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Hypothyroidism Symptoms and What Causes Them: All You Need to Know

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A chart of thyroid hormones functionThe thyroid gland is part of your endocrine system. It’s small, only a couple of inches long, and rests in the base of your neck at the front. It has a butterfly shape, with two lobes connected by a thin tissue. Its main job is to produce and release thyroid hormones, which are essential for regulating your metabolism. Your thyroid can experience two main dysfunctions: hyperthyroidism and hypothyroidism. In this article, we’ll focus on hypothyroidism symptoms, their possible causes, and what to do to find relief.

Symptoms of Thyroid Problems

Thyroid issues are very common. Around 20 million Americans have been diagnosed with one, and it’s estimated that another 12 million have an undiagnosed thyroid condition. Hypothyroidism is more common than hyperthyroidism, and it more commonly affects women than it does men.

Hyperthyroidism Symptoms

Hyperthyroidism is when your thyroid becomes overactive, or “hyper.” It produces an excess of thyroid hormones, and that can speed up your metabolism too much.

Hyperthyroidism symptoms include:

  • Twitching
  • Nervous ticks
  • Trembling
  • Heart palpitations
  • Sensitivity to heat
  • Anxiety
  • Irritability
  • Sleep disturbance
  • Fatigue

Hypothyroidism Symptoms

Hypothyroidism, on the other hand, is when your thyroid becomes underactive. It produces too little thyroid hormones, slowing down your metabolism. The most common cause of hypothyroidism is Hashimoto’s disease, which is an autoimmune condition. But there can be a variety of other causes, including some that are related to other hormone systems.

Hypothyroidism symptoms include:

  • Fatigue
  • Lethargy
  • Constant sleepiness
  • Weight gain
  • Sensitivity to cold
  • Thinning hair
  • Depression
  • Dry skin
  • Constipation
  • General slowness

Goiter Symptoms

Your thyroid can even swell to the point of being a visible lump in your neck. This is called a goiter.

How Your Thyroid Works

Most symptoms of a condition are a reflection of the disruption of functioning the condition has caused. This is true with hypothyroidism. Hypothyroidism symptoms reflect the slowing down or stopping of the functions the thyroid hormones carry out.

Thyrocytes, or thyroid cells, are responsible for producing thyroid hormones, namely T3 and T4. T3 is the active thyroid hormone, and T4 is its pro-hormone, meaning it is converted to T3. Your thyroid uses iodine and the amino acid tyrosine your body absorbs from food to create these hormones.

The thyroid, along with other endocrine glands, only produces and secretes these hormones into the bloodstream when it gets the signal from the brain to do so. This happens via the hypothalamic-pituitary-thyroid (HPT) axis. First, the hypothalamus secretes Thyrotropin Releasing Hormone (TRH), which communicates to the pituitary gland to secrete Thyroid Stimulating Hormone (TSH). TSH then tells your thyroid gland to make and release thyroid hormones.

The Function of Your Thyroid Hormones

A picture of thyroid glandThe main function of thyroid hormones is to regulate your metabolism. But they’re also essential for regulating basal body temperature, body weight, breathing rate, heart rate, cholesterol levels, brain function, and muscle function. They're involved in some way or other in the functioning of all your cells, organs, and systems.

If you look over each of these functions, you can surmise what would happen if thyroid hormone production is slowed. And it is helpful to look at hypothyroidism symptoms accordingly.

There are also some things you can do to relieve some of these symptoms. That includes what you can do to address the problem at the root, which will also lead to symptom resolution.


When your thyroid is underactive, it results in the slowing down of your metabolism. Metabolism, in the simplest terms, is how your body produces and uses energy.

Metabolism creates energy by breaking down what you eat and drink into compounds your cells can then convert into ATP. ATP is the energy currency of life.

That means if your metabolism slows down, that process also slows down. You don’t break down food properly, which can lead to constipation. It also means that because your food is not broken down properly, it gets stored as fat, so you can gain weight. And, for the same reason, it means your cells don’t get enough of the raw materials needed to create ATP, or energy. The lack of energy obviously means you’ll feel more tired, lethargic, and generally slower.

Here, you can improve your diet so that you get more nutrients from fewer calories and also help your digestion with more fiber. A proper diet is also important for recovery, not just symptom relief.

But fatigue, which is one of the most prevalent hypothyroidism symptoms, is not only an issue of low energy levels. It can also happen because thyroid dysfunction is a big stressor on your body. And chronic stress can lead to Adrenal Fatigue Syndrome (AFS), whose main symptom is tiredness. Interestingly, diet is also the cornerstone of AFS recovery as well, which is what we focus on the most with our AFS clients.

Body Temperature

That lack of energy from slowed metabolism can then cause less warmth for your body. That's why you might feel cold all the time and be extra sensitive to cold weather. Your hands and feet can be icy even if the rest of your body is warm. This is also aggravated by the fact that thyroid hormones are responsible for regulating your body temperature as well.

Here, you can layer clothes, dress warmer, wear thick socks and mittens, use a hot water bottle or a heating blanket, and get enough sun during the day. You should try to avoid cranking up the heating in your house because that can lead to other issues, such as sleep disturbance. Instead, for sleep, you should keep your room cool and dark for optimum sleep, and opt for more blankets and heavier duvets to stay warm.

Heart Function

An image of a woman holding her chestLow thyroid levels can affect your cardiovascular system in several ways. First, you can get a slower heart rate, which is called bradycardia. This slowing of your heart rate can lead to dizziness, weakness, and even breathing problems. And if you don’t address it properly, it can destabilize your blood pressure and even cause heart failure. Your heart rhythm can also change. Heart rate is how fast your heart beats per minute. Heart rhythm is the pattern of that beating. Another issue is that your arteries may become less elastic. And, finally, you might get elevated cholesterol levels. All of these can affect your cardiovascular health and lead to very serious complications down the line if they’re not addressed.

Unstable blood pressure is also a symptom in AFS, along with heart palpitations, POTS-like symptoms, and other heart problems. In fact, as you’ll see, your thyroid and adrenal glands are closely connected and share many symptoms even though they are located in very different areas of your body. Your thyroid is in your neck while your adrenals sit atop your kidneys. But the link has to do with hormones.

All hormones affect each other somehow. But thyroid and adrenal hormones are connected by a hormone axis and they are also two of the three components of your NeuroEndoMetabolic (NEM) Stress Response’s Hormone Circuit. Your NEM is your body’s global response to stress, and it’s composed of six circuits of organs and systems that work together to fight stress. They are the Hormone, the Bioenergetics, the Cardionomic, the Neuroaffect, the Inflammation, and the Detoxification circuits. We’re mainly dealing with the Hormone Circuit when talking about hypothyroidism symptoms. But in this case, the Cardionomic Circuit is also involved.

Brain Function

Another very common set of symptoms for both AFS and hypothyroidism has to do with mood and cognitive function. That’s because your brain needs these hormones to work properly. It also needs a lot of energy, which is lacking when you have such conditions. So you can end up with symptoms such as anxiety, depression, irritability, lack of focus, difficulty concentrating, memory loss, slowed thinking, slowed speech, and loss of interest in things. Also, the sleep problems that can come with these conditions can also really affect your mood and brain function.

Here’s what you can do. First of all, give yourself a break. You need a lot of rest and sleep while you undergo whatever recovery plan your healthcare professional has assigned you. That means you shouldn't expect to be back to full capacity at work or school right away, or that you’ll suddenly feel energetic and happy again. You can also look for support groups or therapy that can help you get through this phase. Ask friends and family for help with daily chores, if possible. Just know that once your hormones are balanced again, you’ll feel better.

Hair, Skin, and Nails

An image of a woman looking at her fingernails in shockSome of the more obvious hypothyroidism symptoms are the changes you see in the health of your hair, skin, and nails. Thyroid hormones are important for the health of your hair follicles and hair. So having less of them means your hair might be brittle and prone to breakage. Your hair follicles might stop working properly, so your hair starts thinning. This is not just related to your scalp, as you can even see hair loss on your eyebrows and body. Skin can become dry, rough, thin, scaly, and pale. Nails can become weak, thin, and brittle.

