Hypothyroidism Symptoms: Signs of an Underactive Thyroid, Causes and Treatment

What is hypothyroidism?

Hypothyroidism, or an underactive thyroid, means the thyroid gland is not making enough thyroid hormone for the body's needs. The thyroid is a small, butterfly-shaped gland at the front of the neck. Its hormones set the pace of your metabolism, which is how your body uses energy, so when levels run low, many body systems slow down at once.

That is why symptoms show up in many places at once, sometimes 5 or 6 at a time: energy, weight, bowels, skin, hair, mood, heart rate, periods and memory. People sometimes call it a sluggish thyroid or low thyroid. Hypothyroidism affects about 5 in 100 Americans age 12 and older, most often women and adults over 60.

What are the most common hypothyroidism symptoms?

The most common hypothyroidism symptoms are tiredness, feeling cold, weight gain, constipation, dry skin and thinning hair. Symptoms usually come on slowly over months or years, so many people blame them on stress, aging or a busy life. Common signs include:

• Fatigue and low energy, even after a full night's sleep.
• Feeling cold when others are comfortable, often with cold hands and feet.
• A few extra pounds, mostly from fluid, and difficulty losing them.
• Constipation.
• Dry, rough skin and brittle nails.
• Dry, coarse or thinning hair, including hair loss from the outer eyebrows.
• A puffy face, swollen eyelids or a hoarse voice.
• Muscle aches, cramps, stiffness and joint pain.
• A slower heart rate.
• Heavy or irregular periods, or difficulty getting pregnant.
• Low mood or depression.
• Brain fog: slower thinking and trouble with memory and concentration.

No single symptom proves a thyroid issue, and symptoms can build slowly over months or years before anyone checks. Many of these changes have other explanations, which is why a blood test is needed to confirm it.

What are hypothyroidism symptoms in women?

Women have the same core symptoms as men, but changes in periods and fertility are often the first clue. An underactive thyroid can bring heavy, longer or irregular periods and can make it harder to get pregnant. Women are also much more likely than men to develop hypothyroidism, and the risk rises after pregnancy and around menopause.

• Heavy periods, which can also lead to low iron.
• Trouble getting pregnant, or a thyroid problem found during pregnancy.
• Postpartum thyroiditis: thyroid inflammation in the year after delivery that can lead to a temporary low thyroid phase.
• Symptoms that overlap with perimenopause, such as fatigue, low mood, a few extra pounds and poor sleep.

Because the overlap with menopause is so large, checking thyroid function is a routine step when a woman in her 40s or 50s has new fatigue or a change on the scale.

What are hypothyroidism symptoms in men?

Men usually have the same signs: tiredness, constipation, dry skin and a slower metabolism. Some men also notice, over months, lower sex drive, erectile problems or muscle weakness. Since hypothyroidism is less common in men, these symptoms are often put down to stress or low testosterone first, and both may be checked at the same visit.

Do symptoms look different in older adults?

Yes. In adults over 60, hypothyroidism often causes fewer and milder symptoms, or symptoms that look like normal aging. Memory problems, slowness, depression, constipation or chilliness may be the only signs. A mildly high TSH can also be normal with age, so results in older adults are read with care.

What are hypothyroid legs?

Hypothyroid legs is an informal term for leg symptoms linked to an underactive thyroid, most often swelling, heaviness, cramps and muscle aches. Low thyroid hormone can lead fluid and a gel-like substance to build up in the tissues, which makes the lower legs look puffy. This type of swelling usually does not leave a dent when pressed. Low thyroid also slows muscle function, which can bring on cramps, stiffness and weakness, and it can raise the risk of nerve problems such as tingling in the feet.

Leg swelling has many other causes, including heart, kidney, vein and liver problems and some medicines. New swelling, especially in 1 leg with pain or redness, needs prompt medical attention, since it can be a blood clot.

What causes hypothyroidism?

The most common cause of hypothyroidism in the United States is Hashimoto's disease, an autoimmune condition where the immune system slowly damages the thyroid gland. Other causes include:

• Thyroid surgery that removed part or all of the gland.
• Radioactive iodine or radiation treatment to the neck.
• Thyroiditis, including after pregnancy.
• Certain medicines, such as lithium, amiodarone and some cancer drugs.
• Too little or too much iodine in the diet, which is uncommon in the United States because of iodized salt.
• A thyroid problem present from birth, or, rarely, a problem with the pituitary gland in the brain.

Who is more likely to develop it?

• Women, and people over 60.
• People with a family history of thyroid disease.
• People with another autoimmune condition, such as type 1 diabetes, celiac disease, rheumatoid arthritis or vitiligo.
• Anyone who delivered a baby in the past 6 months.
• People with past thyroid surgery, radioactive iodine or neck radiation.

How is hypothyroidism diagnosed?

