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The Relationship Between Hypothyroidism and Your Reflexes

Are your reflexes slower than usual? It could be related to an underactive thyroid.
The Relationship Between Hypothyroidism and Your Reflexes
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Thyroid hormones regulate your metabolism, energy levels, and overall growth and development. When you’re hypothyroid, your underactive thyroid gland doesn’t produce enough thyroid hormones to support all your glands, organs, tissues, cells, and functions.

One often overlooked symptom of hypothyroidism is its impact on reflexes, those involuntary movements that occur due to a stimulus. Reflexes play a crucial role in maintaining your balance and coordination.

In this article, we’ll explore your reflexes and their connection to hypothyroidism.

What are reflexes?

Reflexes are involuntary and automatic responses to outside stimuli. They are quick and instinctive actions our body takes in response to a particular situation or stimulus, usually to protect us or maintain balance.

Reflexes are controlled by the spinal cord, and they do not require conscious thought or decision-making. They are designed to help us react quickly to potential dangers or threats.

Reflexes are essential to our body’s defense mechanism and help us navigate our environment safely. Examples of reflexes include the knee-jerk reflex, where the leg automatically kicks out when the knee is tapped, or the blinking reflex, where our eyes close automatically in response to a sudden bright light or object approaching.

Reflexes and hypothyroidism

Reflexes involve the rapid transmission of nerve impulses from sensory receptors to your spinal cord and then back to specific muscles, resulting in a swift response. In hypothyroidism, this process is disrupted, leading to slowed reflexes.

There are several reasons for slowed reflexes in hypothyroidism.

One of the main reasons for slowed reflexes in hypothyroidism is the reduced metabolic rate caused by the lack of thyroid hormones. Metabolism refers to the body’s ability to convert food into energy and regulate body temperature. Without enough thyroid hormones, the metabolic rate decreases, resulting in a slower overall functioning of bodily processes.

This decrease in metabolic rate also slows the speed at which nerve cells communicate with each other. Nerve cells rely on an electrical impulse called an action potential to transmit signals throughout the body. However, when the thyroid gland is underactive, and your metabolism is slowed, the generation and propagation of these action potentials are impaired.

Furthermore, the lack of thyroid hormones affects the myelin sheath, a protective covering around nerve fibers. In hypothyroidism, the myelin sheath may become damaged or deteriorate, impairing the efficiency of nerve signal transmission. This damage can lead to delayed reflexes and a decrease in overall coordination.

Finally, another factor contributing to slowed reflexes in hypothyroidism is the overall weakness and muscle stiffness often associated with an underactive thyroid. The decrease in thyroid hormones can lead to muscle wasting and decreased muscle tone, making it more challenging for muscles to respond promptly to reflex stimuli.

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Three types of reflexes

Deep tendon reflex

One common reflex affected by hypothyroidism is the deep tendon reflex, also known as the myotatic or stretch reflex. Deep tendon reflexes occur when a tendon is tapped or when a specific tendon is stretched, both of which cause the muscle to contract.

This reflex is commonly tested by tapping the patellar tendon, just below the kneecap, with a reflex hammer. The tap causes a brief stretch in the quadriceps muscle, resulting in an immediate contraction of the muscle fibers. This contraction causes the leg to kick forward, eliciting the reflex response.

The deep tendon reflex serves several vital functions within the body. First, it helps maintain muscle tone, ensuring muscles are in an optimal state of readiness for movement. Additionally, it helps regulate posture and balance by constantly adjusting muscle tension in response to changes in body position.

In hypothyroidism, deep tendon reflexes are frequently slowed down or even absent. In fact, according to research, the delayed relaxation of deep tendon reflexes, also known as Woltman’s sign, is seen in about 75% of patients with hypothyroidism, and the presence of Woltman’s sign is considered to be 92% predictive in diagnosing hypothyroidism.

For example, the following video shows the delayed relaxation of an ankle tendon.

Plantar reflex

Another reflex that may be affected by hypothyroidism is the plantar reflex, also known as the Babinski reflex. This reflex is tested by stroking the sole of the foot, which usually causes a downward flexing of the toes, known as a plantar response. However, this reflex may be abnormal in individuals with hypothyroidism, with the toes curling upwards or fanning out instead.

