©2018 WebMD, Inc. All rights reserved. eMedicineHealth does not provide medical advice, diagnosis or treatment. See Additional Information.

Symptoms and Signs of Thyroid Problems

Doctor's Notes on Thyroid Problems

Problems or diseases with the thyroid range from underactivity or overactivity of the thyroid gland (hypothyroidism or hyperthyroidism, respectively), nodules or lumps in the gland, inflammation of the gland (thyroiditis), and cancers of the thyroid gland. The cause of these conditions varies depending on the exact type of thyroid problem that is present.

Just as the causes of thyroid problems vary, the symptoms and signs of thyroid problems vary widely according to the exact type of thyroid disease. Associated symptoms and signs of thyroid problems can include enlargement of the thyroid gland (goiter), the presence of lumps or nodules within the thyroid gland, weight gain or loss, menstrual irregularities, skin and hair changes, constipation, muscle weakness, racing heart or slow heart rate, and changes in energy or mood.

Medical Author:
Medically Reviewed on 3/11/2019

Thyroid Problems Symptoms

Symptoms of hypothyroidism in infants can include:

  • Constipation
  • Poor feeding
  • Poor growth
  • Jaundice (yellow discoloration of the skin and eyes)
  • Excessive sleeping

Symptoms of hypothyroidism in children include:

  • Symptoms similar to adult symptoms
  • Excessive fatigue
  • Poor growth
  • Delayed tooth development
  • Delayed sexual maturation
  • Poor school performance

Symptoms of hypothyroidism in adults include:

Early symptoms

Later symptoms

  • Poor appetite
  • Weight gain
  • Dry skin
  • Hair loss
  • Intellectual ability worsens
  • Deeper, hoarse voice
  • Puffiness around the eyes
  • Depression
  • Irregular menstrual periods or lack of menstrual periods

Symptoms of hyperthyroidism in children include:

  • Symptoms similar to adult symptoms
  • Declining school performance
  • Behavior problems
  • Anxiety
  • Hyperkinesis (the need to move all of the time)

Symptoms of hyperthyroidism in adults include:

  • Insomnia
  • Hand tremors
  • Nervousness
  • Feeling excessively hot in normal or cold temperatures
  • Frequent bowel movements
  • Losing weight despite normal or increased appetite
  • Excessive sweating
  • Menstrual period becomes scant, or ceases altogether
  • Joint pains
  • Difficulty concentrating
  • Eyes seem to be enlarging

Symptoms of hyperthyroidism in the elderly may cause:

  • The only sign of goiter or nodule is an enlargement in the lower part of the front part of the neck. This enlargement is often not painful or bothersome.
  • When the nodule or goiter becomes large, there can be pressure on the surrounding normal structures in the neck including the esophagus (swallowing tube), trachea (breathing tube) and the blood vessels that bring blood to and from the head. A common symptom is feeling a constant pressure in the front of the neck that is worse when the head is tilted down. This pressure on the breathing tube (trachea) may cause a small, dry cough that can be constant and worsens when lying down. The pressure on the swallowing tube (esophagus) may be noticed as difficulty in swallowing large pills or dry food such as bread and rice with the food "getting stuck" in the lower part of the front of the neck. Rarely, this pressure can damage the nerve that controls the voice box, causing hoarseness of the voice.
  • The only sign of goiter or nodule is an enlargement in the lower part of the front part of the neck. This enlargement is often not painful or bothersome.
  • When the nodule or goiter becomes large, there can be pressure on the surrounding normal structures in the neck including the esophagus (swallowing tube), trachea (breathing tube) and the blood vessels that bring blood to and from the head. A common symptom is feeling a constant pressure in the front of the neck that is worse when the head is tilted down. This pressure on the breathing tube (trachea) may cause a small, dry cough that can be constant and worsens when lying down. The pressure on the swallowing tube (esophagus) may be noticed as difficulty in swallowing large pills or dry food such as bread and rice with the food "getting stuck" in the lower part of the front of the neck. Rarely, this pressure can damage the nerve that controls the voice box, causing hoarseness of the voice.

Thyroid Problems Causes

Newly diagnosed hypothyroidism in pregnancy is rare because most women with untreated hypothyroidism do not ovulate or produce mature eggs in a regular manner, which makes it difficult for them to conceive.

It is a difficult new diagnosis to make based on clinical observation. The signs and symptoms of hypothyroidism (fatigue, poor attention span, weight gain, numbness, and tingling of the hands or feet) are also prominent symptoms of a normal pregnancy.

Undiagnosed hypothyroidism during pregnancy increases the chance of stillbirth or growth retardation of the fetus. It also increases the chance that the mother may experience complications of pregnancy such as anemia, eclampsia, and placental abruption.

Probably the largest group of women who will have hypothyroidism during pregnancy are those who are currently on thyroid hormone replacement. The ideal thyroxine replacement dose (for example, levothyroxine [Synthroid, Levoxyl, Levothroid, Unithroid]) may rise by 25% to 50% during pregnancy. It is important to have regular checks of T4 and TSH blood levels as soon as pregnancy is confirmed; and frequently through the first 20 weeks of pregnancy to make sure the woman is taking the correct medication dose. It is recommended that the levothyroxine dose be adjusted to keep the TSH level < 2.5 mIU/L during the first trimester of pregnancy and < 3 mIU/L during the last two trimesters of pregnancy. Usually the increase in thyroid hormone needed during pregnancy disappears after the delivery of the baby and the pre-pregnancy dose of levothyroxine can be resumed immediately post-partum.

Hypothyroidism Causes

  • Loss of thyroid tissue: Treatment of hyperthyroidism by radioactive destruction of thyroid tissue or surgical removal of thyroid tissue can result in hypothyroidism.
  • Antithyroid antibodies: These may be present in people who have type 1 diabetes, lupus, rheumatoid arthritis, chronic hepatitis, or Sjogren's syndrome. These antibodies may cause decreased production of thyroid hormones because of thyroid destruction. Hashimoto's thyroiditis, the most common cause of hypothyroidism in an adult, occurs because of autoimmune destruction of the thyroid results in a decreased production of thyroid hormone and an increased amount of TSH.
  • Congenital defects in the production of thyroid hormone: Hypothyroidism can be present from birth. This is commonly discovered early with nationwide newborn screening for this disease. When one of the steps in thyroid hormone synthesis is defective, the production of thyroid hormone is reduced, with a subsequent increase in TSH. The increased TSH results in a goiter (enlargement of the thyroid gland itself that can be seen as an obvious swelling in the front of the neck). If the metabolic block is severe, thyroid hormone levels are low begining at birth, resulting in mental retardation, goiter, and short stature (hypothyroid cretinsim).
  • Medications: Some medications, particularly lithium (Eskalith, Lithobid), may cause a drug-induced hypothyroidism.

Hyperthyroidism Causes

  • Graves' disease: This autoimmune thyroid condition results from abnormal stimulation of the thyroid gland by a material in the blood termed the thyroid stimulating immunoglobulin (TSI). TSI overstimulates the thyroid causing a goiter. It also causes Grave's eye disease, including a "bug-eyed" look and "frightened stare." This can progress to severe eye pain or eye muscle weakness causing tearing and double vision. In severe cases, the swelling of the eye and surrounding tissue can cause loss of vision. It also causes raised, thickened skin over the shins or tops of the feet.
  • Toxic multinodular goiter: This occurs when a nodule in the thyroid gland produces thyroid hormones all by itself, without regard to the degree of TSH stimulation. It usually occurs in people with a long-standing goiter, usually in the elderly. Toxic multinodular goiter is different from Graves' disease because of the general lack of eye complications and less severe signs of hyperthyroidism.
  • Subacute thyroiditis: This temporary inflammatory disorder of the thyroid gland includes such conditions as de Quervain's thyroiditis or postpartum subacute thyroiditis. In these conditions, there may be periods of increased thyroid hormone release due to the inflammation, causing excess thyroid hormone to be released. After the all the thyroid hormone has leaked out of the damaged tissue, a temporary hypothyroid period begins and can last 2-4 months. Usually 90% of people with this condition will go back to normal thyroid function without treatment.
  • Pituitary adenoma: This tumor of the pituitary gland causes independent TSH production leading to overstimulation of the thyroid gland.
  • Drug-induced hyperthyroidism: This is most commonly caused the the  heart medication amiodarone (Cordarone).

