Signs of thyroid issues: What they look like and when to get checked

Your thyroid gland is a bit of a workhorse in your body. It helps manage your metabolism, weight, body temperature, and more. When something goes wrong with it, unpleasant symptoms can crop up, including fatigue, weight changes, temperature intolerance, sleep disturbances, brain fog, anxiety, depression, and even skin and hair changes.

As you can see, the thyroid gland, and the hormones it produces and secretes, matters significantly for your overall well-being and health. That’s why if you have unexplained symptoms, the thyroid gland is worth getting checked out to confirm or rule out a thyroid problem.

When your thyroid is underactive, the condition is called hypothyroidism. When it’s overactive, the condition is called hyperthyroidism. Most commonly these conditions occur because of autoimmune issues. In these cases, immune system proteins called antibodies mistakenly attack the thyroid gland. Hashimoto thyroiditis is autoimmune hypothyroidism. And Graves’ disease is autoimmune hyperthyroidism. However, other factors can lead to thyroid concerns.

In this article, we explore thyroid disease symptoms, signs of hypothyroidism, signs of hyperthyroidism, and more.

What does the thyroid do?

“The thyroid gland, a small butterfly-shaped organ situated at the base of the neck, is the master regulator of your body’s endocrine system, primarily through the production and release of crucial hormones,” says Sonia Gibson, MD, a board-certified lead endocrinologist at Allara. These hormones include thyroxine (T4) and triiodothyronine (T3).

She adds, “This gland plays a central, indispensable role in your body’s overall metabolic functions. It sets the speed for nearly every cellular process in the body.”

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The thyroid’s most crucial functions include the following:

• Managing energy levels and metabolism: “The thyroid dictates the rate at which your body converts nutrients into energy, a process known as the basal metabolic rate (BMR),” Dr. Gibson says. “When thyroid hormone levels are optimal, your energy production is balanced.” 
  
  • Hyperthyroidism can lead to excessive energy and a fast BMR.
  • Hypothyroidism causes sluggishness and a slow BMR.
• Managing weight: “By controlling the metabolic rate, the thyroid directly affects how quickly calories are burned,” Dr. Gibson says. Dysfunctions can lead to unexplained weight changes. 
• Regulating body temperature: “Thyroid hormones influence thermogenesis, the body’s process of generating heat,” Dr. Gibson says. “It is key to maintaining a stable internal body temperature.”
• Cardiovascular health: “The hormones have a powerful effect on the heart, modulating the strength of the heartbeat and, critically, influencing the heart rate itself,” Dr. Gibson explains. 
• Adaptation and homeostasis: “Crucially, the thyroid is responsive to the body’s internal and external environment,” Dr. Gibson says. “It adapts metabolic needs to suit specific lifestyle or health circumstances. For instance, during periods of stress, growth, cold exposure, or pregnancy, the thyroid’s activity may be appropriately adjusted to ensure the body’s homeostatic balance is maintained.”

Common thyroid symptoms

The table below can help you navigate symptoms of hypothyroidism vs. hyperthyroidism and whether they are early signs or indicate a more progressed state.

Here we explore some of the most common thyroid symptoms more in depth.

Energy and fatigue

Extreme chronic fatigue can be a sign of either hypothyroidism or hyperthyroidism. “This is often one of the most prominent symptoms,” Dr. Gibson says. “It is a profound, persistent feeling of tiredness that is not relieved by rest or sleep. This deep, unremitting exhaustion can significantly interfere with professional, social, and personal activities, making even simple tasks feel overwhelmingly difficult.” However, in early hyperthyroidism, you might feel wired or restless instead.

Temperature

In hypothyroidism, you may experience cold intolerance. “This is a direct consequence of the body’s decreased metabolic rate,” Dr. Gibson says, “which reduces the internal heat generation necessary for maintaining optimal body temperature.” With hyperthyroidism, you might feel heat intolerance or increased sweating because of an increased BMR.

