There are very obvious signs you have hypothyroidism and then much more subtle signs that can make this condition easy to miss. Hypothyroidism is an endocrine disorder, which means it affects hormones—in this case, thyroid hormone. Thankfully, providers are getting better at recognizing the signs. Even so, symptoms are often subtle or chalked up to other things, which means it can take longer to get a diagnosis.
Fatigue, constipation, brain fog, and weight gain are just some of the common complaints. And while not everyone with hypothyroidism will experience all these symptoms, many do, and it can significantly affect quality of life.
Here I'll explain a bit more about hypothyroid, the signs you have hypothyroidism, why they happen in the first place, and how you can support your thyroid naturally.
What is Hypothyroidism?
The prefix hypo means “under” or “low,” so hypothyroid translates to “underactive thyroid.” It means the thyroid gland isn't working as efficiently as it should, so the body has less circulating thyroid hormones.
Here's a simplified explanation of how thyroid hormone is regulated in the body:
- Your pituitary gland, a small gland at the base of your brain, regulates thyroid hormones by producing thyroid-stimulating hormone (TSH).
- TSH signals the thyroid gland to produce more thyroid hormones, triiodothyronine (T3) and thyroxine (T4).
- When T3 or T4 levels drop, the pituitary gland releases more TSH, and the thyroid gland releases more thyroid hormone.
- Once the body senses that you have enough thyroid hormone, TSH levels can return to normal.
With hypothyroid, TSH keeps dialing that thyroid gland, but the gland fails to answer the call. The pituitary gland keeps pumping out more TSH to try to get the thyroid to respond, but it can't. So TSH levels keep rising to try and jump-start the sluggish thyroid gland. In some cases, TSH can also be too low, or the body isn't converting thyroid hormone into an active form. All of these mean less active thyroid hormone.
Why does this matter? The thyroid is the master of your metabolism, so without it, everything slows down. There's a range of where people notice symptoms, but when thyroid hormone drops below a certain level, it can have profound effects on the body.
Difference Between Hypothyroidism and Hashimoto's
Hashimoto's thyroiditis is the most common cause of hypothyroidism. It's an autoimmune disease, meaning the body mistakenly attacks its own tissues. With Hashimoto's, the body creates antibodies that flag the thyroid for attack and damage the thyroid gland by the immune system, eventually leading to significant enough thyroid damage that the gland is no longer able to make sufficient hormones.
Antibodies can be elevated for years before any symptoms of hypothyroidism develop. So someone could have Hashimoto's and not know it until their thyroid function declines.
If you have the antibodies, you have Hashimoto’s disease. Once there is enough tissue destruction that your TSH rises and your free T4 and free T3 dip, that is when you are diagnosed as hypothyroid.
In other words, Hashimoto's is a cause of hypothyroidism, but there are other causes of hypothyroidism as well. And it’s important to note that Hashimoto’s is the primary cause of hypothyroidism in developed countries with sufficient iodine levels. In my practice, I find that Hashimoto’s is the number one cause of hypothyroidism with my patients.
What Causes Hypothyroidism?
Aside from Hashimoto's, some of the other potential causes of hypothyroid include:
- Radiation treatment
- Inflammation of the thyroid (aka thyroiditis)
- Surgery that removes the thyroid
- Congenital hypothyroidism—aka you're born with it
- Iodine deficiency
- Conditions affecting the pituitary gland
How Common Is Hypothyroidism?
I touched on the fact that hypothyroidism is increasingly common, but the stats are pretty staggering. It's estimated that around five percent of the population has hypothyroidism, and up to five percent more have it but are undiagnosed.
Women are much more likely to be diagnosed, with estimates that women are five to ten times more likely to be diagnosed with Hashimoto's than men. The symptoms are often ignored or cast off as just part of getting older or becoming a mother while women continue to struggle, making it crucial to be aware of the signs and symptoms.
As a naturopathic endocrinologist, I ensure all of my patients are screened for both Hashimoto’s disease and hypothyroidism.
10 Signs You Have Hypothyroidism
Women are often led to believe that it's normal to feel exhausted all the time, but if you're struggling with fatigue, it could be a sign of an underactive thyroid. Yes, there are many reasons for feeling tired, but the thyroid is a must-check if you struggle with fatigue that doesn't improve with more sleep or lifestyle changes.
Remember that the thyroid is part of the system that regulates metabolism and energy. Without a healthy functioning thyroid, you can feel exhausted even after a good night's sleep. Around 40 percent of people with hypothyroidism experience some level of fatigue.
If you’re tired all the time and have any of the following symptoms, it’s time to get your thyroid checked.
2. High Cholesterol
High cholesterol is a sneaky symptom that's less talked about in discussions about thyroid health. But hypothyroidism can throw off the balance of how much cholesterol is made versus removed from the body—primarily low-density lipoprotein (LDL) cholesterol, aka “bad” cholesterol.
Alterations in cholesterol metabolism can happen even in people with only slightly low thyroid function. As a result, hypothyroidism can increase the risk of heart disease.
3. Weight Changes
When metabolism and energy production slow down, the amount of calories you burn at rest (called your metabolic rate) slows down too. Plus, if you are dealing with fatigue, you are less likely to be active, so the overall amount of energy—or calories—you use each day drops significantly.
4. Bowel Issues
Constipated? It could be your thyroid. Hypothyroid slows everything down, including what's known as gastric motility. Motility refers to the contractions of the muscles in the digestive system that helps move food along. So when you have hypothyroid, those contractions can slow way down, leading to constipation and bloating.
