Thyroid Disease Hypothyroidism Hypothyroidism Guide Hypothyroidism Guide Overview Symptoms Causes Diagnosis Treatment Diet Coping Symptoms of Hypothyroidism By Mary Shomon Mary Shomon Facebook LinkedIn Twitter Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of "The Thyroid Diet Revolution." Learn about our editorial process Updated on June 18, 2022 Medically reviewed by Danielle Weiss, MD Medically reviewed by Danielle Weiss, MD LinkedIn Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Frequent Symptoms Rare Symptoms Hypothyroidism in Children Complications When to See a Healthcare Provider Frequently Asked Questions Next in Hypothyroidism Guide Causes and Risk Factors of Hypothyroidism Your thyroid is a butterfly-shaped organ that sits at the base of your neck. It produces hormones that regulate body functions. When your thyroid gland is underactive (called hypothyroidism), it makes too little hormone. When that occurs, your metabolism slows down, and your thyroid may not function normally. This process may lead to various symptoms, including weight gain, fatigue, depression, dry skin, brain fog, cold intolerance, muscle cramps, and constipation. In addition, without treatment, a goiter (an enlarged thyroid gland) may develop. Other complications can also develop. This article explains hypothyroid symptoms, complications, and when to see a healthcare provider. © Verywell, 2018 Frequent Symptoms The symptoms of hypothyroidism tend to be mild or even unnoticeable when the disease is in the early stages. However, symptoms are more dramatic when it develops rapidly. Moreover, the symptoms can vary significantly from person to person; no single symptom definitively clinches a hypothyroidism diagnosis. The symptoms of hypothyroidism can be non-specific or attributed to other factors, like stress and aging. Therefore, they are often easily missed. For instance, while weight gain is typical in hypothyroidism, many people with an underactive thyroid are of average weight or even thin. People (and their healthcare providers) begin to suspect an underactive thyroid gland only by looking at symptoms in their totality. Slowing Metabolic Processes Some of the symptoms of hypothyroidism are the result of a slowed metabolism. These include: Fatigue and sleepiness Slowed movement and speech Intolerance to cold Weight gain Slow heart rate Sluggish reflexes Constipation Shortness of breath when exercising Muscle cramps, stiffness, and weakness Skin, Hair, and Nail Changes Skin, hair, and nail changes often occur with hypothyroidism. That's because decreased blood flow, water retention, and slow processes accompany the condition. These symptoms may include: Pale, cool, and thick or "doughy" skin Dry, brittle hair, and hair loss, especially near the outer edge of the eyebrows Brittle, dull, and thin nails Decreased sweating Swelling of the hands, face, and eyelids (called edema) "Brain Fog" "Brain fog" is another symptom of hypothyroidism. While this is not a medical term, per se, it has become a well-recognized description of a group of cognitive symptoms. Brain fog may involve: Difficulty concentrating Short-term and long-term memory problems Forgetfulness Lack of focus Feeling "spaced out" Confusion Difficulty thinking clearly Brain fog may occur in hypothyroidism because your brain requires sufficient levels of thyroid hormone to function correctly. Thyroid Disorders and Brain Fog Psychiatric Problems Hypothyroidism may also mimic the symptoms of depression. These shared symptoms may include: FatigueSleepinessSlowed speechLack of interest in personal relationships General apathy People with hypothyroidism may also feel inexplicably anxious or irritable. Sexual and Reproductive Problems For some people with hypothyroidism, their first and perhaps the biggest clue is a history of menstrual and reproductive problems. These may include: Missed or frequent periods Heavy bleeding Recurrent miscarriage Repeated failure to conceive Failed assisted reproduction treatments In addition, as many as half of those with testicles and hypothyroidism experience decreased libido, erectile dysfunction, and delayed ejaculation. Recap While hypothyroidism doesn't always have apparent, identifiable symptoms, there are some common signs that you may want to have your thyroid evaluated. These include fatigue, weight gain, skin, hair, and nail problems, "brain fog," mood problems, and sexual and reproductive difficulties. Rare Symptoms In a person with severe hypothyroidism, a myxedema crisis (also called myxedema coma) may occur. This life-threatening condition results from untreated hypothyroidism. It happens when thyroid hormone levels are extremely low. Symptoms include: Low body temperatureSlowed breathingLow blood pressureLow blood sugarUnresponsivenessUnusual moods Thyroid Disease Symptoms Hypothyroidism in Children Hypothyroidism in children can either be congenital (meaning you are born with it) or acquired (caused by another condition). Congenital Hypothyroidism The most common cause of congenital hypothyroidism is thyroid dysgenesis. The thyroid gland is either missing, malformed, or severely