Chapter
2

Sorting Through Symptoms

In This Chapter

• Identifying thyroid disease symptoms
• Weight and energy changes
• Mental and sexual issues
• Hair, nail, and skin problems
• Testing your suspicions

Thyroid disease is often hard to identify because it can create any of dozens of wildly varying symptoms, ranging from weight change to insomnia to brittle nails to mood swings. Even superb doctors who don’t happen to be experts in this area can fail to realize when a problem is being caused by an ailing thyroid.

The good news is we’re here to help. In this chapter, we’ll guide you through the most common symptoms of thyroid disease, complete with real-life stories about patients who had one or more of these issues and thoroughly overcame them with inexpensive thyroid medication.

Once you’re done reading, you’ll have a checklist of symptoms you can take to your doctor for testing, diagnosis, and possible treatment.

Hearing Your Thyroid’s Messages

As explained in Chapter 1, your thyroid regulates the energy levels of your body by producing hormones that make your cells increase or decrease their activity. Because these hormones affect organs, tissues, and cells throughout your body, if your thyroid starts malfunctioning you may experience myriad problems stemming from your brain, your colon, your skin, your neck … the possibilities are overwhelming.

Some symptoms may be obvious, such as trouble swallowing or eye pain. Others may be so subtle—such as feeling irritable or becoming forgetful—that you’re unlikely to immediately recognize them as the results of an illness.

Diagnosing thyroid disease is tricky for doctors. Different patients can have completely different symptoms, combinations of symptoms, and severity of symptoms, all stemming from an off-kilter thyroid.

While most thyroid-related 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 from debilitating problems simply because neither they nor their doctors have recognized the root cause as a defective thyroid. It’s a tragedy, because thyroid disease is usually easy to treat … but not until it’s been identified.

For example, I had a patient we’ll call Margaret (the names of all patients mentioned in this book have been changed to protect their privacy) who’d been seeing me as her general practitioner for several years. During a routine check-up I asked Margaret if she was sleeping well, and she casually replied, “Actually, I’ve been having insomnia.” I noticed she looked a little too thin, so I checked her weight; it was down 14 pounds from the previous year. Margaret told me she wasn’t dieting: “I just haven’t been as hungry lately, no big deal.” I noticed she was sweating even though the room was cool, and her resting heart rate was a rapid 100 beats per minute. If I weren’t an expert on thyroid symptoms, I might have prescribed sleeping pills instead of putting the pieces together. Instead, I tested Margaret and, as I suspected, she was suffering from hyperthyroidism. Medication soon eliminated all the problems and restored Margaret to a happy life.

Too often we rationalize changes in our bodies, altering our perception of what’s normal rather than acknowledging that there’s something wrong.

This chapter will empower you to listen to your body when it’s saying your thyroid isn’t doing its job.

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 later in this chapter and use the additional information to make your decision.

Thyroid Disease Symptoms Checklist

• ❑ Gaining weight for no apparent reason
• ❑ Losing weight for no apparent reason
• ❑ Frequent exhaustion
• ❑ Sluggishness
• ❑ Nervousness
• ❑ Anxiety
• ❑ Irritability
• ❑ Feeling “shaky”
• ❑ Slowed thinking
• ❑ Memory problems
• ❑ Depression
• ❑ Lowered interest in sex
• ❑ Excessive interest in sex
• ❑ Menstrual problems
• ❑ Infertility
• ❑ Insomnia
• ❑ Constipation
• ❑ Unusually frequent bowel movements
• ❑ 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 or too much
• ❑ Numbness or tingling in the hands and feet
• ❑ Rapidly beating heart
• ❑ Weak muscles
• ❑ Painful and/or enlarged eyes
• ❑ Hoarse voice
• ❑ Enlarged neck

If you have six or more of these common symptoms, there’s a strong chance your thyroid is ailing. 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 doubly true if you’re a woman who’s 30-50 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 for thyroid disease, you’ll soon experience improvement regarding all your thyroid-related symptoms.

