Symptoms

Early Symptoms. Early symptoms of hypothyroidism are subtle and, in older people, can be easily mistaken for symptoms of stress or aging. They include the following:

• Feeling chronically tired.
• Being overly sensitive to cold.
• Headache. In one study, 30% of people with hypothyroidism developed headaches within one to two months of the onset of the thyroid disorder. Those with a history of migraines were at higher risk for this symptom. The headaches were mild but continuous and affected both sides of the head.
• Muscle and joint aches.
• Weight gain. This is common even though appetite diminishes.
• Constipation.
• Dry skin.

In premenopausal women, early symptoms can interfere with fertility. They may experience heavy periods or, in rare cases, a milky discharge from the breasts. A history of miscarriage may be a sign of impending hypothyroidism. Studies suggest that even if thyroid levels are normal, women who have a history of miscarriages often have antithyroid antibodies during early pregnancy and are at risk for developing autoimmune thyroiditis over time.

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Later Symptoms. As free thyroxine levels fall over the following months, other symptoms may develop:

• Impaired mental activity, including concentration and memory, particularly in the elderly.
• Depression. Some experts believe that even mild thyroid failure may increase susceptibility to major depression.
• Muscle weakness, numbness, pain, and cramps. This can cause an unsteady gait. Muscle cramps are common, and carpal tunnel syndrome or symptoms similar to arthritis sometimes develop. In some cases the arms and legs may feel numb.
• Numbness in the fingers.
• Hearing loss.
• Husky voice.
• Sleep appearance.
• Continuing weight gain and possible obesity, in spite of low appetite.
• Some people experience less sweating and their skin becomes pale.
• Skin and hair changes. Skin becomes pale, rough, and dry. Patients may sweat less. Hair coarsens and even falls out. Nails become brittle.
• Snoring and obstructive sleep apnea (a condition in which in the soft palate in the throat collapses at intervals during sleep, thereby blocking the passage of air).