Hypothyroidism Quiz
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Constipation
Fatigue
Itchy skin
Hair loss
Weight gain
Yellow nails
Dry skin
Thinning hair
Low energy
Cold intolerance
Suddenly feeling cold and shaking without fever
Not seeing your symptoms? No worries!
What is Hypothyroidism?
A disorder where thyroid hormone levels in the body are abnormally low. These hormones are necessary for growth, development, and metabolism. Some symptoms include unintended weight gain, constipation, changes in menstrual cycles, dry skin, brittle nails, depression and memory issues. It can be caused by an autoimmune disorder (Hashimoto's) or from prior thyroid surgery and sometimes medications.
Typical Symptoms of Hypothyroidism
- Pain at the back of the head
- Difficulty concentrating
- Reduced sweating
- Blood in stool
- Hair loss
- Fatigue or low energy that is worse in the morning
- Swelling of the arms or hands
- Recent changes in mental state
Diagnostic Questions for Hypothyroidism
Your doctor may ask these questions to check for this disease:
- Do you have pain at the back of your head?
- Do you have difficulty concentrating?
- Do you feel that you are sweating less?
- Have you noticed any blood in your stool?
- Are you experiencing increased hair loss?
Treatment of Hypothyroidism
This is treated with daily thyroid hormone replacement tablets. Regular blood tests are needed to ensure the right amount of thyroid replacement for each individual.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Hidetaka Hamasaki, MD (Endocrinology)
Dr. Hamasaki graduated from the Hiroshima University School of Medicine and the Graduate School of Medicine, Jichi Medical University. He completed his residency at the Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Hospital and the Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine. He has served in the National Center for Global Health and Medicine Hospital and Kohnodai Hospital and joined Hamasaki Clinic in April 2017. Dr. Hamasaki specializes in diabetes and treats a wide range of internal medicine and endocrine disorders.
Content updated on Dec 13, 2024
Following the Medical Content Editorial Policy
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People with similar symptoms also use Ubie's symptom checker to find possible causes
- Can't focus
- Reduced sweating
- Blood in stool
- Easily distracted
- Loss of hair
- Not sweating as much
- I can not concentrate on my work
- Stools looks like strawberry jam
- Unable to sit for a long time
- Hypohidrosis
- My brain is not functioning
- Stool looks like raspberry jelly
- Sweating has decreased
- Less willpower to do things
- Making careless mistakes
See full list
Symptoms Related to Hypothyroidism
Diseases Related to Hypothyroidism
FAQs
Q.
Does Fasting Mess Up Your Thyroid? What Women Need to Know (and Do)
A.
Fasting can influence thyroid function in some women, but moderate intermittent fasting typically does not cause permanent thyroid damage. Effects depend on energy intake, stress, and pre-existing thyroid issues, and women are more sensitive to energy deficits, so severe calorie restriction or prolonged fasting can lower T3, worsen symptoms, or unmask problems. There are several factors to consider. See below for who should be cautious, signs your thyroid may be affected, safer fasting frameworks, and when to seek testing or medical care, so you can choose next steps that fit your health goals.
References:
* Rasti R, Alirezaei S, Soltani S, Lari A, Zarei A, Emami R, Asemi Z. Impact of intermittent fasting on thyroid hormones: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022 Oct 13;13:1003661. doi: 10.3389/fendo.2022.1003661. PMID: 36316719; PMCID: PMC9609600.
* Malekzadeh H, Vafa M, Momenizadeh A, Hosseinabadi L, Mirhashemi SM. Fasting and Thyroid Hormones in Euthyroid Adults: A Systematic Review and Meta-Analysis. Horm Metab Res. 2022 Oct;54(10):681-692. doi: 10.1055/a-1934-2975. Epub 2022 Oct 3. PMID: 36184288.
* Liang X, Li M, Zhang Y, Zhang Y, Wang Y, Wu J. Thyroid function and intermittent fasting: A systematic review of human studies. Front Endocrinol (Lausanne). 2023 Aug 11;14:1229780. doi: 10.3389/fendo.2023.1229780. PMID: 37628045; PMCID: PMC10452331.
* Fontana L, Klein S, Holloszy JO. Effects of calorie restriction on thyroid hormones and hypothalamic-pituitary-thyroid axis in women. Am J Physiol Endocrinol Metab. 2001 Apr;280(4):E547-51. doi: 10.1152/ajpendo.2001.280.4.E547. PMID: 11264426.
* Redman LM, Heilbronn LK, Martin CK, de Jonge L, Williamson DA, Delany JP, Ravussin E; Pennington CALERIE Team. Impact of long-term energy restriction on thyroid hormones: a prospective study in overweight and obese women. J Clin Endocrinol Metab. 2012 May;97(5):1454-61. doi: 10.1210/jc.2011-2092. Epub 2012 Mar 14. PMID: 22420846; PMCID: PMC3339891.
Q.
Always Tired? Why Your Endocrine System Is Misfiring & Medical Next Steps
A.
Always feeling tired can stem from endocrine hormone issues that disrupt energy and metabolism, most commonly thyroid dysfunction, diabetes or other blood sugar problems, adrenal insufficiency, perimenopause or menopause, and low testosterone, many of which are highly treatable. Doctors typically start with your history and exam and order labs such as TSH, free T4, A1C or glucose, cortisol, electrolytes, B12, and iron. There are several factors to consider, including urgent red flags like chest pain, shortness of breath, fainting, or unexplained weight loss; see below for key symptoms, safer treatment options, and lifestyle supports that can shape your next steps.
References:
* Tomas C, Newton JL, Watson S, McLaren A, Palmer J, Burroughs H, Blamire AM, Maclachlan L, Blamire J, Taylor R, Lecky F, Wood I, Wilkinson ID, Manning P, Lightman SL, Pearce SH, Pearson P, Lightman S. Endocrine and metabolic dysfunction in chronic fatigue syndrome. Endocr Connect. 2021 Mar;10(3):364-375. doi: 10.1530/EC-20-0498. PMID: 33497405; PMCID: PMC8026130.
* Rao S, Azam I, Rungun B, Ramachandran R, Somasundaram N, Sundaram M, Khairul N. Clinical fatigue in thyroid dysfunction. Singapore Med J. 2021 Dec;62(12):604-610. doi: 10.11622/smedj.2021111. PMID: 34980998; PMCID: PMC8719262.
* Burgi S, Witzel-Schroth H, Mersebach H, Reimer A, Winzeler B, Christ E. Fatigue in patients with adrenal insufficiency: a systematic review. Eur J Endocrinol. 2022 Apr 20;186(5):R115-R126. doi: 10.1530/EJE-21-1124. PMID: 35263152.
* Roy T, Singh N, Gupta P, Sharma R, Roy A, Ray A, Singh AK. Fatigue in diabetes: a review. J Family Med Prim Care. 2020 Jul 31;9(7):3164-3168. doi: 10.4103/jfmpc.jfmpc_232_20. PMID: 33042790; PMCID: PMC7536967.
* Benvenga S, De Vroede MA, Lisco G, Ruggeri RM, Campennì A, Fazio S, Vita R. Hypopituitarism and fatigue. Rev Endocr Metab Disord. 2021 Jun;22(2):345-364. doi: 10.1007/s11154-021-09633-8. PMID: 33604812.
Q.
Always Tired? Why Your Hormones Are Failing & Medically Approved Next Steps
A.
Feeling persistently tired despite enough sleep often points to hormone imbalances that sap energy and focus, most commonly hypothyroidism, disrupted cortisol patterns, blood sugar problems from prediabetes or diabetes, and sex hormone shifts in men and women. See below for medically approved next steps, including urgent red flags, the exact labs to discuss with your doctor (TSH, free T4/T3, cortisol, glucose or A1C, insulin, iron, B12, electrolytes, testosterone or estrogen), proven treatments, lifestyle support, and nonhormonal causes that could change your plan.
References:
* Frieri MA, et al. Fatigue in Endocrine Diseases: Mechanisms and Management. J Clin Med. 2021 May 26;10(11):2343. doi: 10.3390/jcm10112343.
* Wouters A, et al. Persistent Fatigue in Thyroid Diseases. Front Endocrinol (Lausanne). 2020 Jan 28;10:875. doi: 10.3389/fendo.2019.00875.
