The thyroid is a small, butterfly-shaped gland located at the base of the neck responsible for regulating the body's metabolism. Hypothyroidism (or underactive thyroid) is a condition in which your thyroid gland doesn't produce enough thyroid hormones.
When your thyroid hormone production drops, your body processes slow down and change, affecting virtually every system in your body. Hypothyroidism may not cause noticeable symptoms in the early stages. Still, over time, undiagnosed and untreated thyroid disease puts patients at risk for other ailments, such as cardiovascular diseases, osteoporosis, and infertility.
If you're worried about your symptoms, take an at-home thyroid function test to understand how your thyroid functions. Many labs only look at thyroid-stimulating hormone (TSH). Still, it's also critical to measure free triiodothyronine (fT3), free thyroxine (fT4), and TPO antibodies. These four markers help you understand the big picture of what's happening with your thyroid function and where specifically to make improvements.
Should your results show that your thyroid is underactive, it is typically treatable with thyroid hormone replacement medication. Thyroid medication is a safe and effective form of treatment once you and your health care provider find the proper thyroid medication and dose. Remember, when choosing thyroid medication with your doctor, there is no one-size-fits-all treatment.
You can still live well with hypothyroidism. Beyond taking thyroid hormones, you can support your thyroid with nutrition and self-care. Consider your diet, sleep, stress management, and how you connect with loved ones. Work with a trustworthy health care team who can assess your symptoms, history, and lab results to determine the best treatment plan for you.
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Mary Shomon shares why to listen to your body for signs & symptoms of hypothyroidism.
Hypothyroidism most often impacts women in their middle age and older. Still, anyone can develop hypothyroidism, including babies.
Congenital hypothyroidism is a partial or complete loss of function of the thyroid gland that affects infants from birth (congenital).
Congenital hypothyroidism is most often caused by the baby not getting enough iodine (essential for thyroid hormone production) while in the womb. Another cause of congenital hypothyroidism is thyroid gland damage or malformation.
Causes of damage to the thyroid gland in babies:
Infants with congenital hypothyroidism may only have a few signs and symptoms right after birth. Because the mother's thyroid hormone still circulates in the infant's system right after birth, there often is a delay before symptoms are present.
It's routine practice in hospitals to take a small blood sample from the baby's heel to assess thyroid function by measuring thyroid-stimulating hormone (TSH) and thyroxine (T4). Generally, states require these screening tests for each newborn.
When hypothyroidism in infants isn't treated, even mild cases can lead to severe physical and intellectual disabilities.
Children and teenagers who develop hypothyroidism generally have the same signs and symptoms as adults. Still, they may also experience:
Normal thyroid biomarker ranges are different for those under 18 years, and Paloma Health doesn't currently have the pediatric testing capability. We recommend anyone under 18 be assessed by a pediatric endocrinologist.
Women are five to eight times more likely to experience thyroid dysfunction than men. Still, anyone can develop hypothyroidism. The symptoms, diagnosis, and treatment of hypothyroidism are the same in men and women. Because this condition is more common in women than in men, thyroid disease in men tends to get overlooked. Symptoms of hypothyroidism that are specific to men can include erectile dysfunction or low sperm count. If you notice multiple symptoms of an underactive thyroid, be sure to talk to your thyroid doctor to get to the root.
You're at an increased risk for hypothyroidism if you:
An under-functioning thyroid gland makes insufficient thyroid hormone, affecting virtually every organ in the body, including the heart. Thyroid dysfunction can worsen existing cardiac symptoms or contribute to new ones. It's known that hypothyroidism has adverse effects on blood pressure, endothelial function, and lipid levels.
Hypothyroidism can cause a type of edema called myxedema, swelling of the skin and underlying tissues, giving a waxy consistency. Myxedema is a rare complication of hypothyroidism.
One large study shows that among participants with congestive heart failure, having even a mild case of hypothyroidism increases the risk of death compared to those with normal thyroid function.
Hypothyroidism can cause the arteries to grow stiff, causing diastolic blood pressure to increase.
Hypothyroidism can cause muscle weakness which may cause shortness of breath on exertion or poor exercise tolerance. For those who also have heart disease, shortness of breath may also have to do with worsening heart failure.
Thyroid hormones help to regulate your heart rate. Patients with hypothyroidism typically experience a heart rate of 10 to 20 beats per minute slower than those with normal thyroid function.
Less thyroid hormone may make chest discomfort associated with coronary heart disease less frequent. Still, elevated cholesterol and C-reactive protein may accelerate any underlying coronary artery disease.
Thyroid function plays an essential role in our cognition and other aspects of nervous system activity. All too frequently, patients go to the doctor with neurological symptoms of hypothyroidism but are dismissed or misdiagnosed.
Thyroid hormone imbalance can cause a whole host of neurological signs and symptoms like mood disorders, depression or anxiety, headaches and migraines, eye problems, tremors and other movement disorders, brain fog, executive inability, and in extreme cases, even psychosis. Hypothyroid patients may also experience peripheral neuropathy, which interferes with how the nerves send signals to and from your brain, spinal cord, and body.
