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Hypothyroidism Symptoms: Recognizing the Signs & Symptoms

Hypothyroidism (underactive thyroid) slows systemic metabolism. Symptoms are often subtle, non-specific, and develop gradually.

Common Symptoms (Grouped)

CategorySymptoms
Energy/MetabolicFatigue, lethargy, cold intolerance, weight gain (modest, 5–10 lb), decreased sweating
NeuromuscularMuscle weakness, cramps, stiffness, paresthesias (carpal tunnel), slowed reflexes (delayed relaxation)
DermatologicDry/rough skin, thinning hair (diffuse, eyebrows lateral third), brittle nails, periorbital puffiness, pale/cool skin
CardiovascularBradycardia, diastolic hypertension, pericardial effusion, hyperlipidemia (↑LDL, ↑TC)
GIConstipation, bloating, decreased appetite
Reproductive (Women)Menorrhagia, oligomenorrhea, infertility, miscarriage risk
NeuropsychiatricDepression, brain fog, memory impairment, slowed speech/thought
GoiterDiffuse or nodular enlargement (if iodine deficiency or Hashimoto's)

Red Flags (Myxedema Coma — Medical Emergency)

  • Hypothermia, altered mental status, hypotension, bradycardia, hypoventilation, hyponatremia, seizures.

Diagnosis

  • TSH: Elevated (primary). Free T4: Low (overt) or normal (subclinical).
  • Antibodies: Anti-TPO (Hashimoto's).

Treatment

Levothyroxine (T4) replacement. Dose: 1.6 mcg/kg/day. Take on empty stomach, 30–60 min before food/meds. Monitor TSH every 6–8 weeks until stable, then 6–12 months.

Note

Symptoms overlap with many conditions. TSH is the screening test. Subclinical hypothyroidism (high TSH, normal fT4) may not require treatment.

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