Thyroid Disease Causes and Risk Factors

The thyroid, a butterfly-shaped gland located in your neck, is your master gland of metabolism. When your thyroid doesn't function it can affect every aspect of your health, especially your weight, brain chemistry (contributing or leading to depression and anxiety), energy levels, and heart health.

It's estimated that as many as 59 million Americans have a thyroid problem, but the majority don't know it yet.

For those of you who have been diagnosed, it sometimes seems like your thyroid symptoms—including those of an underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism)—are as hard to pin down as the thyroid diagnosis itself. For those of you who are currently undiagnosed, it's important to know that untreated thyroid problems can increase your risk of obesity, heart disease, infertility, and a host of other symptoms and health problems.

Whether diagnosed or undiagnosed, you may not have all of these thyroid risk factors, signs, or symptoms. But recognizing them is important, and taking action to get a proper diagnosis and thorough treatment is essential.

Risk Factors for Thyroid Disease and Thyroid Conditions

Some of the key risk factors for thyroid disease include:

Gender: Women face a greater risk of thyroid disease than men
Age: Thyroid disease is more common as we get older, especially after 50 (but it can affect people of any age)
Having a personal or family history of thyroid disease
Surgery to remove all or part of the thyroid

Radioactive iodine ablation (RAI) treatment
Currently pregnant or in the first year after childbirth
Being a current or former smoker
Recent exposure to iodine in a medical procedure
Taking iodine from herbs or supplements
Living in an area that is iodine-deficient
Various medical treatments and medications
Overconsumption of raw foods in the goitrogen family, such as Brussels sprouts, spinach, and soy
Trauma or surgery to the neck
Radiation exposure, via medical treatments or nuclear accidents

It’s important for you to know that having a personal or family history of any autoimmune disease raises your risk for thyroid disease. If you or any of your family members have an autoimmune disease, including Hashimoto's thyroiditis and Graves' disease, you should be vigilant about watching for thyroid symptoms.

Some of the other well-known autoimmune conditions include rheumatoid arthritis, lupus, inflammatory bowel disease, multiple sclerosis, psoriasis, vitiligo, type 1 diabetes, Addison's disease, Cushing's syndrome, Raynaud's syndrome, Sjogren's syndrome, and alopecia.

There are more than 80 conditions classified as autoimmune.

As you will see below, there are a variety of thyroid conditions with both overlapping and unique symptoms.

Thyroid and Neck Changes Common to Thyroid Conditions

Thyroid conditions frequently cause symptoms in the neck area where your thyroid is located. Some of the neck-related symptoms that can point to hypothyroidism, Hashimoto’s disease, hyperthyroidism, Graves’ disease, various types of thyroiditis, and thyroid cancer include:

An enlarged neck
Palpable enlargement in the thyroid gland itself (goiter)
A visible or palpable lump or lumps in your neck
Feeling of a lump in your throat when swallowing
A sore throat
Pain or tenderness in the neck
Your neck or throat feels sensitive, and ties, scarves, or turtlenecks don’t feel comfortable
Evidence of increased blood flow to the thyroid, detected by stethoscope

Hypothyroidism/Hashimoto's Disease/Underactive Thyroid Signs and Symptoms

Clinical Signs of Hypothyroidism

In addition to the neck symptoms identified above, there are some observable clinical signs of Hashimoto's disease and hypothyroidism that can be measured, detected, or identified in a clinical examination or testing with your practitioner.

These clinical signs of an underactive thyroid include:

An unusually low pulse
Unusually low blood pressure
Lower-than-normal body temperature
Slow or sluggish reflexes
Puffiness in your face, especially around your eyes
Puffiness or swelling of your hands and feet (known as edema)
Hair loss and, in particular, the loss of hair from the outer edge of your eyebrows, which is a unique hypothyroidism sign
High cholesterol levels that are unresponsive to cholesterol-lowering medication or dietary changes
Chronic or severe constipation that is unresponsive to treatment

Common Hypothyroidism Symptoms

Some common hypothyroidism symptoms include:

Fatigue/Low Energy: You feel run down, sluggish, and exhausted, even after a lengthy sleep.
Mood Changes: You feel depressed or blue; you have feelings of sadness or worthlessness; you feel anxious or restless; your moods change easily.
Weight and Metabolism: You are unexpectedly gaining weight, despite no change to your healthy diet and exercise. You are unable to lose weight, or you may even be gaining weight on a healthy, reduced-calorie diet with increased exercise.

Concentration and Memory: You have “brain fog,” difficulty concentrating, and difficulty remembering.
Body Temperature: You feel cold when others feel hot.
Hair Changes: Your hair is coarse and dry, breaking, brittle, or falling out.
Skin Changes: Your skin is coarse, dry, scaly, and thick, especially the soles of your feet.
Voice Changes: You have a hoarse or gravelly voice.
Pain: You have aches and pains in your joints, shoulders, hands, feet, or pain-related conditions like frozen shoulder, carpal tunnel syndrome, tarsal tunnel syndrome, and plantar fasciitis.
Sex Drive: You have no sex drive or a lower sex drive.
Snoring/Apnea: You’re snoring more lately, or you have developed sleep apnea.
Eye Changes: Your eyes feel gritty, dry, and sensitive to light.

