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Your thyroid produces thyroid hormones – T4 and T3 – that help regulate your body’s metabolism. Every cell in your body needs sufficient levels of thyroid hormone to function correctly. A lack of thyroid hormones, the characteristic marker of hypothyroidism, causes your bodily processes to slow down and change. This results in the symptoms of hypothyroidism.

Often, fatigue and weight gain steal the spotlight when it comes to hypothyroidism symptoms. But there are many other symptoms, and some may even surprise you.

Understanding these lesser-known symptoms is essential to recognizing and managing hypothyroidism effectively. Let’s take a look at 12 surprising and lesser-known symptoms of hypothyroidism.

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The Journal of Headache and Pain found a high prevalence of hypothyroidism in people who experience migraine headaches. Conversely, around 30% of people with an underactive thyroid experience headaches. A recent study echoed these results, showing that the incidence of migraine is higher among those with a thyroid disorder, especially in people with mild (subclinical) hypothyroidism.

It remains unclear whether a sluggish thyroid is the cause of headaches, though it’s a reasonable assumption since the brain relies on thyroid hormone for optimal functioning and overall health. It is also believed that the hormonal imbalances caused by hypothyroidism can trigger changes in brain chemistry that may lead to headaches.

Thyroid hormones also support the development and functioning of brain cells and the production of neurotransmitters, which are essential for communication between nerve cells.

Additionally, fatigue, a common symptom of hypothyroidism, is often associated with migraines and may play a role in triggering migraine headaches.

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When your thyroid levels are too low, your ability to think clearly and remember things can be impaired. Some people refer to this symptom as “brain fog.” People with hypothyroidism often report memory changes and brain fog, and it is not only frustrating, but it can impact daily activities, work performance, and overall quality of life. Apart from the brain fog, hypothyroidism can affect other cognitive functions, such as:

• Attention and concentration
• Perceptual function (how your brain translates sensory information and acts upon it)
• Language (how you speak or understand what others are saying)
• Psychomotor functions (how well your brain controls your movement and coordination)
• Executive tasks like organizing, prioritizing, or working memory

The degree of memory changes varies from person to person. Those with a mild drop in their thyroid hormone levels may not notice a significant change in their memory or cognitive function. However, those with deficient thyroid hormone levels may have a more noticeable change.

The connection between an underactive thyroid and mood swings is primarily due to the impact that thyroid hormones have on the brain. Thyroid hormones play a crucial role in regulating the neurotransmitter hormones responsible for mood regulation. When this process is compromised, it often results in mood changes, such as feelings of sadness, anxiety, and irritability.

Your thyroid is also affected by those neurotransmitter hormones, including serotonin, dopamine, and somatostatin. These neurotransmitters work in your central nervous system, affecting your mood regulation and thyroid levels. For example, a 2022 study found that somatostatin levels were lower in people with depression. Low somatostatin can trigger elevated thyroid stimulating hormone (TSH) levels, and high TSH levels reduce thyroid hormone production and cause hypothyroidism.

Overt hypothyroidism and depression also have similar symptoms, including slowed thought, speech, and movement, fatigue, decreased attentiveness, or lack of motivation. These similarities sometimes lead to a missed diagnosis or incorrect diagnosis of clinical depression.

As mentioned, low thyroid hormone causes your body functions to slow down, and your digestive system is no exception. One of the main reasons for digestive issues in individuals with hypothyroidism is the impact of low thyroid hormones on metabolism. Hypothyroidism can slow digestion and digestive processes, leading to constipation, feelings of bloating, ascites, and abdominal discomfort.

Too little thyroid hormone slows gastric motility, which is the processing of moving food through the digestive tract. This delay in food transit can cause the food to sit in your GI tract for an extended time, leading to constipation. In more severe cases of slowed gastric motility, an overgrowth of bacteria can occur. This can result in small intestinal bacterial overgrowth (SIBO), causing additional GI discomfort, nutrient deficiencies, and diarrhea. SIBO is considered a fairly common related condition in people with hypothyroidism.

Undiagnosed or undertreated hypothyroidism can slow metabolism, which can lead to heartburn. When thyroid levels are low, it can prevent the lower esophageal sphincter (LES) from doing its job: stopping stomach contents from going back into your esophagus. In some patients with hypothyroidism, the LES doesn’t function properly; stomach contents, including stomach acid, can flow back up into the esophagus. This causes symptoms of heartburn, including a burning and sometimes painful sensation in your chest. You may also notice a bitter or acidic taste in your mouth or even have trouble swallowing.

You may find heartburn comes and goes. And severity can differ depending on the foods you eat. For example, spicy foods are common heartburn triggers. But, constant heartburn may also be a sign of gastroesophageal reflux disease (GERD), which requires a visit to your provider.

Hypothyroidism can also lead to a condition called gastroparesis, where the stomach takes longer than expected to empty its contents. This delay in stomach emptying can increase the likelihood of acid reflux and heartburn.