Thyroidian Tip

Virtually any symptom on the checklist can be caused by something beyond a faulty thyroid. Therefore, ask your doctor to give you a full physical, and to explore other potential causes in addition to the thyroid testing. Even if your symptoms turn out to be entirely thyroid-related, that doesn’t mean the search for causes should end. For example, if you have an autoimmune thyroid disease, it might have developed from toxins in your system. Eliminating such toxins (by changing your water supply, switching to organic food, etc.) could result in your eventually not needing thyroid medication … and lead to overall better health.

The rest of this chapter describes common thyroid-related symptoms in more depth, then concludes with some advice about testing.

Gaining or Losing Weight

Your thyroid controls your resting metabolic rate (RMR), which is the rate at which your body burns calories when at rest. To better understand this concept, think of your body as a car that never shuts off. When the car is moving, it burns up gasoline at a higher rate. But even when it’s just idling, it’s burning up a significant amount of fuel.

If you’re like most people, you probably burn 1,300-2,000 calories daily from your resting metabolic rate (and another 300-700 calories from activities). So if an off-kilter thyroid changes your RMR by even just a third, it has an enormous impact on your body’s calorie consumption.

If your thyroid suddenly starts underproducing hormones, your body’s “idle” rate will go down, making you burn fewer calories per hour. This will cause you to gain weight … possibly a lot of weight. Even if you eat less and exercise more, it probably won’t be enough to compensate for your lowered metabolism.

For example, Elizabeth was convinced her thyroid was off because she was struggling so hard with her weight. Noticing she was 5’9’’ and weighed 117 pounds, at first I thought she had a body image problem. Then she explained she thought her current weight was fine, but she was taking extreme measures to maintain it. Six days a week Elizabeth got up at 4:00 A.M., ran 10 miles, and then spent another 30-45 minutes at the gym before going to work. And her diet consisted primarily of fruits and vegetables, never exceeding 900 calories a day! That’s all I needed to hear to be convinced testing was called for; and it turned out Elizabeth was indeed suffering from hypothyroidism. Once we got her on medication, she was able to maintain her weight eating 1,400-1,600 calories and no more than an hour of exercise daily.

Alternatively, if your thyroid suddenly starts overproducing hormones, your body’s “idle” rate will go up, making you burn more calories per hour. This will cause you to lose weight. If you’ve been overweight, that’ll be good news … temporarily. But over time, you’ll become dangerously thin.

In either case, thyroid treatment will return your metabolism to normal.

Thyroidian Tip

Just because you gain weight doesn’t mean you have a thyroid or metabolism problem. If you tend to eat a lot and not exercise, a weight gain is to be expected. However, if you’ve maintained a steady weight, and then suddenly start gaining with no change in your diet or exercise habits, then thyroid testing is called for.

Sluggishness or Exhaustion

If you’re a workaholic getting by on six hours of sleep a day, it’s no surprise you feel exhausted. But if you have a reasonable schedule and normal sleep habits, and for no apparent reason suddenly feel burned out daily, something’s wrong.

See if any of the following statements ring a bell:

• You’re pushing yourself just to get through the day.
• Activities you used to love are such a strain that you’ve stopped enjoying them.
• You’ve stopped exercising, socializing, etc., because you can’t spare the energy.
• You crash in the afternoon, wanting to do nothing but sleep.
• When you get home from work, you feel so dead tired that all you can do is sleep.

If any item on this list resonates, and there’s no clear cause for the problem, seeing a doctor and getting tested for hypothyroidism is a good idea.

Mental Symptoms

It’s obvious an ailing thyroid can cause physical problems. But what many people—including a fair number of doctors—don’t realize is the profound effect the thyroid has on your mental health. Your brain is one of the organs most affected by thyroid hormones. When that supply is thrown off-balance, your thoughts and emotions may soon follow.

The next three sections cover thyroid-related mental issues that can wreak havoc on the quality of your life until they’re identified and treated.