In general, good hormone balance is crucial for beauty at any age. A healthy diet can help with the health of your hair, skin, and nails by providing the nutrients necessary to build them in a healthy way. But a good diet also goes a long way to balance your hormones. You might also be prescribed hormone replacement if it’s needed, and you’ll see these symptoms visibly improve in that case.

Muscles and Joints

Hypothyroidism can cause sore, painful, swollen, tender, and weak muscles and joints. You might also be at higher risk of rheumatoid arthritis. And in that case, you may need to get treated for both conditions rather than just one. Exercise intolerance can be a result of these symptoms as well as the fatigue you get from hypothyroidism.

If you have hypothyroidism or AFS, you shouldn’t push yourself with exercise. Depending on how advanced your condition is, you will need to adjust accordingly. For example, with our AFS clients, we like to start them off with a very gentle adrenal breathing practice. Then, when they’re a little stronger, they move onto adrenal yoga. Then, once they’re recovered or almost recovered, they can try more intense forms of exercise. The important thing is that you customize your exercise routine, and your recovery in general, to your current state and health situation.

Primary and Secondary Hypothyroidism Symptoms

You should always aim to resolve the root cause of a problem rather than only addressing symptoms.

Hypothyroidism can be the result of a so-called primary cause, such as Hashimoto’s Thyroiditis, which is an autoimmune condition that kills the cells that produce thyroid hormone. Iodine deficiency is another primary cause, and though rare in the developed world, it can still happen. But hypothyroidism can also be the result of a secondary cause, such as a hormone dysregulation in other Hormone circuit components.

Your NEM’s Hormone circuit is composed of the adrenals, the thyroid, and the gonads (female ovaries and male testes). We’ll take the ovaries as the example here since hypothyroidism affects more women than men.

All three components function by way of a hormone cascade, starting with the control center in the brain that’s made up of the hypothalamus and pituitary gland. Just like the HPT, there’s also the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-gonadal (HPG) axis. Then, the three components are also directly linked through the ovarian adrenal thyroid (OAT) axis.

That means, generally speaking, when one axis is activated, the others are also activated to a certain extent. For example, the HPA kicks into drive when your body is facing stress. Your body needs to release stress hormones to deal with it, and cortisol is the main anti-stress hormone. So the end goal of HPA activation is to release cortisol, though it also releases many other hormones. But dealing with stress requires your thyroid to ramp up its hormone release as well. Thyroid hormones help your body speed up metabolic rate, breathing rate, and heart rate to help you get the energy you need to handle that stress.

Chronic Stress and Hypothyroidism

An image of a woman having her thyroid examined by her doctorThis is all part of the normal and healthy functioning of your NEM stress response. But when stress is chronic, it can create a lot of problems. First of all, chronic stress will require that these glands work overtime to produce more hormones. This can lead to their dysregulation and weakening, which then results in less hormone production.

When your adrenals dysregulate, you end up with AFS, whose symptoms include fatigue, weight gain, sleep problems, brain fog, anxiety, mild depression, hair loss, dry skin, loss of libido, PMS, infertility, hypoglycemia, salt and sugar cravings, lowered immunity, food and drug sensitivities, heart palpitations, unstable blood pressure, and an inability to handle stress.

As you can see, the symptoms are quite varied. And that’s because AFS is linked to NEM dysregulation, which is composed of all of these different circuits. That includes the Hormone Circuit with its three components. That’s also why some AFS symptoms are also hypothyroidism symptoms.

When your thyroid slows down, whether due to primary or secondary causes, all your body’s non-essential functions slow down as well. For example, your reproductive system isn't essential for your survival. So you can end up with symptoms of reproductive hormone dysregulation, such as low libido, PMS, irregular menstruation, amenorrhea, infertility, fibrocystic breast disease, and miscarriages.

Here’s something to keep in mind: just like adrenal fatigue can cause hypothyroidism, and just like hypothyroidism can cause sex hormone imbalance, the reverse is also true. Hypothyroidism can be a stressor that leads to AFS, as can sex hormone issues. That’s why, for example, we can see adrenal fatigue develop during hormone change milestones, like pregnancy or menopause.

