A-Z Symptoms of Thyroid Disease

I’ve come to understand that Hashimoto’s can look very different from person to person. No two people will present with the exact same list of symptoms, and some people have more mild versions, while others can be completely debilitated. I have witnessed people with uncontrolled Hashimoto’s and overt hypothyroidism who can work an 80 hour week, run a household, become elite body builders, and/or run marathons, while others can barely drag themselves out of bed in the morning and have to go on disability due to debilitating symptoms, even while taking thyroid meds!

I have seen thyroid patients who struggle with being too thin, and people who struggle with being overweight. I want to normalize the fact that as is the case with many autoimmune conditions, Hashimoto’s and hypothyroidism can be a spectrum of symptoms.

I had a long list of symptoms related to my Hashimoto’s (including anxiety, hair loss, digestive issues, carpal tunnel, and many more), and over the years as I tried different interventions and was able to get Hashimoto’s into remission, all of my symptoms went away! These days, I share everything I know in this blog and my books so that you can vanquish your symptoms too!

Thyroid disease is prevalent throughout the world. The American Thyroid Association estimates that some 20 million Americans have some form of thyroid disease. Depending on the source, it’s estimated that 90-97 percent of cases of hypothyroidism are caused by Hashimoto’s, an autoimmune attack on the thyroid — and Hashimoto’s has a unique set of symptoms compared to non-autoimmune hypothyroidism.

This article will cover the many different symptoms that someone with a thyroid condition may be experiencing, and resources for addressing the symptom.

In this article, you’ll learn about:

Why symptoms can fluctuate between hyper- and hypothyroid
The many different symptoms associated with thyroid disease
Resources for how to address these symptoms

The thyroid is the “master controller” of the body, and so virtually all organs and systems in the body are impacted when there is dysfunction. Here’s an overview of symptoms commonly experienced by those with Hashimoto’s, from A to Z.

Acid Reflux

Acid reflux is typically attributed to high levels of acid in the stomach, but often it’s the opposite issue – low stomach acid – that can cause this symptom.

Studies have found that people with Hashimoto’s and hypothyroidism, often have hypochlorhydria (low stomach acid) or achlorhydria (lack of stomach acid). ^{^[1]} This could be due to a number of reasons, including an H. pylori infection, food sensitivities (especially dairy), or a digestive enzyme deficiency.

I personally experienced acid reflux for years, and it turned out that I was sensitive to various foods, including dairy. When I cut dairy out, my acid reflux went away, and I have had hundreds of clients report similar things. Cutting out dairy is a great place to start, but some people may find that other foods trigger their reflux. In that case, they may wish to do an elimination diet or test for food sensitivities. I prefer the Alletess IgG test.

In addition to getting off offending foods, using digestive tract-soothing herbs like mastic gum and DGL can be super helpful for acid reflux. These gentle herbs also have activity against H. pylori and can be found in Rootcology HP Restore.

To support stomach acid, thiamine, herbal bitters and/or betaine with pepsin can be a good starting point. Check out my articles on Hashimoto’s and low stomach acid and acid reflux for more information.

Anemia

Anemia, or low iron levels, is fairly common in those with Hashimoto’s, but it’s not always easily identified or corrected. Not only is anemia often missed because one of the most important tests for iron deficiency isn’t a routine test, but it can be more challenging to correct than simply taking a supplement.

Your doctor may test for anemia by running a panel for red blood cells, hemoglobin, hematocrit, and iron levels, and all of them may come up normal. However, you may still be iron deficient if your iron stores are low…

Ferritin is the iron storage protein that can be tested. Most people who are diagnosed with Hashimoto’s will present with low levels of ferritin. You can check your ferritin levels easily with Ulta Lab Tests. According to some experts, ferritin levels of at least 40 ng/mL are required to stop hair loss, while levels of at least 70 ng/mL are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90-110 ng/mL.

Oftentimes, eating more iron-rich foods and supporting stomach acid can help, but some people do need supplements. I do like lactoferrin as a starting point, though some people may need iron infusions to replenish depleted stores. Some individuals (like me) may also need to do deeper work, such as addressing heavy menstrual cycles to ensure they’re not losing too much blood (i.e. losing iron). See my full article on balancing iron levels for strategies for boosting iron. I also made a recent post on Instagram that shares helpful strategies for resolving low iron levels.

Anxiety

A study in 2004 found an association between the presence of a mood or anxiety disorder, and the presence of anti-TPO antibodies. ^{^[2]} It also noted that a slight reduction in thyroid hormone secretion (such as that found in subclinical hypothyroidism) may affect mood as well. Therefore, it’s possible that the anxiety you are feeling is related to your thyroid. In fact, Trudy Scott, a nutritionist who specializes in anxiety, reports that up to 50 percent of her clients with anxiety have Hashimoto’s!

Anxiety is a common symptom in those with Hashimoto’s, and I personally experienced debilitating anxiety in the years before I was diagnosed with Hashimoto’s.

Blood sugar balance and reducing thyroid antibodies are two of the main strategies to help with anxiety. Selenium is generally my go-to nutrient to lower thyroid antibodies, and may be super helpful for anxiety (and hair loss). ^{^[3]}

In recent years, studies have emerged that selenium tends to work best when combined with myo-inositol. You can read my article on overcoming anxiety with Hashimoto’s for more details!