Hypothyroidism Signs and Symptoms in Women

There are some hypothyroidism signs that are unique to women:

Puberty: Hypothyroidism can cause both early puberty and early onset of menstruation, as well as delayed puberty.
Menstrual Changes: You have severe menstrual cramps, unusually heavy menstrual periods, or irregular menstrual cycles.
Fertility/Pregnancy: You have had trouble conceiving a baby, a history of failed assisted reproduction treatments, a history of recurrent miscarriage, postpartum depression, and/or problems with breastfeeding.
Perimenopause/Menopause: Your perimenopause is starting earlier than normal, you have an earlier menopause, or you are having especially difficult perimenopausal or menopausal symptoms.

Hypothyroidism Signs and Symptoms in Newborns

Some specialized signs of hypothyroidism in newborns include:

Low muscle tone
Poor feeding, failure to gain weight
Hoarse crying

Hypothyroidism Signs and Symptoms in Children/Adolescents

Some specialized signs of hypothyroidism in children and adolescents include:

Decreased growth rate, or growth retardation
Delayed skeletal maturation
Early or delayed puberty
Decreased energy
Appearing swollen or puffy
Weight gain without increased appetite
Constipation or harder stools
Deterioration in handwriting
School problems

Hyperthyroidism/Graves' Disease/Overactive Thyroid Signs and Symptoms

Clinical Signs of Hyperthyroidism

There are some observable signs of Graves' disease and hyperthyroidism that can be measured, seen, or detected in a clinical examination by your practitioner. These signs of an overactive thyroid include:

Goiter (an enlarged thyroid)
An unusually high pulse
Unusually high blood pressure
Fever
Fast or hyperresponsive reflexes
Evidence of heart palpitations, rhythm irregularities, or atrial fibrillation
Unusually low cholesterol levels
Chronic or severe diarrhea that is unresponsive to treatment

Eye Changes

Changes to your eyes are common in hyperthyroidism and Graves’ disease, but can also be due to a related condition, known as Graves’ ophthalmopathy or thyroid eye disease. Symptoms include:

Your eyes feel gritty and dry.
Your eyes are red, dry, swollen, puffy, or watery.
Your eyes are sensitive to light.
Your vision is blurry.
You are having double vision.
Your eyeballs appear to be bulging (proptosis); your eyes aren’t completely covered when your eyelids are closed.
You have “lid lag," when your upper eyelid doesn't smoothly follow downward movements of the eyes when you look down.

Common Hyperthyroidism Symptoms

Some other common hyperthyroidism symptoms you may experience including:

Sleep: You may have insomnia, or find it difficult to fall asleep or stay asleep.
Fatigue/Energy: In some cases, hyperthyroidism may make you feel wired and unusually energetic, but it is also common to feel fatigued, run down, sluggish, and exhausted
Mood Changes: You feel anxious, panicky, irritated, angry, or unusually stressed. You may be easily startled. You may also feel depressed or blue, have feelings of sadness or worthlessness, and your moods change easily.
Weight and Metabolism: You are unexpectedly losing weight, despite no change to your healthy diet and exercise. Or, your appetite has increased and you are eating more, but you are not gaining weight.
Concentration and Memory: You have “brain fog,” difficulty concentrating, and difficulty remembering.
Body Temperature/Sweating: You feel hot when others feel hot; you are sweating and feel thirsty more.
Hair Changes: Your hair is falling out. Your hair is thinning or has become fine.
Skin Changes: You have developed unusually smooth and young looking skin. You have developed hives. You have unusual rashes or blister-like bumps on your forehead and face (milaria bumps). You have spider veins your face and neck area.
Voice Changes: You have a hoarse or gravelly voice.
Pain/Weakness: You have aches and pains in your joints, shoulders, hands, feet, or extreme muscle weakness, particularly in your upper arms and legs.
Sex Drive: You may have an unusually exaggerated sex drive, or you may have a drop in your normal sex drive.
Tremors/Movements: You have tremors or shakiness in your hands, or hyperkinetic movements (i.e., table drumming, tapping feet, jerky movements); this is often more severe in children.
Fingers/Nails: You have swollen fingertips (acropachy) or a separation of fingernails from your underlying nail bed (onycholysis or Plummer's nails).
Shins: You have lesions on your shins or patches of thickened skin, known as pretibial myxedema or dermopathy.

