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Continuing our series on hypothyroidism, part two addresses the risk factors and signs and symptoms of the disorder.

Millions of people live each day with hypothyroidism and don’t even know it. You’re tired and fatigued, you’re gaining weight and depressed, your skin is dry and your nails brittle, your hair may be falling out and you sleep more than normal. Unfortunately, many people don’t recognize these symptoms of hypothyroidism, a condition that affects some 27 million Americans. And if you’re a woman, you have a one-in-eight chance of developing a thyroid disorder in your lifetime. Risk factors and symptoms are listed in detail after the jump.

Family history of thyroid problems or other autoimmune or endocrine disease – Research shows that up to 50 percent of all first-degree relatives of people with autoimmune thyroid disease will themselves have thyroid antibodies that place them at greater risk for also developing autoimmune hypothyroidism. There are also increased risks of hypothyroidism for people whose family members display other autoimmune or endocrine diseases including insulin-dependent type 1 diabetes, Addison’s disease, Cushing’s disease, PCOS, Alopecia, Reynauld’s syndrome, Sjogren’s syndrome, Chronic Fatigue syndrome, and Fibromyalgia. Other more common autoimmune or similar conditions include rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, sarcoidosis, scleroderma, vitiligo and psoriasis. Hypothyroidism is also commonly seen in people with celiac disease/gluten intolerance. In fact, celiac disease has been shown to be a direct trigger of hypothyroidism in some people.

Personal history of thyroid irregularities – Thyroid irregularities can develop after pregnancy or illness and you may have been diagnosed with transient – or temporary – thyroiditis or hypothyroidism. Past thyroid problems increase the likelihood that you will develop hypothyroidism in the future.

Treatment for Graves’, Hyperthyroidism, Goiter, Nodules, Thyroid Cancer Surgery and Treatment

Pituitary Tumors and Pituitary Disease, Hypothalamic Disorders

Aging – If you are over 60, your risks for developing hypothyroidism are greater than for a younger person. The American Thyroid Association estimates that as many as one woman in every ten over the age of 65 may be hypothyroid. The American Association of Clinical Endocrinologists estimates that thyroid problems affect one in eight women ages 35 – 65 and one in five women – 20 percent – over 65. Because hypothyroidism symptoms may be similar to those related to aging, it may be more difficult to spot thyroid disease in older patients.

Fertility, Pregnancy, and Hormonal Issues – According to the American Medical Women’s Association, women are five to eight times more likely than men to suffer from an overactive or underactive thyroid. If you have had a baby in the past year, you are at increased risk of thyroid problems, including the short term postpartum thyroiditis. The period after pregnancy is also a common time for permanent thyroid problems to surface. Some doctors estimate that as many as 10 percent of women will develop a thyroid problem after delivery. Studies also show that drinking alcohol during pregnancy can reduce the levels of thyroid hormone in both mother and baby.

Menopause –Thyroid problems are known to surface both with aging and at periods of hormonal upheaval, but many symptoms of hypothyroidism may be chalked up to menopause in menopausal women.

Smoking and Smoking Cessation – Active or past smokers have an increased risk of hypothyroidism because some of the chemicals in cigarettes affects the thyroid gland and acts as an antithyroid agent. If you have recently quit smoking, this may be the time when hypothyroidism becomes apparent. Hypothyroidism book author May Shomon speculates this is because the nicotine “buzz” from smoking creates an artificially higher metabolism that hides the fatigue and exhaustion and weight gain commonly seen in hypothyroid patients. This may also explain why hypothyroid smokers who quit smoking usually gain more weight than non-hypothyroid people who quit smoking.

Drugs – Certain drugs are known to have an effect on thyroid function, including causing hypothyroidism. Most common are the drug lithium, used to treat bipolar disorder, and the heart drug amiodarone (Cordarone). Other drugs that may cause hypothyroidism in some people include: Glucocorticoids/adrenal steroids like prednisone and hydrocortisone; Propranolol; Aminoglutethimide; Ketocanazole; Para-aminosalicylic acid; Sulfonamide drugs’ Sulfonylureas; Raloxifene (Evista); Carbamazepine; and anti-thyroid drugs like PTU and Tapazole.