Blood Sugar Imbalances

Research has shown that up to 50 percent of those with Hashimoto’s have a carbohydrate intolerance. ^{^[4]} This means that when a high-carbohydrate meal is consumed, our blood sugar levels are more likely to spike quickly, leading to low blood sugar levels (reactive hypoglycemia), also known as a blood sugar “crash”. This can lead to feelings of nervousness, lightheadedness, anxiety, and fatigue. Also… weight gain!

Blood sugar imbalances are often connected to adrenal dysfunction, which you can read more about in my article here. Eating less sugar and starchy food, and prioritizing protein and healthy fats at your meals, is one simple way to start balancing blood sugar. I’ve also found that chromium can help. Learn more about strategies to balance your blood sugar here.

Brain Fog

The term “brain fog” is used to describe a collection of cognitive conditions, including memory problems, a lack of mental clarity, and an inability to focus. Researchers define brain fog as “a constellation of symptoms that include reduced cognition, inability to concentrate and multitask, as well as loss of short- and long-term memory.”

While everyone has moments of mental confusion, when they become more severe and frequent, they can become debilitating and make even simple daily tasks challenging.

Brain fog is one of the most common and debilitating symptoms I see in those with Hashimoto’s or hypothyroidism. I personally experienced it, and many people I know also did. It may be due to common imbalances we typically see in Hashimoto’s like insufficient thyroid hormone, inflammation, blood sugar imbalances, and gut permeability.

I have found that optimizing thyroid function with T3-containing meds and getting on a blend of carnitine and acetyl-carnitine is a game changer for brain fog, and this is often the best place to start. See my article to learn more about brain fog and strategies to support mental function.

Brittle Nails

Brittle or weak nails are a classic symptom of hypothyroidism, and can often be one of the first symptoms that someone experiences. There are a number of reasons someone may be experiencing weak and brittle nails, including not enough thyroid hormone, low protein intake or difficulty digesting/absorbing protein, and nutrient deficiencies like iron, zinc, and essential fatty acids.

Recently, I have found that using methylene blue has transformed the health of my nails. They’ve grown longer and stronger. Methylene blue also helps with focus and attention.

Often, supporting the gut will increase nutrient absorption and can help with nutrient deficiencies, and optimizing thyroid hormones will be important as well. See the linked articles above for in-depth information on each topic.

Carpal Tunnel

When I was first diagnosed with Hashimoto’s in 2010, I struggled with pain in the form of body aches and stiffness, as well as carpal tunnel in both arms. I had to wear wrist braces and take NSAIDs just to get through everyday at work as a pharmacist.

I was able to resolve my carpal tunnel eventually with diet and lifestyle changes that helped put my Hashimoto’s into remission. For me, it turned out that dairy was a huge trigger for my carpal tunnel, and removing it from my diet resulted in much less pain. I also found P5P and chiropractic therapy were game changers.

Read my article on pain for more strategies to manage pain, including carpal tunnel. I also have a carpal tunnel article coming soon!

Cold Intolerance

Cold intolerance is a hallmark symptom of hypothyroidism and Hashimoto’s. People with an underactive thyroid will often feel cold, even when everyone else is comfortable (like me sleeping under two blankets in southern California and wearing sweaters and scarves in my office while everyone else showed up in short sleeves).

The thyroid gland has been called a thermostat for our body, as it helps to regulate heat, and often, people with an underactive thyroid will have a lower basal body temperature as well.

In addition to optimizing thyroid hormones, I love using thermogenic (heat-producing) foods, such as avocado, to support a healthy balance in the body. You can check out my article on cold intolerance for tips on staying warm.

Constipation

Constipation is classified as a syndrome and may include the infrequent (fewer than three a week) or difficult passage of stool, hardness of stool, and/or a feeling of incomplete evacuation. Constipation is a common symptom of hypothyroidism, likely due to the digestive system slowing down, and other digestive challenges that are common in Hashimoto’s. In one study that investigated over 7000 individuals with chronic constipation, the authors found 420 of those individuals also had hypothyroidism. ^{^[5]}

Luckily, there are many supportive strategies to help relieve constipation in Hashimoto’s. One of the first things I recommend is magnesium citrate, which I find to help most of the time. About 76.5 percent of our Gut Recovery Program participants reported improvement in constipation! I will be posting an article on constipation hopefully later this year.

Depression

Clinical depression, or major depression, is a mental health disorder characterized by a persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

Hashimoto’s (and other thyroid disorders) and depression often co-occur — most people are unaware of how frequently this happens. A 2018 review paper found that “the chance of developing symptoms of depression that were of clinical relevance is 3.3 times higher among patients with hypothyroidism compared with healthy controls.” ^{^[6]}

In Hashimoto’s, there is a breakdown of the thyroid gland, which can rush thyroid hormones into the bloodstream, resulting in transient hyperthyroidism. This can result in symptoms such as agitation, anxiety, and even psychosis. Anyone who has experienced symptoms of hyperthyroidism (due to the fluctuations in thyroid hormone often seen in Hashimoto’s) can describe how terrible this feels.

Once the thyroid hormone is cleared out, the person may be functionally hypothyroid, which can be linked with symptoms of depression, such as apathy, low mood, fatigue, and brain fog. Thus, it’s possible that some cases of depression are related to the thyroid. ^{^[7]} Depression may also be a result of the biological impact of hypothyroidism, where the focus shifts toward conserving energy (you’re not as motivated when you’re depressed).

In fact, one reader with thyroid disease told me, “I feel like I’m sitting on the sidelines of life, watching everyone else enjoy their journey, wondering if I’ll ever have my zest for life back.”

