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Hypothyroidism – Risk Factors, Signs & Symptoms

3rd September 2008

Hypothyroidism – Risk Factors, Signs & Symptoms

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.

Risk Factors

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.

Conditions and Illnesses that Raise Suspicion of Hypothyroidism

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 & Symptoms

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.

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This entry was posted on Wednesday, September 3rd, 2008 at 11:27 am and is filed under Health, Nutrition & Fitness, New Research. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

There are currently 21 responses to “Hypothyroidism – Risk Factors, Signs & Symptoms”

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  1. 1 On September 3rd, 2008, Rachel2 said:

    Wow. I think that it’s time to get checked out for this at the very least!

    Thank you so much for bringing this to light, Rachel. It could very well be another source of problems not only for myself, but for apparently millions of other people. Thank you!

  2. 2 On September 3rd, 2008, Catgal said:

    Whoah! I have many of these symptoms! Actually I can count more that I have than those I don’t. I think I need to talk to my MD!

  3. 3 On September 3rd, 2008, Tiana said:

    OMG, stop scaring me! Just kidding, of course. The things is, both my boyfriend and I have been suffering from several of these symptoms (each from a different set) since I gave birth to our child eight months ago. So far we’ve been thinking that I have fibromyalgia which was aggravated by the pregnancy and that his problems were caused by all the stress resulting from me being unable to do things. However not ONE doctor has been able to conclude anything so far. We’re about to run away screaming. I guess I’ve just discovered a new thing that both of us should be tested for …

  4. 4 On September 3rd, 2008, CityGirl said:

    Great Post, Most women never know and most doctors don’t test for it… Its wonderful of you to put the word out there.

  5. 5 On September 4th, 2008, La di Da said:

    At my next doctor’s appointment (soon) I’m going to ask for a blood panel to check out hypothyroidism. I was going to do it anyway, knowing some of the symptoms and how I’ve been feeling over the past few years, but these posts have urged me to research further and try to get this resolved. Especially telling is the connection between sleep apnea and hypothyroidism – studies seem to show that between 1.5% and 5% of people diagnosed with sleep apnea (OSA) actually have their sleep disturbances caused by hypothyroidism. And CPAP or dental devices, or even the throat surgeries sometimes offered, are not appropriate treatment for them even if it seems like they help. I’ve got OSA and about 90% of the things on the risk factor list. :/

    Thanks for this excellent series of posts, Rachel.

  6. 6 On September 4th, 2008, Katrina said:

    I was not diagnosed with hypothyroidism until I was 29, even though I probably had the condition a lot longer. Now I’m pretty good at avoiding some of the risk factors and yoga has been a god send to managing my stress and body.

    But. I wish someone had told me that taking one little pill a day isn’t all you need to do and that other conditions can emerge. For instance last fall, after a few months of scary symptoms, I learned that I was iron deficient and that it’s not uncommon among women with hypothyroidism. I’m a lot better now, but its a wake up call that my hypothyroidism is in fact a condition to be managed all the time.

  7. 7 On September 4th, 2008, i-geek said:

    *eek*

    Thanks for posting this. I have several of the symptoms, most notably the infertility, depression/lack of focus, low sex drive, dizziness/vertigo, and skin issues. I also found out a couple of weeks ago that my maternal grandmother and at least three of my mothers sisters have been treated for thyroid problems. Based on my mom’s menstrual/menopausal symptoms, I wonder if she shouldn’t be tested as well.

  8. 8 On September 5th, 2008, Chris said:

    who do i talk to? I have lot of these symptoms and i think that i might be ADD. But on the other hand i could just be like crazy or something. I was in a car accident and got a permanent injury, and my depression symptoms go away. I don’t know what to do, I don’t like making a big deal out of things. I keep thinking its because I am overweight, and I am young so they will go away. Any advice?

  9. 9 On September 6th, 2008, SLW2004 said:

    Woah. I have a shocking number of those symptoms. On the other hand my new doctor just took bloods to check my thyroid, my hormones, my glucose levels… there were other things but right now I can’t think what they were. Guess I’ll find out in a couple of weeks what the results are. I already have a diagnoses of PCOS so…

    Good post. Very informative.

  10. 10 On October 3rd, 2008, John said:

    Just wanted to say, blood must be drawn before 9.00 am for the results to be accurate. jb

  11. 11 On January 5th, 2009, Women's Health Issues said:

    This is such an informative article. I run a site over at surewomen.com and will have to put an article up on the subject. I had no idea. We need to get this info out there.

  12. 12 On January 21st, 2009, January is Thyroid Awareness Month » The-F-Word.org said:

    [...] Risk Factors, Signs & Symptoms [...]

  13. 13 On February 3rd, 2009, Denise said:

    I’ve been hypothyroid for many years and didn’t know. I’ve been undergoing treatment since July 2008 and it is a condition that has to be managed constantly. I have to take 150mg of iron daily to avoid being anemic (diagnosed with hypothyroidism) because I have heavier periods related to the hypothyroid problem. I can’t stress enough how important it is to talk to your doctor or a naturpath dr. to get on a daily regimen of vitamins, lots of water, and exercise (I try to do 2-3 times per week) and what a difference it makes. Unfortunately, over time you will need to gradually increase your thyroid med as your thyroid function dwindles more and more over time. Not a big deal, but something I realized you have to take much more serious than you would think. Regular blood work is key!