underdeveloped in this condition. Most newborns with congenital hypothyroidism will have no signs of the disease. However, some may exhibit symptoms such as: LethargyPoor feedingConstipationHoarse cry Another telltale sign is prolonged jaundice. This condition is when the yellowish color of a newborn's skin, seen in around 50% of full-term babies, persists for longer than two weeks. When You Don't Have a Thyroid Gland Acquired Hypothyroidism Hashimoto's disease, iodine deficiency, or radiation treatment may cause acquired hypothyroidism. Hashimoto's disease (also known as Hashimoto's thyroiditis) is, by far, the most common cause of hypothyroidism in children. It is an autoimmune disorder in which the immune system malfunctions and attacks healthy thyroid tissue. Verywell / Emily Roberts Kids most at risk for developing acquired hypothyroidism include those with Down syndrome, type 1 diabetes, and children who have received radiation treatment. One of the characteristic signs is the swelling of the neck caused by the enlargement of the thyroid gland. Other symptoms of hypothyroidism in children include: Cold intoleranceConstipationDelayed puberty (often the first noticeable sign in the teen years)FatigueHair lossMenstrual irregularitiesRough, dry skinSlow growthWeight gain or slow to gain weight Recap Hypothyroidism can also occur in children. These cases are either congenital (present at birth) or acquired. Jaundice, poor feeding, and lethargy may be indicators of congenital hypothyroidism in newborns. Hashimoto's disease is the most common cause of acquired hypothyroidism in kids. Thyroid Disease and Diabetes Complications Several medical conditions may occur due to hypothyroidism, especially when untreated or uncontrolled. Goiter A goiter can range from slight enlargement, which may have no other symptoms, to a substantial increase in size. If you have a large goiter, you may feel swelling or general discomfort in the neck area. In addition, scarves or ties may feel uncomfortable due to neck enlargement. In some cases, your neck and throat may be sore or tender. Less commonly, swallowing or even breathing can become difficult. That's because sometimes a goiter can block your windpipe or esophagus. Peripheral Neuropathy Hypothyroidism is known to cause peripheral neuropathy. This condition results when the peripheral nervous system (the network of nerves that extend from the brain and spinal cord) is damaged. It can cause a wide range of symptoms, depending on which nerves are damaged. It often results in localized sensations and pain such as: NumbnessBurning, tingling, or a "pins-and-needles" sensationMuscle weaknessHypersensitivity to touch or temperature The association between thyroid function and peripheral neuropathy isn't fully understood. However, researchers believe that hypothyroidism leads to fluid retention, resulting in swollen tissues. Carpal Tunnel Syndrome One of the areas commonly affected by this fluid retention is the wrist, where nerves travel through a channel of soft tissue known as the carpal tunnel. When excess fluid causes pressure in this area, it can result in carpal tunnel syndrome. Symptoms of carpal tunnel syndrome may begin with burning and tingling in the palm and fingers, especially the thumb, index finger, and middle finger. This discomfort is often worse at night, especially if you sleep with your wrists bent. In addition, if carpal tunnel progresses, hand muscles may waste away, leading to weakness, particularly decreased grip strength. Symptoms of Carpal Tunnel Syndrome Anemia A deficiency of thyroid hormone reduces your body's production of red blood cells in your bone marrow, the spongy tissue that lies in the center of certain bones. Reduced red blood cells can lead to anemia. Anemia Anemia is a condition where red blood cell count is lower than normal. Anemia can cause symptoms like: Fatigue and weaknessPalenessFast or irregular heartbeatsFeeling faintShortness of breath Causes and Risk Factors of Anemia High Cholesterol When the thyroid gland produces too little hormone, it can affect your body's ability to process cholesterol, leading to elevated total cholesterol and LDL levels. LDL cholesterol can build up in your arteries, eventually contributing to blockages that can cause a heart attack or stroke. Besides high cholesterol, other heart-related complications associated with hypothyroidism include high blood pressure and fluid around the heart (pericardial effusion). Myopathy Myopathy (or muscle disease) may result from an underactive thyroid gland. People with hypothyroidism-induced myopathy often complain of muscle pain and stiffness. In addition, they may experience muscle weakness that can make simple activities like rising from a chair, climbing stairs, or washing hair difficult. Infertility and Pregnancy Problems Untreated hypothyroidism can lead to menstrual irregularities, which can lead to infertility. In addition, research suggests that hypothyroidism during pregnancy increases the risk for pregnancy loss, placental abruption, preterm delivery, and neonatal death. Recap Untreated or uncontrolled hypothyroidism can lead