The following symptoms and complaints may indicate hypothyroidism (underactive thyroid):
Leading symptoms
Basal metabolic rate
- Drop in body temperature → feeling cold, hypersensitivity to cold.
- Decreased sweating (hypohidrosis).
- Doughy, cool-dry skin especially on the face and hands and feet.
- Lusterless shaggy hair
- Weight gain (with poor appetite).
Cardial (cardiovascular)
- Normal to bradycardia (heartbeat too slow: < 60 beats per minute) [HMV ↓, cyanosis].
- Blood pressure: diastolic ↑
- Ejection rate of the heart ↓
- Peripheral vascular resistance ↑
- Renin-angiotensin system: activated.
Gastrointestinal (gastrointestinal tract).
- Constipation (constipation)
Nervous system and psyche
- Listlessness
- Fatigue, weakness (increased need for sleep).
- Mood low
Further
- Hypercholesterolemia (lipid metabolism disorder; too high cholesterol in the blood).
- Hypertriglyceridemia (lipid metabolism disorder; excessive triglyceride levels in the blood).
- Myxedema – edematous distension of the subcutaneous tissue due to storage of glycosaminoglycans; skin is pasty, showing a non-push-in edema (swelling) that is not position-dependent
- Peripheral edema – swelling of the legs due to water retention.
Associated symptoms
- Anemia (anemia)
- Alopecia diffusa (diffuse hair loss)
- Dyspnea (shortness of breath)
- Dysphonia (hoarse voice) [Note: Differential diagnoses: bronchial carcinoma (lung cancer), laryngeal carcinoma (cancer of the larynx), thyroid carcinoma]
- Hypacusis (hearing loss)
- Hypertension (high blood pressure)
- Hyporeflexia (lowered intensity of one or more reflexes).
- Hypoventilation (restricted pulmonary ventilation) and respiratory insufficiency/disruption of external (mechanical) breathing denotes, resulting in inadequate ventilation of the alveoli (myxedema coma; hypothyroid coma).
- Carpal tunnel syndrome – nerve compression syndrome on the hand.
- Lack of concentration
- Menorrhagia – increased and prolonged menstruation (7-14 days).
- Oligo- or amenorrhea – too infrequent to no menstrual bleeding.
- Muscle cramps, stiffness
- Paresthesias (sensory disturbances)
- Right, left ventricular dilatation (permanent dilation of the ventricle) with possible hydropericardium/accumulation of serous fluid in the pericardium [ECG: low voltage of P and T waves and QRS complex].
- Goiter (enlargement of the thyroid gland).
- Hearing loss
- Increased incidence of abortions (miscarriages).
- Decreased libido (sex drive).
- Confusion
- Cerebellar ataxia (disorders of movement coordination (ataxia) triggered by pathological changes in the cerebellum).
Symptoms in children with congenital hypothyroidism
The metabolic state is usually hypothyroid, but can also be euthyroid (normal thyroid function).In congenital hypothyroidism, symptoms are delayed because the mother’s thyroid hormones still supply the child during the first 4-12 weeks of life! Early symptoms
- Weakness in drinking
- Constipation (constipation)
- Icterus neonatorum prolongatus – yellowing of the skin, normal in infants but prolonged here.
- Lack of movement
- Enlarged tongue
- Umbilical hernia (umbilical herniaI
- Muscle hypotonia
- Respiratory insufficiency (respiratory weakness)
- Goiter (only in intrauterine (in utero) acquired hypothyroidism).
Late symptoms
- Mental retardation (severe intelligence deficits).
- Muscle pain
- Delayed growth with dysproportionate short stature
- Slowed facial maturation (coarsened facial features).
- Quiet voice
- Myxedema – skin (including subcutaneous and adipose tissue) is doughy swollen, cool, dry, and rough, especially on the extremities and face; patients look puffy
- Sensorineural hearing loss
- Strabismus (squint)
- Spastic gait
Symptoms in elderly patients
In elderly patients, there is often a risk of misinterpreting typical symptoms of hypothyroidism.Classic symptoms of hypothyroidism in old age (age distribution: 50-70 years of age) for this are:
- Hypercholesterolemia (lipid metabolism disorder; too high cholesterol level in the blood).
- Bradycardia (< 60 beats/minute).
- Cold, pale skin
- Patients freeze become tired, easily exhausted and lethargic
Hypothyroid coma (myxedema coma)
The terminology myxedema coma is misleading, as most do not present with coma. Myxedema coma is a life-threatening end-stage of untreated hypothyroidism (very rare; poor prognosis) with the following symptoms:
Basal metabolic rate
- Hypothermia (hypothermia; < 34 °C) [Note: The lower the body temperature, the higher the mortality (death rate)]Note: Due to infection, fever may also exist!
Cardial (cardiovascular)
- Bradycardia [pulse slowing (< 60 beats/minute; sinus bradycardia or AV block) HMV (cardiac output per minute) ↓, cyanosis (cyanosis); possibly also pericardial effusion (pericardial effusion)]
- Hypotension (low blood pressure)
- Shock to death
Pulmonary (respiratory/lung)
- Alveolar hypoventilation (pathologic decrease in normal pulmonary ventilation; restricted pulmonary ventilation) with hypercapnia (increased carbon dioxide levels in the blood) [risk of bronchopneumonia (secondary pneumonia (lung inflammation) that develops from descending bronchitis)]
Gastrointestinal (gastrointestinal tract).
- Constipation (constipation) [gastric atony (gastric paralysis) and paralytic ileus (intestinal obstruction due to intestinal paralysis), if applicable].
Dermal (skin)
- Myxedema – doughy skin/edematous distension of the subcutis due to storage of glycosaminoglycans; skin is pasty, showing non-push-in edema (swelling) that is not position-dependent; it shows:
- Bloated face, large tongue, swollen hands; dry, rough, cool skin.
Nervous system and psyche
- Lethargy
- Depression
- Clouding of consciousness (somnolence) to coma
- Cerebellar symptoms (ataxia (disturbances in movement coordination), adiadochokinesia/inability to perform rapid successive, opposite movements), if any.
- Epilepsy (on the ground of hyponatremia/sodium deficiency), if any.
Further
- Hypoglycemia (low blood sugar)
- Hyponatremia (sodium deficiency)
- Possibly signs of adrenocortical insufficiency (especially in secondary hypothyroidism).
Possible triggers of hypothyroid coma:
