Symptoms and Signs of a Thyroid Condition

Millions Have Undiagnosed Thyroid Problems: Here Are Signs and Symptoms

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Do you have an undiagnosed thyroid problem? Here are the top ten signs.. istockphoto

It's estimated that as many as 59 million Americans have a thyroid problem, but the majority don't know it yet.

The thyroid, a butterfly-shaped gland located in your neck, is your master gland of metabolism. When your thyroid doesn't function, it can affect every aspect of your health, especially your weight, brain chemistry (i.e., depression and anxiety), energy levels, and heart health.

Undiagnosed thyroid problems can increase your risk of obesity, heart disease, infertility, and a host of other symptoms and a host of other health problems.

So while you don't need to have all of these thyroid signs and symptoms in order to have a thyroid condition, recognizing the signs and symptoms are important, and taking action to get a proper diagnosis and treatment is essential.  

THYROID AND NECK CHANGES COMMON TO THYROID CONDITIONS

Thyroid conditions in general frequently cause symptoms in the neck area where your thyroid s located. Some of these symptoms that can point to hypothyroidism, Hashimoto’s disease, hyperthyroidism, Graves’ disease, various types of thyroiditis, and thyroid cancer include the following:

  • An enlarged neck
  • Palpable enlargement in the thyroid gland itself (known as goiter)
  • A visible or palpable lump or lumps in your neck
  • Feeling of a lump in your throat when swallowing
  • A sore throat
  • Pain or tenderness in the neck
  • Your neck or throat feels sensitive, and ties, scarves, or turtlenecks don’t feel comfortable
  • Evidence of increased blood flow to the thyroid–detected by stethoscope

    HYPOTHYROIDISM/HASHIMOTO’S DISEASE/UNDERACTIVE THYROID: SIGNS AND SYMPTOMS

    Clinical Signs

    There are some observable clinical signs of hypothyroidism that can be measured, detected or identified in a clinical examination or testing with your practitioner. These clinical hypothyroidism signs include:

    • An unusually low pulse
    • Unusually low blood pressure
    • Lower-than-normal body temperature
    • Slow or sluggish reflexes
    • Puffiness in your face, and especially around your eyes
    • Puffiness or swelling of your hands and feet (known as edema)
    • Hair loss, and in particular, a unique hypothyroidism sign: the loss of hair in the outer edge of your eyebrows
    • High cholesterol levels that are unresponsive to cholesterol-lowering medication
    • Chronic or severe constipation that is unresponsive to treatment

    Common Hypothyroidism Symptoms

    Some common hypothyroidism symptoms you may experience including:

    • Fatigue/Energy: You feel fatigued, run down, sluggish, and exhausted, even after a lengthy sleep
    • Mood Changes: You feel depressed or blue, you have feelings of sadness or worthlessness, you feel anxious or restless, your moods change easily
    • Weight and Metabolism: You are unexpectedly gaining weight, despite no change to your healthy diet and exercise. You are unable to lose weight, or you may even be gaining weight, on a healthy, reduced-calorie diet with increased exercise.
    • Concentration and Memory: You have “brain fog,” difficulty concentrating, and difficulty remembering
    • Body Temperature: You feel cold when others feel hot
    • Hair Changes: Your hair is coarse and dry, breaking, brittle, or falling out.
    • Skin Changes: Your skin is coarse, dry, scaly, and thick, especially the soles of your feet.
    • Voice Changes: You have a hoarse or gravelly voice.
    • Pain: You have aches and pains in your joints, shoulders, hands, feet or pain-related conditions like frozen shoulder, carpal tunnel syndrome, tarsal tunnel syndrome, and plantar fasciitis
    • Sex Drive: You have no sex drive or a lower sex drive.
    • Snoring/Apnea: You’re snoring more lately, or you have developed sleep apnea
    • Eye Changes: Your eyes feel gritty, dry, and sensitive to light

    Signs and Symptoms in Women

    There are some hypothyroidism signs that are unique to women:

    • Puberty: Hypothyroidism can cause both early puberty and onset of menstruation, as well as delayed puberty
    • Menstrual Changes: You have severe menstrual cramps, unusually heavy menstrual periods, or irregular menstrual cycles
    • Fertility/Pregnancy: You have had trouble conceiving a baby, a history of failed assisted reproduction treatments, a history of recurrent miscarriage, you’ve had or are having postpartum depression, and you’ve had or are having problems with breastfeeding.
    • Perimenopause/Menopause: Your perimenopause is starting earlier than typical, or you are having especially difficult perimenopausal or menopausal symptoms.