Additionally, hypothyroidism can cause a decrease in saliva production, which plays a role in neutralizing stomach acid. Without enough saliva to protect the esophagus, acid reflux is more likely to occur, leading to heartburn.

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Dry skin is a common symptom experienced by individuals with hypothyroidism. It is characterized by rough, scaly, and flaky skin that may feel tight and itchy. This condition typically affects the face, hands, arms, and legs. Dry skin caused by hypothyroidism is often resistant to moisturizers and may persist even with proper skincare routines.

Skin cell turn occurs when new process where new cells replace old. This constant process takes 40 to 56 days. Since body processes slow down in those with undiagnosed hypothyroidism, the time it takes for the skin cells to turnover increases. Hypothyroidism can also affect the skin’s ability to retain moisture. Because of this, old cells stay on your skin longer, resulting in dry, rough, itchy, and scaly skin.

Another reason hypothyroidism leads to dry skin is the reduced sebum production. Sebum is an oily substance produced by the sebaceous glands to lubricate and protect the skin and help it stay hydrated and supple. Inadequate hormone levels hinder normal sebum production, resulting in dryness and a compromised skin barrier.

Hypothyroidism can also affect the skin’s ability to retain moisture. The natural moisture barrier, which helps seal in hydration, becomes weakened, leading to increased water loss from the skin. This further worsens the dryness, making it difficult for the skin to stay hydrated.

In addition to dry skin, hypothyroidism can also cause other skin issues, such as brittle nails, hair loss, and a pale complexion. These symptoms often indicate an underlying thyroid imbalance and should not be ignored.

The inability to tolerate cold temperatures is another classic sign of hypothyroidism.

The hypothalamus in the brain acts as a thermostat by directing the thyroid gland to increase or decrease your body’s metabolism. As cells work, they generate heat, which regulates body temperature.

When thyroid hormone levels are low, as in hypothyroidism, the body’s metabolism slows down. This can result in a decreased ability to generate heat, a process known as thermogenesis. When you’re hypothyroid, you can feel cold even in normal or warmer temperatures, and you may have a lower tolerance for colder temperatures. You may notice that your hands and feet are frequently cold, you shiver even when bundled up, or you’re still feeling chilled when others feel warm.

In some cases, cold intolerance may be one of the first symptoms of hypothyroidism, along with fatigue, weight gain, and dry skin.

One lesser-known symptom of an underactive thyroid gland is menstrual irregularities. The thyroid gland plays a crucial role in regulating the body’s metabolism, including the hormones involved in the menstrual cycle. When the thyroid is not functioning properly, it can affect the production of hormones such as estrogen and progesterone, essential for regular menstrual periods. 

An underactive thyroid can disrupt the menstrual cycle and lead to a wide range of menstrual irregularities, including irregular periods, heavy, prolonged bleeding, infrequent periods, or even amenorrhea (a total absence of periods).

Roughly 80% of women with hypothyroidism have some menstrual irregularity during their childbearing years.

While heavy menstrual bleeding is common, absent or infrequent menstruation is commonly reported in those with an underactive thyroid. This may occur due to a possible increase in thyrotropin-releasing hormone (TRH).

The hypothalamus releases TRH. TRH triggers the release of thyroid-stimulating hormone (TSH) and prolactin from the pituitary gland. Too much prolactin, often referred to as the “milk hormone,” can interfere with estrogen production, resulting in

• Infrequent or absent periods
• Unwanted milk production and leaky breasts, known as galactorrhea
• Symptoms of menopause

Of course, while undiagnosed or undertreated hypothyroidism is one potential cause of menstrual irregularities, there are other possible diagnoses. You should consult with your care team if you have menstrual irregularities.

As discussed earlier, poorly treated or untreated hypothyroidism can lead to irregular menstrual cycles, as well as ovulation problems and problems with the uterus that can make it difficult to conceive. Thyroid hormones also play a crucial role in the development and maturation of the egg. The health of the uterine lining can be affected, and it is essential for the implantation of a fertilized egg and a successful pregnancy.

Specifically, the lack of thyroid hormone characteristic of hypothyroidism can change the levels of your reproductive hormones, especially estrogen and androgens. These shifts in estrogen and androgen levels can affect your TSH levels. As a result, it may be more difficult for some people to get pregnant.

Furthermore, these hormonal shifts can result in irregular ovulation. Irregular ovulation may make it harder to get pregnant. Based on a 2023 study, higher TSH levels during childbearing years are linked to poor ovarian (egg) reserves, a known factor in fertility challenges.

In men, hypothyroidism can lead to decreased libido, erectile dysfunction, and sperm abnormalities. Thyroid hormones are essential for the production of testosterone and sperm, so any imbalance can negatively impact male fertility. In men, low thyroid hormone levels can also alter sperm number, motility, and shape. These changes can make it harder for sperm to reach the egg, increasing the risk of thyroid-related infertility.

Muscle aches and weakness -- known as hypothyroid myopathy -- are common symptoms associated with hypothyroidism.