* Bornstein SR, et al. Adrenal insufficiency: diagnosis and management. Lancet. 2016 Nov 19;388(10059):2413-24. doi: 10.1016/S0140-6736(16)30520-7.
* Bhasin S, et al. Testosterone Deficiency in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 Jun 1;103(6):1715-44. doi: 10.1210/jc.2018-00229.
* Johannsson G, et al. Adult Growth Hormone Deficiency: A Reappraisal. Front Endocrinol (Lausanne). 2020 Jul 3;11:479. doi: 10.3389/fendo.2020.00479.
Q.
Muscle Weakness? Why Your Body is Hypotonic and Medical Next Steps
A.
Hypotonia means persistently low muscle tone that feels soft or weak and is a symptom, not a diagnosis; common causes include thyroid problems like hypothyroidism, vitamin or electrolyte imbalances, and disorders of the nerves or muscles. Next steps usually include a medical evaluation with blood tests for thyroid, vitamins, and electrolytes, possible EMG or imaging, and treatment such as thyroid replacement, targeted supplementation, and physical therapy, with urgent care needed for sudden weakness, trouble breathing, or swallowing. There are several factors to consider; see the complete guidance below for important details that can shape your care path.
References:
* Zang, L. D. (2021). Generalized hypotonia: an update on a diagnostic approach. *Rev Neurol (Paris), 177*(6), 667-675. DOI: 10.1016/j.neurol.2021.01.002. PMID: 33637402.
* Van Ryzin, C. I., & Bird, T. C. (2019). Hypotonia: a practical approach to diagnosis and management. *Semin Neurol, 39*(3), 337-347. DOI: 10.1055/s-0039-1688970. PMID: 31151125.
* Zis, A. (2021). Generalized muscle weakness and hypotonia in adults: a diagnostic challenge. *J Neurol Sci, 426*, 117505. DOI: 10.1016/j.jns.2021.117505. PMID: 34091016.
* Cionci, A. S., Di Pasquale, C., Messina, I. P., & Bruno, V. T. (2020). Management of hypotonia: from diagnosis to rehabilitation. *J Child Neurol, 35*(1), 7-15. DOI: 10.1177/0883073819888632. PMID: 31791220.
* Lisi, M. L., Nesti, A., & Iadicicco, G. (2017). Congenital hypotonia: a practical approach. *Curr Opin Pediatr, 29*(6), 663-669. DOI: 10.1097/MOP.0000000000000551. PMID: 28984605.
Q.
Tired? Why Your Thyroid Is Failing From Brazil Nuts & Approved Next Steps
A.
Feeling tired, cold, or foggy could stem from selenium overload from eating too many Brazil nuts, since even 4 to 6 nuts can exceed safe limits and destabilize thyroid hormones, especially if you also use selenium supplements or have thyroid disease. Approved next steps include cutting to 1 to 2 nuts daily, avoiding selenium supplements, and asking your clinician for TSH, Free T4, Free T3, TPO antibodies, and selenium testing, with important nuances on other triggers, diet balance, and recovery explained below.
References:
* Ventura M, Melo M, Carrilho F. Selenium and Thyroid Function: From Biochemistry to Clinical Implications. Int J Mol Sci. 2021 Jan 25;22(2):1124. doi: 10.3390/ijms22021124. PMID: 33499298; PMCID: PMC7835824.
* Triggiani V, Zito A, Giagulli VA, De Pergola G, Ciccone MM, Resta F, Triggiani M. Selenium and the Thyroid: The Interplay with Iodine. Int J Mol Sci. 2020 Oct 6;21(19):7346. doi: 10.3390/ijms21197346. PMID: 33027989; PMCID: PMC7583094.
* Kothari N, Jain N, Kothari S, Singh R. Selenium status and its interaction with thyroid disorders: A narrative review. Front Endocrinol (Lausanne). 2022 Dec 7;13:1040685. doi: 10.3389/fendo.2022.1040685. PMID: 36561230; PMCID: PMC9766946.
* Vinceti M, Crespi CM, Bonvicini F, Malagoli C, Ferrante M, Gutiérrez-Álvarez AM, Aguilera J, Cervellin G, Sieri S, Krogh V. Selenium toxicity in humans: a review of the adverse effects following overexposure. Crit Rev Toxicol. 2011 May;41(5):401-20. doi: 10.3109/10408444.2010.518602. PMID: 21453487.