    Signs and Symptoms in Newborns

    Some specialized signs of hypothyroidism in newborns include: 

    • Low muscle tone
    • Poor feeding, failure to gain weight
    • Hoarse crying

    Signs and Symptoms in Children/Adolescents

    Some specialized signs of hypothyroidism in children and adolescents include: 

    • Decreased growth rate, or growth retardation
    • Delayed skeletal maturation
    • Early or delayed puberty
    • Decreased energy
    • Appearing swollen or puffy
    • Weight gain without increased appetite
    • Constipation or harder stools 
    • Deterioration in handwriting
    • School problems
    • Deleted:,

    HYPERTHYROIDISM/GRAVES’ DISEASE/OVERACTIVE THYROID: SIGNS AND SYMPTOMS

    Clinical Signs

    There are some observable signs of hyperthyroidism that can be measured, seen or detected in a clinical examination by your practitioner. These signs of hyperthyroidism include:

    • Goiter – an enlarged thyroid
    • An unusually high pulse
    • Unusually high blood pressure
    • Fever
    • Fast or hyperresponsive reflexes
    • Evidence of heart palpitations,  rhythm irregularities, or atrial fibrillation
    • Hair loss, and in particular, a unique hypothyroidism sign: the loss of hair in the outer edge of your eyebrows
    • Unusually low cholesterol levels
    • Chronic or severe diarrhea that is unresponsive to treatment

    Eye Changes

    Changes to your eyes are common in hyperthyroidism and Graves’ disease. These can be symptoms of the Graves’ disease, or you may also have a related condition, known as Graves’ Ophthalmopathy or Thyroid Eye Disease. Some of the eye-related symptoms include:

    • Your eyes feel gritty and dry
    • Your eyes are red, dry, swollen, puffy or watery
    • Your eyes are sensitive to light
    • Your vision is blurry
    • You are having double vision
    • Your eyeballs appear to be bulging (known as proptosis), your eyes aren’t completely covered when your eyelids are closed
    • You have “lid lag"–when your upper eyelid doesn't smoothly follow downward movements of the eyes when you look down

    Common Hyperthyroidism Symptoms

    Some other common hyperthyroidism symptoms you may experience including:

    • Sleep: You may have insomnia, or find it difficult to fall asleep or stay asleep
    • Fatigue/Energy: In some cases, hyperthyroidism may make you feel wired and unusually energetic, but it is also common to feel fatigued, run down, sluggish, and exhausted
    • Mood Changes: You feel anxious, panicky, irritated, angry, or unusually stressed. You may be easily startled. You may also feel depressed or blue, have feelings of sadness or worthlessness, and your moods change easily.
    • Weight and Metabolism: You are unexpectedly losing weight, despite no change to your healthy diet and exercise. Or, your appetite has increased and you are eating more, but you are not gaining weight.
    • Concentration and Memory: You have “brain fog,” difficulty concentrating, and difficulty remembering
    • Body Temperature/Sweating: You feel hot when others feel hot, you are sweating more, and you feel thirsty more
    • Hair Changes: Your hair is falling out. Your hair is thinning or has become fine.
    • Skin Changes: You have developed unusually smooth and young looking skin. You have developed hives. You have unusual rashes or blister-like bumps on your forehead and face (known as milaria bumps). You have spider veins your face and neck area.
    • Voice Changes: You have a hoarse or gravelly voice.
    • Pain/Weakness: You have aches and pains in your joints, shoulders, hands, feet or extreme muscle weakness particularly in your upper arms and legs
    • Sex Drive: You may have an unusually exaggerated sex drive, or you may have a drop in your normal sex drive
    • Tremors/Movements: You have tremors or shakiness in your hands, or hyperkinetic movements–i.e., table drumming, tapping feet, jerky movements (often more severe in children)
    • Fingers/Nails: You have swollen fingertips (a condition known as acropachy,  a separation of fingernails from your underlying nail bed (called onycholysis, or Plummer's nails)
    • Shins: You have lesions on your shins, or patches of thickened skin, known as pretibial myxedema or dermopathy

    Signs and Symptoms in Women

    There are some hyperthyroidism signs that are unique to women:

    • You are pregnant but losing weight
    • You are rapidly losing weight after having a baby
    • You are pregnant and having excessive nausea or vomiting
    • You have a history of irregular menstrual cycles, especially skipped periods, shorter and lighter periods, and longer periods of time between periods,
    • You have history of infertility or recurrent miscarriage

