Symptoms of Thyroid Disease

There is no single symptom or cluster of symptoms that lead to a definitive diagnosis of hyper- or hypothyroidism. Both can affect the same part of the body or system, but in different ways.

Weight Changes

Unexplained weight changes can be a sign of hypothyroidism or hyperthyroidism:

• In hypothyroidism, you may be gaining weight and you may fail to lose weight despite ramping up exercise and reducing calories.
• In hyperthyroidism, you may lose weight while eating as usual or have difficulty maintaining weight despite increased caloric intake.

Temperature Issues

Sensitivity to temperature can be a symptom of both forms of thyroid disease:

• In hypothyroidism you may feel intolerant of the cold.
• In hyperthyroidism you may feel hot and sweaty despite a normal environmental temperature.

Fatigue and Sleeping Problems

Sleep issues and general fatigue—which are only worsened when you don't get a good night's rest—are common complaints of people with thyroid issues. At times, they can be so profound that they greatly impact one's daily life.

Mental Health Problems

Depression, anxiety, and other mood disorders can be associated with thyroid problems:

• In hypothyroidism, you may have depression symptoms or depression that doesn't respond to antidepressants.
• In hyperthyroidism, you may experience anxiety, panic disorder, or panic attacks.

Neck or Throat Discomfort/Abnormalities

These symptoms can be associated with hyperthyroidism, hypothyroidism, autoimmune thyroid disease, nodules, goiter (an enlarged thyroid), and thyroid cancer.

• A feeling of swelling or fullness in the neck
• Visibly enlarged neck
• Discomfort wearing turtlenecks or neckties
• Difficulty swallowing or breathing
• Tenderness in the neck
• A hoarse, raspy voice

Neck swelling is often a symptom of thyroid disease, but it can also indicate a more serious condition, including certain types of cancers, infections, or neurological disease.

Hair, Skin, and Nail Changes

Hair, skin, and nails are vulnerable to thyroid hormone imbalances.

Bowel Problems

The last thing you may be thinking of when you have digestive troubles is your thyroid, but gastrointestinal symptoms are common, reinforcing the far-reaching effects of this important gland:

• In hypothyroidism, you may have severe or long-term constipation that doesn't respond to treatments or remedies.
• In hyperthyroidism, you may have diarrhea, loose stools, or irritable bowel syndrome.

Menstrual Irregularities and/or Fertility Concerns

Thyroid conditions, especially hypothyroidism, can increase your risk of infertility, may interfere with the success of assisted reproduction treatments, and may increase the chances of recurrent miscarriage. Menstrual irregularities are also common:

• In hypothyroidism, you may have heavier periods, painful menstruation, or less time between periods.
• In hyperthyroidism, you may have shorter periods, lighter menstrual flow, infrequent periods, or periods may stop altogether.

Eye Problems and Vision Changes

A number of eye-related symptoms and changes are common in hypothyroidism, hyperthyroidism, and Graves’ disease.

Common symptoms include:

• Eye dryness
• Gritty feeling in the eye
• Blurry vision
• Eye redness
• Swollen, puffy, or watery eyes
• Sensitivity to light
• Double vision
• Proptosis (eye-bulging), one of the most distinctive symptoms of Graves'
• "Lid lag"—when your upper eyelid doesn't smoothly follow movement of the eyes when you look down

Cognitive Problems

"Brain fog," a term used to describe a group of cognitive symptoms that is often used by patients and doctors alike, is a symptom common to hypothyroidism specifically. Brain fog may involve:

• Difficulty concentrating
• Short-term and long-term memory problems
• Forgetfulness
• Lack of focus
• Feeling "spaced out"
• Confusion
• Difficulty thinking clearly

Musculoskeletal Problems

When you're hypothyroid, you may experience aches and pains in your muscles and joints, especially in your arms and legs. Fibromyalgia-like pain is also common for people with an underactive thyroid. If you are hyperthyroid, you may have pain or unusual weakness in the upper arms, and calves. 

With hypothyroidism, there is also a greater risk of developing carpal tunnel syndrome in your hands, which can cause weakness and pain in your forearms, wrists, hands, and fingers. A similar condition, tarsal tunnel, is also a risk, causing weakness and pain in the shins, ankles, feet, and toes.

While rarer than the above, these symptoms must be considered both individually and in the context of all of the issues a patient presents with. In some cases, these could be some of the first tip-offs that a thyroid diagnosis should be investigated.

Hypothyroidism

• High cholesterol levels: If you have high cholesterol levels, especially when they are not responsive to diet, exercise, or cholesterol-lowering medications such as statins, you may have undiagnosed hypothyroidism.
• Myxedema: This skin condition, which can occur in severe hypothyroidism, involves the deposition of mostly hyaluronic acid in the lower layer of the skin, causing coarse hair and skin, puffiness of the face or all over, tongue enlargement, and hoarseness.

Hyperthyroidism

• Low cholesterol levels: Unusually low cholesterol levels that do not correlate with diet, weight, and exercise may be a sign of hyperthyroidism.
• Graves’ ophthalmopathy: This condition is most easily recognized by proptosis, in which your eyeballs appear to be bulging and your eyes may not be completely covered when your eyelids are closed.
• Rashes: There are two unusual rashes associated with hyperthyroidism and Graves' disease: Pretibial myxedema, also known as thyroid dermopathy, can appear on the skin of the shins. A bumpy rash known as miliaria can appear on the face.

While some of the thyroid symptoms you may be experiencing may seem more annoying than harmful, remember that your thyroid gland and the hormones it produces impact your metabolism, heart, digestion, brain, bones, and more.

Hypothyroidism

• Neuropathy: Low levels of thyroid hormone can result in nerve damage, called neuropathy, characterized by tingling and numbness in the extremities. A painful foot condition known as plantar fasciitis may also develop in your feet, caused by edema (fluid buildup) around the nerves.
• Difficulty conceiving a baby: Even mild hypothyroidism can impede ovulation and the proper implantation of an embryo, making it difficult for a woman to conceive.
• Pregnancy complications: Hypothyroidism may put a pregnant woman at a higher risk of miscarriage, placental abruption, preterm delivery, and neonatal death. 

Hyperthyroidism

• Osteoporosis: Bone weakening makes a person more prone to breaking bones with even minor bumps or falls.
• Atrial fibrillation: This heart arrhythmia can lead to serious problems like stroke or heart failure. It is more common in older people.
• Pregnancy complications: Moderate-to-severe hyperthyroidism in a pregnant woman can sometimes lead to preterm birth, stillbirth, and possibly congenital malformations. 

If you have symptoms of thyroid disease, consult with your doctor, who will do a thorough physical exam, ask you details about your symptoms, and do a blood test to check your thyroid levels. Fortunately, in most cases, both hypothyroidism and hyperthyroidism can be effectively treated.

Thyroid storm is a rare but very serious, potentially life-threatening condition that occurs in people with untreated hyperthyroidism. It may be triggered by a stressful event like surgery, trauma, or infection. Thyroid storm is characterized by exaggerated symptoms of hyperthyroidism, such as a very fast heart rate, high fever, diarrhea, agitation, delirium, and/or decreased consciousness.

Myxedema coma, on the other hand, is a life-threatening emergency that can result from hypothyroidism.