  14. 14 On February 10th, 2009, Jenelle Sullivan said:

    L kept telling the Drs for 10 years that there was something wrong with me. They kept treating the symptoms or treating me as if it was all in my mind. I had primary peritineal cancer. A simple CA125 blood test could have told them it was there but they didn’t do it. If the cancer was running true to form I would have been dead long ago. I now figurativly hold a gun to my Drs head if I want something done. I had unexplained weight gain. Did a yahoo search and the only thing that came up in the top ten was thyroid. He didn’t want to test me but I told him to humour me. Guess what, I was right. Just started the treatment. I have nearly all of the symptoms. For the last ten months I have had swollen ankles and legs up to the knee with extreme knee pain but no arthritis. I fall asleep in the middle of writing a test message on my phone.
    DON”T ever take your Drs word for it and make them test you. Drs bury their mistakes. Don’t be one.

  15. 15 On February 11th, 2009, sandra hernandez said:

    I am concerned about my health. I have been treated for Chronic Yeast syndrome which affects my intestines caused by a long history of antibiotics. This is the second time I have had this return. I was put on the medication in mid October 2008 and I still have the urticaria that will not go away. I am on a yeast free diet and still if I eat anything sweet I get an immediate pain in my upper left abdomen below my rib. I am feeling worse now because I have brain fog, migraines, bad focus issues, bad circulation in my legs caused from swelling and of course no energy, if I had the time I would be sleeping. I feel like my thyroid gland is swollen I feel my heart beating fast at times. I have been through blood work that eliminates thyroid, diabetes, gluten/celiac but I still all of these symptoms. I have also had an endoscopy done along with with visits to a cardiologist which have not found anything wrong with me. I have the symptoms of hormonal imbalance, candida yeast, thyroid and a fatty liver. I am tired of feeling this way.

  16. 16 On February 13th, 2009, Jenelle Sullivan said:

    Sandra a combination of CT scan and CA125 (tumour marker test)could help to rule out cancer. The symptoms of ovarian and peritineal cancer mimic most of the gastroenteroligical(?sp) diseases. I was also diagnosed with non alcoholic fatty liver disease. My liver function test results are a lot better since the cancer was treated.
    They also wanted to remove my gall bladder even though there was no sogn of stones. They said I had irritable bowel, a hiatus hernia and gastric reflux disease.
    be careful; of your medications. I found that panadeine forte caused brain fog, and focus issues and headaches. They talked about chronic fatugue syndrome too. Please get those tests done, if you are clear that is wonderful but I would feel a lot better isf you were sure. Oh by the way, the first CT scan that showed up my cancer was not diagnosed by either the radiologist or the gynacologist. The second ‘something’ was found and at a meeting of the entire gastroenterology and radiology departments of a large regional hospital only ONE person had seen anything like it.

  17. 17 On February 24th, 2009, Shorty said:

    Hi everyone! I was tested for hypothyriodism a few months ago and the blood test came back normal but it seems like the more time that goes on I get more of the symptoms. I’m getting more and more tired and recently started getting dizzy spells/vertigo (among other symptoms). What do I do! should I see a different doctor?

  18. 18 On March 11th, 2009, Hypothyroidism update and worthless doctor rant » The-F-Word.org said:

    [...] Risk Factors, Signs & Symptoms [...]

  19. 19 On March 24th, 2009, desertgirl26 said:

    I have had hashimoto’s since 2003–after having my baby girl… and yeah…it’s not exactly fun, this site though has a lot of useful information I have been searching for. I am also a silent or occular migraine sufferer and had one about a week and a half ago and still have experiencing light sensitivity which is usually not the case, I am always kind of sensitive to light and am now thinking maybe it’s because of the thyroid condition,I have been on hormone replacement ever since I was diagnosed, I didn’t know being hypothyroid could do that –whats the reason the behind it(anyone know?), hypothyroid and light sensitive?

  20. 20 On November 11th, 2009, aims said:

    I actually had my dr test me for my iron level as I was always feeling tired. It was a big difference from 6 months ago because I use to workout and I figured it was cause I took such a long break but nope. My Iron level came back fine and for some reason she had me do another set of blood test and I didn’t know it was for my thyroid. And what did you know! I had hyperthryoidism. Just got that treated and am waiting to get down to hypo (which I think would be now). I’m back to being very tired, hard to lose weight, blurry vision, etc. So I have another blood test to do before I go see my endocrinologist. All I can say is that being hyperthyroidism this past year has REALLY taken a toll on my body and self esteem. Esp the fact that I would get irritated and snap at ppl for no apparent reason.

  21. 21 On January 7th, 2010, Jov said:

    Thank you for this list of symptoms! My medical doctor said that Vertigo had “nothing to do with Vertigo” and that it’s only a flu-virus in the vestibular-ear region. I had my doubts on this and it is now confirmed that I’m right. Plus my mom has many of the symptoms you listed here for hyperthyroidism, in fact, she had her thyroid gland removed years ago!!! and now on useless Levothyroxine T4 only med. The doctor clearly committed negligence toward his patient and insulted me too when I questioned about T3 thyroid meds..outrageous, a reflection of our corporate Medical System’s failure here in the United States..

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