Early Signs of Thyroid Problems

Experiencing the early signs of thyroid problems can be confusing. For instance, you may feel fatigued despite getting plenty of Zs at night and drinking several cups of coffee throughout the day. You could also deal with constipation, even though your fiber consumption is top-tier. And how about that 10 pounds that seemingly appeared out of nowhere? It’s no wonder you’re thinking, WTF is going on?

The good news: Your body isn’t falling apart. It’s possible that all of your symptoms collectively point to one issue with that tiny gland in your neck. 

“There are thyroid hormone receptors in every cell of the body, so the thyroid is regulating things from head to toe, nonstop,” endocrinologist Steven Wise, M.D., explains. “A change in thyroid hormone levels can cause multiple symptoms to occur all over your body at once.”

Women are five to eight times more likely than men to develop a thyroid problem, according to the American Thyroid Association (1). This risk heightens in middle age, especially as hormone levels ebb and flow during perimenopause. 

Wise stresses the importance of catching signs of thyroid problems early, so that you can start treatment before symptoms intensify and multiply. Step number one is to identify them. “Symptoms are somewhat like evidence accumulated for a trial,” Wise says. “The more symptoms you have, the more likely there is a thyroid disorder.”

About the Experts

Steven Wise, M.D., is an endocrinologist and contracted physician with Broad Health, Hone Health’s partnered medical practice. He specializes in thyroid disease, parathyroid disorders, and adrenal disorders.

Caroline Messer, M.D., is an endocrinologist with board certification in internal medicine, diabetes, and metabolism. She specializes in treating metabolic and thyroid diseases.

Types of Thyroid Problems

For such a small gland, the thyroid can cause a plethora of issues when it’s not functioning optimally. And each thyroid condition causes its own unique symptoms. The most common thyroid conditions:

Hypothyroidism

Hypothyroidism occurs when your thyroid gland gets enough TSH thyroid-stimulating hormone (TSH) from your pituitary gland, which triggers your thyroid to make hormones T3 and T4. This condition can slow down your metabolism and cause you to gain weight (2). (Your metabolism also affects your heart rate, blood circulation, and body temperature.)

Who is most susceptible to this condition? Hypothyroidism is often caused by Hashimoto’s thyroiditis, an autoimmune disorder in which the immune system attacks the thyroid. Middle-aged women are more likely to develop this condition, but iodine deficiency, and having part of your thyroid removed can also increase your risk (3, 2). Left untreated, hypothyroidism can lead to cardiovascular disease.

Hyperthyroidism

Hyperthyroidism is, you guessed it, when the thyroid pumps out too much thyroid hormone, leading to an ultra-fast metabolism (4). Sounds great right? Wrong. A fast metabolism also comes with a host of symptoms such as anxiety, heart palpitations, and excessive sweating. 

The most common causes of hyperthyroidism are Graves’ disease, an autoimmune disorder, and thyroid nodules that trigger excess production of thyroid hormone. Graves’ disease impacts around three percent of the population, with women over 30 years old being most susceptible (5). 

Hyperthyroidism can lead to other health issues such as atrial fibrillation (an irregular, rapid heart rhythm), osteoporosis (bone density loss), and a life-threatening condition called thyroid storm that can lead to organ failure (4).

The Most Common Early Signs of Thyroid Problems

Wise reiterates that each person with a thyroid problem will have slightly different symptoms. But there are a few commonalities to watch out for.

Fatigue

If you’ve been feeling mad tired lately—no, not the kind that happens after staying up late on a work night—it could be an early sign of a thyroid problem. Fatigue, which describes severe mental and physical exhaustion, is a symptom of hypo- and hyperthyroidism, Wise notes. 

Why? One of your thyroid’s main gigs in the body is regulating energy metabolism, or the process by which your cells turn nutrients into ATP (aka, energy) (5). (Remember that from middle school biology?). 

For someone with hyperthyroidism, energy metabolism kicks into overdrive, which can make you feel amped up, but only for short-lived bursts (6). Entering in and out of this heightened state can exhaust your energy reserves, leading to crippling mental fatigue. Around 89 percent of people with hyperthyroidism report intense mental fatigue, according to a 2023 study (6).

Fatigue is also one of the most common symptoms of hypothyroidism (7). This condition slows metabolism, which then negatively affects energy levels (7). 

Temperature sensitivity

Do your friends call you out for sporting a sweatshirt in the summer? Or maybe your partner raises an eyebrow at you turning on the air conditioner before bed in the winter. 