Hyperthyroidism Signs and Symptoms in Women

There are some hyperthyroidism signs that are unique to women:

You are pregnant but losing weight.
You are rapidly losing weight after having a baby.
You are pregnant and having excessive nausea or vomiting.
You have a history of irregular menstrual cycles, especially skipped periods, shorter and lighter periods, and longer periods of time between periods.
You have a history of infertility or recurrent miscarriage.

Hyperthyroidism Signs and Symptoms in Infants/Children/Adolescents

In infants, children, and adolescents, some common symptoms include:

Easy startling, jumpiness
Attention deficit hyperactivity disorder (ADHD)-type symptoms
Hyperactivity or temper tantrums
Trembling hands
Hyperkinetic movements such as drumming on tables, jerking of leg, tapping feet
Delayed puberty
Difficulty gaining weight
A big appetite without weight gain, or with weight loss
Trouble concentrating and poor school performance
Sweating
Sleep problems and insomnia
A wide-eyed stare

Thyroiditis Signs and Symptoms

Thyroiditis includes a variety of inflammatory thyroid conditions. Some cases of thyroiditis have no symptoms at all. There are also situations where the thyroiditis is either slowing down or speeding up the thyroid, so the symptom patterns fit into those of hypothyroidism or hyperthyroidism as described above.

Some unique symptoms that are found in certain types of thyroiditis include the following:

Enlargement of the thyroid (goiter)
Pain, tenderness, or soreness in the neck or throat area
Difficulty swallowing
Fever
Enlarged lymph nodes near the thyroid.
Hoarseness in your voice

A form of thyroiditis known as acute infectious thyroiditis is characterized by more significant symptoms, including:

The rapid onset of neck pain and tenderness, usually only one side of the neck
The onset of pain is accompanied by fever, chills and other symptoms of infection
An enlargement or mass in your neck area; it may be "movable" to your touch

Multinodular Goiter Signs and Symptoms

Multinodular goiter involves multiple nodules, as well as enlargement of the thyroid gland. Symptoms can include:

a swollen, tender, tight, or full feeling in the neck or throat
pain or pressure in the neck
hoarseness or coughing
difficulty swallowing or breathing
heart palpitations
insomnia
fatigue

Thyroid Cancer Signs and Symptoms

Thyroid cancer, especially early in its development, may not cause any symptoms at all. But as a thyroid cancer grows and develops, it's more likely to cause localized symptoms in your neck and throat. Some of the symptoms that may point to thyroid cancer include the following:

A lump or nodule in the neck, especially in the front of the neck in the area of the Adam's apple (Note: Sometimes the lump or nodule may grow quickly.)
Enlargement of the neck
Enlarged or swollen lymph nodes in the neck
Changes to your voice, including hoarseness, scratchiness, and difficulty speaking
Difficulty swallowing or a choking feeling
Difficulty breathing
Pain in your neck or throat, including pain from the neck to the ears
Sensitivity in the neck; discomfort with neckties, turtlenecks, scarves, necklaces
A persistent or chronic cough not due to allergies or illness
Asymmetry in your neck; one side may be larger than the other

A Word From Verywell

One of the challenges in thyroid diagnosis is that your thyroid symptoms overlap with and are common to many other issues. This can lead to being misdiagnosed with another condition—maybe your symptoms are said to be "normal for just having had a baby,” for example—without a thorough investigation, diagnosis, and treatment of your thyroid. In some cases, without a thorough evaluation of your thyroid, you may even be diagnosed with a mental health condition like depression or panic disorder.

A special situation can also be a challenge. The symptoms of Hashimoto's disease usually parallel the hypothyroidism that is a result of the disease. Occasionally, however, while the thyroid is failing, it can have periods where it sputters into life and even becomes temporarily overactive. This is known as Hashitoxicosis. Symptoms can be confusing, cycling over a period of days or weeks between hypothyroidism and hyperthyroidism symptoms.

One important tip: Make sure that you bring a checklist of your risks and symptoms with you to the doctor. If you have a practitioner who—despite your potential thyroid symptoms—refuses to even do a clinical examination and blood test, or acknowledge that these symptoms may warrant further treatment, you may need to find a new doctor.

Also be aware that certain health conditions may cause, be caused by, or are more common in thyroid patients. If you have any of these conditions, you should also be on the watch for potential thyroid symptoms and have your thyroid periodically evaluated. These conditions include celiac disease; fibromyalgia; chronic fatigue syndrome; Lyme disease; carpal tunnel syndrome; tarsal tunnel syndrome; tendonitis; plantar fasciitis; hypercholesterolemia (high cholesterol) especially when unresponsive to medication; infertility; recurrent miscarriage; frozen shoulder; and hemochromatosis.

Sources:

Bahn, R., Burch, H, Cooper, D, et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocrine Practice. Vol 17 No. 3 May/June 2011.

Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL/Wolters Kluwer; 2012.

Garber, J, Cobin, R, Gharib, H, et. al. "Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association." Endocrine Practice. Vol 18 No. 6 November/December 2012.