Getting thyroid hormones into a healthy range may help resolve depression in some people. Additionally, others find that adding T3 hormone to their prescription regimen is a complete game changer for depression. Often people will say their depression lifted with Cytomel (liothyronine) or natural desiccated thyroid prescriptions such as Armour. Beyond those strategies, I often see that vitamin D and essential fatty acids can be a game changer! I have a deep dive article on the depression and Hashimoto’s connection that talks about other supportive strategies.

Diarrhea

While many people with hypothyroidism or Hashimoto’s will experience constipation, others will experience diarrhea, classified as loose, watery stool, oftentimes occurring multiple times per day. Some people will find that they alternate between constipation and diarrhea.

Chronic infections caused by certain bacteria, protozoa/parasites, and fungi/yeast, are common in those with Hashimoto’s, and can contribute to diarrhea. Diarrhea can also be a result of food sensitivities.

Check out my articles on S. boulardii (a favorite supplement of mine for diarrhea and clearing out pathogens) and my fundamental gut protocol, for more information. In my Gut Recovery Program, 66.7 percent of participants experienced an improvement in their diarrhea after completing the program (which focuses on eradicating gut infections!).

Digestive Issues

Someone with Hashimoto’s may experience a number of other gastrointestinal symptoms such as bloating, burping, gassiness, stomach pain, irritable bowel syndrome, and undigested food in the stool.

The gut plays a key role in the development of autoimmunity and Hashimoto’s, and most people with Hashimoto’s have some level of intestinal permeability (leaky gut). Many people with Hashimoto’s struggle with digestion.

Some articles you may find helpful include my gut protocol article and my article on leaky gut.

Dry Hair and Skin

Dry, brittle hair and dry skin are common in Hashimoto’s and hypothyroidism. This could be due to a number of factors, including insufficient thyroid hormone, nutrient depletions (especially depletions in essential fatty acids), and not digesting fats or protein well.

Supporting the gut can increase nutrient absorption and can help with nutrient deficiencies; optimizing thyroid hormones will be important as well. Check out my articles on essential fatty acids and fat digestion for more support for dry skin and hair.

Fatigue

Fatigue was the most debilitating symptom I experienced with Hashimoto’s. It started eight years before I was finally diagnosed in 2009, after I had contracted mono (the Epstein-Barr virus) in college. I needed to sleep for 12 hours each night to be able to function… and by “function,” I mean after hitting the snooze button on my alarm clock for two hours (ask my poor husband), I would drag myself out of bed and then had to drink 4 to 6 cups of caffeine every day to keep myself awake. I often had Red Bull and Pepsi for breakfast, and was the epitome of “wired but tired.”

It is very common in Hashimoto’s and hypothyroidism. This type of fatigue is not relieved by rest or sleep. In general, this can be caused by hormonal imbalance (low levels of thyroid hormone) and a slowed metabolism, but it may be linked to a number of other factors.

Betaine with Pepsin and benfotiamine have been two major game changers for me and many of my clients with fatigue. I share more strategies in my comprehensive article on ways to overcome Hashimoto’s fatigue.

Food Sensitivities

Food sensitivities can be both a root cause and a symptom of Hashimoto’s. This can be tied to leaky gut, which is present to some degree in everyone with Hashimoto’s. ^{^[8]} For some, eliminating food sensitivities can help resolve thyroid symptoms.

The most common food sensitivities in those with Hashimoto’s are gluten, dairy, and soy. I often recommend starting by removing these three foods from your diet and note any change in symptoms. Some people will have to do more digging to identify other food sensitivities.

Please note that not all food sensitivity tests are created equally!

I often recommend an elimination diet or Alletess food sensitivity testing (there are options for 96 foods or 184 foods) to determine foods sensitivities, and I have found that addressing gut infections, probiotics, digestive enzymes, and systemic enzymes (taken on an empty stomach) can help with reducing food reactions.

Check out my articles on food sensitivities, leaky gut, and my fundamental gut protocol for a more in-depth look at food sensitivities, how to do an elimination diet, and other strategies for healing leaky gut.

Hair Loss

Hair loss was one of the symptoms I experienced on my journey with Hashimoto’s, and one of the early clues I had that something was not right inside my body. I know first-hand how distressing it can be to wash your hair in the shower and watch huge clumps of hair clog the drain!

Hair loss in Hashimoto’s could be due to a number of factors, including low thyroid hormone, selenium deficiency, essential fatty acid deficiency, and low iron/ferritin levels, all of which are common in Hashimoto’s.

Check out my article on hair loss for strategies to overcome Hashimoto’s hair loss.

Hypersomnia

Hypersomnia, or sleeping too much, was one of my first symptoms of Hashimoto’s. One study showed that slow-wave sleep, which is the deepest dreamless sleep, was reduced in those with hypothyroidism. ^{^[9]} This deep sleep is where the body heals, repairs, and detoxifies, so not getting enough of this critical sleep phase can impact the body’s ability to heal from Hashimoto’s. Perhaps that’s why we need more sleep.

Sleep apnea or nocturnal low blood sugar due to reactive hypoglycemia can be causes of hypersomnia. Mitochondrial support can work wonders for sleep apnea, and chromium is very helpful for reactive hypoglycemia. Check out the linked articles, and my article on sleep solutions.

Hypoglycemia

Blood sugar issues are incredibly common in those with Hashimoto’s, especially hypoglycemia (low blood sugar).

