Symptoms of Low or Underactive Thyroid, Hypothyroidism

Low levels of thyroid hormones, either caused by an underactive thyroid gland, or other disorders that affect circulating thyroid hormone levels (euthyroid sick syndrome) results in a range of symptoms that collectively indicate hypothyroidism. These symptoms may vary in intensity and in early stages of hypothyroidism, few or no symptoms may be present (subclinical hypothyroidism).

Signs and Symptoms of Hypothyroidism

The most characteristic signs and symptoms of hypothyroidism include :

  • Fatigue. Severe tiredness and lethargy, after a little activity or for no apparent reason. This may also be experienced or interpreted as excessive sleepiness, diminished concentration, low energy levels or general ‘weakness’.
  • Weight gain. The degree of weight gain may differ among individuals but it is usually a modest weight gain. This means that a person with a normal or healthy BMI (body mass index) will not gain weight to the degree that they will shift into the ‘obese’ category. Rather they may shift to the upper range of a healthy BMI or even fall into the overweight category.
  • Sensitivity to cold. There is a noticeable intolerance to cold but should be differentiated from normal sensitivity to low temperatures. When related to hypothyroidism, the sensitivity to cold usually refers to an intolerance of low temperatures which were previously not a cause of discomfort.

In most cases, the presence or persistence of even one of these symptoms may warrant diagnostic investigation for low thyroid levels.

Other signs and symptoms, which may also be present, should not be immediately attributed to hypothyroidism, unless other possible causes have been excluded or if the one or more of the above symptoms are also present. These  signs and symptoms may include :

  • Depression
  • Constipation
  • Dry skin and/or dry, coarse (rough) hair.
  • Weak or brittle hair and nails.
  • Goiter – enlargement of the thyroid gland which is more common in Hashimoto’s thyroiditis.
  • Menstrual changes – particularly  menorrhagia, which is prolonged and/or heavy periods.
  • High blood cholesterol levels.
  • Intellectual impairment, such as difficulty concentrating, forgetfulness or poor memory, difficulty in completing certain mental tasks or may even present as personality changes.
  • Pale skin
  • Muscle aches
  • Joint pains
  • Leg swelling
  • Puffy face
  • Droopy eyelids
  • Puffiness or swelling around the eyes
  • Dull facial expression
  • Hoarse voice
  • Slow speech
  • Macroglossia – enlargement of the tongue.
  • Hypothermia – low body temperature.
  • Anemia
  • Vitamin B12 deficiency
  • Carotenemia – orange discoloration of the skin.
  • Bradycardia – heart rate under 60 beats per minute.
  • Abnormal reflexes
  • Psychosis known as ‘myxedema madness’.
  • Pleural effusion – fluid or ‘water’ around the lung.
  • Abdominal effusion – fluid or ‘water’ in the abdominal cavity.
  • Numbness or tingling of the hands and feet (paresthesia).

Myxedema Coma

Myxedema is the medical term for severe hypothyroidism resulting in  number of serious symptoms caused by the severity of the low thyroid hormone levels as well as the prolonged state of hypothyroidism. This state usually occurs in  case of undetected, misdiagnosed or a poorly managed case of hypothyroidism.

Myxedema coma is a life-threatening complication of severe hypothyroidism and is triggered by exposure to cold, trauma, infection or drugs that suppress the central nervous system (like ‘sleeping tablets’, anesthetics or in alcohol abuse). Characteristic features of myxedema coma is a coma with hypothermia (low body temperature), depressed or absent reflexes (areflexia), shallow breathing, hypoxia, seizures and reduced blood flow to the brain. Immediate medical treatment is required or death may occur.


  1. Hypothyroidism (Myxedema). Merck
  2. Hypothyroidism. Medline

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  • ppatter815

    I have many of the symptoms of hypothyroidism, however, my blood tests keep coming back within the normal ranges. I have cycles of slow speech ( I sounds like I have been drinking when I haven’t), weight gain, my skin is so dry and looks like scales in the sun. My hair texture has completely changed. I am very fatigued, sleep cycle has changed, I feel like I am waking up at times gasping for breath (feel like I have quit breathing) and have shortness of breath, carpel tunnel, trigger fingers and tendonitis in my elbow. I have a one droopy eyelid, my vision has changed and so has my hearing. My last TSH was around 3 and my doctor is using on the scale of 5. I am at wits end about what to do because I feel terrible. Also, I do have a nodule on my thyroid (at least 5 years) that basically has been stable until this year. It grew .2 mm. I am 58 years old and have gone through menopause the past 18 months.