Goiter or Nodules Causes

  • Most of the time thyroid nodules and thyroid goiters do not cause any symptoms. Some goiters are found because of the thyroid hormone overproduction or underproduction from the thyroid gland. Some nodules are found because a patient or doctor sees or feels a lump in the neck. If the goiter becomes very large, the person may feel a pressure in the front of the neck with swallowing hard or firm foods such as bread crusts or meat. This pressure may also cause a small dry chronic cough. It is rare that the thyroid can become large enough to completely block swallowing or breathing.
  • Nodular or multinodular goiter: This is a condition in which multiple nodules form in the thyroid. There are only two conditions that cause thyroid enlargement and nodules: 1) external radiation exposure, or 2) iodine deficiency. Often several members of a family. will have an enlarged goiter as the condition can be inherited
  • Thyroid cancer: There are several types of thyroid cancer. The most common type, papillary thyroid carcinoma, occurs in more than 85% of cases. This type of cancer can be caused by radiation exposure as a child or adolescent, including therapeutic radiation used in the treatment of cancers or in accidents such as the Chernobyl nuclear disaster. Most of the time, the reason for developing thyroid cancer is unknown.

Newly diagnosed hyperthyroidism occurs in about 1 in 2,000 pregnancies. Graves' disease accounts for 95% of cases of hyperthyroidism newly diagnosed during pregnancy.

As with hypothyroidism, many symptoms of mild hyperthyroidism mimic those of normal pregnancy. However, anyone experiencing symptoms such as significant weight loss, vomiting, increased blood pressure, or persistently fast heart rate should have blood tests to evaluate whether hyperthyroidism is present.

Mild or subclinical hyperthyroidism defined as a lower than normal TSH and normal Free T4 level is not dangerous to the mother or baby and does not need to treated. Thyroid tests should be checked again in 4 weeks. However, untreated moderate to severe hyperthyroidism does cause fetal and maternal complications including poor weight gain and tachycardia (an abnormally fast heart rate).

There are new recommendations for the treatment of hyperthyroidism during pregnancy Propylthiouracil is used during the first trimester to block the synthesis of thyroid hormone and to bring thyroid hormone levels to borderline or slightly higher than normal levels. Propylthiouracil has a lower risk of some rare fetal malformations compared to methimazole (Tapazole) and is preferred during the critical fetal developmental period during the first trimester. Propylthiouracil is not recommended during the remainder or pregnancy because of the risk of serious hepatitis. During the second and third trimester, propylthiouracil should be switched to methimazole. The incidence rate of side effects for each medication is not increased in pregnancy.

Iodine will cross the placenta, so its use in either a thyroid scan or in treatment with radioactive iodine is prohibited in pregnancy.

One positive note for women with hyperthyroidism is that those with Graves' disease or Hashimoto's thyroiditis may have improvement in their symptoms as the pregnancy progesses.

Newly diagnosed hyperthyroidism occurs in about 1 in 2,000 pregnancies. Graves' disease accounts for 95% of cases of hyperthyroidism newly diagnosed during pregnancy.

As with hypothyroidism, many symptoms of mild hyperthyroidism mimic those of normal pregnancy. However, anyone experiencing symptoms such as significant weight loss, vomiting, increased blood pressure, or persistently fast heart rate should have blood tests to evaluate whether hyperthyroidism is present.

Mild or subclinical hyperthyroidism defined as a lower than normal TSH and normal Free T4 level is not dangerous to the mother or baby and does not need to treated. Thyroid tests should be checked again in 4 weeks. However, untreated moderate to severe hyperthyroidism does cause fetal and maternal complications including poor weight gain and tachycardia (an abnormally fast heart rate).

There are new recommendations for the treatment of hyperthyroidism during pregnancy Propylthiouracil is used during the first trimester to block the synthesis of thyroid hormone and to bring thyroid hormone levels to borderline or slightly higher than normal levels. Propylthiouracil has a lower risk of some rare fetal malformations compared to methimazole (Tapazole) and is preferred during the critical fetal developmental period during the first trimester. Propylthiouracil is not recommended during the remainder or pregnancy because of the risk of serious hepatitis. During the second and third trimester, propylthiouracil should be switched to methimazole. The incidence rate of side effects for each medication is not increased in pregnancy.

Iodine will cross the placenta, so its use in either a thyroid scan or in treatment with radioactive iodine is prohibited in pregnancy.

One positive note for women with hyperthyroidism is that those with Graves' disease or Hashimoto's thyroiditis may have improvement in their symptoms as the pregnancy progesses.

Thyroid Problems Explained Slideshow

Thyroid Problems Explained Slideshow

It's hard to tell if you have thyroid abnormalities. You might feel run down and tired, or have what is known as "brain fog." You may be gaining weight, pregnant, or experiencing hair loss. Others may feel "hyper," anxious, or sweat a lot more than usual. All of these are common symptoms of thyroid disorders. The thyroid gland regulates many processes within the body, and women are particularly likely to have disorders that affect the function of this essential gland. Recognizing and treating these conditions is critical for optimum health and preventing long-term health problems.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.