Research has shown that up to 50 percent of those with Hashimoto’s have a carbohydrate intolerance. ^{^[10]} This means that when a high-carbohydrate meal is consumed, our blood sugar levels are more likely to spike quickly, leading to low blood sugar levels (reactive hypoglycemia), as well as feelings of nervousness, lightheadedness, anxiety, and fatigue.

My blood sugar was around 50 mg/dL (very low), right before I got diagnosed with Hashimoto’s. I often used to feel lightheaded, faint, and anxious, without knowing why.

Including fat and protein at every meal, reducing high carbohydrate foods, and eating regularly can be hugely helpful in keeping blood sugar levels stable. Cutting out carbs and taking chromium can be very helpful for reactive hypoglycemia. See my article on blood sugar balancing strategies for more information.

Infertility

Infertility can be a symptom of both hypothyroidism and hyperthyroidism. Our thyroid is our master sensor and gives the rest of our body information about the safety of our environment. If the thyroid senses that our environment is not safe (due to stress, sleep deprivation, intense exercise, or nutrient deficiencies), it sends messages to the body to slow down, conserve energy, and also that it’s not a good time to carry a child. This is what I call the “safety theory”, and you can read more about it here.

Thyroid antibodies are also associated with pregnancy complications. Thyroid antibodies appear to be directly pathogenic to reproductive organs and can impact egg implantation. It’s been shown that thyroid antibodies can pass through the blood-follicle barrier and create a cytotoxic environment that can damage the maturing egg, as well as reduce its quality and its fertilization potential.

In a study of 31 women undergoing IVF, 14 had thyroid antibodies. ^{^[11]} In this group of women, oocyte fertilization, embryo quality, and pregnancy rates were lower, while their early miscarriage rate was higher.

Irregular menstrual cycles and hormonal imbalances are other common symptoms of thyroid conditions and may contribute to infertility (more on this below).

In addition to optimizing thyroid hormones and reducing thyroid antibodies, other strategies for balancing hormones can be helpful. Supplementing with myo-inositol, which has been studied for its benefits in women with PCOS, may be helpful since a high concentration of myo-inositol is required to ensure healthy oocyte (immature egg) maturation in the ovary. ^{^[12]} See my articles on pregnancy, strategies to reduce thyroid antibodies and estrogen dominance for more information.

Insomnia

While insomnia is typically associated with excess thyroid hormone in the body (and most people with hypothyroidism sleep too much), there are other factors like hormonal imbalances and nutrient deficiencies/excesses that can cause insomnia and difficulty sleeping. Additionally, someone with Hashimoto’s may have insomnia if they’re experiencing hypo/hyperthyroid swings.

I’ve found that magnesium supplements, adrenal support, and blood sugar balance can be super helpful for resolving insomnia, but there are many other, less common causes. Check out my article on sleep solutions for many other potential root causes and protocols.

Low Libido

Among the many symptoms of thyroid disease, there is one in particular that significantly impacts people’s relationships and overall happiness, yet it’s a symptom people seldom seek help for: low libido (low sex drive).

In fact, research has shown that women with thyroid disease experience a higher prevalence of low libido at some point in their lives. This goes for men, too – with some 59-63 percent of hypothyroid men suffering from diminished libido, along with other sexual function issues (such as erectile dysfunction, delayed ejaculation, and sperm abnormalities). ^{^[13]}

Low levels of thyroid hormone can lead to low levels of testosterone, so for some men, simply correcting thyroid levels with the right dose of medication can help also bring their testosterone levels back into balance, which is important for a healthy libido.

Through many of the lifestyle changes that will help to address thyroid issues, we can also improve libido, as well as overall sexual function, for both women and men. I love using adaptogens as a great place to start – check out my article on low libido to learn more.

Menstrual Issues

Many women with hypothyroidism and Hashimoto’s experience a number of issues surrounding their monthly cycles. They may have debilitating PMS symptoms, and periods may be painful, irregular, and/or and heavy. This could be due to a number of factors that are often associated with Hashimoto’s, such as overt hypothyroidism, estrogen dominance, low iron levels, and the MTHFR gene variation.

Often, a few things need to be corrected to stop the vicious cycle of heavy periods. A person may need to supplement with thyroid hormones, myo-inositol, iron, progesterone, and methylfolate to get everything in balance.

See each article linked above for more in depth information on each topic.

Muscle Wasting

Muscle weakness, pain, and muscle wasting are common symptoms for people with Hashimoto’s. Research has shown that as many as 80 percent of people with thyroid disorders also have muscle-related disorders. ^{^[14]}

Muscle wasting is a catabolic state of the body, when the body shunts resources away from building up our muscles and our muscles become weaker, instead of stronger. During muscle catabolism, the body begins to break down muscle protein to provide fuel to other functions.

In an inflammatory condition like Hashimoto’s, it will break down more protein than it produces. It will eventually resort to obtaining its needed protein via consuming skeletal muscle. Over time, a loss of lean body mass – and other muscle related symptoms – can occur.

In my experience, supplementing with carnitine can be a game changer for muscle weakness in people with both Hashimoto’s and Graves’ disease. Research has shown that, in hypothyroid patients, there was indeed a trend for muscle carnitine content to be lower than normal, and that carnitine levels improved with thyroid hormone treatment. ^{^[15]} Check out my article on muscle wasting to learn more about muscle loss and how to address it.

Obsessive Compulsive Disorder

The connection between obsessive compulsive disorder (OCD) and thyroid disorders is complex, with many different factors connecting the two conditions.