Unexplained weight or appetite changes

With hypothyroidism, “individuals may experience weight gain, despite no change in diet or exercise routine,” Dr. Gibson says. “This weight gain is often accompanied by puffiness or swelling, particularly around the face, eyelids, hands, and feet, due to fluid retention and a slowed metabolism.” With hyperthyroidism, weight loss can occur despite an increased appetite.

Cardiovascular symptoms

Hypothyroidism typically slows the heart rate, a condition called bradycardia, Dr. Gibson explains, while hyperthyroidism accelerates it, a condition called tachycardia, which may cause palpitations.

Hair and skin changes

Hair and skin changes are also common with thyroid conditions. With hypothyroidism, the skin often becomes noticeably dry, rough, and thickened. “There may be a lack of perspiration, and the skin can feel cool to the touch,” Dr. Gibson says. “In some cases, the skin takes on a pale or yellowish tinge.” Skin changes might be less noticeable with hyperthyroidism, though unexplained hot or flushed skin can be a sign.

Excessive hair shedding or thinning across the scalp and the loss of the outer third of the eyebrows can indicate hypothyroidism. “The hair itself may become dry, brittle, and coarse due to the impact of low thyroid hormone on hair follicle health and the hair-growth cycle,” Dr. Gibson explains. Hair thinning, however, can also be a sign of hyperthyroidism.

Bowel habit changes

Changes in bowel habits can occur with thyroid conditions. Typically, constipation correlates with hypothyroidism, while diarrhea or loose stools correlate with hyperthyroidism. These changes can be subtle at first. With hypothyroidism, you may first notice hard and dry stools, for example.

Mental and cognitive changes

Thyroid conditions can also affect your mental and cognitive health. Hypothyroidism sometimes leads to brain fog (difficulty focusing, concentrating, or thinking). It can also contribute to depression symptoms. Hyperthyroidism is linked to anxiety, panic, nervousness, and irritability.

Sleep changes

Sleep issues are common with thyroid disorders. Reduced sleep quality or insomnia may be an indicator of either hypothyroidism or hyperthyroidism.

Muscle changes

Muscle weakness is a symptom of both hypothyroidism and hyperthyroidism. Stiffness or cramping sometimes occurs with hypothyroidism. And muscle loss is common with hyperthyroidism.

Menstrual health and fertility

Both hypothyroidism and hyperthyroidism can lead to fertility issues and menstrual changes, including irregular periods and even amenorrhea (the absence of periods). With hypothyroidism, you may experience heavier periods, while with hyperthyroidism they may be lighter. 

Eye changes

Puffy eyelids or skin around the eyes is common with hypothyroidism, while gritty or dry eyes are common symptoms of hyperthyroidism. Graves’ disease sometimes causes proptosis (bulging eyes).

Voice and neck symptoms

Your voice can change because of thyroid conditions, with hoarseness a common symptom of hypothyroidism, and goiter (an enlarged thyroid gland) a symptom of hypothyroidism. Goiter symptoms include neck lumps or a sensation of fullness or even difficulty swallowing or breathing in extreme cases.

Changes to reflexes

Your reflexes may be slowed with hypothyroidism, but with hyperthyroidism, you might experience hyperreflexia, where your reflexes are overactive or exaggerated.

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When are symptoms worth checking out?

If you have unexplained symptoms, especially any of the issues mentioned in the previous section, getting checked out is a good idea. “Although these symptoms are common and non-specific, a simple blood test can rule out a thyroid condition,” Dr. Gibson says.

Additionally, you can ask your regular physician to incorporate routine testing. “Incorporating a basic thyroid-stimulating hormone (TSH) screening into the annual preventive physical examination is often considered best practice,” Dr. Gibson notes. “This routine screening can detect subclinical or early-stage thyroid dysfunction before overt symptoms manifest, allowing for timely intervention.”

