your TSH and free T4 levels—which are all many doctors test for—will show that your thyroid is functioning perfectly. This is a prime example of why you should pay more attention to your symptoms than to lab test results.
An additional complication is that because your thyroid and your adrenal glands work together, when one of them underachieves, the other will strain to pick up the slack. If this goes on for a long time, it can result in both your thyroid and adrenals becoming defective. This is another example of why you should pay attention to your symptoms, and seek testing and treatment as soon as you have good reason to suspect a problem. For more information—including how to detect, test for, and treat adrenal gland disease—see Chapter 14.
Pituitary Gland Disease
You can also develop hypothyroidism when your thyroid is functioning normally if your pituitary gland becomes underactive. That’s because your thyroid follows the pituitary’s orders on how much hormone to produce, and when the pituitary grows weaker, so do its orders.
This condition can be easily picked up by hormone blood tests.
- Seemingly unrelated symptoms can all be caused by hypothyroidism.
- Hypothyroidism symptoms include fatigue, weight gain, confusion, memory loss, lowered sex drive, depression, brittle nails, dry skin, and thinning hair.
- If you have even one hypothyroidism symptom, get your thyroid tested.
- Talk to your doctor about also testing you for conditions that you might have instead of or in addition to hypothyroidism.