Research has shown that that anxiety, depression, mood fluctuations, OCD behaviors, and a general feeling of being “unwell,” are early signs of an autoimmune attack on the thyroid, and can be correlated to thyroid antibodies, even when the TSH level is still “normal.” ^{^[16]}

There is also a growing body of evidence connecting Streptococcus infections and an overgrowth of Strep bacteria in the gut, to the development of OCD symptoms. ^{^[17]}

Interestingly, the most common type of anxiety disorder reported in people with thyroid antibodies is obsessive-compulsive disorder (OCD). ^{^[18]} I myself used to have issues relating to OCD (which is very common in pharmacists and those with Type A personalities, like yours truly!) and anxiety, which seemed to rear their ugly heads before I got my Hashimoto’s into remission, and when I have had flare-ups.

Lowering thyroid antibodies, NAC, and myo-inositol supplementation are strategies that can reduce obsessive compulsive tendencies in those with Hashimoto’s. Check out the linked articles to learn more, and stay tuned for my article on OCD and Hashimoto’s coming soon for a deep dive into how these two conditions are connected, and further strategies to support OCD symptoms.

Pain

Over the years of working with people with Hashimoto’s, I have learned that most people will experience pain on some level. For some, it may manifest as a chronic condition, such as migraines or joint pain. In other cases, people may experience gastrointestinal pain that comes and goes. When I was first diagnosed with Hashimoto’s in 2010, I struggled with pain in the form of body aches and stiffness, as well as carpal tunnel in both arms.

Pain in Hashimoto’s is often the result of inflammation. When inflammation arises, specific pathways are activated, releasing molecules such as histamine, prostaglandins, and/or eicosanoids, all of which create the sensation of pain. This can also promote autoimmune processes.

Check out my article pain for strategies for managing pain.

Premature Ovarian Insufficiency or Failure

Premature ovarian failure means a woman goes into menopause earlier than expected and will likely struggle with ovulation and fertility. Before premature ovarian failure occurs, premature ovarian insufficiency will be present. This was me in 2011. Around the time of my Hashimoto’s diagnosis, before I had recovered my health, I had markers and symptoms of premature ovarian insufficiency. I had night sweats, irregular menses, mood swings, as well as an elevated FSH (Follicle Stimulating Hormone: when elevated, this lab can indicate a low ovarian reserve, premature ovarian failure, or menopause).

Evidence is growing that premature ovarian failure is connected to autoimmune disease. Thyroid disorders are the most common co-occuring conditions with premature ovarian failure, and a deficiency in the hormone DHEA (associated with the adrenals, which are, in my experience, dysfunctional in 90 percent of people with Hashimoto’s) has also been connected.

Research suggests that 25 mg of DHEA three times per day can increase oocyte quality and quantity. ^{^[19]} I took DHEA in a much lower dose in my earlier years when I optimized my health, and I’ve seen many women who were helped with DHEA as well, but there are other methods such as Traditional Chinese Medicine that may be helpful. I’ve been researching this topic more in-depth recently due to wanting to expand my family and no longer being a spring chicken… and I will be sure to post more as I learn more!

Sleep Apnea

Many of my clients have reported issues with falling asleep, staying asleep, and waking up too early – symptoms that may be classified as insomnia, given a long enough duration. It may also be related to sleep apnea, another common issue in those with Hashimoto’s. Research suggests that 25-66 percent of people with Hashimoto’s also have sleep apnea! ^{^[20]}

Dietary changes and correcting nutrient deficiencies can be helpful for sleep apnea, and I’ve especially found BenfoMax to be helpful because of its brain and mitochondrial benefits. Check out my article on sleep apnea for more interventions.

Thybrows

A red flag symptom of hypothyroidism is losing eyebrow hair, especially in the outer third of the eyebrows (sometimes affectionately called “thybrows”). This is typically due to low levels of thyroid hormone, and most people find that when they correct thyroid hormone levels, the hair grows back.

Other supportive strategies may include addressing essential fatty acid deficiency and low iron/ferritin levels, both of which are common in Hashimoto’s and can affect hair growth. Check out my article on hair loss for many more strategies to overcome Hashimoto’s-related hair loss.

With that being said, I have not found a cure for having thin eyebrows from overplucking in high school, so please let me know if you find one, as I’m tired of painting mine on. 😉

Voice Changes/Hoarseness

This is perhaps a lesser known symptom of hypothyroidism, but the function of our thyroid directly affects our voice! There are thyroid hormone receptors in the larynx, and thyroid hormone acts on the laryngeal tissue. This has been shown to cause changes to the voice, including a rough or hoarse voice, reduced vocal range, and vocal fatigue. ^{^[21]}

Balancing thyroid hormones can help restore your voice. For my clients and myself personally, I found that the gut infection H. pylori, which I’ve personally had a few times (thanks stress!), always made my voice more hoarse, most likely because my thyroid antibodies would increase as well. After treating H. pylori, my thyroid antibodies lowered and my hoarse voice went away.

Weight Gain

Weight gain is a common symptom of thyroid disease. People may also have difficulty losing weight, feeling that no matter what they do, the extra weight won’t budge.

This can be due to a number of factors, including slowed metabolism, compromised gut health, dysregulated cortisol/adrenals, hormonal imbalances, and nutrient deficiencies.

While many people are advised to go on low-calorie diets to lose weight, this is typically NOT the best strategy for those with Hashimoto’s or hypothyroidism. Many of my clients report that focusing on gut health, via treating infections, getting rid of reactive foods, and taking berberine has been a game changer! Check out my article on losing weight with Hashimoto’s to learn about what might actually help.

