11 Early Warning Signs of Thyroid Problems in Women

Dealing with constant fatigue or feeling cold when everyone else is comfortable can be frustrating — and it often leaves you wondering, “What’s going on with my body?"

Dr. Reddy, M.D, endocrinologist with UnityPoint Health, explains the most common, and often confusing, early warning signs of hypothyroidism. She guides you through what exactly to look for and when it's time to talk to your doctor.

Hypothyroidism vs. Hyperthyroidism

Your thyroid gland is a small, butterfly-shaped organ in your neck. It produces thyroid hormones that control your metabolism. When your thyroid is overactive, you have hyperthyroidism. When the thyroid is underactive, you have hypothyroidism. These two conditions have different symptoms from each other.

Early Warning Signs of Thyroid Problems in Females

Because thyroid hormones regulate your metabolism, hypothyroidism causes the body to slow down, affecting energy levels, digestion and even mood. Dr. Reddy notes that hypothyroid symptoms in females vary based on age and other factors, but some are far more common than others. Listed below are some of the primary hypothyroidism symptoms:

• Cognitive issues: Dr. Reddy says this is common in older adults. You may have brain fog, difficulty concentrating or memory loss.
• Cold intolerance: Feeling cold, even when others are comfortable, is a classic symptom of hypothyroidism.
• Constipation: The decrease in thyroid hormones slows the movement of the muscles in the digestive tract — and that can back you up.
• Depression: Low thyroid hormone levels slow down the central nervous system and directly affect the brain's supply of mood-regulating neurotransmitters, like serotonin.
• Dryness: Nails may be brittle and skin dry with hypothyroidism.
• Fatigue: Dr. Reddy says about 83% of patients report this as their most prominent symptom.
• Hair loss: Hyperthyroidism often causes hair loss.
• Itchiness: Dryness often leads to itchy skin, though not usually a specific hypothyroidism rash.
• Low heart rate: A key indicator of hypothyroidism is a low heart rate. "Everything is slowing down, because the thyroid levels are low. Nearly 12-15% of patients get bradycardia (low heart rate),” Dr. Reddy says.
• Weight Gain: Fatigue is often accompanied by weight gain in hypothyroidism.

While physical changes occur with hypothyroidism — like dry skin, hair loss and weight gain — it isn’t detectable by looking at someone, except in some extreme cases.

Additionally, Dr. Reddy adds, “While the main symptoms — fatigue and weight gain — are the same for both genders, the overall incidence of hypothyroidism is lower in men.”

Symptoms Not Typically Linked to Hypothyroidism

There are common misconceptions about what an underactive thyroid causes. Dr. Reddy clarifies that the following are generally not common symptoms of hypothyroidism:

• Anxiety: Hypothyroidism is more often linked to depression and low mood, not anxiety.
• High blood pressure or dizziness: These are symptoms more often associated with hyperthyroidism (overactive thyroid).
• Hot flashes: Hypothyroidism is associated with feeling cold, not hot flashes.
• Puffy face: It’s generally only seen in very severe, uncontrolled cases of hypothyroidism where the patient’s thyroid-stimulating hormone (TSH) numbers are high.
• Rust-colored stains on hands: This isn’t a symptom associated with hypothyroidism.

Understanding Hashimoto's Disease in Females

Hashimoto's disease is the most common cause of hypothyroidism. It’s an autoimmune condition where the body produces antibodies that destroy the thyroid gland. The result can be an underactive thyroid.

"Hashimoto's is simply one of the reasons why most people develop hypothyroidism,” Dr. Reddy says.

It’s also important to note that if you have the antibodies associated with Hashimoto's, it doesn't mean you have thyroid disease. Dr. Reddy stresses this is a major point of confusion for many patients.

"If your thyroid gland is fighting off and making enough thyroid hormones for you, you don't have hypothyroidism, even if you have a positive antibody test,” she says.

A simple TSH blood test done by your doctor is the definitive way to confirm the diagnosis and check your thyroid function.

Other Hashimoto’s Misconceptions

While dry skin is common, a specific Hashimoto's skin rash is not. Dr. Reddy says if you have hives, a doctor may check your thyroid as part of the overall workup, but hypothyroidism is unlikely to be the cause.

Also, if your medication is balanced, Hashimoto’s shouldn’t cause symptom flare-ups.

“Medication needs to be adjusted based on changes in weight, pregnancy or any other medication that can change absorption of your thyroid medication,” Dr. Reddy says.

Thyroid Treatment and Natural Support

If testing confirms you have hypothyroidism, the standard treatment is medication. Levothyroxine (brand name may include Synthroid) is most prescribed, which replaces the missing thyroid hormone.

For those with diagnosed hypothyroidism, maintaining proper nutrition is also important to support overall thyroid function and well-being.

"If you're eating a balanced meal, you don't have to take any supplements for your thyroid," Dr. Reddy says.

Key nutrients for hypothyroidism include iodine (found in iodized salt, dairy and seafood) and selenium (nuts, grains and poultry).

To keep inflammation down — which can impact autoimmune conditions like Hashimoto's — Dr. Reddy recommends an anti-inflammatory diet, such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains and healthy fats.

When to See a Doctor

For most patients, hypothyroidism is safely and effectively managed by their primary care provider, family practice doctor or OB/GYN.

Dr. Reddy notes that endocrinologists typically see patients in more complicated situations.

"I never see a hypothyroid patient who's doing fine on medication managed by primary care," she says.

"I see them when they’re having trouble balancing the medication, or they're taking medication and still don’t feel well."

If you’re experiencing any of the persistent symptoms listed above, the best first step is to talk to your primary care provider about a blood test to rule out, or confirm, any thyroid issues.