Depression and Anxiety

If you’re experiencing depression, anxiety, or moodiness, you may find friends disregarding these feelings as being “just in your mind.” You may even rationalize them yourself as being tied to outside circumstances, such as stress at work. (In the past our ancestors blamed problems on hexes; in our modern age we blame them on stress.)

But if your mental difficulties are ongoing, and if you have other thyroid-related symptoms (fatigue, weight change, hair loss, etc.) along with them, you shouldn’t hesitate to get tested. In fact, even if you have no other symptoms but you can’t identify a cause for the problem, a thyroid test is worth doing.

For example, Brittany came to see me for anxiety. She said it was caused by her boss feeling nothing she did was good enough—but upon questioning her, I learned Brittany’s performance evaluations were always positive and she received a raise after every review. Clearly there was something else going on. As we talked more, I learned Brittany was just as anxious about her relationships with friends, her personal safety, and various other areas of her life. Her anxiety actually had nothing to do with work or stress.

Brittany had undergone talk therapy with an experienced psychologist, and had also tried anti-anxiety medication. None of it helped. The psychiatrist referred her to me to see if there was a possible physical cause. Brittany had no other symptoms, but since she’d reached a dead end, I saw no harm in testing her thyroid as part of a blood evaluation.

To my surprise, the lab tests were positive. It’s unusual for thyroid disease to manifest with just one symptom; but as Brittany’s case demonstrates, every now and then it happens. And if I hadn’t ordered that $50 test, Brittany might have struggled with anxiety for years, wrecking her life.

Instead, over the course of four months I gently raised Brittany’s dose of thyroid medication, and frequently checked her blood until her levels normalized. Even with no therapy or other medication, the intrusive thoughts that disrupted her days virtually disappeared. On the rare occasion when Brittany felt anxious, she was able to make the discomfort go away simply by exercising.

Even worse than anxiety is depression, which is one of the most devastating diseases for one’s quality of life. In the words of a patient: “The really odd part about this is there’s nothing upsetting or unusual going on in my life. And yet I notice my mood has significantly shifted. I don’t have any interest in things I did before, I have to force myself to do much of anything, and I’m not enjoying anything.”

If you have depression along with other thyroid-related symptoms, get tested. That said, there have been studies in which patients didn’t test positive for thyroid disease but weren’t responding to antidepressants, so T3 (in the form of Cytomel) was added to the mix of meds to see if it would help regardless. In the majority of cases, it did. No data exists on whether doctors misinterpreted the lab tests (see Chapter 7) and the patients really had thyroid problems after all. At any rate, using T3 as a supplement to antidepressants is becoming increasingly common.

Thyroidian Tip

If your doctor is prescribing Cytomel as a supplement to other medication, make sure he’s monitoring your thyroid blood levels via TSH, free T4, and free T3 tests. Otherwise you could end up with too much T3 in your system and start experiencing hyperthyroid symptoms.

Fogginess and/or Forgetfulness

Roughly 20 percent of the calories burned up during your resting metabolic state are used by your brain. If your thyroid hormones decrease, they’ll set your brain to be less active and fire up less frequently. As a result, your thinking may slow down, leading you to feel foggy and unfocused.

You may also have trouble remembering even simple things like the names of people you know, where you put your keys, the reason you’re standing in your closet ….

There are other possible causes of these symptoms. But if they occur along with fatigue, depression, etc., have your thyroid checked.

Nervousness and/or Irritability

Nervousness, irritability, and shakiness are typically thought of as hyperthyroid symptoms—that is, the results of your body being too revved up. And, in fact, they are. But they can also be evidence of hypothyroidism—particularly if they’re accompanied by anxiety.

Either way, if you have such symptoms and there’s no other clear cause, get tested. The results will tell you precisely what’s going on.