Hypothyroidism is diagnosed with a blood test, not by symptoms alone. The main test is TSH (thyroid-stimulating hormone). A high TSH usually means the thyroid is underactive, and free T4 shows how much active thyroid hormone is in the blood. Each lab sets its own normal range, so results are compared with the range on your report. Thyroid antibody tests (TPO antibodies) can show whether Hashimoto's disease is responsible.

• High TSH with low free T4: overt hypothyroidism.
• High TSH with normal free T4: subclinical hypothyroidism, a mild or early stage that may or may not need treatment.

Read our guide to TSH levels and what your result means

How is an underactive thyroid treated?

An underactive thyroid is treated with levothyroxine, a daily pill that replaces the thyroid hormone your gland is not making. It is the same hormone (T4) the thyroid makes naturally. The dose is based on your weight, age, heart health and TSH, then adjusted until TSH is back in range. TSH is usually rechecked 6 to 8 weeks after starting or changing the dose, and about once a year once it is stable.

Most people need treatment for life when the cause is Hashimoto's disease or thyroid surgery. Symptoms often start to ease within a few weeks, though hair, skin and weight changes can take several months. Some points from the levothyroxine label:

• Take it once a day on an empty stomach, 30 to 60 minutes before breakfast, with a glass of water.
• Take it at least 4 hours apart from calcium, iron, antacids and some other medicines, since they block absorption.
• Soybean flour, walnuts, high-fiber foods and grapefruit juice can reduce or delay absorption, so keep your routine consistent.
• Levothyroxine should not be used to treat obesity or for weight loss. Too high a dose can lead to a fast or irregular heartbeat, anxiety, poor sleep and bone loss.

Learn more about thyroid hormone replacement therapy

Is there a diet for hypothyroidism?

There is no special diet that cures hypothyroidism, and no single food you must eat every morning; the 1 morning habit that matters is taking your pill on an empty stomach. Levothyroxine replaces the missing hormone. Food matters mainly in how it affects absorption of your pill and your overall health. Practical points:

• Iodine: most people in the United States get enough from iodized salt, dairy and seafood. Iodine or kelp supplements are not needed and can make some thyroid conditions worse.
• Soy and fiber: you do not need to avoid them, but keep them away from the time you take levothyroxine and keep your intake steady.
• Cruciferous vegetables such as broccoli and cabbage are fine in normal amounts.
• Bananas and other fruits are fine to eat; no fruit harms the thyroid. There is no proven list of 'worst foods' for an underactive thyroid.
• Coffee: wait 30 to 60 minutes after your pill before drinking it.
• Gluten-free eating is needed only if you also have celiac disease.

Self-care habits that support thyroid health

• Take your pill at the same time, the same way, every day.
• Get your blood tests on schedule, and tell your doctor about new supplements, especially biotin, which can skew thyroid results.
• Eat a balanced diet, stay active and protect your sleep, which supports energy and weight.
• Tell your doctor early if you are pregnant or planning a pregnancy, since doses often need to go up.

Hypothyroidism vs hyperthyroidism: what is the difference?

Hypothyroidism is too little thyroid hormone; hyperthyroidism is too much. They tend to produce opposite symptoms. An overactive thyroid often causes weight loss, a fast heartbeat, anxiety, shaky hands, sweating and feeling hot. Graves' disease is behind most cases. Hyperthyroidism affects about 1 in 100 Americans and is treated differently, with medicines, radioactive iodine or surgery, and is usually managed together with an endocrinologist.

When should you see a doctor?

See a doctor if you have several of these symptoms for 2 to 3 weeks or more, especially with a family history of thyroid disease, a recent pregnancy or another autoimmune condition. Get urgent care for:

• Severe drowsiness, confusion or a very low body temperature in someone with known low thyroid. This can be myxedema coma, a rare emergency.
• Chest pain, a very slow or irregular heartbeat, or shortness of breath.
• A neck lump that grows quickly, or trouble swallowing or breathing.

How Dr. Munib approaches suspected hypothyroidism

Dr. Munib looks at the whole picture in a single visit, since thyroid symptoms overlap with anemia, low vitamin D, sleep problems, depression and menopause. An evaluation usually includes:

1. 1.A review of symptoms, medicines, supplements, periods, pregnancy plans and family history.
2. 2.Blood tests: TSH and free T4, with thyroid antibodies when useful, plus checks for related conditions such as cholesterol, anemia and blood sugar.
3. 3.A plan that depends on the results: watching and retesting, starting or adjusting levothyroxine, or a referral to an endocrinologist for nodules, an overactive thyroid or harder cases.

See chronic condition care at The Pur Health

If tiredness is your main concern, read why you might be always tired

Get your thyroid checked in Irvine

If these symptoms sound familiar, a visit and a simple blood test can tell you whether your thyroid is behind them. The Pur Health is at 114 Pacifica, Suite 280, Irvine, and is in-network with most PPO plans. Cash visits are $190 for new patients and $150 for returning patients. Call (949) 647-5234 to book.