You’re exhausted, constipated, and depressed, your periods are a nightmare, and your hair feels brittle and dry—it’s gotta be your thyroid, right? Not so fast.
“If I had $1 for every time I get asked that question, I’d be sitting in Hawaii right now,” Afreen Shariff, MD, an associate professor and endocrinologist at Duke University School of Medicine and the director of Duke’s Endo Oncology Program, tells SELF. “I always say half my job is to tell you what it is, and half my job is to tell you what it’s not.”
Because you need thyroid hormones for so many processes in your body, it can wreak havoc “from your hair to your toenails” when they get out of whack, Dr. Shariff says. But the symptoms are so common and varied—a true smorgasbord of options!—that it’s often hard to figure out if that little butterfly-shaped gland in your neck is to blame or if you have other run-of-the-mill problems.
About 5% of Americans over the age of 12 are believed to have hypothyroidism—when you don’t make enough of some key hormones—and another 5% may have it and not know it. That’s fairly common, so if you have a handful of the symptoms of an underactive thyroid, plus a risk factor or two for the condition, doctors are usually pretty quick to send you to the lab to check, Susan L. Samson, MD, PhD, a professor at the Mayo Clinic College of Medicine and Science and the president of the American Association of Clinical Endocrinology, tells SELF.
Here are 10 common hypothyroidism symptoms.
If you have this condition, you’re probably dealing with several of these symptoms:
- Weight gain
- Fatigue
- Heavier periods
- Depression
- Dry skin or hair
- Thinning hair
- Cold intolerance
- Muscle cramping or pain
- Joint pain
- Slow heart rate
The problem is, these can also sometimes be caused by simply…existing. You could be tired because work has been super stressful lately or thanks to a new medication you just started taking, for example, Dr. Shariff says.
Or you could have another health problem entirely. “The symptoms really overlap with a lot of conditions,” Dr. Samson says.
“It would be neat and tidy to have a convenient equation that told you if you had, say, three of those, your thyroid was to blame. But unfortunately that’s not the way things work. Everyone’s symptoms and experiences are different,” Dr. Shariff says. That’s why doctors look at the “constellation” of other symptoms you’re experiencing to help determine what’s going on, she says.
In many cases, your health care provider may ask you about any relatively recent changes in how you look or feel, although symptoms can also sneak up on you gradually, Dr. Samson says. You might only decide it’s time to talk to your doctor once things get extreme—maybe your period feels like a waterfall for no obvious reason after seeming just a little heavier for several months or your teeth are chattering in your air-conditioned office when you used to feel just a little chilly.
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To better connect the dots, your doctor will likely ask you questions about your symptoms, health history, and do a physical exam. “It’s kind of putting the whole picture together,” Dr. Samson says.
Risk factors can paint a clearer picture
How likely you personally are to have a thyroid issue is also part of the assessment, Dr. Shariff says. Hypothyroidism is more common in women, especially over age 60. The chances of your symptoms stemming from an underactive thyroid are higher if you have:
- A family member who has hypothyroidism
- Type 1 diabetes, lupus, rheumatoid arthritis, or another autoimmune disease
- Depression
- A history of cancer treatment that can affect the thyroid (like radiation)
- Been pregnant in the last 6 months
If you have some of the risk factors and some of the common symptoms above, it might be time for some bloodwork. Your primary care doctor can absolutely handle thyroid testing; you don’t have to seek out an endocrinologist to get a diagnosis, Dr. Samson says.
What to expect from thyroid testing
Most of the time, you’ll be given a blood test to measure your thyroid stimulating hormone (or TSH). It’s a barometer of your thyroid health: High levels signify hypothyroidism, because if your thyroid is underactive, the pituitary gland in your brain releases more TSH into your blood to try to correct the problem. You may also have another test to measure thyroid hormones, usually T4. This is also called a thyroxine test and the combination of low T4 and high TSH (which is a little confusing!) means you likely do indeed have hypothyroidism.
Occasionally doctors find some people who have elevated TSH but normal T4, which suggests that they have something called subclinical hypothyroidism. This generally doesn’t cause symptoms and often goes away on its own, so docs may adopt a “watchful waiting” approach and check your levels over time.
A note of caution: You should stop taking any biotin—which is a B vitamin some people take to strengthen their hair or nails—at least a few days but ideally a week before your blood test, Dr. Samson says. Biotin doesn’t affect thyroid hormones, but it can interfere with your results.
If blood tests show you have hypothyroidism, your doc will likely give you synthetic thyroid hormone known as levothyroxine to replace what your body’s not making, Dr. Shariff says. (You generally take it daily or weekly in a tablet, capsule, or liquid form.)
But if your bloodwork is normal, your doctor should work with you to try to figure out what else might be going on, Dr. Shariff says: “It doesn’t mean you should magically feel fine.” There’s more detective work ahead at that point. Her next steps? Maybe ordering a sleep test to check for sleep apnea or additional bloodwork to investigate possible iron or vitamin D deficiencies. Based on the symptoms that are bothering you the most, “you kind of follow that path to see if it fits a diagnosis,” she says.
Even though you’re likely eager for answers, try not to take matters into your own hands: Over-the-counter supplements for hypothyroidism can be dangerous, especially if your bloodwork is normal, Dr. Samson says. Some can contain actual hormones like T4, which could make your levels way too high. And if that happens, you can get symptoms similar to hyperthyroidism, or overactive thyroid, which can include a racing heart, irritability, shakiness, and sensitivity to heat, according to the NIDDK.
If your doctor isn’t taking your symptoms seriously, it might be time to find another one. You deserve someone who will be empathetic and thoughtful as you try to figure out what’s bothering you—even if that’s not ultimately your thyroid. “It’s important for physicians to think, hear, and understand what the patients are going through,” Dr. Shariff says.
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