Weight Loss (Unwanted)

Whenever I mention weight gain, inevitably I’ll get questions from people who are losing weight, and who want to know how they can maintain their weight, or even gain weight.

Thyroid symptoms can look different for everybody – I personally experienced periods of both weight gain and weight loss, and I didn’t feel good in either situation. For some people, weight loss may be a result of muscle wasting or switching to a new healing diet, reduced nutrient absorption, or hyperthyroidism/Graves’ disease.

For more information about maintaining a healthy weight with Hashimoto’s, check out the linked article. You may also find my article about muscle wasting helpful.

Why Do People Have a Spectrum of Symptoms?

One thing that makes Hashimoto’s challenging to identify and diagnose is that an individual can have such a broad spectrum of symptoms. Symptoms themselves, as well as the severity of symptoms, can shift over time, which is why Hashimoto’s can have so many different faces.

While one person may simply feel a little extra tired (which is often just chalked up to “life”), another person will be totally debilitated by fatigue. Someone else may experience panic attacks and anxiety, while another person won’t experience anxiety at all.

One person may be struggling with excess weight gain, while another one may be losing too much weight!

Furthermore, many of us don’t fully understand the impact of our condition, because there are so many non-specific symptoms that are related to autoimmune thyroid disease, and these are often brushed off as being part of everyday life. I can’t tell you how many doctors told me that my symptoms were just because I was getting older (I was in my twenties!).

Autoimmune Component

Autoimmune disease is complex, and it manifests differently in different people. Currently, over 80 different autoimmune conditions have been identified. While the driving force behind these conditions is the body attacking itself (autoimmunity), they can show up in the body in so many different ways – Hashimoto’s is an attack on the thyroid, multiple sclerosis is an attack on the nervous system, alopecia attacks the hair follicles, and so on.

To zoom out even more, the triggers of autoimmunity can be different for everybody. These triggers are what I call the “root causes”, and finding your own unique root causes will be key to reducing symptoms and eventually putting Hashimoto’s into remission.

For one person, the root cause may be a gut infection or gut dysbiosis; for someone else, it was a period of intense stress that threw their adrenals off; and for yet another person, an overburdened liver was the trigger. Symptoms can vary, as they are related to different systems such as the liver, the gut, and the adrenals.

Even when TSH levels appear to be in a normal range, elevated thyroid antibodies can contribute to symptoms such as pain, anxiety, distress, fatigue, weight gain, and depression (check out my article on this very topic for more information). ^{^[22]} This is why it’s so important to get the right tests, including a full thyroid panel!

A Combination of Hyper- and Hypo- Symptoms, Sometimes with Symptoms and Levels Fluctuating

I wanted to mention a common phenomenon that I see, particularly in those with Hashimoto’s, and that is the fluctuation between hyper- and hypo- thyroid symptoms. Some people may also have a combination of both types of symptoms at the same time!

For example, they may be overweight (typical HYPO symptom) AND anxious (typical HYPER symptom). They may have depression (typical HYPO symptom) AND insomnia (typical HYPER symptom).

Classic hypothyroid symptoms include:

Dry, coarse hair
Loss of eyebrow hair
Puffy face
Enlarged thyroid (goiter)
Slow heartbeat
Constipation
Weight gain
Brittle nails
Arthritis
Cold intolerance
Depression
Dry skin
Fatigue
Forgetfulness
Infertility
Muscle aches
Heavy periods

Classic hyperthyroid symptoms include:

Hair loss
Bulging eyes
Enlarged thyroid (goiter)
Sweating
Rapid heartbeat
Weight loss
Frequent bowel movements
Warm, moist palms
Tremor of fingers
Soft nails
Difficulty sleeping
Heat intolerance
Infertility
Irritability
Muscle weakness
Nervousness
Scant periods

When the thyroid is not functioning properly, there may be an excess or lack of thyroid hormone production, which can lead to hyper- or hypo- thyroidism, respectively.

For those with Hashimoto’s, as the thyroid is destroyed, stored hormones can be released, causing sudden high levels of thyroid hormone (producing hyperthyroid symptoms). Then, as that is depleted and the thyroid becomes damaged further, thyroid levels can become low, with hypothyroidism redeveloping.

Additionally, someone may have Hashimoto’s but have a single thyrotoxic (producing too much thyroid hormone) nodule, resulting in hypo/hyperthyroid swings.

Though most people with Hashimoto’s end up with hypothyroid symptoms, some may initially have hyperthyroid symptoms, or swing between hyper- and hypo- thyroid, during the destruction of the thyroid gland.

How to Help Yourself

Helping others heal from Hashimoto’s has been my life mission for over a decade now. Whether you’ve just been diagnosed with Hashimoto’s or have been struggling with thyroid symptoms for years – there is hope for you! I have seen people who thought they would never be able to work again, feel well enough to work full time, and do everything else they enjoy in life!

I’ve helped thousands of people eliminate their symptoms and reverse Hashimoto’s, and get their lives back! In addition to all of my articles I’ve linked here, I have a number of other resources you may find helpful.

I created my documentary series, The Thyroid Secret, early on in my Hashimoto’s journey because I, like so many others, wanted answers to questions like what’s really causing thyroid conditions, and why are SO MANY people dealing with unexplainable symptoms?