Hypothyroidism is not the only cause of an impaired plantar reflex. It can also indicate other neurological disorders, including stroke, multiple sclerosis, spinal cord injury, and brain tumor. It’s also important to note that an abnormal plantar reflex does not necessarily mean a person has a neurological disorder. It is just one piece of information that healthcare providers use to make a diagnosis.


While hypothyroidism is generally associated with slowed reflexes, there are some cases reported where fast, exaggerated reflexes – known as hyperreflexia – can occur. In fact, one study found that 38% of patients with hypothyroidism had generalized hyperreflexia.

The exact mechanism of hyperreflexia in hypothyroidism is not well understood, but it may be related to altered neurotransmitter function or changes in the excitability of the motor neurons.

Treating slowed reflexes

Slowed reflexes can be a frustrating symptom of hypothyroidism. If you are experiencing slowed reflexes due to hypothyroidism, there are several steps you can take to help manage and treat this symptom.

Consult with a healthcare professional: The first step in treating slowed reflexes due to hypothyroidism is to consult a healthcare professional. They will be able to evaluate your symptoms, conduct necessary tests, and provide you with a proper diagnosis. They can also prescribe appropriate medication to help regulate your thyroid hormone levels. As thyroid hormone levels return to normal, the functioning of the nervous system and reflexes frequently improve.

Take medication as prescribed: The primary way to resolve thyroid-related slowed reflexes is the treatment of hypothyroidism. Hypothyroidism is typically treated with thyroid hormone replacement medication. It is important to take this medication as prescribed by your healthcare professional. Regularly taking your medication can help restore your thyroid hormone levels to normal, which may improve your reflexes over time.

Engage in regular exercise: Regular exercise can help improve overall muscle strength and coordination, including reflexes. Engaging in yoga, tai chi, or Pilates can be particularly beneficial, as they focus on balance, flexibility, and body awareness. Please consult your healthcare professional before starting any new exercise regimen to ensure it is safe and suitable for your condition.

Manage your stress levels: Stress can worsen symptoms of hypothyroidism, including slowed reflexes. Practice stress management techniques such as deep breathing exercises and meditation, or engage in hobbies or activities you enjoy. Getting enough sleep and maintaining a healthy work-life balance can also help reduce stress levels.

Consider physical therapy: If your reflexes are severely affected and impacting your daily life, you may benefit from physical therapy. A physical therapist can provide exercises and techniques to help improve your reflexes, coordination, and overall mobility. They can also address any muscle weakness or imbalances contributing to your symptoms.

Regularly monitor your thyroid levels: It is essential to regularly monitor your thyroid hormone levels through blood tests. This will allow your healthcare professional to adjust your medication dosage if necessary. Keeping your thyroid hormone levels within the optimal range can help alleviate symptoms, including slowed reflexes.

Remember, everyone’s experience with hypothyroidism is different, and what works for one person may not work for another. It is essential to work closely with your healthcare professional to develop a personalized treatment plan that addresses your specific symptoms and needs. With proper management and treatment, you can improve your reflexes and regain control over your daily life.

A note from Paloma

If you suspect you may – or know that you – have hypothyroidism and are experiencing changes in your reflexes, it is important to consult with your Paloma team or other healthcare professional with expertise in hypothyroidism. They can perform a thorough evaluation and recommend the necessary thyroid function testing to determine your thyroid hormone levels. You can also get Paloma’s Complete Thyroid Home Test Kit to easily test your thyroid levels from the comfort of your home.

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Cyriac S, d’Souza SC, Lunawat D, Shivananda P, Swaminathan M. A classic sign of hypothyroidism: a video demonstration. CMAJ. 2008 Aug 12;179(4):387. doi: 10.1503/cmaj.070318. PMID: 18695193; PMCID: PMC2492977.

Duyff R, Van den Bosch J, Laman D, van Loon BJ . P, Linssen W. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Journal of Neurology, Neurosurgery, and Psychiatry. 2000;68(6):750-755. doi:

Delayed relaxation of ankle jerk- Hypothyroidism (Pseudomyotonic reflex) video. Accessed September 11, 2023.

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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