The connection between muscle issues and hypothyroidism is due to the impact of low thyroid hormone levels on muscle function. Thyroid hormone helps regulate the metabolism of muscle cells, including the production of energy needed for proper muscle contractions. During a muscle contraction, muscles tighten, shorten, or lengthen to help you complete an activity such as walking or typing. Low thyroid hormone levels limit the strength and how often your muscles contract. The result is weak, stiff, and achy muscles.

Additionally, low thyroid hormone levels can also affect the muscle tissues directly. Lack of proper hormone levels can disrupt the balance of electrolytes such as calcium and magnesium, essential for maintaining muscle health. This imbalance can lead to muscle pain, cramps, spasms, overall weakness, body aches, and joint pain.

Hypothyroidism can also contribute to the accumulation of fluid in the tissues, a condition known as edema. This fluid retention can affect the muscles, leading to swelling, stiffness, and overall discomfort.

In addition, hypothyroidism can also lead to an increase in muscle inflammation, which can cause muscle aches and pain. This inflammation can result from the immune system attacking the thyroid gland, leading to a condition known as Hashimoto’s thyroiditis, which is the most common cause of hypothyroidism.

Finally, in some cases, muscle weakness in people with hypothyroidism can develop into a condition called Hoffman’s syndrome, which involves weakness, spasms, and twitching in the muscles of your extremities.

Did you know you shed up to 150 hairs per day? However, new growth usually replaces them immediately, so you generally don’t notice.

Thyroid hormones play a crucial role in regulating the body’s metabolism and energy production, including the growth of hair follicles. When thyroid hormone levels are low, as in the case of hypothyroidism, the hair growth cycle can be disrupted.

One of the ways hypothyroidism affects the hair growth cycle is by prolonging the resting phase of the cycle, known as telogen. This means that hair remains in the resting phase for extended periods, leading to delayed shedding and the appearance of thinner hair.

In addition, hypothyroidism can also lead to a decrease in the production of new hair follicles, as thyroid hormones are essential for the growth and regeneration of hair. This can result in overall hair thinning and less volume over time.

Furthermore, hypothyroidism can also have an impact on the overall health of the hair. Coarse, dry, and brittle hair is more prone to breakage and damage, which contributes to the appearance of thinning hair and overall hair loss.

The hair on your head is not the only hair affected by low thyroid hormone levels. You may notice hair loss on your eyebrows. Eyebrow hair loss on the outer edges is typically a characteristic sign of hypothyroidism.

Because the hair growing and shedding cycle can slow down, it may be three to four months after the onset of hypothyroidism before you start noticing thyroid-related hair loss. Similarly, it can take several months of thyroid hormone replacement medication before hair loss slows down and regrowth begins.

One of the most common symptoms of hypothyroidism is goiter, which is an enlargement of the thyroid gland. This swelling can cause a visible bulge in the neck. Goiter is also frequently associated with other throat-related symptoms, including: 

• Difficulty swallowing: Enlargement of the thyroid gland can put pressure on the esophagus, leading to problems swallowing or a sensation of a lump in the throat. This symptom can be particularly bothersome for individuals with severe cases of hypothyroidism.
• Hoarseness: Changes in the voice, such as hoarseness or a deepening of the voice, can occur due to the inflammation of the vocal cords caused by the thyroid hormone imbalance.
• Neck discomfort: Pressure or a feeling of tightness in the throat area (like wearing a tight turtleneck or collar) 
• Sore throat: Some individuals with hypothyroidism may experience a persistent sore throat or discomfort in the throat area. This can be due to the swelling of the thyroid gland or the dryness of the throat caused by the condition.

You can perform a simple at-home neck check to help with early detection. A self-exam can help you find lumps or enlargements that may indicate a thyroid condition.

The good news is that by understanding and addressing the symptoms of hypothyroidism, you can experience significant improvements in your overall well-being. Optimal thyroid treatment, including medication, lifestyle changes, and regular monitoring, can alleviate or completely resolve these symptoms, leading to a better quality of life.

The first step, though, is evaluating how well your thyroid functions. You can do this using Paloma Health’s at-home testing kit. The convenient and affordable Paloma blood test kit measures the most common thyroid biomarkers – TSH, T4, and T3 – needed to diagnose a thyroid condition. The basic panel also includes Thyroid Peroxidase (TPO) antibodies, to diagnose autoimmune Hashimoto’s thyroiditis, and you have the option of adding on Reverse T3 and Vitamin D testing. Your results will determine if there is a likelihood of thyroid dysfunction and whether you need further evaluation by a thyroid specialist.

If you need to work with a knowledgeable healthcare provider for your hypothyroidism care, consider becoming a Paloma member. Paloma Health specializes in providing comprehensive thyroid care, offering personalized treatment plans tailored to your needs. Paloma’s team of experts is dedicated to helping you achieve optimal thyroid function, utilizing advanced diagnostic tools and evidence-based treatments. With Paloma Health, you can take control of your thyroid health and look forward to a future with fewer symptoms and greater vitality.