to other medical conditions. These include goiter, peripheral neuropathy, anemia, high cholesterol, myopathy, and fertility and pregnancy problems. Fertility and Pregnancy Challenges With Thyroid Disease When to See a Healthcare Provider If you are worried that you or a loved one is experiencing one or more symptoms of hypothyroidism, call your healthcare provider for an appointment. In addition to a medical history and physical examination, they can perform a blood test called the thyroid-stimulating hormone (TSH) test, which can narrow down if there is a thyroid problem. Seek medical attention right away if you are experiencing symptoms of myxedema coma, such as severe fatigue or extreme cold intolerance. Lastly, if you are pregnant or considering pregnancy and taking thyroid hormone replacement medication, be sure to work with a healthcare provider. Discussing your situation with a doctor will ensure that your thyroid hormone level is at the correct level for the health of both you and your baby. Summary Hypothyroidism is a condition where the thyroid produces too little thyroid hormone. Symptoms commonly include fatigue, weight gain, "brain fog," and mood problems. Rarely, a condition called myxedema coma can occur when thyroid levels fall to dangerously low levels. Hypothyroidism can lead to other medical conditions, so getting timely diagnosis and treatment is important. Frequently Asked Questions What is the first sign of Hashimoto disease? For many people, a goiter is commonly the first sign of Hashimoto disease. Other symptoms such as fatigue or weight gain may appear before the goiter, but people might dismiss them as related to aging or stress. Learn More: Symptoms of Hashimoto's Disease How serious is an underactive thyroid? If left untreated, hypothyroidism could lead to very serious complications. These include heart disease and a rare, life-threatening condition known as myxedema, in which the skin thickens and swells, especially around your face and legs. Learn More: What Is Myxedema Coma? What is a Hashimoto flare-up? A flare-up is when you feel hypothyroidism symptoms. These flare-ups can occur even if you're on daily hormone replacement therapy. For instance, you might feel unusual fatigue, aches, sensitivity to cold, or memory problems. In addition, stress, diet, and certain medications may cause these flare-ups. Learn More: Hashimoto's Flare-Up Causes and Risk Factors of Hypothyroidism 18 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Biondi B. Thyroid and obesity: an intriguing relationship. J Clin Endocrinol Metab. 2010;95(8):3614-7. doi:10.1210/jc.2010-1245 American Thyroid Association. Hypothyroidism. Safer JD. Thyroid hormone action on skin. Dermatoendocrinol. 2011;3(3):211-5. doi:10.4161/derm.3.3.17027 Samuels MH. Psychiatric and cognitive manifestations of hypothyroidism. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):377-83. doi:10.1097/MED.0000000000000089 Saran S, Gupta BS, Philip R, et al. Effect of hypothyroidism on female reproductive hormones. Indian J Endocrinol Metab. 2016;20(1):108-13. doi:10.4103/2230-8210.172245 Mathew V, Misgar RA, Ghosh S, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011;2011:493462. doi:10.4061/2011/493462 National Library of Medicine. Hypothyroidism. Rastogi MV, Lafranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis. 2010;5:17. doi:10.1186/1750-1172-5-17 National Institute of Diabetes and Digestive and Kidney Diseases. Hashimoto's disease. American Thyroid Association. Hashimoto's Thyroiditis. American Academy of Pediatrics. Acquired hypothyroidism in children. Cincinnati Children's. Acquired hypothyroidism. Nada A, Mohamed ahmed A, Vilallonga R, Armengol M, Moustafa I. A giant euthyroid endemic multinodular goiter with no obstructive or compressive symptoms. Case Rep Med. 2011;2011:620480. doi:10.1155/2011/620480 Cleveland Clinic. Anemia. Maraka S, Ospina NMS, O’Keeffe DT, et al. Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis. Thyroid. 2016;26(4):580-590. doi: 10.1089/thy.2015.0418 Cleveland Clinic. Hashimoto’s disease. Leung AM. Thyroid emergencies. Journal of Infusion Nursing. 2016;39(5):281-286. doi:10.1097%2FNAN.0000000000000186 Trifirò G, Parrino F, Sultana J, et al. Drug interactions with levothyroxine therapy in patients with hypothyroidism: observational study in general practice. Clin Drug Investig. 2015;35(3):187-195. doi:10.1007/s40261-015-0271-0 Additional Reading Samuels MH. Psychiatric and cognitive manifestations of hypothyroidism.Curr Opin Endocrinol Diabetes Obes.2014 Oct;21(5):377-83. Surks MI. (2017). Clinical manifestations of hypothyroidism. Ross DS, ed. Waltham, MA: UpToDate Inc. Hanley, P.; Lord, K.; and Bauer, A. Thyroid Disorders in Children and Adolescents A Review. JAMA Pediatrics. 2016; 170(10):1008-1019. Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. J Epidemiol. 2017 Mar;27(3):117-22. Tagami T et al. Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia. Endocr J. 2011;58(6):449-57. By Mary Shomon Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of "The Thyroid Diet Revolution." See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit