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 is certainly unsettling, so kudos to you for gathering some information about what might be happening. While some of your symptoms seem to mirror those of hypothyroidism, it’s also possible that there’s another cause, so getting a diagnosis from a health care provider is key. As you accurately stated, hypothyroidism tends to be more prevalent in those assigned female at birth who are over 50 years old. However, people of any age are able to develop the condition, so it’s possible to be tested, if necessary.

Hypothyroidism is a condition where the thyroid gland (a large, butterfly-shaped gland that sits just below the Adam's apple in the throat) is less active, leading to underproduction of certain hormones. The thyroid 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. Symptoms of this condition, plus a couple you mentioned, include:

  • Dry and flaky skin
  • Fatigue
  • Hoarse voice
  • Hair loss or coarse hair
  • Muscle aches
  • Feeling cold
  • Constipation
  • Difficulty concentrating
  • Weight gain
  • Headache
  • Irregular menstruation
  • Milky discharge from breasts
  • Depression

There are a number of potential causes of hypothyroidism, some of which include:

  • Goiter, which is the enlargement of the thyroid gland
  • 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, such as lithium, antidepressants, and anticonvulsants
  • Radiation therapy
  • Pre-existing diseases, such as 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 gland from producing enough thyroid-stimulating hormone (TSH) to get the thyroid gland working

Both lists adapted from University of Maryland Medical Center.

Hypothyroidism screening is recommended for adults over 50 years of age, pregnant women, and infants. Although it’s not routine if you don’t fit into those groups, this certainly doesn't mean you can't be tested at all. It might be helpful to make an appointment with your provider to discuss your symptoms and they can determine it’s appropriate to get screened via a physical exam, a blood test, imaging tests like an ultrasound, or a needle aspiration biopsy of the gland. 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 hypothyroidism isn’t the only cause of dry skin, insomnia, and tiredness. Similarly, hypothyroidism can cause general tiredness, but 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 will be able to help diagnose the underlying cause and create a treatment plan.

Take care,


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