Recognize Symptoms of Hypothyroidism

Hypothyroidism is a condition arising from insufficient thyroid hormone production, affecting 4.6% of those over age 12 in the U.S. Hypothyroidism can result from iodine insufficiency (especially in developing countries), exposure to radioactive iodine-131, autoimmune destruction of the thyroid gland (known as Hashimoto's disease), or absence of the thyroid gland altogether (e.g. from surgical removal or missing at birth). Untreated hypothyroidism can lead to serious consequences, including a life-threatening myxedema coma, although this is rare. Because thyroid hormones regulate many systems of the human body, symptoms of hypothyroidism are diverse.

Steps

Evaluating Early Symptoms

1. Recognize your risk of getting hypothyroidism. If you know you’re at risk for a disease, you are much more likely to pay attention to its symptoms. This is especially important with hypothyroidism because the thyroid gland affects the entire body, making symptomatic identification alone difficult—blood tests are required to confirm it. Women are more likely to develop it, as are people over age 60. You are also more likely to develop hypothyroidism if you have one of the following conditions:
   • Have delivered a baby (or been pregnant) in the last six months
   • Have previously experienced problems with the thyroid gland
   • Have another autoimmune disease (lupus, type 1 diabetes, anemia, rheumatoid arthritis, etc.)
   • Have had the thyroid gland removed
   • Have received radiation to the thyroid, chest, or neck
   • Have the female genetic disorder Turner syndrome
   • Thyroid diseases runs in your family
   • Have received surgery to correct a thyroid problem
2. Watch for constipation. Hard stools or trouble pushing stools out (constipation) can indicate hypothyroidism because when your body doesn’t get enough thyroid hormone, its processes start slowing down, including digestion.
3. Measure your sensitivity to cold. As hypothyroidism progresses, you may notice an increased sensitivity to cold temperatures wherever you are located. This is due to the body’s processes slowing down from lack of thyroid hormone.
4. Notice if you feel fatigued. You may also continue to feel tired and lethargic as hypothyroidism progresses because the lack of thyroid hormone causes your metabolism to slow down. Hypothyroidism can also cause sleep apnea and anemia, both of which cause fatigue.
5. Look for irregular periods (if you’re a girl). In females, the decrease in thyroid hormone causes irregular periods and can lead to a reduction or impairment of fertility, the ability to get pregnant. It can also cause periods with really heavy flow.
6. Look out for sex-related problems (if you're a man). Many men with untreated hypothyroidism experience decreased libido, erectile dysfunction, and delayed ejaculation. If you're suffering from a combination of these problems, you should go to your doctor to get tested for hypothyroidism.
7. Watch for brittle fingernails. Hypothyroidism can cause brittle nails, or cause fingernails to split from the nail bed through the nail plate. Brittle nails are an irritating, discouraging result of body systems slowing down as hypothyroidism begins to affect the body.
   • Hypothyroidism can also cause dry, brittle hair and hair loss.
8. Notice if you feel weak. Feeling weak goes hand-in-hand with feeling fatigued and lethargic, which are a result of the body’s systems slowing down as it gets low (or no) levels of the thyroid hormone. Feeling weak means that you experience reduced strength in various muscle groups.
9. Watch for a pale or dry complexion. Although a pallid complexion alone does not indicate that you have hypothyroidism, paleness combined with general dry skin is a symptom of hypothyroidism. If you have to repeatedly apply moisturizing creams, be aware that this can be a result of a bigger problem within your body.
   • You may also sweat less if you have hypothyroidism.
10. Pay attention to weight gain. Abnormal or rapid weight gain can indicate hypothyroidism because hormone fluctuation or a decrease of hormones—e.g., lack of thyroid hormone—causes unintentional or unexplained weight gain.
11. Stay vigilant about joint or muscle pain. You can start to experience pain in your joints and muscles as the body is affected by reduction in thyroid hormone. This pain often translates as stiffness and tenderness in the muscles and stiffness and swelling, or general pain, in your joints.
12. Be aware of feelings of sadness. Women suffering from hypothyroidism after delivering a baby can be misdiagnosed as having baby blues or postpartum depression because some of the symptoms are the same—moodiness and depression. A woman within 6 months of being pregnant or having a baby should see a doctor about hypothyroidism if they suspect they are developing post partum depression, or if fatigue and lethargy don’t disappear within a few months.
    • Hypothyroidism can also cause a "mental fogginess."

Evaluating Late Symptoms

1. Discern if you have a decreased sense of taste. If hypothyroidism goes untreated, the lack of thyroid hormone in the body starts to affect more systems. If you have a decreased sense of smell and taste, this is an indication that you aren’t getting enough thyroid hormone.
2. Watch for puffiness in the hands and feet. If hypothyroidism goes untreated, lack of thyroid hormone can progress to a point of affecting your face, hands, and feet by making them puffy. If you notice puffiness in all three of these areas, by this point you are probably experiencing a host of other symptoms and you should get to a doctor as soon as possible.
   • When you have hypothyroidism, your sweating generally does not "pit," meaning that when pressure is applied to the swollen area, an indention is not typically left.
3. Pay attention to difficulty speaking. Hoarseness is a symptom of untreated hypothyroidism. This happens as a result of the body’s processes slowing due to lack of thyroid hormone.
4. Notice if your skin gets thicker while your eyebrows get thinner. Thinning hair in general is a symptom of hypothyroidism, and by the time it reaches your eyebrows, you know you’ve got some thyroid issues. Also, as your body suffers from lack of thyroid hormone, your skin can start to become thicker.
5. Pay attention to a slower heart rate. Again, as the body suffers from lack of thyroid hormone, its systems are affected. The heart, the most important system in the body, will begin to slow, a noticeable system in untreated hypothyroidism.
   • You can tell your resting heart rate is slowing down by taking note of your heartbeat when you wake up every morning. This might be a smart thing to start chronicling if you suspect your body of not producing enough thyroid hormone.
6. Watch for a hoarse voice. Changes in the way you talk can also be a symptom of untreated hypothyroidism. One result of a slow metabolism is a decreased ability to speak clearly. If you notice a hoarse quality to the way you talk, this can be an indication that hypothyroidism is advanced.
   • Since the thyroid gland is located at the base of the throat, it is not surprising that hoarseness is a symptom.

