Symptoms of Thyroid Disease

Considering how small it is, your thyroid plays a surprisingly important part in determining how your body functions and feels. The hormones that this tiny gland produces are key players in almost every metabolic process in your body (via WebMD). When people have difficulty with their thyroid, it’s usually the result of alterations in the production of thyroid hormones. These issues are generally very treatable once they’ve been appropriately diagnosed. In some conditions, too many thyroid hormones are produced, resulting in various forms of hyperthyroidism. Hyperthyroidism can be genetic, result from the formation of nodules in the thyroid gland, stem from inflammation of the gland, or be linked to malfunctions of the pituitary gland or cancerous growths in the thyroid gland.

If too little thyroid hormone is produced, hypothyroidism develops. This can happen due to an autoimmune disorder in which the body recognizes the thyroid as foreign and destroys it, following surgical or chemical removal of the thyroid gland (such as during cancer treatment), or from the administration of certain drugs or medical tests involving iodine. 

Your Mood Has Been Off

young girls sitting in cafe with one on cell phone and other upset

Just like other hormones, those produced by the thyroid can seriously mess with your mood. According to the Mayo Clinic, hyperthyroidism can rev you up, causing nervousness, restlessness, anxiety, and irritability. You might feel like you drank way too much coffee. As you might guess, hypothyroidism will usually make you feel precisely the opposite — sluggish, sleepy, and depressed. Interestingly, elderly patients with hyperthyroidism often present with psychiatric symptoms more commonly associated with hypothyroidism, such as apathy and lethargy.

A study published in the Journal of Thyroid Research in 2011 delved more deeply into this topic. Many people struggling with depression might never know that it’s at least partly caused by hypothyroidism because the thyroid problems are not severe enough (overt) to be diagnosed. According to the authors of this study, less than four percent of patients with affective disorders are found to have overt hypothyroidism. However, up to 40% of patients with affective disorders have subclinical hypothyroidism.

The association between hyperthyroidism, anxiety, and depression is not always clear-cut, either. The boundaries can get a bit muddy. In fact, while 60% of individuals with hyperthyroidism have an anxiety disorder, 31-69% also have depressive disorders. The American Association of Clinical Endocrinologists cautions medical providers that, “The diagnosis of subclinical or clinical hypothyroidism must be considered in every patient with depression.” Treatment for hypothyroidism does not always improve depression, even when hormone levels are normalized; the reasons for this might be genetic. 

Beginning in the late 1960s, thyroid hormones have been used as an antidepressant therapy and are believed to speed up the response to tricyclic antidepressants, especially among women. Among a very select number of patients, administration of thyroid hormones might also augment treatment with selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants today. 

Your Sleep Schedule Has Changed

exhausted woman sleeping face down on bed

Per the Sleep Foundation, the nervousness and irritability of hyperthyroidism can cause insomnia for people, especially when coupled with other symptoms such as night sweats and frequent urination. Meanwhile, people with hypothyroidism might be struggling to deal with constantly feeling cold coupled with the joint and muscle pain that comes with low thyroid hormone levels. Although they can’t sleep at night, some people with hypothyroidism find themselves inexplicably drifting to sleep during the day. Either hypothyroidism or hyperthyroidism can play a factor in the development of restless leg syndrome, which causes uncomfortable sensations in the legs and an irrepressible urge to move or kick the legs when the rest of the body is resting. Rarely, hyperthyroidism causes night terrors.

People with hypothyroidism are more likely to have obstructive sleep apnea, compounding the daytime sleepiness the lethargy that hypothyroidism already causes. Changes to respiration and enlargement of the tongue caused by hypothyroidism increase the risk of developing obstructive sleep apnea. Additionally, individuals with hypothyroidism are more likely to struggle with obesity, a significant risk factor for obstructive sleep apnea (via Verywell). 

Your Weight Is Changing Even Though You Are Eating the Same

overweight man with measuring tape around waist and scale under arm

Many of us can empathize with the plight of those battling their weight to no avail — the number flashing on the scale just won’t go down no matter how much we cut back on our food intake or how much activity we add to our daily life. This is even more frustrating when we encounter people who gladly tell us that the weight just fell off when they switched coffee creamers or stopped eating ice cream every night. An article written by the American Thyroid Association, appearing on the British Thyroid Foundation site, puts this into context for those with thyroid problems. Patients with hypothyroidism have to learn to cope with a low basal metabolic rate, which means they burn fewer calories than other people at rest. Still, most of the weight gain in hypothyroidism is due to salt and water retention, which is rectified with treatment. Usually, five to ten pounds of weight can be attributed to hypothyroidism. 