There’s also some interplay between thyroid-related symptoms. For example, if you’re suffering from fatigue, it could cause insomnia because you need to get “played out” to properly unwind and sleep at night. That can’t happen if you’re too tired to be active.

There are so many potential causes for a sleep disorder that this symptom by itself shouldn’t make you think “thyroid.” But it’s definitely notable when combined with other thyroid-related symptoms.

Sex and Fertility Symptoms

Thyroid hormones directly affect the gonads, and so influence ovary and testicle functioning. This can impact menstruation, fertility, and sexual feelings.

For example, if you’re a woman with an underperforming thyroid, your ovaries may do a poor job of synthesizing estrogen and progesterone, causing your menstrual cycles to become irregular. In more severe cases, it may also cause dysfunctional heavy bleeding, and make the ovarian lining inadequate for proper fertilization. The latter can cause infertility, or lead to a miscarriage.

It’s also quite common for hypothyroidism to affect sexual desire—when your thyroid becomes underactive, your libido often will, too. That’s in part because of the connection between thyroid hormones and your sexual organs. In addition, when your metabolism slows down, you’re likely to feel less energetic and enthusiastic about everything … including sex.

For example, my patient Sandra had a very active sex life with her husband for the first three years of marriage; her girlfriends referred to them as “the bunnies.” But over the next two years, she lost interest. “It’s gotten so bad,” she told me, “that I’ve begun making secret marks on the calendar to remind me to initiate sex at least a few times a month. Otherwise it wouldn’t even occur to me.”

Sandra wanted to try testosterone therapy. I told her that we first needed to run tests to determine the root cause of the problem. To be thorough, I included a thyroid test; and to my surprise, even though Sandra had no other thyroid-related symptoms, she tested positive for advanced hypothyroidism. As mentioned previously, it’s unusual for one thyroid symptom to appear in isolation—but it can definitely happen.

After several months of treatment, I received a “thank you” card from a man I didn’t know. It had nothing on it but an illustration of two rabbits lounging by a river. I checked the last name against my patient records … and realized it was from Sandra’s husband.

Irregularity Symptoms

Your small intestine and colon form a very long tube lined by rings. Think about “the wave” crowds do at sports stadiums. That’s sort of what happens in this tube; the first ring fires, and then the next ring, and so on, coaxing undigested material through your body. This process is called peristalsis, and its intensity is regulated by thyroid hormones.

If you’re hypothyroid, peristalsis will be sluggish. As a result, you may experience constipation. In addition, you may absorb more calories, because food is lingering longer in your long intestine and colon—which means you’ll gain weight even faster from eating exactly the same amount of food as usual. Further, you risk being exposed to more toxins, because bad chemicals that normally would be flushed out of your system quickly are instead sticking around.

Conversely, if you’re hyperthyroid, peristalsis is sped up. This can lead to increased bowel movements and/or loose stools. In addition, the undigested food racing through your body doesn’t allow enough time for calories to be absorbed adequately. This is a major reason for losing weight under hyperthyroidism.

Occasional constipation and excessive bowel movements aren’t unusual. But if the problem is ongoing, and no other cause is evident, your thyroid is worth considering as the culprit.

Hair, Skin, and Nail Symptoms

When you have hypothyroidism, your body is forced to make a choice. With limited resources to call upon, it focuses energy on vital functions such as keeping you breathing, while diverting energy from nonessentials … which include keeping your hair thick and full, skin soft and supple, and nails strong and healthy.

The latter are structural parts of your body. Hypothyroidism won’t make them break down any quicker; but it may greatly slow down the rebuilding process, leading to eventual degeneration. It’s like a city neglecting its infrastructure. Everything will keep running, but over time it’ll look increasingly awful.

Hair That’s Thin or Falling Out

If your hair becomes dry or thin, that’s notable for thyroid concerns only in combination with other thyroid-related symptoms.

If you’re losing hair, though, the details become meaningful. When caused by hypothyroidism, hair loss won’t be patchy or localized, but instead diffuse, even, and non-patterned. And it will typically include the full length of the shafts and follicles, as opposed to hair merely breaking off.

