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Hypothyroidism Signs and Symptoms

Take a detailed look at the many signs and symptoms of an underactive thyroid.
Hypothyroidism Signs and Symptoms
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You may be aware of the common symptoms of hypothyroidism like fatigue, weight gain, and brain fog. But a lack of thyroid hormones can affect almost every organ and gland, and cause symptoms from head (hair loss) to toes (joint aches)! But there are many other symptoms experienced by people with an underactive thyroid, and some of them may surprise you! In this article, you’ll find a detailed summary of common – and unusual – symptoms that may indicate that you’re hypothyroid.

Symptoms you may experience

Energy and Sleep Problems

Fatigue is one of the most common complaints in hypothyroid patients. But your fatigue may be a daily occurrence, unlike occasional fatigue after a bad night’s sleep. You may feel weak, rundown, sluggish, and lethargic, and like you never get enough sleep. You may accidentally oversleep, find it difficult to wake up, and when you do, feel unrefreshed. You may need a nap to get through the day. And don’t be surprised if you find yourself drinking too much coffee or other caffeinated beverages in order to have enough energy to get through the day!

Sleep problems are also prevalent. You may find it difficult to fall asleep or stay asleep. You may also wake up in the middle of the night, and then have a hard time falling back asleep. In some cases, you may wake up too early, and find it difficult or impossible to go back to sleep. Narcolepsy is also more common in hypothyroidism.

Another characteristic symptom is snoring, or even a diagnosis of sleep apnea, which can cause you to wake up feeling like you’re choking.

It’s also common to see restless leg syndrome interfering with sleep in people with hypothyroidism.

Weight Challenges

As mentioned, weight gain – even though you haven’t changed your diet and exercise – is a common hypothyroidism symptom. But you may also find it difficult or impossible to lose weight, even with a rigorous and supervised diet and exercise program. (You may even have some doctors or weight loss program leaders accuse you of “not following the program!”)

Also, if you’ve just had a baby, it’s normal for a new mother to take time to lose the baby weight. But if you are finding it incredibly difficult to shed even a few pounds after childbirth, you may have a postpartum thyroid problem.

Brain Fog, Thinking, and Cognition Problems

Brain fog is a very common complaint in people with hypothyroidism. You may find it difficult to focus, concentrate, or make decisions. Your thinking may seem disorganized, and you may occasionally feel confused. You may even find it difficult to read or do numerical calculations. It’s common to have memory problems or forget things, and you may notice that your mind “goes blank” more often. Some thyroid patients have even reported driving their cars and forgetting the route they drive regularly.

Neurological Symptoms

If you’ve ever had an internal sensation like a cell phone vibrating inside you, you may be experiencing “body buzzing” – a symptom that is common in thyroid patients. It can feel like as “inner trembling,” “inner tremors,” or vibrations inside your body.

Neuropathy – numbness and tingling in the hands and/or feet – is also common.

Some people with hypothyroidism experience vertigo, a feeling of dizziness and loss of balance.

Throat, Neck, Mouth, and Vocal Symptoms

With Hashimoto’s and hypothyroidism, it’s fairly common to have a goiter – an enlarged thyroid. You may be able to feel – or even see – a lump in your neck. You may also notice enlarged or tender lymph nodes in your neck. In some cases, you may observe that your neck looks slightly enlarged or fuller. People with hypothyroidism sometimes find neckties, turtlenecks, necklaces, and scarves uncomfortable. You may feel like you have trouble swallowing, and even feel like you’re choking when swallowing food. You may also have a sensation like something is stuck in your throat. Occasionally, you may notice pain, tenderness, or stiffness in your neck.

When you have low thyroid hormone levels, it’s common for your tongue to feel thicker than normal. You may even notice that the edges of your tongue have become “scalloped,” due to pressure against your teeth.

When you’re hypothyroid, you may experience changes to your voice. It can sound more hoarse and husky, or more gravelly than normal.

Bloating and Fluid Retention

Bloating is often experienced in hypothyroidism, especially ascites, an accumulation of fluid in the abdominal area. You may have abdominal discomfort and distention, or notice weight gain in the abdominal area (aka “belly fat.”) Fluid retention can also affect other areas, including the face, eyelids, hands, ankles, and feet.

Cold Intolerance and Low Body Temperature

Feeling cold when the temperature is warm – or when others are hot – is characteristic of hypothyroidism. In some cases, the hands and/or feet are especially affected throughout the year, regardless of the temperature. You may also feel especially intolerant of cold temperatures.

Some people with hypothyroidism have an unusually low basal body temperature – your first temperature upon waking – that runs lower than 97.8 to 98.2 degrees Fahrenheit.