The higher-than-average basal metabolic rate of hyperthyroidism is not as welcome as overweight people would expect. Thankfully, it reverses as soon as the hormonal balance is achieved with treatment. Thyroid hormones have historically been used as a weight-loss tool, but as soon as treatment is stopped, any weight that has been shed is regained. The use of thyroid hormones to instigate weight loss carries health risks, including muscle loss. 

Still, these rules aren’t hard and fast. The relationship between metabolism, hormones, environment, and body weight is intricate and challenging to unravel. Some people with thyroid problems are surprised that they haven’t experienced any weight changes. 

You Have a Lump in Your Neck

concerned woman with both hands on her throat

Perhaps you’ve heard the term “goiter,” which refers to an abnormal enlargement of the thyroid gland. This can occur in hyperthyroidism, hypothyroidism, or even when thyroid levels are normal (via the American Thyroid Association). When goiter was first discovered, the most common cause was iodine deficiency. The thyroid gland uses iodine to produce thyroid hormone. Since then, much of the salt used in food production in the United States has been fortified with iodine. For some people, the growth of multiple nodules on the gland leads to the development of goiter.

Hashimoto’s thyroiditis, an autoimmune disease destroying the thyroid gland, is the most common cause of goiter in the U.S. today. Unfortunately, goiter often remains even following successful treatment and a return to normal hormone levels. 

Graves’ disease, another condition linked to a malfunction of the immune system, can also cause goiter. In this condition, the immune system produces thyroid-stimulating immunoglobulin, which triggers the growth of the thyroid gland and causes hyperthyroidism. If Graves’ disease is treated with radioactive iodine, the goiter will usually disappear. 

 Your Muscles Feel Weak

fatigued man at gym holding onto dumbbell

The Muscular Dystrophy Association explains that overproduction or underproduction of thyroid hormones can cause weakness and atrophy of the muscles. The shoulders are affected in both hypothyroid and hyperthyroid myopathy, although the hips are more often a problem with hyperthyroidism and the thighs with hypothyroidism. Hypothyroidism tends to cause more muscle cramping than hyperthyroidism. The muscles of the face and throat and those involved in breathing might also be affected, more often in hyperthyroid myopathy. Hyperthyroid and hypothyroid myopathies are usually cured once thyroid hormone levels are normalized with medical treatment. 

Rarely, a potentially life-threatening condition, rhabdomyolysis, which results in the sudden breakdown of muscle, can occur. A very dangerous condition, thyrotoxic periodic paralysis, causes severe muscle weakness. These temporary episodes of significant weakness are associated with low levels of potassium in the blood. Hypothyroidism occasionally causes another muscle problem, Hoffman’s syndrome, which causes enlarged muscles accompanied by muscle stiffness, weakness, and pain (via Verywell). 

Your Hair and Nails Have Changed

brush on a white table with long locks of hair stuck in it

Both hypothyroidism and hyperthyroidism can cause the hair on your scalp and body to become dry, brittle, and thin (via Healthline). The hormones produced by your thyroid gland affect the development of hair roots so the hair that falls out (sometimes over a hundred each day) might not be replaced by new growth. Some people even develop patches of hair loss. According to the American Academy of Dermatology (AAD), people with undiagnosed or untreated thyroid problems might notice that their eyebrows are thinning or sparse on the ends or that their scalp is dry and itchy, possibly with dandruff. The problem is compounded because some medications used to treat thyroid disorders contribute to hair loss. Take heart, though. In most cases, your hair will return to its former glory once your thyroid problems have been corrected.

The AAD adds that if your nails seem more burdensome to cut, keep breaking or peeling, and appear to be soft and shiny, these are signs that you may want to have your thyroid checked. Other problems that thyroid issues can exhibit include visible ridges on the nails, a change in the speed of growth, nails that appear to “lift” off of the bed, or curved nails with a swollen fingertip and thick skin on the tip of the finger right above the nail. 