Most importantly, the hair loss will happen at a substantially greater rate than what you were used to when your thyroid was normal.

Thyroid Factoid

Your head has around 100,000 hairs. So even if you start losing hair due to hypothyroidism, it will take years before you become bald—and because you’re reading this book, you’ll be on thyroid medication long before that happens.

Even better news is that if you’re treated within two years, the chances are all the hair you lost will grow back.

Rough, Itchy, and/or Thinning Skin

Your skin’s cells have a very high rate of turnover; they’re continually flaking off and being replaced. When your body’s repair rate slows down, though, your skin will become rough, calloused, itchy, and/or thin—especially on your fingertips, hands, upper arms, and feet.

Acne

When your body’s energy decreases, the reduced maintenance of your skin can cause fatty acids and other wastes to build up and clog your pores. This makes your skin more vulnerable to bacterial infection, and may lead to various forms of acne such as pimples, boils, whiteheads, and blackheads … even if you’re long past the teen years usually associated with acne.

Puffy and/or Cold Skin

Hypothyroidism causes a fluid called mucin to build up right below the skin. This results in a puffy appearance.

Thyroid Factoid

Centuries ago doctors didn’t understand the role of the thyroid in disease, but they noticed when patients came in with swelling from mucin buildup so severe it could be spotted from across the room. In 1877 the condition was named myxedema; and to this day you may see the term myxedema used interchangeably with hypothyroidism.

Further, because your metabolism slows down, there’s less energy available to generate heat. This can make you feel cold, as well as lower your skin’s resistance to cold. For example, you may find yourself bringing a sweater along wherever you go because you expect to feel colder than anyone else in the room. The feeling of cold tends to be specially prominent in the feet and hands; so you may also suddenly find yourself wearing heavy socks to bed, or wearing gloves when you’ve never needed to before.

Other Symptoms

As mentioned previously, a malfunctioning thyroid can lead to scores of different problems. The next six sections cover some of the most common ones that don’t fit neatly into any category.

Racing Heart

One of the most frequent symptoms of hyperthyroidism is a rapidly beating heart. In fact, if you start taking thyroid medication, a good doctor will ask you to pay attention to ongoing heart palpitations, because that’s the most obvious sign your thyroid levels are getting too high and you need to scale back on the meds (in which case you should contact your doctor about getting retested ASAP).

In the earliest stages of hyperthyroidism you might not notice your heart beating more quickly during the day, when you have lots of distractions, but you may become aware of it at night as you lay quietly in bed. As the disease progresses, your increased heartbeat will become more pronounced. At that point you shouldn’t think twice about seeing a doctor.

Thyroidian Tip

If you’re hyperthyroid, or suspect you are, avoid exercise until you’ve been fully treated. Normally exercise will take you from a resting heart rate of around 70 beats per second to 130 bps; but if your resting heart rate is abnormally rapid, exercise could raise it to a dangerously high level of 170-200 bps. And much worse, once your rate goes up that high, it might stay there even after you’ve finished your session. That’s a risk not worth taking. Instead, skip working out until you’re okay again.

Numb or Tingling Hands and Feet

Your thyroid regulates the rate at which your nerves conduct signals through your body.

If you’re hypothyroid, your nerves may start conducting signals with less energy. This will slow down your reflexes, and may also cause sporadic numbness, especially in your hands and feet.

Conversely, if you’re hyperthyroid, your nerves may relay signals with excessive energy. This can result in exaggerated reflexes, tremors, and/or sporadic tingling or pain, particularly in your hands and feet.

Weak Muscles

One of the paradoxes of thyroid disease is that certain conditions can be caused by both too little and too much thyroid hormones. And a prime example is weakened muscles.

If you’re hypothyroid, your muscles are being told to reduce their activity. Because the body has a “use it or lose it” policy, over time this will sap their strength.

