This article has been medically reviewed by Dr. Charles Penick, MDDr. Charles Penick

Top 10 Thyroid Symptoms: Thyroid disease affects about 1 in 20 people in the U.K. and up to 20 million people in America, the majority being women. And those are only the ones who have been diagnosed. In reality, many people have symptoms of thyroid conditions for years before receiving an actual diagnosis.

Because women tend to be affected more than men (up to eight times more), diagnosis can be difficult. Many initial symptoms can be subtle or brushed off related to a “normal” part of aging, being a mother, or stress.

Understanding your thyroid and the symptoms associated with hypothyroid can help you get the right diagnosis so you can feel better quickly.

Top 10 Thyroid Symptoms: What is hypothyroidism?

Hypothyroidism, the most common of all thyroid disease, occurs when the thyroid gland is either not making enough thyroid hormone, or there is an issue converting thyroid hormone to active forms. There can also be situations similar to insulin resistance where your cells cannot use the hormone even if your thyroid is producing it.

Your thyroid, a butterfly-shaped gland found at the base of your neck, is the metabolic manager for your body. Your thyroid plays a role in many processes:

  • Growth and brain development in utero and through childhood
  • Hormone synthesis
  • Bone health
  • Central nervous system function, including temperature control and heart rate
  • Mood and cognitive function
  • Reproductive health
  • Weight management
  • Cardiovascular health (including cholesterol levels)

Yet, many people walk around without the proper diagnosis. In fact, the standard labs drawn by most primary care physicians to check for a sluggish thyroid can miss early signs that do show up in other labs but aren’t always drawn. This is the case for Hashimoto’s thyroiditis, an autoimmune version of hypothyroid where the body mistakenly attacks the thyroid gland. Without proper treatment, the thyroid is destroyed by the improper activation of the immune system. Thyroid antibodies can be elevated for years before diagnosis by the standard labs. During this period, you can still experience symptoms even if the values are “within normal limits,” making it essential for you to know what to look for.

What are the top ten thyroid symptoms?

  1. Constipation. An underactive thyroid slows everything down, including your GI tract. Peristalsis, the automatic wave-like movement by the GI tract muscles, is reduced in hypothyroid, which can cause constipation.
  2. Dry skin. Your skin cells are continually turning over. When the thyroid isn’t working optimally, this process slows down. As a result, older skin remains on the body longer, which can cause dry, itchy skin.
  3. Weight gain. Weight gain is the most common symptom associated with hypothyroid. Since the thyroid regulates metabolic function in your body, your ability to burn calories also slows. You can suddenly start gaining weight even without changing any eating habits.
  4. Fatigue. Since the thyroid controls metabolism and energy levels, feeling extra run down and exhausted is a sure sign that something is off. This is the type of fatigue that persists day in and day out, interrupting your everyday quality of life. It also makes it extra difficult for weight management as you may feel less like working out and instead want to lie down on the couch.
  5. Feeling cold all the time. Again, your thyroid is a regulator of your metabolism and how efficient you are at burning calories. As that shuts down, your core body temp also cools down. People with hypothyroid may feel especially cold in their feet and hands or have difficulty adjusting to temperature changes.
  6.  Mood changes. Research has connected hypothyroid and depression. The symptoms of both are very similar – weight gain, fatigue, brain fog – making it difficult for researchers to understand the root cause, but evidence points towards a significant relationship.
  7. Brain fog. Your thyroid has a significant impact on your cognitive function, with a low functioning thyroid impacting concentration and memory. Several studies have shown people with hypothyroid have a difficult time with verbal memory that improves with treatment.
  8. Hair loss. Thinning hair, including eyebrow hair, are a sign of hypothyroid. Since your thyroid regulates hair follicles, a low thyroid hormone level affects hair growth. This means that you will continue to lose average amounts of hair but won’t regrow the same amount to replace it. The good news is with treatment, hair will usually grow back.
  9. Weak, achy joints and muscles. A combination of fatigue and muscle breakdown can cause feelings of weakness or achiness for people with hypothyroid. Muscle weakness is a significant issue for thyroid patients, affecting almost 80% of people with hypothyroid. While the reasoning is not well-understood, thyroid hormone deficiency impairs your muscle cells and eventually can lead to muscle atrophy or loss.
  10. High cholesterol. Does your cardiologist check your thyroid labs? Many are surprised to learn that your thyroid and cholesterol are deeply connected. Low thyroid levels affect the body’s ability to remove LDL cholesterol (the bad cholesterol) and increase the absorption of cholesterol.

You have some of the top 10 thyroid symptoms, now where should you start?

If you found yourself checking the box after each symptom, it’s a good idea to get a workup. As mentioned, the tricky piece of the hypothyroid puzzle is that many of these symptoms are vague – but in combination, they can really add up.

Luckily the combination of appropriate medication with lifestyle changes can make all the difference in how you feel. The first step is getting the appropriate workup, which likely means asking for more than the standard lab order. Make sure you have a conversation with your practitioner or find one who is well versed in thyroid health and start with the following labs:

  • TSH: Hypothyroid is characterized by an elevated TSH (thyroid-stimulating hormone), which regulates thyroid production. TSH signals to the thyroid gland to make T4 (thyroxine), which is converted to T3 (triiodothyronine), to be used by the body, but because the thyroid is not responding appropriately, more and more, TSH is pumped out. However, it is possible to have a normal TSH and still have elevated thyroid antibodies.
  • Free T4: T4 accounts for most of what is produced by the thyroid (a minimal amount of T3 is produced too). In hypothyroid, T4 is usually low. As mentioned, T4 must be converted to T3, the active thyroid hormone, to be used.
  • Free T3: T3 is also low for people with hypothyroid and can even be low with normal TSH if not enough T4 is converted to T3. This poor conversion can still cause symptoms, even if the TSH not abnormal.
  • TPO and antithyroglobulin antibodies: These are all measurements of the level of antibodies giving information about autoimmune thyroid conditions. Elevated antibodies mean the body is mounting an immune attack, in this case, on the thyroid.

Top 10 Thyroid Symptoms: Putting it all together

If you are concerned about any of the above symptoms, it’s a good idea to get started with a full workup that includes the above labs. It’s also vital to remember to advocate for yourself – meaning if you have a history of hypothyroid and still don’t feel right, make sure to keep digging. With the right combo of diet, lifestyle, supplements, and in some cases,  thyroid medications, you can get your energy and vitality back.



Medical Disclaimer: This article is based upon the opinions of Dr. Daniel Pompa. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Pompa and his associates. This article has been medically reviewed by Dr. Charles Penick, MD for accuracy of the information provided, but Dr. Pompa encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional.


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  4.  Yen, P. M. “Physiological and Molecular Basis of Thyroid Hormone Action.” Physiological Reviews 81, no. 3 (July 2001): 1097–1142.
  5.  Smith, Jeremy W., A. Tudor Evans, B. Costall, and James W. Smythe. “Thyroid Hormones, Brain Function and Cognition: A Brief Review.” Neuroscience and Biobehavioral Reviews 26, no. 1 (January 2002): 45–60.
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  7.  National Institute of Diabetes and Digestive and Kidney Diseases. “Hashimoto’s Disease | NIDDK.” Accessed February 8, 2021.
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