Constipation can mean you go less often or that stools are hard and difficult to pass. Regular bowel movements are essential for healthy detoxification and hormone balance, so if you notice any changes here, it's time to get things checked out.
Yet another symptom that can be chalked up to “just part of life” is moodiness or feeling down. But if you struggle with anxiety, depression, or other mood disorders, it could indicate that your thyroid is out of balance.
There's a big-time correlation between mental health, mood, and thyroid health, especially depressive symptoms. The reason isn't exactly clear—and likely multifactorial—but even mild hypothyroidism is linked to lower mood. The good news is that when treated correctly, depressive symptoms improve significantly.
But think about the women who may feel tired and depressed and are given an antidepressant instead of having their thyroid checked.
6. Muscle Aches and Joint pain
Muscle pain, weakness, or joint pain, can all stem back to thyroid health. Weakness for no reason is a big red flag. What's the connection to the thyroid? It's called hypothyroid myopathy and can affect up to 80 percent of people with hypothyroidism, primarily those with untreated conditions. It may be related to cellular health. As thyroid hormone affects cellular energy and metabolism, muscle cells can lose strength and break down.
7. Hair problems
Hair doesn't grow as quickly as it should, so not only can hair fall out, but it doesn't necessarily come back as thick as it once was.
8. Changes in skin
Dry, scaly skin can also indicate low thyroid hormone levels. Receptors for thyroid hormone (receptors are like locks that thyroid hormone “keys” into) and even genes that respond to thyroid hormone are found all over the body, including on your skin. As thyroid hormone levels drop, skin changes—especially on the soles of the feet or hands—can appear.
9. Difficulty Swallowing or Changes in Neck Size
If you have trouble swallowing or notice that your neck area looks swollen, it could be due to an enlarged thyroid gland, known as goiter. This can be seen in both hypo- and hyperthyroidism.
While it's usually painless and benign, if large enough, a goiter can push against the trachea (windpipe) and make it difficult to breathe or swallow. If you notice any changes in your neck, have it checked out by a doctor.
10. Menstrual Irregularities & Infertility
Every woman with irregular periods or fertility concerns should have their thyroid checked. Hypothyroidism is a big reason for amenorrhea (the absence of periods). It can also cause other changes like heavier or lighter bleeding than usual or shorter or longer cycles. You can read more about how hypothyroidism affects the menstrual cycle here.
Irregular cycles affect fertility, but if someone can become pregnant, hypothyroidism can cause miscarriages, so it's critical to get thyroid levels in check before trying to conceive.
If you are experiencing any of the above, even if it's just one, it's a good idea to get your thyroid checked.
But here's what I want you to know: you may have to ask your doctor to test more than the standard TSH test.
What Are Normal Thyroid Levels?
Here's what I suggest you ask your doctor to order. The ranges can vary depending on the lab, but in general, here are normal levels:
- TSH: Technically, a normal range is 4 to 5 mU/L, but I like to see a range between 1 and 2.
- Total and Free T4: Normal total T4 ranges from 5 to 12 mcg/dl, and free T4 ranges from 1.0 to 1.8 mg/dl.
- Total and Free T3: Total ranges 79 – 165 ng/dL, and free T3 ranges 3 – 4.1 pg/mL.
- Reverse T3: Normal is 10 to 24 ng/dL. This should be interpreted in relation to free T3.
- Anti-TPO: Less than 9 IU/mL
- Anti-thyroglobulin: Less than 4 IU/mL
How to Treat Hypothyroidism Naturally
If you have hypothyroidism, there are a few things you can do to help support your thyroid and improve your symptoms.
Keep in mind that many women will need thyroid medications on top of taking charge through diet and lifestyle changes—and that's one hundred percent okay.
One of the best things you can do is ensure you're eating a nutrient-rich diet. This means plenty of vegetables, fruits, healthy fats, and quality protein. You can find a free meal plan with recipes here to help you get started.
Support your gut.
A healthy gut is critical for thyroid health, especially for autoimmune conditions like Hashimoto's. Make sure you take a supportive probiotic, eat plenty of fermented foods, and extra fiber for prebiotic support.
Chronic stress can impact thyroid function, so finding ways to reduce stress in your life is essential. This might include things like meditation, yoga, or spending time in nature.
A few key nutrients are critical for thyroid function, including iodine, selenium, zinc, and vitamin D. If you're not getting enough of these in your diet (especially if you are on a restricted diet), you may want to consider supplementing (learn more about supplements for thyroid health here). I created the Thyroid Support Kit to include all of the key nutrients your thyroid needs to do it's job, along with support so that your body can use the thyroid hormone at each cell.
Avoid endocrine disruptors.
Endocrine disruptors are chemicals that can interfere with hormone function, like some pesticides, BPA, and plastics. Try to buy organic produce whenever possible, use glass instead of plastic containers, and avoid using personal care products that contain synthetic fragrances.
Manage blood sugar.
Keeping blood sugar levels in check is vital for overall health, but it's also critical for thyroid function. There's a close relationship between hypothyroidism and blood sugar dysregulation—people with type 2 diabetes are more likely to have hypothyroidism than those without.
Eating for blood sugar balance means regularly eating (don't skip meals), filling up on fiber and other nutrient-dense foods, and limiting processed sugars.
Monitor thyroid hormone levels.
If you're on medication for hypothyroidism, it's essential to keep an eye on your thyroid hormone levels. This can be done by getting regular blood tests and working with your doctor to adjust your dosage as needed.
Each person has an individual experience with hypothyroidism, so work with your doctor to find the right treatment plan for you.
If you're feeling exhausted, depressed, or just noticing something isn't right, go with your gut. Always listen to the messages your body is trying to tell you!
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