If you’re hyperthyroid, your muscles are being told to get super-active; but at the same time you aren’t absorbing the nutrients you need to nourish them.

So while the reasons are different, both conditions can produce the same symptom.

Irregular Sweating

Your sweat glands are regulated by thyroid hormones. As a result, if your thyroid is underactive, you may suddenly find yourself barely sweating under conditions in which you’d normally be pouring buckets. Conversely, if your thyroid is overactive, you may be sweating gallons for no apparent reason.

The areas of your body most affected are typically your underarms, hands, and back of your head. For example, if you normally go to the gym and sweat a ton under your arms, you could suddenly find your shirt is virtually dry after a workout. This makes it tougher for your body to expel heat and can make exercising uncomfortable. If this keeps happening and nothing else has changed, get tested.

Painful and/or Enlarged Eyes

Your eyes are vulnerable to a hyperthyroid state called Graves’ disease. This condition spawns antibodies that may attack the fat and muscles near your eyes. This can make you sensitive to light; feel a painful dryness or grittiness in your eyes; or experience double vision. Even worse, as the disease progresses it can make your eyes protrude, creating a “bug-eyed” look. But if you’re diagnosed during the early stages, an experienced doctor can treat you to keep that from happening.

Enlarged Neck and/or Hoarse Voice

There are a couple of ways your thyroid can grow so large that it affects your neck and/or your voice. When your pituitary gland senses your thyroid hormone levels are low, it tells your thyroid to grow new cells to get production back on track. That’s normally a good thing. But if your thyroid develops a problem and substantially underachieves, your pituitary gland will respond by telling your thyroid to grow a lot larger than is good for you. In this case, one or more growths from your thyroid (called goiters) may get so big that they create a noticeable bulge in your neck. Further, they may put pressure on your nearby larynx, or voice box, causing your voice to sound hoarser. They could even make you have trouble swallowing.

Alternatively, a thyroid can develop smaller bumps, called nodules. Sometimes these nodules do no harm; but sometimes they’re indications of thyroid cancer (see Chap-ter 13). As nodules continue growing, they’re eventually visible as small bulges in the neck.

If you see or feel anything growing in your neck, see a doctor without delay. It’ll probably be very treatable; but the sooner you’re diagnosed, the better.

When in Doubt, Get Tested

If you’ve read through this chapter, you may now be feeling as if every ailment under the sun is caused by a faulty thyroid. Naturally, that’s not the case. For example, most people who have weight problems simply eat too much and exercise too little. And most people who are fatigued just aren’t giving their bodies enough rest and loving care.

But the chances are 10-20 percent of them really are suffering from thyroid disease. As explained in Chapter 1, thyroid disease has become an epidemic. Since thyroid blood tests are quick, easy, and relatively inexpensive, if you have a reasonable suspicion that your thyroid is malfunctioning, it’s wise to err on the side of caution and get yourself tested.

If you don’t have health insurance and are hesitant to see a doctor based on just a guess, you can perform preliminary blood tests yourself by drawing a blood sample at home and mailing it to a nationally certified lab. To find recommended companies that provide this service, visit this book’s website at CIGThyroid.com. After your lab results arrive—typically within two weeks—you can use Chapter 7 (for hypothyroidism) or Chapter 11 (for hyperthyroidism) to interpret them.

If the numbers indicate a thyroid problem, get yourself insured and then go see a doctor for formal testing, diagnosis, and possible treatment. Beyond thyroid testing, a good doctor will perform a thorough check to identify other problems that might be causing your symptoms instead of—or in addition to—any thyroid issues. For advice on finding and selecting a physician, see Chapter 4.

The Least You Need to Know

• Seemingly unrelated symptoms can all be caused by thyroid disease.
• Symptoms can involve your weight, energy, thinking, mood, sex drive, heart, hair, nails, skin, and more.
• If you have even one thyroid-related symptom, get tested.
• Ask your doctor to test your thyroid in addition to other tests, not instead of them.