What are the symptoms of hypothyroidism (underactive thyroid)?

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From the Guidelines

Hypothyroidism 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, irregular or heavy menstrual periods, thinning hair, slowed heart rate, depression, and impaired memory. These symptoms occur because the thyroid gland doesn't produce enough thyroid hormones, which regulate metabolism, energy production, and many bodily functions 1. Symptoms typically develop slowly over years as thyroid function gradually declines. The severity varies widely between individuals, with some experiencing mild symptoms while others have more pronounced effects. Elderly patients may show fewer classic symptoms, sometimes presenting primarily with fatigue or memory issues. If you experience multiple symptoms, especially persistent fatigue, weight gain despite no change in diet, or increased cold sensitivity, consult a healthcare provider for thyroid function testing. Early diagnosis allows for treatment with synthetic thyroid hormone (levothyroxine), which effectively manages symptoms when taken daily at the appropriate dosage determined by your doctor. Some key points to consider:

  • The most common cause of hypothyroidism in the United States is chronic autoimmune (Hashimoto) thyroiditis 1.
  • Risk factors for an elevated TSH level include female sex, advancing age, white race, type 1 diabetes, Down syndrome, family history of thyroid disease, goiter, previous hyperthyroidism, and external-beam radiation in the head and neck area 1.
  • The serum TSH test is the primary screening test for thyroid dysfunction, and multiple tests should be done over a 3- to 6-month interval to confirm or rule out abnormal findings 1. It is essential to consult a healthcare provider for proper diagnosis and treatment, as early intervention can significantly improve quality of life and reduce the risk of complications.

From the Research

Symptoms of Hypothyroidism

The symptoms of hypothyroidism can be non-specific and may overlap with other conditions, making diagnosis challenging in some cases 2, 3, 4, 5, 6. Some common symptoms include:

  • Fatigue and lethargy
  • Weight gain due to a decrease in fat-burning rate
  • Increased sensitivity to cold (cold intolerance) due to a decrease in heat production by the body
  • Irregular bowel movements (constipation)
  • Dry skin (xeroderma)
  • Voice changes
  • Menstrual cycle abnormalities

Clinical Presentation

The clinical presentation of hypothyroidism can differ with age and sex, among other factors 4, 5. In adults, the most common symptoms are fatigue, lethargy, cold intolerance, weight gain, constipation, change in voice, and dry skin. However, some people may not exhibit any symptoms, while others may experience life-threatening symptoms such as myxedema coma.

Diagnosis and Treatment

Diagnosis of hypothyroidism is based on laboratory tests that measure the levels of thyroid hormones (T3 and T4) in the blood, as well as thyroid-stimulating hormone (TSH) levels 2, 3, 6. 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, 3, 5, 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Hypothyroidism: Diagnosis and Treatment.

American family physician, 2021

Research

Hypothyroidism.

Lancet (London, England), 2017

Research

Hypothyroidism.

Lancet (London, England), 2024

Research

Hypothyroidism: Diagnosis and Evidence-Based Treatment.

Journal of midwifery & women's health, 2022

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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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