Truth is, you could run hotter or colder than the average person. But, if you find that your temperature sensitivity has suddenly changed, this could be an early sign of hypo- or hyperthyroidism (8). 

Here’s how: Hyperthyroidism fires up your metabolism, signaling your body to produce more heat, which can make it feel like your internal oven is on all the time (8). In hypothyroidism, your body struggles to produce heat, which can make even mild temperatures feel nippy (9).

Weight changes

Since thyroid hormone takes the reins of metabolic functioning, even a small imbalance can shift the scale in either direction.

Weight gain

When metabolic rate slows due to hypothyroidism, the body burns fewer calories at rest. This can lead to modest weight gain—usually less than 20 pounds—even without an increase in food intake (10). But this symptom is sometimes overlooked because weight gain is frequently blamed on aging and lifestyle choices, Wise notes.

Wise recalls treating a man who experienced a sudden spike in cholesterol levels and gained 20 pounds relatively quickly. “He noted that he was tired a lot and that his ‘get-up-and-go had got-up-and-went,’” Wise recalls. Lab results revealed that the man had low thyroid hormone, which can cause cholesterol levels to spike, as well as weight gain and fatigue. Bingo. 

“Some primary care providers might have just started him on a cholesterol medication and weight loss program,” Wise says. Advocating for your doctor to check in on your thyroid can be a game-changer in a situation like this one. 

Weight loss

Hyperthyroidism, on the other hand, can spur rapid weight loss—and not the good kind.

Increased metabolic rate makes you burn calories quickly, which results in weight loss, despite making no changes to your diet or exercise routine (10). 

You might be thinking: What’s so bad about losing weight without effort? Well, a couple of things, actually. For one, your body may also break down muscle tissue for energy in the absence of fat—and muscle loss can severely hinder your health span in the long run.

Sleep changes

Many people have issues getting quality Zs after a stressful day. But if you struggle to sleep deeply even when calm, that could be an indication of hyperthyroidism. Excess thyroid hormone stimulates the nervous system, which can make you feel energetic and alert, even at the most inopportune times (11). 

Conversely, hypothyroidism can disrupt your sleep by making you feel ultra-drowsy at various points throughout the day (11). That might mean crashing on the couch for a quick snooze after work instead of heading to the gym for a workout. By the time bedtime hits, your body thinks you’ve already slept. 

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Irregular bowel movements

Whether your BMs are too much or not enough, your thyroid could be behind your irregularity.

Constipation

Hypothyroidism can lead to feeling plugged up. As metabolism slows, so does digestion and gut motility. Not having enough thyroid hormone reduces muscle contractions in your intestines, making it harder for your body to push waste through your gastrointestinal (GI) tract (12).

Diarrhea

On the flip side, an overactive metabolism from a hyperactive gland can lead to more frequent, loose stools, Wise explains (13). Why? Food speeds through your intestines, meaning there’s less time for your intestines to absorb water from your food, which can also lead to softer, and more urgent stools.

Changes to your menstrual cycle

If Aunt Flo suddenly goes MIA, your thyroid could have told her to get lost (14). In other words, if you miss a period (alongside symptoms such as fatigue, sudden anxiety, or skin changes), it’s worth getting your thyroid checked out, Wise notes.

Irregular periods are a primary symptom for many women with thyroid conditions (14).
There are plenty of reasons your menses can disappear. For instance, perimenopause kicks into gear in middle age. While menopause and thyroid symptoms have some overlap, research shows that dwindling estrogen levels could impact thyroid function (15). (Sounds like the worst two-for-one deal ever.)

Mental health changes

One in five American adults report struggling with a mental illness like anxiety or depression (16). And there’s a lot that goes into your emotional well-being. But if you’re suddenly not feeling like yourself mentally, unbalanced thyroid hormone could be the culprit. 

Anxiety

Don’t get us wrong. The occasional bout of anxiety is not just normal, but healthy. However, if you constantly feel weighed down by your nerves or are always on edge, that could be a sign something is amiss—chemically speaking. 

Hyperthyroidism can overstimulate your nervous system—the same system that keeps you cool and calm when you’re safe and makes you alert when danger is near (17). Overstimulation can activate your stress response, causing feelings of restlessness, irritability, and a constant sense of unease.
Not to mention other symptoms of hyperthyroidism such as a racing heart, trembling hands, palpitations, and feeling amped up all mirror the physiological sensations associated with anxiety (17).