With hours of interviews with the world’s leading thyroid experts, this documentary series is a deep dive into all things thyroid health. For a very limited time in honor of World Thyroid Day, I am screening the entire series for FREE! But only until May 26th at 11:59pm PT. You can access all the episodes for free

There is also an option to also purchase your very own copy of The Thyroid Secret for less than $5 an episode! That’s less than a grande latte these days (and it will give you MUCH more energy in the long run, trust me!).

If a normal day for you feels like fatigue, anxiety, infertility, hair loss, depression, yo-yo dieting, tired adrenals, or just feeling off, then this series is a great place to start.

I also have helpful books, including:

Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause – My first book! An in-depth look at Hashimoto’s and its root causes, along with interventions that will help bring balance back to the body.
Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back – This book outlines a practical pathway for healing and reversing the autoimmune damage at the root of Hashimoto’s.
Hashimoto’s Food Pharmacology: Nutrition Protocols and Healing Recipes to Take Charge of Your Thyroid Health – Nutrition protocols and healing recipes for those with Hashimoto’s.
Adrenal Transformation Protocol: A 4-Week Plan to Release Stress Symptoms and Go from Surviving to Thriving – This is my most recent book focusing on adrenal health, which I have found to be a factor for the majority of people with Hashimoto’s.

Additionally, I offer a number of courses that help guide you through my signature protocols, with even more resources and information inside of them, plus live support from me and my team, and a thyroid community so that you can connect with others who understand what you’re going through! My courses include:

Hashimoto’s Self-Management Program – This course is self-paced, so you can go through it in a way that works for you. It has 12 modules, chock full of information on all things Hashimoto’s.
Root Cause Reset – This program takes you through my liver support protocol, and helps significantly reduce many people’s symptoms. There are self-paced and live options for this program.
Adrenal Transformation Program – The success of this program is what inspired my latest book. As the name implies, it focuses on restoring optimal adrenal function, which I find brings many people relief from their thyroid symptoms. This is available as a live option at this time.
Gut Recovery Program – Tending to the gut is a major part of addressing autoimmune disease from a root cause perspective, and this course helps guide you through the proper steps of gut healing. This course is currently only available as a live option.

Hashimoto’s is still poorly understood by conventional medicine, so if you’re not feeling seen or heard by your doctors, or if the conventional treatment of thyroid medication is not bringing you the relief you anticipated, I encourage you to start taking charge of your own health!

I’m living proof that you can put your Hashimoto’s into remission, and so are the thousands of people who have done the same! Here’s what a few had to say:

“I have already made so much progress since following your page and reading and applying all the information you so generously provide to your readers. In 2013 I was diagnosed with Hashimoto’s. Then I had a thyroglobulin of 262 and my thyroid peroxidase was 516. Since following you, I have not carried the thyroglobulin antibody in over a year and my last thyroid peroxidase in March was 73. :)” – Kathleen

“I wanted to share with you that because of all your work publishing The Root Cause and The Hashimoto’s Protocol, I started taking Selenium (among other things). A recent blood test revealed that for the first time in 15 years my antibodies are normal. I was able to get them down in the 60’s by removing gluten from my diet and I think Selenium took care of the rest. Thank you for your research and sharing your knowledge with so many people. While seeing a endocrinologist the first 10 years of my diagnosis, never once was I told that changing my diet or using supplements would help. Sincerely, A big fan…” – Kelly

“I want to share a heartfelt and HUGE thank you to Dr. Wentz for her blog articles and books. They have been my #1 go-to resource since I found out I was dealing with hypothyroid. I love your warm, informative, helpful, non sales-pitchy writing style (I find some of the other thyroid bloggers a little alarmist, which raises my cortisol! Not so on ThyroidPharmacist.com) THANK YOU, THANK YOU for helping me reclaim my health!” – Cate

Takeaway

The symptoms of thyroid disease can vary widely, and people’s experiences and combination of symptoms is unique to them.

The good news is, there are many supportive strategies to help ease these symptoms, while you’re searching for the root cause of your thyroid condition. Often, when you support the health of your thyroid, lower thyroid antibodies, and optimize thyroid hormones, many of these symptoms will resolve.

I had a long list of symptoms related to Hashimoto’s (including fatigue, hair loss, digestive issues, carpal tunnel, anxiety, and more), and over the years as I tried different interventions and was able to get Hashimoto’s into remission, all of my symptoms went away.

Are you experiencing any of these symptoms? What has your experience with thyroid disease been?

Wishing you all the best on your healing journey!

P.S. I love interacting with my readers on social media, and I encourage you to join my Facebook, Instagram, TikTok, and Pinterest community pages to stay on top of thyroid health updates and meet others who are following similar health journeys. For recipes, a FREE Thyroid Diet start guide, notifications about upcoming events, and the Nutrient Depletions and Digestion chapter from my first book for free, be sure to sign up for my email list!