Iodine Imbalances – Severe iodine deficiency is known to cause hypothyroidism. This irregularity is more prevalent in countries that do not add iodine to salt, which includes regions in the U.S. known as “Goiter Belt” areas (Appalachian Mountains, Great Lakes basin west through Minnesota, South and North Dakota, Montana, Wyoming, southern Canada, the Rockies, and into non-coastal Oregon, Washington and British Columbia).

Overconsumption of Goitrogenic Foods – This is usually considered problematic only for people who eat these foods raw often or consume them in large quantities. These foods have been shown to promote goiters and reduce the amount of iodine available to help synthesize T4 and T3. Common goitrogenic foods include Brussels sprouts, rutabaga, turnips, kohlrabi, radishes, cauliflower, African cassava, millet, cabbage, kale, soy products, horseradish, mustard, corn, broccoli, carrots, peaches, strawberries, peanuts, spinach, watercress, mustard greens and walnuts. Cooking these foods suppresses the effects of most of them and when consumed raw, the concern is largely with overconsumption.

Environmental Exposures – One of the reasons more people have hypothyroidism today than in previous decades is thought to be caused by environmental exposures to fluoride, chlorine and from mercury, a component in dental fillings. Some doctors recommend drinking only distilled water, while others are concerned about excessive exposure to chlorine in chlorinated water supplies and swimming pools.

X-Ray and Radiation Treatments – People who have had radiation for head, neck and throat cancers (with or without chemo) are at greater than normal risk for developing hypothyroidism. Patients who had X-ray treatments to the head, neck and chest from the 1920s through the 1960s are also at greater risk.

Infection – There is a strong causative relationship between bacteria known as Yesinia enterocolitica infection (found in the fecal matter of livestock and domesticated and wild animals) and Hashimoto’s thyroiditis.

Severe Snakebite – Severe illness due to snakebite can result in pituitary damage that causes hypothyroidism.

Neck Trauma / Whiplash – Some research suggests that trauma to the neck can result in hypothyroidism because of injury sustained to the thyroid tissues themselves.

Nuclear Plant and Perchlorate Exposure, Exposure to Other Toxic Chemicals – Few people have been exposed to a nuclear plant, but perchlorate is found in drinking water in at least 22 states. Long-term exposure to toxic chemicals like MTBE and various insecticides have also been shown to affect the thyroid.

A number of conditions are more common in people with hypothyroidism or may be triggers that cause hypothyroidism or may result from undiagnosed hypothyroidism. These conditions include:

Epstein-Barr Virus and Mononucleosis;
Carpal Tunnel Syndrome, Tarsal Tunnel Syndrome, Tendonitis, Plantar Fascitis;
Polycystic Ovarian Syndrome (PCOS);
Heart Disease/Mitral Valve Prolapse;
Down Syndrome;
Depression and Bipolar Disease;
Iron Imbalances;
Celiac Disease/Gluten Intolerance;
Infertility/Recurrent Miscarriage;
Skin problems like eczema, hives, psoriasis, alopecia, and vitigo;
Premenstrual Syndrome/Difficult Menopause;
Dyslexia and AD/HD;
Endometriosis;
Candidiasis/Yeast Overgrowth;
Chronic Fatigue Syndrome and Fibromyalgia;
Type 1 Diabetes;
Metabolic Syndrome/Insulin Resistance/Type 2 Diabetes;
High Cholesterol/Hyperlipidemia;
Elevated C-Reactive Protein and Total Homocysteine Levels

Signs and symptoms of hypothyroidism can vary in both number and severity for different people at different TSH levels. Clinical signs your doctor may look for include:

Slowed Achilles reflex and other slowed reflexes;
Low body temperature;
Slow heartbeat or irregular heartbeat and/or palpitations;
Blood pressure irregularities;
Loss of outer edge of eyebrow hair;
Coarse brittle hair and/or loss of scalp, underarm and/or pubic hair;
Dry skin and dry mucous membranes;
Yellowish cast to skin (jaundice) and/or paleness of skin and lips;
Dull facial expression;
Eyeball protrusion;
Puffiness around the eyes;
Slow movement and speech;
Hoarse voice/enlarged neck, goiter;
Edema (swelling) of the feet

Other hypothyroidism symptoms you may notice include:

Low body temperature / Feeling cold

Tiredness and Weakness

Low Sex Drive

Muscle and Joint Aches and Pains

Obesity / Weight Gain – Key symptoms of hypothyroidism include a sudden weight gain or inability to lose weight despite following a reasonable diet.

