What are the signs and symptoms of hypothyroidism?

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From the Guidelines

Hypothyroidism typically presents with symptoms such as fatigue, increased sensitivity to cold, constipation, dry skin, unexplained weight gain, puffy face, hoarseness, muscle weakness, elevated blood cholesterol, muscle aches and stiffness, joint pain or stiffness, irregular or heavy menstrual periods, thinning hair, slowed heart rate, depression, and impaired memory, as noted in the study by 1. The symptoms of hypothyroidism can vary widely in severity and may develop slowly over years as thyroid function gradually declines.

  • Common signs and symptoms include:
    • Fatigue
    • Increased sensitivity to cold
    • Constipation
    • Dry skin
    • Unexplained weight gain
    • Puffy face
    • Hoarseness
    • Muscle weakness
    • Elevated blood cholesterol
    • Muscle aches and stiffness
    • Joint pain or stiffness
    • Irregular or heavy menstrual periods
    • Thinning hair
    • Slowed heart rate
    • Depression
    • Impaired memory Some patients may also experience a visible enlargement of the thyroid gland called a goiter, as mentioned in the study by 1. Hypothyroidism occurs because insufficient thyroid hormones slow down the body's metabolic processes, affecting virtually every organ system.
  • Elderly patients might present with more subtle symptoms that can be mistaken for normal aging, such as cognitive decline.
  • Infants with congenital hypothyroidism may have poor feeding, jaundice, frequent choking, or a protruding tongue. If you suspect hypothyroidism based on these symptoms, medical evaluation with thyroid function tests is necessary for diagnosis and appropriate treatment, as recommended by the study by 1. The principal treatment for hypothyroidism is oral T4 monotherapy (levothyroxine sodium), as stated in the study by 1.

From the Research

Signs and Symptoms of Hypothyroidism

The signs and symptoms of hypothyroidism can vary and may not be specific, making it harder to diagnose in some cases. Common symptoms include:

  • Fatigue
  • Weight gain
  • Increased sensitivity to cold (cold intolerance)
  • Irregular bowel movements (constipation)
  • Dry skin (xeroderma) 2
  • Change in voice
  • Lethargy 3
  • Cold intolerance, fatigue, weight gain, dry skin, constipation, and voice changes are also reported in adults 4

Clinical Presentation

The onset of hypothyroidism is insidious in most cases, and symptoms may present relatively late in the disease process 5. There is a large variation in clinical presentation, and the presence of hypothyroid symptoms can differ with age and sex, among other factors 3.

Severity of Symptoms

Clinical manifestations of hypothyroidism can range from life-threatening to no signs or symptoms 3. If left untreated, hypothyroidism can lead to severe complications like mental retardation, delayed milestones, etc., in infants and heart failure, infertility, myxedema coma, etc., in adults 2.

Diagnosis and Treatment

The diagnosis of hypothyroidism is based on laboratory tests that measure the levels of thyroid hormones (T3 and T4) in the blood 2. Treatment typically involves lifelong hormone replacement therapy with synthetic thyroid hormone replacement medication, such as levothyroxine, to help regulate hormone levels in the body 2, 5, 4.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Hypothyroidism.

Lancet (London, England), 2017

Research

Hypothyroidism: Diagnosis and Treatment.

American family physician, 2021

Research

Hypothyroidism.

Nature reviews. Disease primers, 2022

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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