7 Signs of an Underactive Thyroid

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7 Signs of an Underactive Thyroid

Underactive thyroid function or hypothyroidism is one of the most commonly misdiagnosed conditions on the planet.  Many people suffer for years with various symptoms related to poor thyroid function without ever getting the help they need.  The goal of this article is to help you understand 7 signs of an underactive thyroid so you don’t have to suffer unnecessarily anymore.

Hypothyroidism affects women much more frequently than men with some reports saying anywhere from 5 to 8 times more (1).  Reports suggest that up to 60% of those with thyroid problems are not aware of the issue.  Here are 7 of the main symptoms we see associated with hypothyroidism.

1. Unexplained Weight Gain  

Many people notice that they begin gaining weight without making any changes in their nutrition and activity levels.  Often, I see women who eat a healthy diet and exercise regularly, but continue to gain unwanted weight.

The thyroid controls our metabolic rate within the cells.  When we are unable to get enough thyroid hormone within the cell, our cellular activity slows down and we burn less calories and store more fat.

When mammals go into hibernation, there thyroid levels drop, which slows down their metabolism so they can survive during a famine.  When we are ill, we often don’t have an appetite and our thyroid levels drop so we can rest and heal.

In the same manner, an underactive thyroid or inability to utilize thyroid hormone effectively is a sign the body needs more rest in order to heal.  In our society, when we have unexplained weight gain, we are told we need to exercise more.  This is most often counterproductive and actually makes thyroid function worse.

2.  Constant Fatigue and Tiredness

If you are noticing fatigue throughout the day, it is a classic sign of low thyroid activity.  This is a natural sign the body gives us that we need to slow down and rest.  If we are noticing a constant fatigue, it is imperative to listen to our body before we drive it even further into hormonal chaos.

Thyroid hormone drives cellular activity and ignites our energy levels.  There are delicate pathways between the adrenal glands, the hormone control centers in the brain (the pituitary gland and the hypothalamus) and the thyroid gland.  When we get excessive activity of stress hormones produced by the adrenal glands, it can lead to lowered thyroid activity and the resulting fatigue and tiredness.

Thyroid Health, 5 Natural Remedies For Thyroid Health

3. Muscle Soreness and Pain

Many individuals with an underactive thyroid present with muscle soreness and pain throughout their body.  They have often been misdiagnosed with fibromyalgia or chronic pain disorder and will often see significant reduction in their pain levels when their thyroid hormone levels are balanced.

The medical literature discusses chronic, generalized pain associated with hypothyroidism presenting in multiple parts of the body including the ankles, legs, wrists, back, neck, arms and shoulders (2).  These cases are often made worse with exposure to cold weather and are often accompanied by cramping, numbness and tingling.

It is estimated that 80% of all thyroid conditions are autoimmune in nature (3).  When we have an autoimmune reaction to one tissue, our body most likely has developed autoimmunity to additional tissues.  This may include the muscle sheath, myelin sheath around our nerves or joint capsules, all of which would result in pain if enough tissue damage took place.


4.  Menstrual and Fertility Problems

Women who have issues with their menstruation or are struggling with infertility should consider hypothyroidism as a cause.  An underactive thyroid is linked to 3 major issues with menstruation (4).  These include the following:

Early Menstruation:

This is also called precocious puberty and involves girls having their period begin before the age of 10.

Heavy Periods:

This is called menorrhagia and involves women or young girls having periods that are heavier than usual.

Frequent or Longer than Normal Periods:

Many women with hypothyroid issues will notice a significant shortening of her cycle or periods that last longer than normal.

When the thyroid is not working properly, the body believes it is important to be in a hibernation mode and that the outside environment is not safe to have a child.  Here is how it effects fertility:

High Prolactin Levels:

Prolactin is a hormone released from the anterior pituitary gland that allows for lactation to develop after childbirth.  High prolactin levels reduce fertility in women, which is why women are significantly less fertile when nursing.

The anterior pituitary gland is also where thyroid stimulating hormone is released and if the hypothalamus senses low thyroid hormone activity, it will ramp up thyroid releasing hormone, which will then effect the anterior pituitary and often lead to elevated prolactin levels as a result of a massive jolt of activity on the pituitary gland (5).