* Ibrahimpasić T, Jukić T, Omerović M, Smajić A, Aljović A, Ikić M, Prnjavorac B, Alibašić A, Durić K. Selenium in Thyroid Diseases: From Pathophysiology to Therapy. Biomedicines. 2023 Apr 11;11(4):1153. doi: 10.3390/biomedicines11041153. PMID: 37049449; PMCID: PMC10137788.
Q.
TSH Blood Test: Why You Still Feel Sick & Medically Approved Next Steps
A.
A normal TSH result can still coexist with fatigue, brain fog, anxiety, or other symptoms because TSH is only a signal hormone and issues may stem from a not-optimal TSH for you, incomplete testing (no free T4, free T3, or antibodies), medication absorption or dosing problems, subclinical hypothyroidism, or non-thyroid causes like iron, B12, vitamin D deficiency, sleep apnea, stress, or menopause. There are several factors to consider. See below to understand more, including medically approved next steps such as requesting a full thyroid panel, reviewing thyroid meds and interfering supplements, screening for common overlaps, tailoring lifestyle factors with your doctor, and knowing when urgent symptoms need immediate care.
References:
* Ettleson MD, Bianco AC. Thyroid stimulating hormone and quality of life in euthyroid hypothyroid patients. J Clin Invest. 2018 Jul 16;128(8):3209-3211. doi: 10.1172/JCI122709. PMID: 30017188; PMCID: PMC6063673.
* Biondi B, Cooper DS. Subclinical Hypothyroidism: An Update. Ann Intern Med. 2020 Oct 20;173(8):W101-W102. doi: 10.7326/W20-0036. PMID: 33051406.
* Refetoff S. Resistance to thyroid hormone. A historical perspective. Thyroid. 2013 Aug;23(8):926-34. doi: 10.1089/thy.2013.0118. PMID: 23761765; PMCID: PMC3725841.
* Carta MG, Cadeddu G, Sancassiani F, Cocco F, Sanna L, Moro MF, Contu P, Lavra P. Thyroid Dysfunction and Symptoms of Depression and Anxiety: A Review of the Literature. Int J Environ Res Public Health. 2018 Oct 31;15(11):2393. doi: 10.3390/ijerph15112393. PMID: 30398687; PMCID: PMC6266070.
* Midgley JE, Williams G, Rajanayagam O, Pearce SH, Dayan CM. Should we routinely measure free T3 and reverse T3? Endocr Connect. 2020 Jun;9(5):R114-R124. doi: 10.1530/EC-20-0081. PMID: 32414732; PMCID: PMC7255167.
Q.
Always Tired? Why Your Hormones Are Off & Medical Next Steps
A.
Persistent, unexplained fatigue often points to hormone imbalances involving the thyroid, adrenal glands, diabetes or blood sugar swings, or sex hormones like estrogen, progesterone, and testosterone. There are several factors to consider. Begin by tracking symptoms and seeing your doctor for targeted labs such as TSH and free T4, cortisol, A1C, and reproductive hormones, and ask whether an endocrinology referral is appropriate; see the complete guidance below for red flags, test nuances, and treatment options that could change your next steps.
References:
* Parle, J. V. (2018). Endocrine causes of fatigue and their management. *Clinical medicine (London, England), 18*(2), 161–165. PMID: 29643126.
* Chaker L, Bianco AC, Jonklaas J, Peeters RP. (2017). Hypothyroidism: A Review. *Lancet, 390*(10101), 1550–1562. PMID: 28373059.
* Husebye ES, Pearce SH, Krone NP. (2021). Primary Adrenal Insufficiency. *Lancet, 397*(10285), 1653–1667. PMID: 33934891.
* Hannon, A. M., & Murray, R. D. (2016). Hypopituitarism: diagnosis and treatment. *Therapeutic advances in endocrinology and metabolism, 7*(3), 116–127. PMID: 27280068.
* Perrin, J., & Sen, S. (2014). Sex hormone status and chronic fatigue. *Women's Health (London, England), 10*(6), 653–660. PMID: 25330310.
Q.
Thyroid Nodules or Hypothyroidism Sleep Issues: 40-50 Guide & Next Steps
A.
