Thyroid Disease Hypothyroidism Hypothyroidism Guide Hypothyroidism Guide Symptoms Causes Diagnosis Treatment Diet Coping Symptoms of Hypothyroidism By Mary Shomon facebook twitter linkedin 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 Mary Shomon Medically reviewed by Medically reviewed by Do-Eun Lee, MD on August 11, 2020 linkedin Do-Eun Lee, MD, has been practicing medicine for more than 20 years, and specializes in diabetes, thyroid issues and general endocrinology. She currently has a private practice in Lafayette, California. Learn about our Medical Review Board Do-Eun Lee, MD Updated on June 05, 2021 Print Table of Contents View All Table of Contents Frequent Symptoms Rare Symptoms In Children Complications When to See a Doctor Frequently Asked Questions Next in Hypothyroidism Guide What Causes Your Thyroid to Be Underactive? When your thyroid gland is underactive (called hypothyroidism) and produces too little hormone, your metabolism slows down and your organs' ability to function normally is diminished. This may lead to a variety of symptoms, including weight gain, fatigue, depression, dry skin, brain fog, cold intolerance, muscle cramps, and constipation. Without treatment with thyroid hormone replacement, a goiter (an enlarged thyroid gland) may develop, as well as other complications like high cholesterol, nerve pain, anemia, and infertility. It's also worth noting that the symptoms of hypothyroidism are often non-specific, easily missed, or attributed to stress, aging, or some other cause. It is only by looking at symptoms in their totality that people (and their doctors) begin to suspect an underactive thyroid gland. © Verywell, 2018 Frequent Symptoms The symptoms of hypothyroidism tend to be mild or even unnoticeable when the disease develops gradually, but more dramatic when it develops rapidly. Moreover, the symptoms vary greatly from person to person; there is no single symptom that definitively clinches a diagnosis of hypothyroidism. 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 common in people with hypothyroidism, many people with an underactive thyroid are of normal weight or even thin. Slowing of Metabolic Processes Some of the major symptoms and signs that may manifest in hypothyroidism (as a result of a slowed metabolism) 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 and stiffness, in addition to weakness Skin/Hair/Nail Changes Due to decreased blood flow, water retention, and slow processes (for example, hair regrowth), the following skin, hair, and nail changes are seen in hypothyroidism: 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" Another symptom commonly described in connection with hypothyroidism is "brain fog." While this is not a medical term, per se, it has become a well-recognized description of a group of cognitive symptoms that are often used by patients and doctors alike. Brain fog may involve: Difficulty concentrating Short-term and long-term memory problems Forgetfulness Lack of focus Feeling "spaced out" Confusion Difficulty thinking clearly The reason brain fog may occur in hypothyroidism is because your brain requires sufficient levels of thyroid hormone in order to function properly. Thyroid Disorders and Brain Fog Psychiatric Problems Hypothyroidism may mimic the symptoms of depression. Fatigue, sleepiness, slowing of speech, in addition to a lack of interest in personal relationships and general apathy, are signs of depression and hypothyroidism. People with hypothyroidism may also feel inexplicably anxious or irritable. Sexual and Reproductive Problems For some women with hypothyroidism, their first and perhaps the biggest clue is a history of menstrual and reproduction problems, including missed or frequent periods, heavy bleeding, recurrent miscarriage, repeated failure to conceive, or failed assistive reproduction treatments. Over half of men with hypothyroidism experience decreased libido, erectile dysfunction, and delayed ejaculation. Rare Symptoms In a person with severe hypothyroidism, myxedema may occur. This skin condition involves the deposition of connective tissue components (mostly hyaluronic acid) in the lower layer of the skin, causing symptoms and signs like: Coarse hair and skin Puffiness of the face or all over Tongue enlargement Hoarseness Myxedema Coma Rarely, a life-threatening condition, called myxedema coma may be triggered by trauma, infection, cold exposure, or certain medications. Myxedema coma causes a low body temperature and blood pressure, in addition to a loss of consciousness. In Children The cause of hypothyroidism in children can either be congenital (meaning inherited from your parents) or acquired (caused by other conditions such as Hashimoto's disease, iodine deficiency, or radiation treatment). Congenital Hypothyroidism The most common cause of congenital hypothyroidism is thyroid dysgenesis wherein the thyroid gland is either missing, deformed, or severely underdeveloped. Most newborns with congenital hypothyroidism will have no signs of the disease. Newborns with hypothyroidism may exhibit lethargy, poor feeding, constipation, and a hoarse cry. Another telltale sign is prolonged jaundice. This is when the yellowish color of a newborn's skin, seen in around 50 percent of full-term babies, persists for longer than two weeks. What to Expect When Your Baby Has Hypothyroidism 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 launches an attack on healthy thyroid tissue. Verywell / Emily Roberts Acquired hypothyroidism occurs in girls 4 times more often than in boys. One