Anovulatory Cycles:  Very high prolactin levels will often result in what is called anovulatory cycles.  This is where no ovulating egg occurs, which of course, makes pregnancy impossible.  Many women with hypothyroidism do not ovulate.

Luteal Phase Irregularities:  High prolactin can cause a reduced amount of progesterone to be produced after ovulation.  This would result in a weak uterine lining that is less viable for embryo implantation.  This can result in a period that comes shortly after ovulation, thus more frequent but shorter periods can occur.

Other Hormonal Issues:  Some of the other issues involved with hypothyroidism can include estrogen dominance and low sex hormone binding globulin (SHBG), which will both interfere with normal reproductive capabilities (6).

5.  Dry and Flaky Skin & Brittle Hair

Thyroid hormone is important to the production of the sebum in the sebaceous glands of the skin.  Sebum is the oil that provides for healthy skin and hair.  With inadequate sebum production, one will often develop dry and flaky skin and dandruff (7).

The skin can also become extremely cold, dry and pale with hypothyroidism.  The dryness can be so bad that there may not be any sweating and the palms and soles can get thick and dry causing a condition known as keratoderma.

Hair loss can be diffuse and widespread involving the entire scalp rather than discrete areas.   In many cases this is due to an autoimmune attack against the hair follicles.  Since 80% of thyroid problems are autoimmune in nature, this is a common mechanism.

Additionally, thyroid hormone is important for the growth and development of the hair follicles and without adequate thyroid hormone the hair can become very dry and brittle (8).


6.  High Cholesterol Levels

One of the biggest reasons for high LDL cholesterol levels has to do with low thyroid hormone production.  Unfortunately, most medical doctors run a simple lipid panel, see the high cholesterol and treat with statin medications that never get to the cause of the real issue – the thyroid.  In fact, statin medications deplete CoQ10 in the mitochondria, causing a worsening of thyroid function (9).

Thyroid hormone is a key player in the formation of cholesterol and LDL receptor expression.  Low thyroid function leads to poor expression of the LDL receptor and increased cholesterol production by the body (10).  Basically the body doesn’t realize how much LDL it is producing as the receptor is not reading it properly.

Thyroid hormone is important in bile production, of which cholesterol is a major component.  Bile is how the body gets rid of excess LDL, but in individuals with hypothyroidism, they have sluggish bile motility.  The cholesterol component of bile is typically taken up and eliminated through the stool. Constipation is another common sign of low thyroid and poor bile motility plays a role.

A study in the Journal of Clinical Endocrinology and Metabolism demonstrated that elevations in TSH without a reduction of T4 can even cause an increase in LDL cholesterol (11).

7.  Poor Concentration and Memory

Thyroid hormone plays an important role in brain function.  In fact, the brain is saturated with thyroid hormone receptor sites which play a role in the formation of key neurotransmitters like dopamine, acetylcholine and serotonin.  Low dopamine levels can lead to poor concentration, while low serotonin can lead to depression and insomnia.

One of the classic symptoms of hypothyroidism is depression (12).  Many physicians will diagnose and treat depression without ever considering the thyroid.  Others will experience insomnia and be treated with medications for that without any focus on testing the thyroid.

There is a strong link in the literature between underactive thyroid and dementia.  Hypothyroidism causes lowered levels of acetylcholine production which leads to forgetfulness and often constipation.  Correcting the cause of the thyroid imbalance can and should be addressed in these cases.

underactive thyroid


Underactive thyroid problems can be the cornerstone of a number of major health symptoms.  If you are experiencing any of these conditions than it is wise to have your thyroid analyzed.  Most physicians will only look at a few factors such as TSH, T4 and T3.  This is not enough data to rule out an underlying thyroid problem.

I recommend looking at free T4 and free T3 as elevations in estrogen or testosterone can effect the free levels of these hormones which can cause poor T3 utilization in the cells.  Since 80% of hypothyroidism is due to an autoimmune condition, we should always look at antibodies.  In particular, we study thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies to look for autoimmune activity against the thyroid.