Additionally, according to a 2018 study, there is a correlation between mental health and thyroid disease, particularly thyroid disease caused by autoimmune disorders like Hashimoto's disease. Hashimoto's thyroiditis (the leading cause of hypothyroidism in the United States) is known to coexist with other autoimmune conditions that can cause neurological symptoms like:
Because hypothyroidism so often manifests in these neurological symptoms, misdiagnosis can be common. For instance, people often conclude they have depression before exploring other causes like a thyroid condition. Treating the thyroid may be just the ticket for also managing low mood. However, this is not always the case in people with clinical depression without thyroid involvement.
Thyroid dysfunction frequently causes problems in the gastrointestinal system. In the case of hypothyroidism, most gastrointestinal manifestations have to do with reduced motility, ranging from mild constipation to paralytic ileus. Often, symptoms of vague abdominal pain are misdiagnosed as functional bowel disease.
Similarly, autoimmune thyroid diseases (AITD) like Hashimoto's or Graves' disease are linked to autoimmune disorders of the gastrointestinal tract like celiac disease or atrophic gastritis. For instance, patients with AITD are 5-10 times more affected by celiac disease than the general population.
What's more, the gut microbiome affects the body's ability to absorb critical nutrients like iodine, selenium, zinc, iron, B-vitamins, vitamin A, and tyrosine, which are essential to healthy thyroid function. While more research is needed, we know that the gut microbiome also influences the conversion of the inactive thyroid hormone T4 to the active hormone T3. This may be partly due to the gut microbiome's influence on the availability of micronutrients like selenium and zinc needed for thyroid hormone conversion.
Gastrointestinal symptoms usually resolve with the treatment of hypothyroidism. Paloma Health doctors believe that treating your thyroid doesn't stop at thyroid medication but also involves a more holistic approach. Beyond medication, it's crucial to reduce inflammation and ensure a healthy gut.
Thyroid problems cause reproductive symptoms in both men and women, though the two genders are affected differently. In men, thyroid issues can cause erectile problems and problems with sperm quality. Whereas in women, thyroid issues can cause problems with fertility or disruption in regular menstrual cycles.
Studies suggest that low thyroid hormone contributes to 6% of all cases of erectile dysfunction. Hypothyroidism can also cause several symptoms that interfere with sexual response, such as fatigue, weight gain, depression, or joint or muscle pain. These symptoms can also impact sexual desire and the ability to achieve and maintain an erection.
Studies also show that hypothyroidism is associated with reduced sperm morphology (the size, shape, and appearance of sperm). If a man is experiencing infertility, thyroid function tests should be part of the diagnostic workup.
Each month, the female reproductive system goes through ovulation, producing an egg. The pituitary gland releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) during ovulation. FSH acts as a 'messenger' to stimulate the development of follicles in the ovaries, and LH helps regulate the menstrual cycle and egg production. These two hormone levels rise and fall together during the monthly menstrual cycle, signaling the ovaries to release an egg.
Research suggests that one of the factors responsible for successful ovulation is adequate levels of thyroid hormones. However, a Journal of Applied and Basic Medical Research study finds that 2-4% of women in the reproductive age group have low thyroid hormone levels. This thyroid dysfunction may result in irregular menstrual cycle patterns, abnormal endometrial development, high prolactin levels, or sex hormone imbalances. All of these can affect fertility.
Similarly, thyroid disease can cause an increased risk of miscarriage, placental abruption, hypertensive disorders, and growth restriction when untreated during pregnancy. Women at high risk, including those with a history of thyroid or autoimmune disease, current or past use of thyroid therapy, or a family history of thyroid or autoimmune disease, should be screened for thyroid dysfunction during pregnancy.
After birth, around 3-8% of new moms can develop postpartum thyroiditis, an inflammation of the thyroid within the first year after giving birth. Postpartum thyroiditis may last several weeks to several months. Researchers aren't entirely sure what causes postpartum thyroiditis. It can be challenging to diagnose because its symptoms are often confused with the stress of having a newborn or postpartum mood disorders (i.e., the "baby blues"). If you experience any unusual symptoms after giving birth, consider taking an at-home thyroid blood test to understand how your thyroid functions.
Thyroid hormones affect virtually every system in the body, including the growth of hair follicles, skin cells, and nail beds. When your thyroid hormone production drops, these body processes slow down and change, too.
Hair typically goes through phases of growth, regression, resting, shedding, then growth again. However, an under-functioning thyroid gland can alter hair and skin structure and function. Research shows that thyroid hormones can directly impact hair follicle cycling. So, inadequate thyroid hormone slows the hair growth cycle. Generally, hair loss with hypothyroidism occurs over the entire scalp rather than specific areas. Coarse hair, thinning hair, or hair loss could be one symptom that indicates hypothyroidism. You may also notice that the outer third of your eyebrows starts thinning; this is a telltale sign of hypothyroidism.