Your Menstrual Cycle Has Changed, or You Are Experiencing Infertility

calendar page with a red circle around a date

The Office on Women’s Health points out that it is not uncommon for women with thyroid problems to notice significant changes in their periods. It turns out the thyroid gland determines how heavy your flow is and how regularly you menstruate. People with hyperthyroidism will often experience fewer and lighter periods (sometimes they stop altogether), while women with hypothyroidism might have to deal with heavier flows. Women with hypothyroidism should also be prepared for the unexpected, as the menstrual cycle sometimes becomes irregular (via Everyday Health). If it is determined that your thyroid disease is related to an autoimmune condition, you may go through early menopause (before your 40th birthday). These changes to reproductive functioning can cause infertility or complications during pregnancy, as well. 

Dr. Elena Christofides, MD, FACE, and Fellow of the American Association of Clinical Endocrinologists said when speaking to a writer for endocrineweb that, “abnormal TSH levels can interfere with ovulation…when you have any type of thyroid disorder (without proper management), you will see a luteal phase (the last half of the cycle after ovulation) disruption.” The author further explains that thyroid disorders also increase the risk of early miscarriage because of incomplete implantation. Men, too, can experience fertility issues related to damaged sperm quality and mobility brought about by thyroid issues. 

You Are Always Either Hot or Cold

beautiful woman standing outside in winter with bulky turtleneck sweater pulled over mouth and nose

People with hyperthyroidism often feel intolerably hot and sweat more than expected. In contrast, people with hypothyroidism just can’t seem to warm up. These problems with temperature regulation occur because thyroid hormones both affect how much blood vessels dilate and change the metabolic rate (via Medical News Today). 

Paloma explains that people with hypothyroidism don’t have enough energy for their thyroid gland to regulate temperature appropriately. When someone with hypothyroidism goes outside in cold weather, their bodies will shuttle blood away from the hands and feet, putting them at greater risk for developing hypothermia. With medication, proper thermoregulation is usually recovered. People with hypothermia may need more sleep in colder weather to help the body recover from the increased energy expended trying to maintain an appropriate body temperature. Wearing layers, using hot packs, and snuggling into warm bedding will help take the chill off.

On the other hand, if you have hyperthyroidism and struggle with heat intolerance, you’ll want to dress in cool, breathable clothing, drink icy beverages, employ a water mister and portable fan, and experiment with wet, cold washcloths (via Verywell). 

Your Vision Isn’t What It Was

man holding a magnifying glass over one eye

Thyroid disease associated with an autoimmune disorder can cause a myriad of vision issues, including dry eyes, bulging eyes, double vision, and watery eyes. People with thyroid disease might even be told that they have bulging eyes or unintentionally “stare” at others. They might also have difficulty closing their eyes and have a partner tell them that they sleep with their eyes open (via Cleveland Clinic).

Thyroid disease causes inflammation of the lacrimal glands, which precipitates the development of either wet or dry eyes. The eyelids can look swollen or baggy due to the abnormal immune reaction, leading to a feeling of pressure around the eyes. Alternatively, the muscles in the eyelid can clench and cause the upper lid to move up and the lower lid to move down, creating a startled look. The double vision sometimes encountered stems from swelling of the muscles that regulate eye movement. 

If the eyes do not close at all, corneal ulcers might form, which will cause scarring and blindness if not promptly treated. Also, if swollen tissues compress the optic nerve, permanent loss of vision could result without immediate medical attention. 

According to Prevent Blindness, smoking increases the risk of thyroid eye disease by a startling seven to eight times and also reduces treatment efficacy. Selenium deficiency increases the chances of someone with thyroid disease encountering optical complications. Selenium is found in Brazil nuts, seafood, organ meats, beef, pork, poultry, cereals, whole grains, dairy products, and eggs (via the National Institutes of Health). 

You Can’t Concentrate or Remember Things

young woman chewing pen and desk with day planner in front of her

It’s not uncommon for people with either hypothyroidism or hyperthyroidism to fear that they are developing dementia because of trouble remembering things (including words) and a feeling of fogginess or inability to focus on anything. Some research has found a loss of volume in the hippocampal part of the brain among individuals with untreated hypothyroidism. 

It’s not just the memory problems, and trouble concentrating that make people with thyroid issues worry about their cognitive abilities — they might also feel like they aren’t able to plan, have difficulty controlling their impulses, and struggle to make decisions (via Verywell). People with hyperthyroidism might also have delayed reaction times, be unable to appropriately judge where objects are in relation to one another, or interpret visual information. Luckily, though, the cognitive problems associated with thyroid disease are usually rectified with the treatment of the underlying condition.