    What would you suggest? I’m so tired of going to the doctor and getting well all your tests are normal and getting the look of it is in your head. The only thing that I have had done is the thyroid ultrasound scan and do not know if it is hot or cold.

    • Dr. Chris

      Hi PPatter

      You must also realize that a lot of your symptoms do occur with menopause. So this has to be taken into consideration. Adrenal insufficiency is another condition that needs to be ruled out. If you have a history of long term corticosteroid use and so on, it would be wise to check for Cushing’s syndrome. At this point, you should see your gynecologist and an endocrinologist.

  • Ginger

    Since the onset of symptoms of a 3rd ventricle cyst, I have had difficulty losing weight despite chronic dieting and intense(in the two years before diagnosis), aerobic exercise. The brain surgery(ies) exacerbated the issue, I believe, when I suffered a brain injury in the area of the third ventricle. What might help to know with regard to the location and extent of the injury is that I lost my LT/ST memory for a year and a half. Just about all that I know about my injury and surgeries came from family and friends as well as doctors notes that I was fortunate to get. Furthermore, I had multiple, subsequent surgeries to place, replace, and revise bilateral VP shunts due to the non communicating chronic, severe hydrocephalus.

    It might also help to know that I have had a seizure disorder since then and take anti-seizure medication. In addition, I have a left-sided hemi-paresis due to two hemorrhagic strokes, which made exercising very difficult for a long time. I now have full use of my arm and leg on that size, albeit a little weaker. When I got my awareness and some memory back, I discovered that I wasn’t menstruating and in my mid to late 30’s, I thought I was experiencing early menopause or perimenopause – which I am experiencing now at 45 y/o.

    I am convinced that my current problems with weight, cholesterol, and blood glucose are caused in part by my medical situation before and after the surgeries, with high cholesterol and Type 2 Diabetes being familial for the most part. I don’t use much, if any, added salt, and don’t eat pre-packaged foods, so, I probably don’t get enough iodine in my diet. Should I supplement it? If so, are there iodine supplements available?

    I’m pretty sure that I have seen TSH on the lab sheets that I bring to the lab to get blood drawn, but do not know what the numbers are and trust that if there was something concerning I would be told about it and would be treated accordingly.

    Am I way off base with this?? I will be seeing an Endocrinologist next month and would like to be able to discuss this with him intelligently and provide some basis on which to propose these causes in order to find an appropriate way to treat my symptoms. After seemingly fruitless efforts to lose weight, I am getting discouraged. I get excited even if I see just a half lb loss on the scale. I usually have to starve myself to do that, which I know is bad as well. I do take a multi-vitamin though.

    I don’t want to seem like a hypochondriac, but with having been misdiagnosed for a potentially deadly brain tumor which almost took my life, I am a little short on trust right now. There seems to be reluctance on the part of my doctors to investigate these factors as possible long term causes or even to explain that there is something I can do about it, but also acknowledge and understand my concerns and WHY they are unfounded.

    I am well past the statute of limitations for any kind of malpractice suit related to my injury, so, I don’t understand why no one will investigate this as a reason. I feel powerless to affect any change at this point.

    • Dr. Chris

      Hi Ginger

      I cannot say for sure whether these are the definite causes of your weight gain but at some points, you may be making correlations between different events and factors that could be “off base” as you said. No, you should not supplement your iodine. You don’t clearly state whether you do have a thyroid problem (hypothyroidism) and even so iodine supplementation may not be the issue here. Hypothyroidism occurs for various reasons even with normal iodine intake. You focus a lot on your history and assumptions yet you do not mention your eating habits and lifestyle. Bear this in mind – even in the setting of hypothyroidism dietary factors and exercise still play important roles. Even if it is not going to drastically change your weight overnight, it would at least help with your other known problems – cholesterol and diabetes mellitus. The visit with the endocrinologist is essential. Working with a dietitian is also necessary. And exercise should be overseen by a reputable fitness trainer. You should also consider the assistance of a psychologist in helping you come to terms with the past/recent events which are obviously a disturbance in your life today.