    Signs and Symptoms in Infants/Children/Adolescents

    In infants, children, and adolescents, some common symptoms include:

    • Easy startling, jumpiness
    • Attention deficit hyperactivity disorder (ADHD) type symptoms
    • Hyperactivity or temper tantrums
    • Trembling hands
    • Hyperkinetic movements such as drumming on tables, jerking of leg, tapping feet
    • Delayed puberty
    • Difficulty gaining weight
    • A big appetite along with weight loss
    • Trouble concentrating, and poor school performance
    • Sweating
    • Sleep problems and insomnia
    • A wide-eyed stare

    THYROIDITIS: SIGNS AND SYMPTOMS

    Some cases of thyroiditis have no symptoms at all. 

    There are also situations where the thyroiditis is either slowing down or speeding up the thyroid, so the symptom patterns will fit into those of hypothyroidism or hyperthyroidism described above.

    Some unique symptoms that are found in certain types of thyroiditis include the following:

    • Enlargement of the thyroid (goiter)
    • Pain, tenderness, or soreness in the neck or throat area
    • Difficulty swallowing
    • Fever
    • Enlarged lymph nodes near the thyroid.
    • Hoarseness in your voice

    A form of thyroiditis known as acute infectious thyroiditis is characterized by more significant symptoms, including:

    • The rapid onset of neck pain and tenderness, usually only one side of the neck
    • The onset of pain is accompanied by fever, chills and other symptoms of infection
    • An enlargement or mass in your neck area, and it may be "movable" to your touch 

    THYROID CANCER: SIGNS AND SYMPTOMS

    Thyroid cancer, especially early in its development, may not cause any symptoms at all.

    But as a thyroid cancer grows and develops, it's more likely to cause localized symptoms in your neck and throat. Some of the symptoms that may point to thyroid cancer include the following:

    • A lump or nodule in the neck -- especially in the front of the neck, in the area of the Adam's apple. (Note: Sometimes, the lump or nodule may grow quickly.)
    • Enlargement of the neck
    • Enlarged or swollen lymph nodes in the neck
    • Changes to your voice, including hoarseness, scratchiness, and difficulty speaking
    • Difficulty swallowing or a choking feeling
    • Difficulty breathing
    • Pain in your neck or throat, including pain from the neck to the ears
    • Sensitivity in the neck -- discomfort with neckties, turtlenecks, scarves, necklaces
    • A persistent or chronic cough not due to allergies or illness
    • Asymmetry in your neck – noticing that one side is enlarging more than the other 

    A WORD FROM VERYWELL

    One of the challenges in thyroid diagnosis is that your thyroid symptoms overlap with and are common in many other issues. This can lead to your being misdiagnosed with another condition – for example, anorexia, or infertility, or told that your symptoms are normal for “just having had a baby,” or “someone in perimenopause” – without a thorough investigation, diagnosis, and treatment of your thyroid. In some cases, without a thorough evaluation of your thyroid, your symptoms may even be diagnosed with a mental health disorder like depression or panic disorder.

    One important tip: make sure that you bring a checklist of your risks and symptoms with you to the doctor, and if you have a practitioner who – despite your potential thyroid symptoms -- refuses to even do a clinical examination and blood test, that’s a good sign that you need to find a new doctor.

    It’s also important for you to know having a personal or family history of any autoimmune disease raises your risk for thyroid disease.  So be if you or any of your family members have an autoimmune disease, you should be vigilant about watching for thyroid symptoms. Some of the more well-known autoimmune conditions include rheumatoid arthritis, lupus, inflammatory bowel disease, multiple sclerosis, psoriasis, vitiligo, type 1 diabetes, Addison's disease, Cushing's syndrome, Raynaud's syndrome, Sjogren's syndrome, and alopecia. There are more than 80 conditions classified as autoimmune.

    Also be aware that certain health conditions may cause, be caused by – or are more common in – thyroid patients.  If you have any of these conditions, you should also be on the watch for potential thyroid symptoms, and have your thyroid evaluated.

    Sources:

    Bahn, R., Burch, H, Cooper, D, et al. < a href="https://aace.com/files/hyper-guidelines-2011.pdf">"Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists." Endocrine Practice. Vol 17 No. 3 May/June 2011.

    Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL/Wolters Kluwer; 2012.

    Garber, J, Cobin, R, Gharib, H, et. al. "Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association." Endocrine Practice. Vol 18 No. 6 November/December 2012.

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