of the characteristic signs is the swelling of the neck caused by the enlargement of the thyroid gland (goiter). Other symptoms of hypothyroidism include: Short stature or deceleration of growth Rough, dry skin Constipation Cold intolerance Headaches Fatigue Excessive sleeping Vision problems Easy bruising Milky nipple discharge (called galactorrhea) Early puberty (mostly seen in children with severe, longstanding disease) Delayed puberty (often the first obvious sign in the teen years) Menstrual irregularities Complications A number of medical conditions may occur as a result of hypothyroidism, especially when untreated or uncontrolled. Goiter Some people with hypothyroidism experience thyroid enlargement known as a goiter. Your goiter can range from slight enlargement, which may have no other symptoms, to a substantial increase in size that is symptomatic. If you have a large goiter, you may feel swelling or general discomfort in the neck area. Scarves or ties may feel uncomfortable due to neck enlargement. In some cases, your neck and/or throat may be sore or tender. Less commonly, swallowing or even breathing can become difficult if a goiter is blocking your windpipe or esophagus. Peripheral Neuropathy Hypothyroidism is known to cause a condition known as peripheral neuropathy, which causes abnormal localized sensations and pain such as: Numbness Burning, tingling, or a "pins-and-needles" sensation Muscle weakness Hypersensitivity to touch or temperature How to Treat the Symptoms of Peripheral Neuropathy Although the association between thyroid function and peripheral neuropathy isn't fully understood, it is believed that hypothyroidism leads to fluid retention, resulting in swollen tissues. 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 pressure is exerted in this area, it can result in carpal tunnel syndrome. Symptoms of carpal tunnel syndrome may begin with burning and tingling in the palm of the hand and fingers, especially the thumb, index finger, and middle finger. This discomfort is often worse at night, causing a person to wake up in the morning feeling like they need to "wring their wrist out." If carpal tunnel progresses, hand muscles may waste away leading to weakness, particularly decreased grip strength. Anemia A deficiency of thyroid hormone impairs the production of red blood cells in your bone marrow, the spongy tissue that lies in the center of certain bones. With this, anemia develops, causing symptoms like: Fatigue and weakness Paleness Fast or irregular heartbeats Feeling faintish Shortness of breath High Cholesterol When the thyroid gland produces too little hormone, your body's ability to process cholesterol becomes impaired. This can lead 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, along with proximal muscle weakness that can make simple activities like rising from a chair, climbing stairs, or washing hair difficult. Infertility and Pregnancy Problems Besides the fact that untreated hypothyroidism can lead to menstrual irregularities, which can lead to infertility, research suggests that hypothyroidism puts a pregnant woman at a higher risk for pregnancy loss, placental abruption, preterm delivery, and neonatal death. When to See a Doctor If you are worried that you or a loved one is experiencing one or more symptoms of hypothyroidism, call your doctor for an appointment. In addition to a medical history and physical examination, your he or she can perform a blood test called the thyroid-stimulating hormone (TSH) test, which can rule in or out a thyroid problem. Seek medical attention right away if you are experiencing symptoms of myxedema coma, such as severe fatigue and/or extreme cold intolerance. Lastly, if you are considering pregnancy or are pregnant and taking thyroid hormone replacement medication, be sure to work with your doctor to ensure that your thyroid hormone level is optimized for the health of both you and your baby. What Causes Your Thyroid to Be Underactive? Frequently Asked Questions What is the first sign of Hashimoto disease? A goiter, when the thyroid gland in the neck becomes noticeably enlarged, is commonly the first sign for many people. Other symptoms such as fatigue or weight gain may appear prior to the goiter, but they might be dismissed as being related to aging or stress. How serious is an underactive thyroid? If it’s left untreated, hypothyroidism could lead to very serious complications including heart disease and a rare, life-threatening condition known as myxedema in which the skin thickens and swells especially around your face and legs. 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. Stress, diet, and certain medications may cause these flare-ups. Was this page helpful? Thanks for your feedback! Losing weight with thyroid disease can be a struggle. Our thyroid-friendly meal plan can help. Sign up and get yours free! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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 Hypothyroidism. American Thyroid Association. 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. 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Thyroid Disorders in Children and Adolescents A Review. JAMA Pediatrics. 2016; 170(10):1008-1019. Maraka S et al. Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid. 2016;26(4):580. 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. 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. UpToDate. Waltham, MA: UpToDate Inc. Tagami T et al. Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia. Endocr J. 2011;58(6):449-57.