Thyroid dysfunction similarly affects skin tissues. Thyroid hormones regulate skin cell renewal. When thyroid hormone production slows, the slowed skin renewal cycle results in dry and flaky skin. Changes in the skin that are not due to allergies or new products could indicate a thyroid problem. Itchy, dry, and flaky skin is a possible indicator that your thyroid levels are off-balance.
Thyroid dysfunction can also affect your nails, causing abnormality in nail shape, nail color, or attachment to the nail bed. Ongoing hangnails, ridges in your nails, splitting, peeling, or even dry cuticles could be a symptom that indicates hypothyroidism.
The symptoms of hypothyroidism listed so far in this article are far from exhaustive. Every person presents with a different combination of symptoms. The severity of each person's hypothyroidism varies from person to person. Untreated hypothyroidism worsens with age with worsening symptoms. Ahead are some additional common symptoms of hypothyroidism.
People with hypothyroidism have low thyroid hormone levels, which causes your metabolism to slow down. People with a slower metabolic rate often experience weight gain or have difficulty maintaining a healthy weight. When thyroid hormones are low, your body has a more challenging time using energy from fat stores. Hence, people then notice increased body fat. What's more, is the difficulty with using fat stores for energy is also why people with hypothyroidism struggle with cold intolerance.
Thermoregulation occurs primarily by thyroid hormones signaling to the body to increase available energy resources. Fat cells store energy, and specifically, brown fat cells play an essential role in converting T4 into the active form of T3. The body requires T3 to produce ATP (adenosine triphosphate), the active form of energy utilized by cells. ATP is essential for generating heat. People with hypothyroidism often suffer from cold intolerance because they do not produce enough thyroid hormone to convert and use stored energy effectively. As such, there is less energy available to regulate body temperature than individuals with normal thyroid hormone levels.
Hypothyroidism can cause musculoskeletal symptoms ranging from general muscle and joint aches to actual muscle disease or arthritis. Thyroid hormones play an essential role in developing many tissues—including the reproduction and growth of bone and cartilage, at the cellular level. Most reported cases of joint pain in hypothyroid patients involve the knees and hands. About 79% of hypothyroid patients experience hypothyroid myopathy, characterized by generalized aches and pains and muscle weakness. Patients with untreated hypothyroidism may develop significant muscle disease leading to severe functional limitations.
A goiter is the enlargement of the thyroid gland. It may be an overall enlargement or irregular cell growth that forms one or more nodules or lumps on the thyroid. The most common cause of goiters worldwide is iodine deficiency. However, in the United States, where the use of iodized salt is commonplace, goiters may be caused by:
Of course, it can feel discouraging to get your thyroid lab results back only to find out that everything is "normal," despite feeling frustrating symptoms. It's still possible to have the symptoms of hypothyroidism with normal thyroid labs. Other factors may contribute to these symptoms.
Subclinical hypothyroidism is defined as a mildly elevated TSH level in the presence of normal free T4. Clinical symptoms of hypothyroidism usually show up when the condition is fully developed. However, there may still be a correlation between higher TSH levels and the severity of symptoms. Suppose you or your doctor suspect subclinical hypothyroidism. In that case, it may be worthwhile first to retest to confirm the finding before starting thyroid hormone replacement therapy.
Our bodies require vitamins and minerals to function correctly. Adequate levels of micronutrients help us maintain a healthy metabolism, immune function, growth and development, bone health, and much more. Common deficiencies include iron, vitamin D, folate, and vitamin B-12 which can cause symptoms similar to hypothyroidism like aches and pains, fatigue, or skin and hair issues.
Central hypothyroidism is a rare problem with the brain's pituitary gland and/or hypothalamus. Thyroid hormone deficiency from pituitary failure is 'secondary hypothyroidism,' and thyroid hormone deficiency from a hypothalamus disorder is 'tertiary hypothyroidism.' Central hypothyroidism differs from primary hypothyroidism (a problem with the thyroid gland not producing enough hormones). Suppose you or your healthcare provider suspect central hypothyroidism. In that case, your doctor can confirm this diagnosis with a thyrotropin-releasing hormone stimulation test.
Stress is anything that disrupts the body's natural balance (homeostasis). Factors like blood sugar imbalance, gut dysfunction, food intolerances, chronic infections, environmental toxins, and inflammation can impact the adrenal glands, causing them to produce more stress hormones. Overburdened adrenal glands may cause hypothyroid symptoms without any problem in the thyroid gland itself. You can take a saliva cortisol test or a urine cortisol test to assess adrenal hormones.
Your body needs to convert the inactive thyroid hormone T4 into the active hormone T3 to use it. If you have poor thyroid hormone conversion, you may still experience some common symptoms of hypothyroidism. Some causes of poor thyroid hormone conversion may include leptin resistance, insulin resistance, acute or chronic dieting, or environmental toxins.
Suppose your thyroid function lab results come back normal, but you still have symptoms. In that case, we suggest you find a trustworthy primary care physician who takes an integrative approach to treatment.