The thyroid gland produces hormones that provide energy, and when we don’t have enough energy, everything can slow down. You may notice this slowness in several ways:

  • Your movements may be slower than normal for you
  • Your speech may be slower
  • Your thinking and decision making may be slower

Cardiovascular Issues

The heart is especially sensitive to low levels of thyroid hormone, and you may notice a number of heart-related signs and symptoms. These include:

  • An unusually slow pulse rate or slow heart rate. (You may even be told "you have the heart rate of a marathon runner!")  
  • Unusually low or high blood pressure
  • Heart palpitations, flutters, skipped beats, strange patterns or rhythms
  • Elevated cholesterol levels

Gastrointestinal and Digestive Issues

People with hypothyroidism often have a variety of other gastrointestinal and digestive problems and related symptoms. These include:

Nasal Issues and Breathing Problems

Some people with hypothyroidism report asthma-like symptoms, including periodic shortness of breath, tightness in the chest, and a feeling known as air hunger. You may find yourself frequently yawning as a way to get a full breath.

Snoring and sleep apnea can also be associated with hypothyroidism.

Hearing and Ear Symptoms

Problems with hearing are a little-known symptom of hypothyroidism. These problems include tinnitus (ringing or roaring in the ears) and sudden hearing loss. People with hypothyroidism also report a tendency to build up excessive earwax, which can cause pain, temporary hearing impairment, and ear infections.

Muscle and Joint Issues

Hypothyroidism is known to affect muscles and joints. Muscle aches and muscle cramps are common. You may notice that your arms, shoulders, and/or legs feel especially weak. You may even experience episodes of hypothyroid myopathy -- extreme muscle weakness that makes it difficult to walk or raise your arms over your head. In addition to muscle pain, it’s also common to have pains, aches, and stiffness in various joints.

Several conditions are also more common in hypothyroidism, including:

  • Carpal-tunnel syndrome, which causes pain and weakness in the fingers, wrist, and forearms
  • Tarsal-tunnel syndrome, which causes pain and weakness in the toes, feet, ankles, and shins
  • Foot pain, especially plantar's fasciitis, which causes pain in the balls of the feet

Skin and Face Problems

Changes in the skin and face are common. You may notice that your mucous membranes in the mouth and eyes are especially dry and sensitive. It’s also common to have puffiness and swelling around your eyes and eyelids. Skin in general may become dry, itchy, and scaly.

It’s also more common in hypothyroidism and Hashimoto’s to have more frequent episodes of hives or angioedema (swelling under the skin).

Hand and Nail Issues

Some people notice hypothyroidism symptoms in their hands and nails. You nails may become dry, brittle, and break more easily. Fingernails may also develop noticeable ridges.

It’s also common for hands to be puffy or swollen, and you may notice pain in your finger joints.

It’s also common to experience neuropathy, numbness or “pins and needles” sensations in your hands and fingers.

Hair Changes

Hair is one of the places where hypothyroidism symptoms can be very visible. One of the most telltale signs of hypothyroidism is loss of hair from the outer edge of the eyebrows.

You may also notice that your hair is falling out more than usual. This can affect not just hair on your head, but body hair as well. Dry hair is a common symptom, and hair texture can also change, becoming rougher and coarser. Brittle hair is a common complaint of hypothyroidism. You may notice that your hair breaks more easily.

An interesting but little-known sign: Patients with autoimmune Hashimoto’s are also more likely to develop prematurely grey hair.

Legs, Feet, and Toe Problems

Hypothyroidism can affect your legs, feet and toes in several ways.  You may notice that your toes are puffy or swollen, and you may have pain in the toe joints. Feet can also become swollen.

Two characteristic conditions that are more common with hypothyroidism are tarsal tunnel syndrome, which can cause pain and weakness in the toes, feet, ankles, and lower legs, and plantar's fasciitis, which can cause pain in the balls of the feet.

Vision and Eye Issues

Problems with your eyes are often reported in hypothyroid patients. Most common is dry eyes, with sensitivity, a gritty feeling, and blurry vision. You may notice that your eyes are tearing and watering frequently. Your upper and lower eyelids can appear irritated and puffy.

One unusual symptom reported by some hypothyroid patients is an increase in tics and twitches in the eyes and eyelids.

Depression and Anxiety

Changes in your mood are very common in hypothyroidism. You may notice that your moods change easily, and you may find yourself experiencing periods of depression, anxiety, or both.

One characteristic sign of hypothyroidism is treatment-resistant depression and anxiety. If you’re taking a antidepressant for your condition and it’s not working, this could be related to hypothyroidism.