The Basics of Recovery

The more the dysregulation progresses, in whichever component, the more your entire Hormone Circuit and NEM weaken. At some point, there may be a total shutdown of one or several of your systems. Many of our patients come to us after years of trying to figure out what’s wrong and trying different therapies that backfire. And some are completely bedridden and hopeless. This is often because not all healthcare professionals look at potential secondary causes that, if left unaddressed, continue to weaken the thyroid and wreak havoc on overall health.

So if your hypothyroidism symptoms get worse even with conventional treatment, or if they keep recurring and you never feel completely recovered, it may be the case that other hormone systems are at play. That's why it’s better to take a look at your entire Hormone circuit to make sure, and then create an individualized recovery plan.

If this sounds complicated or overwhelming, there is good news: just like one system’s imbalance can cause another’s imbalance, balancing one system will positively affect the others as well. So, let’s say that what caused your hypothyroidism is indeed AFS. Focusing your efforts on adrenal fatigue recovery may very well clear up your hypothyroidism symptoms without the need for thyroid hormone replacement therapy. Or let’s say you have Hashimoto’s thyroiditis and you start thyroid hormone replacement therapy; then your adrenal fatigue will likely improve.

In all cases, the four main components of adrenal fatigue recovery we work on with every client will help whatever hormone imbalance you have. And they are the following.


An image of healthy foods displayed on a platterThe adrenal fatigue diet is the most important piece of the puzzle. First of all, it’s about eating nutrient-dense food that will replenish your depleted energy and nutrient stores. Secondly, it’s about keeping your blood sugar levels stable, so you don’t get peaks and crashes. Thirdly, it’s about optimizing what you eat to your hormone fluctuations, so that you get the right foods at the right time. This will vary from person to person, so it’s crucial to work with an experienced coach on your nutrition plan.


A gentle supplements protocol can do wonders for you. Its main goal is twofold: to fill in any nutritional gaps left over by your diet and to give you a therapeutic boost when needed. Therapeutic boosts are usually done with higher doses for a shorter period of time. But, again, this protocol will depend heavily on your current condition and needs. One protocol that’s good for one person may backfire in another. You also need to be aware of the possibility of paradoxical reactions and adrenal crashes.

Rest and Sleep

We already talked about this in the section on hypothyroidism symptoms and the brain. But if you have AFS, it’s even more important to get this right. You need a lot of rest and sleep for recovery. With sleep, some sleep hygiene routines will help a lot. For example, keep your room cool and dark, stop using screens at least two hours before bed, eat a light snack before bed to avoid middle-of-the-night hypoglycemia, don’t drink a lot of liquids before bed, and meditate or do some other relaxation techniques before sleep. Some supplements may also help here, but, again, this needs to be customized to your body.


Gentle forms of exercise might be useful, but you have to make sure they fit with the stage of adrenal fatigue or hypothyroidism you’re in. In the beginning of recovery, it may be better to wait on this until you have a little more strength and energy, or do very gentle exercises such as adrenal breathing or yoga.

In Conclusion

Hypothyroidism is a very common condition. It affects millions of Americans, more women than men, and it usually starts between ages 30 and 50. Its causes can be primary, like Hashimoto’s thyroiditis, or secondary, like adrenal fatigue and Hormone circuit dysregulation.

Depending on what the underlying cause is, your therapy options may differ. With Hashimoto’s thyroiditis, thyroid hormone replacement may be necessary. But with AFS, an adrenal fatigue recovery plan may be all you need. It’s better to take some time to get to the bottom of the matter than to jump onto any care plan in the hopes of getting fast relief, because this can backfire.

If you have questions about adrenal fatigue and hypothyroidism symptoms, you can get in touch to arrange a free initial consultation with one of our expert coaches. We can help you figure out the best course of action for your unique situation and needs.

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Dr. Lam’s Key Question

Some of the most common hypothyroidism symptoms are fatigue, hair loss, dry skin, brain fog, anxiety, depression, constipation, and blood pressure. But these also feature prominently in adrenal fatigue. So it’s worth checking if there’s a direct link first before starting hormone replacement. You might need a different recovery plan.

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