Dear Alice,

I am an insomniac. I also have very dry skin despite frequent lotioning. I have other skin problems associated with dryness and flaking. I am always tired, but as I said before, I cannot sleep, ever! I never have energy. I read somewhere that these may be the symptoms of hypothyroidism, but they don't test for it in women under 35 years of age. I am 24 years old. Could it be hypothyroidism? What else could these symptoms be about?

— Overtired and flaky

Dear Overtired and flaky,

Experiencing a slew of symptoms without a clear reason can certainly be unsettling, so it’s a good idea to start gathering some information about what might be going on. Some of your symptoms do seem to mirror those of hypothyroidism. It’s also possible that they may be caused by a number of conditions, so getting a diagnosis from a health care provider is key. Also, you’re right that hypothyroidism tends to be more prevalent in women who are over 50 years old. However, people of any age can develop the condition, so there's no reason you can’t be tested and be treated if necessary.

Hypothyroidism means the thyroid gland is under-active, leading to underproduction of thyroid hormones. The thyroid is a large, butterfly-shaped gland that sits just below the Adam's apple in the throat. It produces hormones known as thyroxine (or, T4) and triiodothyronine (or, T3) that are essential to a number of functions in the body including metabolism, protein creation, and the regulation of body temperature and heart rate. One potential indication of hypothyroidism is an enlargement of the thyroid gland, called a goiter. Here are some of the other symptoms associated with the condition, including a couple that you mentioned:

  • Muscle weakness
  • Cramps
  • Dry and flaky skin
  • Hair loss
  • Weight gain
  • Lethargy

There are a number of underlying conditions that can cause an under-active thyroid, such as:

  • Autoimmune diseases, (the most common cause), in which the body develops antibodies against its own thyroid gland, such as Hashimoto’s thyroiditis, atrophic thyroiditis, Riedel’s thyroiditis, and postpartum thyroiditis
  • Iodine abnormalities, such as too much or too little in your diet
  • Thyroid surgery
  • Certain medications, like lithium, antidepressants, and anticonvulsants
  • Radiation therapy
  • Pre-existing diseases, like hemochromatosis, scleroderma, and amyloidosis
  • Overtreatment for hyperthyroidism, which is the over-activity of the thyroid gland
  • Pituitary gland issues, such as a pituitary tumor that keeps the pituitary from producing enough thyroid-stimulating hormone (TSH) to get the thyroid gland work

List adapted from University of Maryland.

Hypothyroidism screening is recommended for adults over 50 years of age, pregnant women, and infants. Although your health care provider might not do a routine screening if you don’t fit into those groups, this certainly doesn't mean that you can't be tested at all. It might be helpful to make an appointment with your provider to discuss your symptoms and request screening. There are a few ways to screen for hypothyroidism, including a physical exam, imaging tests like an ultrasound, a needle aspiration biopsy of the gland, or blood tests. Blood tests are the most common, and your provider would be looking for either high TSH levels or low thyroxine levels to move forward with a diagnosis and treatment. Standard treatment involves daily oral supplements of the synthetic thyroid hormone levothyroxine, which restores hormone levels and helps most people feel less symptomatic in as soon as one to two weeks.

It might also be useful to keep in mind that many conditions could cause dry skin, insomnia, and tiredness. For example, hypothyroidism can cause general tiredness, but insomnia can also be the cause of lethargy (and insomnia is not a symptom of hypothyroidism). Having insomnia and the resulting lethargy might be due to an unrelated condition or circumstances. Whether you have hypothyroidism or another condition, your health care provider can work with you to diagnose the underlying cause and create a treatment plan.

Take care,


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