Finally, we should also look at reverse T3 (rT3) which is an inactive form of T3 that blocks thyroid activity.  rT3 rises with adrenal fatigue as a way of slowing down metabolism so the body can heal.

The test I use is called our Comprehensive Blood Analysis, which looks at all of the above factors as well as other key data points such as vitamin D levels, C reactive protein, homocysteine, a complete blood count and metabolic panel.  This is what you want to order if you are concerned about an underactive thyroid condition.

, Comprehensive Blood Analysis

Sources For This Article Include:

1. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord Trùndelag (PDF)
2. Kiran HS, Sudharshana Murthy KA, Aparna AN. A young lady with swelling and stiffness of calf muscles. Indian Journal of Endocrinology and Metabolism. 2011;15(2):130-131
3. Prummel MF, Strieder T, Wiersinga WM. The environment and autoimmune thyroid diseases. Eur J Endocrinol. 2004 May;150(5):605-18. PMID: 15132715
4. Koutras DA. Disturbances of menstruation in thyroid disease. Ann N Y Acad Sci. 1997 Jun 17;816:280-4. PMID: 9238278
5. Bahar A, Akha O, Kashi Z, Vesgari Z. Hyperprolactinemia in association with subclinical hypothyroidism . Caspian Journal of Internal Medicine. 2011;2(2):229-233.
6. Santin AP, Furlanetto TW. Role of Estrogen in Thyroid Function and Growth Regulation. Journal of Thyroid Research. 2011(2011)875125.
7. Goolamali SK, Evered D, Shuster S. Thyroid disease and sebaceous function. British Medical Journal. 1976;1(6007):432-433.
8. Vincent M, Yogiraj K. A Descriptive Study of Alopecia Patterns and their Relation to Thyroid Dysfunction. International Journal of Trichology. 2013;5(1):57-60.
9. Deichmann R, Lavie C, Andrews S. Coenzyme Q10 and Statin-Induced Mitochondrial Dysfunction. The Ochsner Journal. 2010;10(1):16-21.  Underactive Thyroid
10. Shin DJ, Osborne TF. Thyroid hormone regulation and cholesterol metabolism are connected through Sterol Regulatory Element-Binding Protein-2 (SREBP-2). J Biol Chem. 2003 Sep 5;278(36):34114-8. PMID: 12829694
11. Wang F, Tan Y, Wang C, Zhang X, Zhao Y, Song X, Zhang B, Guan Q, Xu J, Zhang J, Zhang D, Lin H, Yu C, Zhao J. Thyroid-stimulating hormone levels within the reference range are associated with serum lipid profiles independent of thyroid hormones. J Clin Endocrinol Metab. 2012 Aug;97(8):2724-31. PMID: 22730515
12. Hage MP, Azar ST. The Link between Thyroid Function and Depression. Journal of Thyroid Research. 2012(2012)590648.

Thyroid Health, 5 Natural Remedies For Thyroid Health

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  1. I hope this will cover what to do when your thyroid gland has been removed. I don’t want to take the synthroid medication. Actually I quit taking it but can’t really find any other alternative.

    1. Hi Connie I also had my thyroid removed and am currently talking eltroxin. I took synthroid and it made me feel very nauseous. So I was switched to Eltroxin. Not sure if this would help you either to ask your doctor about it.

  2. dear Dr I’m a patient from Iraq I read your article ,and a thousand articles like this one ,I have all these symptoms of hypothyroidism ,but the worst is that my all lab tests are normal .none of the endocrinologist helped me ! they don’t believe if any thing is wrong wrong with me ,even my husband suspicious that I may have some psychological issues ,I tried every thing no one can help me 😢😢

  3. Hello, I have noticed a growth on the front part of my neck. I also feel pains around my neck area when I put my glasses on, and when I put on a scarf. How can I know if it’s hypothyroidism or hyperthyroidism. Thank you

    1. Hey Richlove, A doctor can test your thyroid function and confirm if you are have a thyroid condition. I would recommend working with a functional practitioner to get to the root cause of the issue and customize a specific plan. This article can help you understand the major symptoms associated and what a thyroid test offers.

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