Depression

Depleted thyroid hormone can really bring down your mood. Slowed brain function that comes with hypothyroidism can make your mood unstable, leading to feelings of sadness, hopelessness, and a lack of interest in activities that you used to obsess over (18).

Thyroid hormone also plays a role in the production and regulation of feel-good neurotransmitters, such as the hormone serotonin (19). When thyroid hormone levels are low, your body may make less serotonin, which makes depression even worse. (If you or someone you know needs help, visit 988lifeline.org or call or text the Suicide and Crisis Lifeline at 988.)

Difficulty focusing

Both hypothyroidism and hyperthyroidism can wreak havoc on your ability to focus, as they both tamper with brain function and mental clarity.

People with hypothyroidism frequently report “brain fog,” which manifests as difficulty concentrating, forgetfulness, and sluggishness (20). Not to mention the intense fatigue you may already be feeling can make it challenging to stay engaged.

Conversely, hyperthyroidism can lead to restlessness and an inability to calm the mind, which can make it challenging to concentrate on a single task (21). 

Skin changes

You’ve struggled with dry skin your whole life and your face starts turning into an oil slick. Maybe your pits sweat profusely when you’re doing the laborious job of… writing emails? Abrupt changes to your skin type could indicate that you’re starting to develop hypo or hyperthyroidism.

Dry skin

Hypothyroidism can make you feel chapped for several reasons. First, skin cell turnover—or the rate at which your skin discards old cells—slows down along with your metabolism if your thyroid levels are low (22). 

This slowdown affects the skin’s ability to regenerate and repair itself, leading to a buildup of dead skin cells on the surface, which can make the skin appear dry and dull.

Hypothyroidism also decreases the production of natural oils in the skin. The reduced blood flow and circulation caused by a slower metabolism can also contribute to the skin’s lack of hydration, making you feel dryer than the Sahara.

Oily skin

Most of us remember stashing a packet of oil-blotting sheets in our backpacks in middle school. But if your pores are suddenly back in overdrive decades later, there’s a chance hyperthyroidism is at play.

Excess thyroid hormones can lead to more activity in your sebaceous glands (23)—you know, the ones that produce sebum (your skin’s natural oil). 

The increased hormone levels can also make your skin cells regenerate more quickly (24), which combined with excess oil production, can contribute to clogged pores.

Increased sweating

Walking out of a hot yoga class drenched makes sense. Sweating bullets while you’re chilling at home doesn’t. 
Hyperthyroidism can make you sweat way more than usual, by driving up your body temperature and stimulating the nervous system (25). When your body senses that your internal temperature has gone up, it tries to offset it by making you sweat.

I Have Some of These Symptoms. Do I Need a Thyroid Test?

Diagnosing a thyroid condition is actually kind of complicated. As is the case with nearly all health conditions, hyper- and hypothyroidism share many of their respective symptoms with several other diseases, Messer points out. 

For instance, the Colorado Thyroid Disease Prevalence Study found that 17 percent of people without hypothyroidism had at least four classic hypothyroidism symptoms (26). And, as many as 25 percent of those who actually had the condition reported less than four of those same symptoms. 
There’s so much overlap between thyroid symptoms and the symptoms associated with stress, aging, sleep apnea, low testosterone, and many other disorders, Wise says, that the only way to confirm you have a thyroid problem is to get a test.

When to see a doctor

If you have one of the above symptoms, you may think it’s time to book an appointment with a health professional. But endocrinologist Caroline Messer, M.D., says that just because you have some of these symptoms doesn’t automatically mean you have a thyroid problem.

“I would definitely not suggest that patients get a thyroid function test every time they feel tired, gain a few pounds, or notice brittle hair or dry skin,” Messer says. Instead, it’s more about how many symptoms you’re experiencing concurrently, Wise suggests.

“If you develop several new and seemingly unrelated symptoms within a relatively brief span, that would raise suspicion of thyroid disease,” Wise explains. 

So if you’re suddenly tired and anxious, or experiencing weight gain and skin changes, it’s a good idea to bring up your concerns to your doctor.

The American Thyroid Association recommends lab screening for thyroid hormone every five years in healthy folks starting at age 35 (27). But If you have risk factors for thyroid disease (like a family history of thyroid disease, or if you’re on medications like amiodarone or lithium) or there are mild abnormalities in your lab work, your doctor may want to check your gland annually.