Here are a few additional factors to consider that warrant an evaluation with a clinician:

• Chronic and progressing symptoms: “Evaluation is strongly recommended if an individual experiences a cluster of symptoms that have persisted for several months and are demonstrably worsening over time,” Dr. Gibson says.
• Significant family history of thyroid conditions: “A strong family history is a critical risk factor,” she adds.” If immediate family members have been diagnosed with autoimmune thyroiditis (such as Hashimoto’s or Graves’ disease), thyroid cancer, goiter, or any other diagnosed thyroid dysfunction, the likelihood of an individual developing a related condition is significantly increased.”
• Prior radiation exposure to the neck area: “Individuals who have undergone therapeutic or high-dose diagnostic radiation directed to the head and neck region—often for the treatment of head and neck cancers, lymphomas, or certain benign conditions—are at a substantially elevated risk for developing thyroid conditions,” Dr. Gibson explains.
• Unexplained recurrent miscarriages: “For individuals who experience recurrent unexplained pregnancy loss, typically defined as two or more consecutive miscarriages, a thyroid workup is an essential part of the diagnostic investigation,” she adds. “Autoimmune thyroid disease, even in a subclinical state, is a known contributor to infertility and adverse pregnancy outcomes, including miscarriage.”

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The importance of getting your thyroid checked

“Thyroid conditions can range from common hypothyroidism and hyperthyroidism to more complex issues like myxedema coma and thyroid storm, which are serious and can indeed be life-threatening if left undiagnosed and untreated,” Dr. Gibson says.

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“The good news,” she adds, “is that thyroid disorders are exceptionally well-understood and are typically easy to treat through the use of precise medications (such as synthetic thyroid hormones) or other proven modalities.”

How are thyroid issues evaluated?

The first step to evaluating your thyroid gland is a blood test to check your levels of thyroid stimulating hormone (THS), a hormone that your pituitary gland secretes. 

“This hormone is considered the gold standard initial test because it exhibits a remarkably long, linear, and inverse relationship with the levels of the free thyroid hormones,” Dr. Gibson says. These hormones include free thyroxine (fT4) and free triiodothyronine (fT3). 

Although fT4 and fT3 are the hormones that exert the actual biological effect, measuring them initially has some significant limitations. That’s why clinicians measure THS. 

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“This delicate feedback loop can be conceptualized using the furnace and thermostat analogy,” Dr. Gibson explains.

• In this analogy, think of fT4 and fT3 as the thermostat,” she says. They sense and regulate the body’s metabolic temperature.
• TSH acts as the furnace’s control unit. When the circulating levels of fT4 and fT3 drop, indicating the body is cold or needs more metabolism, the pituitary gland releases more TSH, which signals the thyroid gland to produce more hormone. 
• Conversely, if thyroid hormone levels are high, indicating the body is hypermetabolic or “too hot,” TSH release is suppressed.
• “This highly sensitive mechanism ensures metabolic stability,” Dr. Gibson says.

Key takeaways

• Your thyroid gland is in your neck, and it’s crucial for regulating your metabolism and weight, body temperature, and more.
• Thyroid issues can lead to a host of symptoms that can dramatically affect your quality of life and overall health.
• Common signs of thyroid issues include unexplained fatigue or restlessness, weight changes, and heat and cold intolerance.
• If you suspect you have a thyroid issue because of unexplained symptoms, Allara can help investigate and tailor a treatment plan to you.

FAQ

What is the 3 p.m. crash in hypothyroidism?

The “3 p.m. crash in hypothyroidism” isn’t a medical term. It’s a phrase people use to describe heavy fatigue mid-afternoon that can lead to brain fog, which is an inability to concentrate and think.

At what age do thyroid problems start?

Thyroid conditions can show up at any age from infancy to your senior years. However, one of the most common times for symptoms to arise is during perimenopause, also called the menopause transition, and beyond.

How can I check my thyroid myself?

You can watch for thyroid symptoms to appear, but the only way to check thyroid health is through a blood test analyzed by a clinician.

Can thyroid problems cause anxiety or depression?

Yes, thyroid problems can cause mental and cognitive health symptoms. Depression tends to correlate more with hypothyroidism, while anxiety tends to show up more in hyperthyroidism.

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