Menstrual Issues

Hypothyroidism can have a dramatic effect on the menstrual cycle and symptoms. You may have the complete cessation of menstrual periods (but you’re not in menopause.) You may also notice that irregular periods, or periods that come less frequently.

It's common for women with hypothyroidism to experience unusually heavy periods, and they may also be longer than normal. You may also notice that premenstrual syndrome (PMS) seems to have gotten worse.

Sexual Dysfunction

A low or nonexistent sex drive is a common complaint when you have an underactive thyroid gland. 

Women describe difficulty getting enough lubrication, and men have higher rates of erectile dysfunction, in some cases due to low testosterone levels associated with hypothyroidism.

Both men and women also complain of more difficulty reaching orgasm.

Fertility Challenges

Healthy thyroid function is essential to fertility and conception. Hypothyroid patients report fertility challenges and difficulty getting pregnant. A history of one or more miscarriages is also common. If you track fertility signs, or use an ovulation predictor, you may also detect signs that you are not ovulating.

Some women who have failed assisted reproduction treatments – including in vitro fertilization (IVF) and donor eggs – have discovered that their hypothyroidism was a factor in the failed treatment.

Symptoms During and After Pregnancy

Pregnancy and the postpartum period also common times for hypothyroidism and Hashimoto’s to show up in women. It can be confusing, however, because the symptoms are also seen in pregnant and postpartum women who don’t have a thyroid condition.

You may discover you’re hypothyroid during pregnancy if you have excessive weight during pregnancy, or extreme fatigue during pregnancy.

Postpartum hypothyroidism symptoms can include:

  • Low milk supply, and difficulty breastfeeding
  • Extreme and abnormal fatigue
  • Difficulty losing the baby weight
  • Depression and mood swings
  • Loss of large amounts of hair
  • Brain fog and difficulty concentrating

Other Symptoms

Some other signs and symptoms that don’t fit the above categories include the following:

  • People with hypothyroidism often report more headaches and migraine attacks associated with their condition.
  • Exercise intolerance – where you feel wiped out longer than normal after a workout or physical activity
  • Worsening allergies – including seasonal allergies and food allergies
  • If your breasts are leaking milk, but you are not currently lactating or breastfeeding, this can be a sign of hypothyroidism
  • You may experience changes in your sense of smell and taste. In particular, some people with hypothyroidism report phantosmia (where you experience phantom smells, like cigarette smoke)

Eating and Drinking Habits

Several eating and drinking habits can contribute to your risk of hypothyroidism. These include:

  • Overconsumption of soy products
  • Overconsumption of raw goitrogenic vegetables (like spinach, kale, and broccoli)
  • Daily raw juicing of raw goitrogenic vegetables
  • Elimination of salt from the diet – especially iodized salt

It’s also notable that some hypothyroid patients report salt cravings.

Family and Personal History

Hypothyroidism is more common if you have a personal or family history of other thyroid problems. Similarly, your risk of developing Hashimoto’s thyroiditis – the most common cause of an underactive thyroid in the U.S. – is also higher if you have a medical history of any autoimmune disease, personally, or in your family.

While thyroid problems can trigger obesity, there’s also evidence that obesity is a risk factor for hypothyroidism and Hashimoto’s.

Your risks are also higher if you have another condition associated with Hashimoto's or hypothyroidism, including:

Finally, hypothyroidism is more common in people who:

A note from Paloma

If you have signs and symptoms of hypothyroidism, your next step is a complete panel of thyroid blood tests to evaluate your Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPOAb). Paloma makes this easy, with the Paloma Complete Home Thyroid Test Kit. The simple finger-prick test can be done at home and takes just a few minutes. Within a week, you’ll get comprehensive results from our CLIA-certified lab, securely delivered to you electronically.

With test results in hand, you can work with Paloma’s thyroid-savvy team of healthcare providers to have a convenient virtual consultation. If you’re diagnosed with hypothyroidism, you’ll get comprehensive and life-changing hypothyroidism care that optimizes your health and quality of life!

A free resource!

Don’t forget that you can download a printable PDF checklist to accompany this article here.

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Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017 Sep 23;390(10101):1550-1562. doi: 10.1016/S0140-6736(17)30703-1. Epub 2017 Mar 20. PMID: 28336049; PMCID: PMC6619426.

Mayo Clinic. Hypothyroidism (underactive thyroid). Mayo Clinic. Published 2020.

American Thyroid Association. Hypothyroidism | American Thyroid Association. Published 2016.

National Institute of Diabetes and Digestive and Kidney Diseases. Hypothyroidism (Underactive Thyroid) | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published July 7, 2019.

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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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