Digestive problems/constipation – Constipation is a common symptom of hypothyroidism and often does not respond to increased dietary fiber and water consumption and laxatives.

“Brain Fog” – Forgetfulness, difficulty in concentrating, inability to focus… all are symptoms of hypothyroidism.

Slow/Rapid Pulse and/or Low/High Blood Pressure, Heart Palpitations – According to the National Institutes of Health, a blood pressure of 120/80 mm is considered to be normal for most adults. A level such as 105/65 mm may be considered low, whereas 140/90 mm is considered to be high. Although well trained athletes can have a normal pulse of 40 – 60 beats per minute, pulses slower than 60 – 85 beats per minute in non-athletes may be a symptom of hypothyroidism.

High Cholesterol – Unusually high cholesterol levels may be a sign of underlying hypothyroidism, especially cholesterol that doesn’t respond to diet or cholesterol-lowering drugs.

Skin Problems – May include paleness or a yellowish cast, dry mucous membranes, easy bruising, cracked skin on elbows and kneecaps, hives, chronic itching, psoriasis, eczema, etc…

Hair and Nail Changes – Hair may become brittle and break more easily or it may fall out. Nails can become dry, brittle and may break more easily than normal.

Menstrual Changes – Menstrual irregularities may occur with hypothyroidism including longer and/or heavier periods, a shorter cycle or a less regular cycle.

Fertility Problems – Women with hypothyroidism may find it difficult to become pregnant and it may increase their risk of miscarriage.

Menopausal and Postpartum Symptoms – Premature and exaggerated symptoms of menopause and exaggerated postpartum symptoms are all more common symptoms of hypothyroidism.

Breast Changes – Some people with hypothyroidism have imbalances in prolactin, the hormone that controls breast-feeding. Some women with hypothyroidism report lactation (milk leaking from the breasts) in a woman who is otherwise not breast-feeding.

Mood, Depression – A change in mood and depression are both common symptoms of hypothyroidism. For those who take antidepressants and are still depressed, you may be suffering from an undiagnosed thyroid problem.

Eye Problems – There is a form of eye disease associated with Graves’ disease that can cause an inflammation of the eyes with swelling of the tissues around the eyes and bulging of the eyes. While thyroid eye disease is most associated with Graves’ Disease, others with hypothyroidism may experience light sensitivity, frequent tics, headaches from eye sensitivity, eyes that feel gritty or dry, rapidly shifting gaze and blurry vision.

Neck and Throat Complaints - A goiter, swelling or thickness in the neck are obvious signs of hypothyroidism, but people without these conditions have reported difficulty swallowing, a choking sensation or discomfort with neckties or scarves.

Hearing Issues – According to some researchers, tinnitus (hearing sounds that aren’t there like ringing or whistling) can be correlated to the severity of hypothyroidism. Hearing loss is also a symptom, although not very common.

More Infections and Lowered Resistance – People with hypothyroidism report getting more frequent cold, flus and sinus infections, and have a longer and more difficult time recuperating from these infections.

Allergies – Development of allergies or a worsening of existing allergies may be signs of hypothyroidism.

Sleep Apnea and Snoring – Snoring can be a symptom of sleep apnea and sleep apnea can be a symptom of hypothyroidism.

Dizziness and Vertigo – Lightheadedness, dizziness and vertigo can all be symptoms of hypothyroidism, however these are typically worse with higher TSH levels.

Puffiness and Swelling – Puffiness and swelling can affect all parts of the body but may be more visible in the eyes, eyelids, and face, and can sometimes be painful and visible in the feet and hands.

Headaches – Chronic headaches and migraines are both symptoms of hypothyroidism.

The above list is not inclusive and you may have unique symptoms specific to your own health and hypothyroidism. If you suspect you have hypothyroidism or if you have been diagnosed and are still experiencing symptoms, keep a journal charting your symptoms and progression, along with other variables including diet, exercise, supplements and other medication taken, and blood test values you may have. Tomorrow’s series will address the various forms of tests to detect hypothyroidism and treatment for it.