Subclinical hypothyroidism, which isn’t apparent in lab work, can also cause cognitive problems. According to a study summarized on endocrineweb, researchers in Italy reviewed 13 studies looking at the effects of subclinical hypothyroidism. They uncovered a 56% increased risk of impaired cognitive function and an 81% increased risk of dementia among all participants. James Hennesey, associate professor of medicine at Harvard Medical School and clinical director of the Division of Endocrinology, Diabetes and Metabolism at Beth Israel Deaconess Medical Center in Boston, is quoted in this article: “Mild, non-specific neuro-cognitive symptoms may be seen in subclinical hypothyroidism.” He also asserts that “The younger we are, the more likely it is that subclinical hypothyroidism will have an impact on cognition.” 

Your Voice Has Changed

two women sitting on separate park benches talking to each other

According to a study published in the Eurasian Journal of Medicine, thyroid problems most often result in a reduction of the fundamental frequency of the voice but can also be to blame for hoarseness, roughness, loss of voice, trembling voice, reduced intensity of voice, and audible breathing. The authors contend that 27% of patients with hyperthyroidism have voice changes. 

Dr. Reena Gupta, Director of the Division of Voice and Laryngology at OHNI, emphasizes that in severe, untreated hypothyroidism, the vibrating layer of the vocal cords can thicken. This condition, known as myxedema, causes a harsh “smoker’s voice” to develop. On the other hand, people with hyperthyroidism sometimes develop a tremulous voice. Compression of the thyroid gland can injure vocal muscles and nerves and generate major voice symptoms. 

Your Skin is Different

closeup of person applying lotion to hands

The American Academy of Dermatology lists common skin complaints among those with thyroid disease. The skin of people with hypothyroidism is often dry, pale, and cool to the touch, while that of people with hyperthyroidism is quite the opposite — moist, velvety, and warm. Sometimes people describe scaly, hard, and waxy patches of skin. The skin on the palms of the hands and soles of the feet might crack, scale, or develop a yellowish-orange or reddish color. You might notice that cuts and abrasions also seem to take longer to heal. Others notice that their gums and other tissues of the mouth appear darker. 

Graves’ dermopathy (sometimes referred to as pretibial myxedema) is a skin problem associated with severe Graves disease. It causes a red, swollen rash and other skin changes brought about by the deposition of sugar molecules in the skin, which then attract water and cause swelling to develop. The skin might have the texture of orange peel, most often on the shins and the top of the feet. This same buildup of carbohydrates can occur in the eyes — a condition known as Graves ophthalmopathy (via the Mayo Clinic).

Your Bowel Movements Are Different

close up of restrooms signs

As you might expect, hypothyroidism can cause sluggish bowels and constipation, while hyperthyroidism results in more bowel movements than usual. The good news is that once the underlying thyroid disease is treated, these problems should turn around for you. 

Constipation, either three or fewer bowel movements per week or painful and unproductive bowel movements, are often one of the primary symptoms of hypothyroidism. Besides taking your medicine as directed and following up with your doctor regularly, ensuring adequate hydration, exercising when possible, eating plenty of fiber-rich foods such as vegetables and legumes, and considering bowel retraining or biofeedback therapy might help you feel better (via Everyday Health). 

According to a study in the World Journal of Gastroenterology, as many as a quarter of patients with hyperthyroidism must deal with mild-to-moderate diarrhea and frequent bowel movements, often coupled with some fat malabsorption.

Your Face Looks Pale and Puffy

young, very pale man looking up at camera

The face and eyes become puffy with hypothyroidism (via Merck Manual). According to a study published in Plastic and Reconstructive Surgery, autoimmune thyroid eye disease will eventually increase the fat volume around the eyes and eyebrows. This is a result of inflammation and soft-tissue expansion.

Treatment may include monoclonal immunoglobulin administration. In this study of 23 patients, the majority of whom were women with a mean age of 51; treatment significantly improved periorbital fat and protrusion of the eyeball (proptosis). A quarter of the patients strongly agreed that their facial appearance had returned to what it was before the development of thyroid eye disease. The most significant change in volume with treatment was over the lower third of the face.