The thyroid produces hormones that affect every part of the body. When the thyroid secretes too much hormone, it’s called overactive thyroid or hyperthyroidism. Symptoms of hyperthyroidism can include feeling nervous or restless, a fast or irregular heartbeat, trouble sleeping, diarrhea, weight loss, weakness, and feeling hot. Some people will experience hand tremors or note changes in the menstrual cycle.
When there is too little thyroid hormone, it’s called underactive thyroid or hypothyroidism. People with hypothyroidism may feel sluggish, tired, or depressed. Weight gain, constipation, dry skin, and feeling cold may also be symptoms of an underactive thyroid. Hypothyroidism can also cause changes in the menstrual cycle.
At first, people often don’t realize that it’s the thyroid causing their symptoms. Many cases of hypothyroidism and hyperthyroidism are subclinical in the beginning, meaning that symptoms are very mild and hard to detect. Sometimes another diagnosis is made before the thyroid is checked.
RELATED: Hypothyroidism vs. hyperthyroidism
Thyroid symptoms may be caused by a variety of health conditions, or as a side effect of medications or other medical treatments.
Thyroid symptoms usually improve when the underlying condition is treated.
Hypothyroidism is treated with medications such as levothyroxine. Hyperthyroidism is treated with procedures or medications such as methimazole and propylthiouracil.
Save on prescriptions for thyroid conditions with a SingleCare prescription discount card.
The most common cause of hypothyroidism is:
Hashimoto’s disease, an autoimmune disorder in which the immune system attacks healthy tissues in the thyroid
Other causes of an underactive thyroid include:
Thyroid surgery
Radiation treatment to the neck, head, or brain
Radioactive iodine treatment
Being born with an underactive thyroid (congenital hypothyroidism)
Side effect of some prescription drugs (including amiodarone, interferon-alpha, nivolumab, pembrolizumab, alemtuzumab, and lithium)
Some types of thyroid cancer
Not enough hormone produced by the pituitary gland in the brain
Changes during or after pregnancy
Thyroid swelling (thyroiditis)
Not getting enough iodine in the diet
The most common causes of hyperthyroidism are:
Graves disease, an autoimmune disease in which antibodies stimulate over-secretion of thyroid hormone
Enlargement of the thyroid with multiple thyroid nodules (multinodular goiter)
A single, overactive thyroid nodule
Inflammation of the thyroid
Other causes of hyperthyroidism include:
A side effect of some medications
An overactive pituitary gland
Taking too much thyroid medication
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See a healthcare provider if you experience symptoms of an underactive or overactive thyroid. Untreated thyroid problems can lead to long-term complications, or could even cause a medical crisis.
Untreated hypothyroidism can lead to mental health problems, long-term thyroid enlargement, chronic pain, high cholesterol, and swelling. Even mild hypothyroidism
creates a higher risk for cardiovascular disease, stroke, heart failure, and cognitive decline. In children and adolescents, hypothyroidism can delay growth and development. In older adults, confusion or memory problems may be symptoms of a thyroid problem.
Severe hypothyroidism is called myxedema. It is a potentially fatal medical emergency. Any of the causes of low levels of thyroid hormone can lead to myxedema. Get immediate medical attention for symptoms of:
Altered mental status
Low body temperature
Slow breathing
Dry skin
Hair loss
Slow reflexes
Slow heart rate
Low blood pressure
Puffy face
Lethargy
Coma
High levels of thyroid hormone are equally serious. Hyperthyroidism could escalate into a “thyroid storm” if thyroid hormones rise to dangerous levels. A thyroid storm is a time-critical medical emergency. It can be life-threatening and lead to heart failure, dangerous heart rhythms, and liver failure. Get emergency medical care for symptoms of:
Extreme anxiety or panic
Confusion, delirium, or other changes in mental status
High fever
Diarrhea
Very fast heartbeats or heart flutters
Loss of consciousness
Symptoms of heart failure such as swelling of the legs, shortness of breath, fatigue, and weakness
Symptoms of liver dysfunction like yellow skin, yellow eyes, or abdominal pain
Untreated hyperthyroidism from Graves disease may lead to eye problems such as double vision or bulging eyes.
A healthcare professional will perform a physical exam, medical history, and a blood test. The first blood test usually measures the level of thyroid-stimulating hormone (TSH). Based on that test, additional blood tests may include T3 (triiodothyronine), T4 (thyroxine), and a check for antibodies that may be affecting the thyroid. Imaging studies, like an ultrasound or thyroid scan, may be needed to pinpoint the cause.