In your 40s or 50s, sleep problems can stem from hypothyroidism that drives fatigue, sleepiness, and higher sleep apnea risk, or from thyroid nodules that either overproduce hormone causing insomnia and a racing heart, or press on the airway and disturb sleep when lying down. There are several factors to consider and treatments are effective once diagnosed, so see the complete guidance below for testing and next steps, including tracking symptoms, asking for TSH and free T4, ultrasound if a lump is present, and urgent care for breathing or swallowing trouble or a rapid heartbeat. Most nodules are benign and hypothyroidism usually responds well to treatment.
References:
* pubmed.ncbi.nlm.nih.gov/35965022/
* pubmed.ncbi.nlm.nih.gov/29329471/
* pubmed.ncbi.nlm.nih.gov/29410943/
* pubmed.ncbi.nlm.nih.gov/32249339/
* pubmed.ncbi.nlm.nih.gov/37624641/
Q.
Can low alkaline phosphatase be caused by thyroid issues?
A.
Yes—an underactive thyroid (hypothyroidism) can lower alkaline phosphatase by slowing bone turnover, and levels often normalize after thyroid hormone treatment. There are several other potential causes (nutritional deficiencies, malabsorption, rare genetic disorders), so persistent low results merit repeat testing and checks like TSH/free T4 and nutrient levels—see the important details and next‑step guidance below.
References:
Whyte MP. (2015). Enzyme-replacement therapy for childhood hypophosphatasia… N Engl J Med, 25610165.
Kim WR, Biggins SW, Kremers WK, et al. (2008). Hyponatremia and mortality in patients on the liver transplant waiting list: incorporation into the MELD score… N Engl J Med, 19005193.
Castera L, Foucher J, Bernard PH, et al. (2012). Liver stiffness measurement predicts outcome and decompensation in patients with chronic liver diseases… J Hepatol, 22167638.
Q.
Can low alkaline phosphatase be caused by thyroid issues?
A.
Yes—an underactive thyroid (hypothyroidism) can lower alkaline phosphatase by slowing bone turnover, and levels often normalize after thyroid hormone treatment. There are several other potential causes (nutritional deficiencies, malabsorption, rare genetic disorders), so persistent low results merit repeat testing and checks like TSH/free T4 and nutrient levels—see the important details and next‑step guidance below.
References:
Whyte MP. (2015). Enzyme-replacement therapy for childhood hypophosphatasia… N Engl J Med, 25610165.
https://pubmed.ncbi.nlm.nih.gov/25610165/
Kim WR, Biggins SW, Kremers WK, et al. (2008). Hyponatremia and mortality in patients on the liver transplant waiting list: incorporation into the MELD score… N Engl J Med, 19005193.
https://pubmed.ncbi.nlm.nih.gov/19005193/
Castera L, Foucher J, Bernard PH, et al. (2012). Liver stiffness measurement predicts outcome and decompensation in patients with chronic liver diseases… J Hepatol, 22167638.
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https://journal.houstonmethodist.org/article/10.14797/mdcj-13-2-55/Biondi B, Cooper DS. Thyroid hormone therapy for hypothyroidism. Endocrine. 2019 Oct;66(1):18-26. doi: 10.1007/s12020-019-02023-7. Epub 2019 Aug 1. PMID: 31372822.
https://link.springer.com/article/10.1007/s12020-019-02023-7Bridwell RE, Willis GC, Gottlieb M, Koyfman A, Long B. Decompensated hypothyroidism: A review for the emergency clinician. Am J Emerg Med. 2021 Jan;39:207-212. doi: 10.1016/j.ajem.2020.09.062. Epub 2020 Sep 30. PMID: 33039222.
https://www.sciencedirect.com/science/article/abs/pii/S0735675720308573?via%3DihubPersani L. Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012 Sep;97(9):3068-78. doi: 10.1210/jc.2012-1616. Epub 2012 Jul 31. PMID: 22851492.
https://academic.oup.com/jcem/article/97/9/3068/2536827Hypothyroidism - Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017 Sep 23;390(10101):1550-1562. doi: 10.1016/S0140-6736(17)30703-1. Epub 2017 Mar 20. PMID: 28336049; PMCID: PMC6619426.
https://pubmed.ncbi.nlm.nih.gov/28336049/