Seeking Help for Your Symptoms

1. See a doctor if symptoms accumulate. If you start to notice that you’re having more than one or two of these symptoms, it is probably time to make a doctor appointment. It is especially important to be seen if you start to see signs of late stage hypothyroidism, such as a slower heart rate and decreased senses of smell and taste.
   • At the onset of hypothyroidism, you may not notice it because it just looks like a bit of weight gain and fatigue, symptoms that also come with aging. You will develop further symptoms, however, as your metabolism slows down.
2. Expect to be examined thoroughly. A doctor will ask very specific and thorough questions about your symptoms before moving to the next stage of diagnosing hypothyroidism, which is blood tests. Be prepared for these questions by taking detailed notes of your symptoms before arriving at the doctor’s office.
   • You may consider typing your symptoms as you notice them into the Notes feature in your phone, or downloading a symptom tracker app.
   • You should also give the doctor a detailed medical history, such as past issues with your thyroid gland (including any surgeries or other symptoms and treatments), family history with the thyroid gland, and any general medications you have taken recently.
3. Anticipate having blood tests. Since hypothyroidism cannot be determined by symptoms alone, the doctor must take blood tests to measure your thyroid hormone levels. Hypothyroidism symptoms also tend to be similar to symptoms of other diseases, so blood tests are truly the best way to determine hypothyroidism.
   • One test is the TSH test. The TSH is a very sensitive test that measures thyroid activity. A reading of “above normal” indicates hypothyroidism, and a reading of “below normal” indicates Treat Hyperthyroidism.
   • Another is the T4 test. The T4 test measures the level of thyroid hormone in the blood. A reading lower than normal indicates hypothyroidism.
   • A common test is the thyroid autoantibody test. Thyroid autoantibodies are only present in the blood if a person’s hypothyroidism is cause by Hashimoto’s disease, so while this test unequivocally proves that someone has hypothyroidism, if autoantibodies are not present, a person may still have hypothyroidism caused by something else.
4. Be prepared to start taking thyroid medicine. Once you have been diagnosed with hypothyroidism, most doctors will put you on medication. Hypothyroidism is a condition that cannot be cured, so hormone replacement is the only way to help the body regulate TSH and T4. Your medication will be pills containing T4, also known as thyroxine.
   • You must be careful to take the exact dosage prescribed. Taking too little of the medication will make your hypothyroidism persist, and taking too much can make you develop the opposite condition, hyperthyroidism.
   • Symptoms of hyperthyroidism include rapid heartbeat, inability to sleep, nervousness, increased appetite, and feeling shaky.
5. Follow up to see if you need medicine changes. At first, you may need to increase your dosage of T4 based on symptoms. Every time your doctor increases your dosage of T4, you need a blood test 6 to 10 weeks afterward in order to ensure that your T4 levels are normal.
   • Eventually you and your doctor will feel comfortable about the dosage you’re taking, and you can get your T4 levels checked only once a year.
   • Babies and young children must strictly maintain their medication regimes or risk mental retardation and stunted growth.
6. Stay alert about possible medication complications. Everyone is different, so you must pay attention to your body. You may have to return to the doctor if complications arise, or if you start to take other medications that interfere with your T4 medicine.
   • Pay attention to a return or worsening of symptoms. This may mean that you aren’t taking enough medicine.
   • Other issues that may arise with taking T4 can include taking medicines that prevent your body from absorbing T4 like calcium-based antacids, iron tablets, or medications that contain estrogen.
   • If you notice a weight gain or loss of 10 or more pounds when you aren’t trying to, it may indicate an issue with your thyroid medication.

Tips

• Hypothyroidism can also be a result of drug interference with medicines that seem to have nothing to with the thyroid. If you take the following drugs, watch for symptoms of hypothyroidism:
  • amiodarone (for heart problems)
  • interferon alpha (for cancer)
  • lithium (for bipolar disorder)
  • interleukin-2 (for kidney cancer)
• Newborns who have missing or malfunctioning thyroid glands are identified during the newborn screening in developed countries. Untreated hypothyroidism in infants can lead to mental retardation and stunted growth. Look for symptoms like jaundice, a large tongue, facial puffiness, and frequent choking, but always ask your pediatrician if you see any symptoms in your baby.

Warnings

• The information in these steps is for educational purposes only. Always seek a healthcare professional for confirmation of symptoms and treatment.
• Untreated hypothyroidism can lead to a lot of complications, including:
  • a goiter in the neck (an enlarged thyroid gland) which affects appearance and ability to breathe and swallow
  • heart problems, because it increases the amount of bad cholesterol in the body
  • depression
  • slowed mental processing
  • peripheral neuropathy, where your Central Nervous System ceases to control parts of your body, ultimately causing loss of muscle control
  • birth defects such as mental retardation (but the baby can improve with treatment)
  • myxedema, a rare development wherein a patient suffers a coma because of the slow-functioning body systems, only occurring in patients with long term untreated hypothyroidism

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