How To Tell if You Are Hypothyroid

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Hypothyroidism is a term used to describe when the thyroid gland is not producing enough, or sometimes any, thyroid hormone. It is this hormone that helps regulate how our organs, tissues, and cells use oxygen and energy. Any deficit reduces our ability to function in many different ways.

Although hypothyroidism affects women more than men, many of the symptoms are the same irrespective of sex. They include fatigue, cold intolerance, muscle weakness, muscle cramps, constipation, weight gain, and mood swings.

Because these symptoms are often so non-specific, diagnoses are often missed or attributed to some other causes. It is only by looking at the symptoms in their totality that people begin to suspect that it's not all in their head and that these may, in fact, be hypothyroid.

Knowing the Risk Factors

The first step in exploring whether you are hypothyroid is to identify the risk factors that place at higher or lower risk. From the broader standpoint, women over 50 are at greatest risk. Women, in general, are four times more likely to be hypothyroid than men, according to research published in the British Medical Bulletin in 2011.

Other risk factors include:

  • A family history of thyroid disease or an autoimmune disorder
  • A current autoimmune disorder such as rheumatoid arthritis
  • Type I diabetes

Spotting the Clues

Hypothyroidism is often characterized by tell-tale symptoms, mainly in and around the neck where the thyroid gland is located.

A hypothyroid person will often have a noticeably enlarged neck as well as a palpable lump or enlargement.

There may also be hair loss, especially around the outer edge of the eyebrow. Puffiness of the hands, feet, and face (especially around the eyes) may complete the “classic” portrait and lead to a speedy diagnosis.

But, clearly, not everyone has some—or even any—of these symptoms. In the absence of these, you sometimes need to look at the combination of both obvious and less-obvious symptoms of the hypothyroid disease. These may include a range of symptom which affects different organ symptoms and functions, such as:

  • Mood and behavior
    • Fatigue and lethargy
    • Chronic sleepiness
    • Depression
    • Poor memory and concentration
    • Mood swings often exaggerated with strong emotions
  • Metabolic
    • Cold intolerance
    • Dry skin and decreased perspiration
    • Low body temperature
    • Muscle or joint pain
    • Muscle weakness
    • Weight gain
    • Decreased appetite
    • Chronic or severe constipation
    • A hoarse, gravelly voice
  • Hormonal
    • Irregular periods
    • Severe menstrual cramping
    • Impaired fertility
    • Loss of libido, both male and female
  • Neurological
    • Burning or tingling sensations in the hands, feet, legs, and arms
    • Blurred vision
    • Hearing loss
    • Sluggish reflexes

For many women with hypothyroidism, their first and perhaps the biggest clue is a history of reproduction problems, including a history of recurrent miscarriage, repeated failure to conceive, or failed assisted reproduction treatments. Hypothyroidism is commonly explored when faced with these sorts of difficulties.

Making the Diagnosis

If your symptomatic profile suggests you are hypothyroid, your doctor can perform a clinical exam and run a number of blood tests to evaluate your thyroid stimulating hormone (TSH) levels as well as other associated hormone levels.

Based on the result, your doctor may be able to make a diagnosis if:

  • The TSH level at the lower end or below the normal range (0.5 to 5.5).
  • The total T4 is at the lower end or below the normal range (4.5 to 12.5).
  • The free T4 is at the lower end or below the normal range (0.7 to 2.0)
  • The total T3 is at the lower end or below the normal range (80 to 220).
  • The free T3 is at the lower end or below the normal range (2.3 to 4.2).

Even if the numbers come back normal, the doctor may still be able to perform a thyroid antibodies test if your symptoms and risk profile for hypothyroidism are compelling.


Vanderpump, M. "The epidemiology of thyroid disease." Brit Med Bul. 2011; 99(1):39-51: DOI: 10.1093/bmb/ldr030.