Hypothyroidism symptoms?

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 (the small, butterfly-shaped gland that sits just below the Adam's apple in the throat) fails to produce enough of certain hormones, such as thyroxine (or T4) and triiodothyronine (or T3). These hormones are essential to a number of functions in the body including 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
  • Thinning hair
  • Muscle aches
  • Feeling cold
  • Constipation
  • Impaired memory
  • Weight gain
  • Slowed heart rate
  • Irregular menstruation
  • Painful, stiff, or swollen joints
  • Depression

List adapted from Mayo Clinic.

There are several potential causes of hypothyroidism, some of which include:

  • 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 and amiodarone.
  • Radiation therapy, as it can cause patients to lose part or all of their thyroid function.
  • Pre-existing diseases, such as hemochromatosis, sarcoidosis, and amyloidosis.
  • Over-response for hyperthyroidism, which is the over-activity of the thyroid gland.
  • Pregnancy, in which the body develops antibodies against the thyroid gland during or after pregnancy.
  • 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.

List adapted from the American Thyroid Association.

Although hypothyroidism screening is generally recommended for adults over 50 years of age, individuals with a family history of thyroid disease, and pregnant people, this certainly doesn't mean you can't be tested at all. In fact, both infants and teens can develop hypothyroidism. With regards to infants, babies who are born without a thyroid gland, or one that doesn't work properly, initially show few symptoms, but as time goes on, they're likely to have issues feeding and growing properly. If left untreated, hypothyroidism can lead to severe physical and mental problems. In terms of teens, those who develop hypothyroidism generally have the same signs and symptoms that adults have, with the addition of poor growth, delayed puberty, and poor mental development. With that being said, it might be helpful to make an appointment with your provider to discuss your symptoms. They can help determine if it’s appropriate to get screened via a physical exam, a blood test, imaging tests such as 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,

Last updated Oct 15, 2021
Originally published Jan 26, 1995

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