References

^{^[1]} Fatima R, Aziz M. Achlorhydria. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 14, 2023.
^{^[2]} Carta MG, Loviselli A, Hardoy MC, et al. The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future. BMC Psychiatry. 2004;4:25. Published 2004 Aug 18. doi:10.1186/1471-244X-4-25
^{^[3]} Gärtner R, Gasnier BC, Dietrich JW, Krebs B, Angstwurm MW. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002;87(4):1687-1691. doi:10.1210/jcem.87.4.8421
^{^[4]} Gierach M, Gierach J, Skowrońska A, et al. Hashimoto’s thyroiditis and carbohydrate metabolism disorders in patients hospitalised in the Department of Endocrinology and Diabetology of Ludwik Rydygier Collegium Medicum in Bydgoszcz between 2001 and 2010. Endokrynol Pol. 2012;63(1):14-17.
^{^[5]} Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician. 2012;86(3):244-251.
^{^[6]} Siegmann EM, Müller HHO, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis [published correction appears in JAMA Psychiatry. 2019 Jun 19;:]. JAMA Psychiatry. 2018;75(6):577-584. doi:10.1001/jamapsychiatry.2018.0190
^{^[7]} Hage MP, Azar ST. The Link between Thyroid Function and Depression. J Thyroid Res. 2012;2012:590648. doi:10.1155/2012/590648
^{^[8]} Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012;42(1):71-78. doi:10.1007/s12016-011-8291-x
^{^[9]} Steiger A. Thyroid gland and sleep. Acta Med Austriaca. 1999;26(4):132-3.
^{^[10]} Gierach M, Gierach J, Skowrońska A, et al. Hashimoto’s thyroiditis and carbohydrate metabolism disorders in patients hospitalised in the Department of Endocrinology and Diabetology of Ludwik Rydygier Collegium Medicum in Bydgoszcz between 2001 and 2010. Endokrynol Pol. 2012;63(1):14-17.
^{^[11]} Bucci I, Giuliani C, Di Dalmazi G, Formoso G, Napolitano G. Thyroid Autoimmunity in Female Infertility and Assisted Reproductive Technology Outcome. Front Endocrinol (Lausanne). 2022;13:768363. Published 2022 May 26. doi:10.3389/fendo.2022.768363
^{^[12]} Unfer V, Nestler JE, Kamenov ZA, Prapas N, Facchinetti F. Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. Int J Endocrinol. 2016;2016:1849162. doi:10.1155/2016/1849162; Gupta D, Khan S, Islam M, Malik BH, Rutkofsky IH. Myo-Inositol’s Role in Assisted Reproductive Technology: Evidence for Improving the Quality of Oocytes and Embryos in Patients With Polycystic Ovary Syndrome. Cureus. 2020;12(5):e8079. Published 2020 May 12. doi:10.7759/cureus.8079
^{^[13]} La Vignera S, Vita R. Thyroid dysfunction and semen quality. Int J Immunopathol Pharmacol. 2018;32:2058738418775241. doi:10.1177/2058738418775241; Gabrielson AT, Sartor RA, Hellstrom WJG. The Impact of Thyroid Disease on Sexual Dysfunction in Men and Women. Sex Med Rev. 2019;7(1):57-70. doi:10.1016/j.sxmr.2018.05.002
^{^[14]} Duyff RF, Van den Bosch J, Laman DM, et al. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Journal of Neurology, Neurosurgery & Psychiatry. 2000;68:750-755. doi:10.1136/jnnp.68.6.750
^{^[15]} Benvenga S, Amato A, Calvani M, Trimarchi F. Effects of carnitine on thyroid hormone action. Ann N Y Acad Sci. 2004;1033:158-167. doi:10.1196/annals.1320.015
^{^[16]} Siegmann E, Müller HHO, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018;75(6):577–584. doi:10.1001/jamapsychiatry.2018.0190.; Müssig K, Künle A, Säuberlich AL, et al. Thyroid peroxidase antibody positivity is associated with symptomatic distress in patients with Hashimoto’s thyroiditis. Brain Behav Immun. 2012;26(4):559-563. doi:10.1016/j.bbi.2012.01.006
^{^[17]} Endres D, Pollak TA, Bechter K, et al. Immunological causes of obsessive-compulsive disorder: is it time for the concept of an “autoimmune OCD” subtype?. Transl Psychiatry. 2022;12(1):5. Published 2022 Jan 10. doi:10.1038/s41398-021-01700-4; Arnold PD, Richter MA. Is obsessive-compulsive disorder an autoimmune disease?. CMAJ. 2001;165(10):1353-1358.
^{^[18]} Caykoylu A, Kabadayi Sahin E, Ugurlu M. Could the thyroid gland dominate the brain in obsessive-compulsive disorder? [published online ahead of print, 2022 Apr 20]. Neuroendocrinology. 2022;10.1159/000524627. doi:10.1159/000524627
^{^[19]} Mamas L, Mamas E. Premature ovarian failure and dehydroepiandrosterone. Fertil Steril. 2009;91(2):644-646. doi:10.1016/j.fertnstert.2007.11.055
^{^[20]} Bozkurt NC, Karbek B, Cakal E, Firat H, Ozbek M, Delibasi T. The association between severity of obstructive sleep apnea and prevalence of Hashimoto’s thyroiditis. Endocr J. 2012;59(11):981-988. doi:10.1507/endocrj.ej12-0106; Xerfan EMS, Facina AS, Andersen ML, Tufik S, Tomimori J. Hashimoto Thyroiditis as a Cause or Consequence of Obstructive Sleep Apnea. J Clin Sleep Med. 2019;15(11):1703. doi:10.5664/jcsm.8054
^{^[21]} Junuzović-Žunić L, Ibrahimagić A, Altumbabić S. Voice Characteristics in Patients with Thyroid Disorders. Eurasian J Med. 2019;51(2):101-105. doi:10.5152/eurasianjmed.2018.18331
^{^[22]} Carta MG, Loviselli A, Hardoy MC, et al. The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future. BMC Psychiatry. 2004;4:25. Published 2004 Aug 18. doi:10.1186/1471-244X-4-25