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Hypothyroidism Symptoms: One Size Does NOT Fit All

Mary Shomon shares why to listen to your body for signs & symptoms of hypothyroidism.
Hypothyroidism Symptoms: One Size Does NOT Fit All

Mary Shomon

Patient Advocate

Many of us know that hypothyroidism – an underactive thyroid – is associated with symptoms like fatigue and weight gain.  And, given that hypothyroidism slows down the body's processes, other symptoms like constipation, brain fog, or low body temperature make sense.


But, as with all things thyroid, one size never fits all! There are some unusual, unexpected, and lesser-known symptoms of an underactive thyroid that might surprise you - the signs and symptoms you and your doctor might miss that could point to a hypothyroidism diagnosis or less than optimal treatment.


I'll start with my own experience.

A few weeks after I was diagnosed and started hypothyroidism treatment, I began having a maddening tic in my left eye. It pulsed and jumped like it was keeping beat to the music, and worst of it, it continued for days. It was distracting, and nothing I tried – eye drops, cold compresses, meditation – stopped it. Around that time, I had some thyroid lab work scheduled. The doctor reported that I needed an increased dosage of my thyroid medication. Within a day after starting on the new dosage, I had a surprise: the tic disappeared! I didn't put it all together until a few months later when it reappeared – but this time, the tic came with some fatigue and a few extra pounds.


This time, I got myself back in right away for thyroid tests, and sure enough, I needed another bump in my dosage. Again, within a day, the tic stopped. Now, when the tic periodically returns, it's my sign to get retested, and every single time, it's been a reliable indicator that my thyroid levels are off. So, while an eye tic is not a textbook hypothyroidism symptom, it is an obvious symptom – for me.


In several decades of coaching thyroid patients, I've heard many other unusual hypothyroidism symptoms unique to individual patients, including nasal congestion, rib pain, more frequent migraines, and scalp sensitivity. In every case, when dosages were adjusted to provide more optimal hypothyroidism treatment, the symptoms disappeared, time and time again!


So, here's my take-home message: while you can't jump to conclusions about every ache, sniffle, or tic, you should keep track of any unusual signs or symptoms that you may experience. Pay attention to whether they correlate with periods of undertreatment for your hypothyroidism and thyroid test levels. Over time, you may discover that your weird finger twitch is a sign that your thyroid needs an adjustment!


There are also some unexpected signs and symptoms that can be linked to hypothyroidism but are not especially well-known to patients or even some doctors. 


These unexpected signs and symptoms may include:

  • Tendency to build up excessive earwax
  • Chronic sinus symptoms and sinus headaches
  • Low milk supply when breastfeeding
  • Puffiness around your eyes
  • Excessive snoring 
  • Breathlessness, a feeling of air hunger, or asthmatic-like symptoms
  • Frequent ovarian cysts
  • Extreme dry eye syndrome
  • Swelling in the legs or feet
  • Extra heavy and long menstrual periods, and worsening PMS symptoms
  • Unusual rashes
  • Rough and calloused elbows, knees and feet
  • Feeling like you have something stuck in your throat


And, do you want to hear a truly offbeat hypothyroidism symptom? How about an aversion to wearing scarves, turtlenecks, ties, or necklaces? It's more common than you'd think!


Finally, there's a small subset of hypothyroid patients I call the "upside-downers." Instead of characteristic "slowdown" symptoms of hypothyroidism, these patients have opposite signs and symptoms that are typically associated with an overactive thyroid and a sped-up metabolism. 


For example, instead of the fatigue, slow heart rate, and low blood pressure, they have insomnia, a rapid heart rate, and high blood pressure, and it frequently worsens as they become more hypothyroid.


Hypothyroidism may cause symptoms of depression, whereas anxiety is associated with hyperthyroidism. Still, upside-downers can experience anxiety – and even episodes of panic attacks, or a diagnosis of panic disorder – as the thyroid becomes less active.


And while weight gain and difficulty losing weight are among the best-known hypothyroidism symptoms, upside-downers may actually lose weight rapidly when they're hypothyroid, even without changes to diet or exercise.


Getting hypothyroidism diagnosed and treated correctly can be challenging even when you have the most common hypothyroidism symptoms.  If your hypothyroidism symptoms don't fit the classic picture taught in medical school, it's a safe bet that you'll find it even more difficult. One solution that I recommend is to work with a Paloma Health practitioner.


Paloma Health's experts have experience listening to and treating thousands of patients with hypothyroidism. That means, they can pinpoint a wide range of signs and symptoms of an underactive thyroid, and quickly move on to the business of helping you live and feel well with hypothyroidism.


A note from Paloma Health

In medicine, an accurate diagnosis is critical to determine the most effective course of treatment. Hypothyroid symptoms are often nonspecific and could indicate several different causes. You can start with a blood test to better understand your thyroid function and the appropriate next steps.


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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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