RELATED: How to understand thyroid panel results
Symptoms of hypothyroidism or hyperthyroidism usually improve once the underlying condition is treated. Some symptoms caused by severe or longstanding diseases may take longer to resolve.
Thyroid symptoms caused by medication side effects or diet are resolved by stopping the medications or adjusting the diet. Thyroid symptoms that occur during pregnancy or after delivery may resolve on their own or need treatment for a short time. Sometimes an illness or inflammation also causes temporary thyroid problems that improve in a few weeks or months.
But most thyroid conditions will require treatment in the form of medication, radioactive iodine treatment, or surgery.
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Treatment of thyroid symptoms will depend on the nature of the thyroid problem. Underactive thyroid is treated with thyroid hormone pills, usually levothyroxine, Armour Thyroid, or similar prescription thyroid hormones. An overactive thyroid can be managed with drugs that block the thyroid’s production of hormones, including methimazole or propylthiouracil. Beta blockers may also be used to block the effects of too much thyroid hormone, such as a fast heart rate or tremor. Overactive thyroid may require radioactive iodine treatment or surgery to eliminate hormone-producing tissues in the thyroid. These treatments will result in permanent hypothyroidism, so thyroid hormone replacement will be required from that point on.
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The best way to live with thyroid symptoms is to work with your healthcare provider to diagnose and treat your thyroid condition.
Natural remedies for thyroid symptoms lack evidence of efficacy and safety, according to the American Thyroid Association. Taking certain supplements or medications without the guidance of a healthcare professional can even lead to thyroid symptoms. However, a lifestyle that includes a healthy diet, exercise, getting enough sleep, avoiding smoking, limiting alcohol, and managing stress can help to support a healthy hormone balance.
While up to 12% of the population has thyroid disease, as many as 60% of those people don’t know they have it. Symptoms may be very mild, nonspecific, or mimic other health conditions. At best, thyroid problems interfere with daily life. At worst, they can lead to serious complications. If you have symptoms of thyroid problems, even if they’re mild, see your healthcare provider. This is especially important if you’re pregnant or planning for pregnancy, if you’re over the age of 60, if you have an autoimmune condition, including Type 1 diabetes, or have an immediate family member with thyroid problems. Most states also require newborn screening, which includes a test for congenital hypothyroidism.
RELATED: Thyroid health 101: Common problems you should watch out for
Some men may experience breast growth (gynecomastia) or erectile dysfunction in addition to other symptoms of hypothyroidism.
Both hyperthyroidism and hypothyroidism can interfere with the menstrual cycle, leading to absent or irregular periods. Additionally, women are more likely than men to have subclinical hypothyroidism, with few or mild symptoms. This condition still needs to be diagnosed and treated to prevent more serious problems in the future. For this reason, women are encouraged to get screened for thyroid dysfunction.
The thyroid affects many different body functions, so there are no definitive early warning signs of thyroid problems. However, some of the common symptoms, even if they’re not specific, are good indicators that medical help is needed. For instance, persistent fatigue or a change in bowel habits is a good reason to talk to a healthcare provider. Other symptoms like unintended weight gain or weight loss, or heart palpitations are also convincing reasons to make a visit to your healthcare provider.
How to understand thyroid panel results, SingleCare
What is a TSH test and what do the results mean?, SingleCare
Hypothyroidism vs. hyperthyroidism: Compare causes, symptoms, treatments, and more, SingleCare
Hypothyroidism treatments and medications, SingleCare
The best diet for Hashimoto’s thyroiditis, SingleCare
The best diet for hyperthyroidism, SingleCare
Thyroid hormones: uses, common brands, and safety info, SingleCare
How long does it take thyroid medication to work?, Paloma Health
Subclinical hypothyroidism and the risk of coronary heart disease and mortality, JAMA
Subclinical hypothyroidism and the risk of stroke events and fatal stroke: an individual participant data analysis, The Journal of Clinical Endocrinology & Metabolism
Myxedema, StatPearls
Subclinical hypothyroidism, StatPearls
Thyroid storm, Cleveland Clinic
What are thyroid nodules?, SingleCare
Anne Jacobson, MD, MPH, is a board-certified family physician, writer, editor, teacher, and consultant. She is a graduate of University of Wisconsin School of Medicine and Public Health, and trained at West Suburban Family Medicine in Oak Park, Illinois. She later completed a fellowship in community medicine at PCC Community Wellness and a master's in Public Health at the University of Illinois-Chicago. She lives with her family near Chicago.
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