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What Are Early Warning Signs of Thyroid Problems?

Written by Dr. Ruscio on March 8, 2022

Written by Dr. Ruscio on March 8, 2022 — Reviewed by Heidi Turner

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

Know the Symptoms, When to Get Blood Work, and What Could Be the Root Cause

• What Are Early Warning Signs of Thyroid Problems|
• Blood Tests for Thyroid Health|
• What if It’s Not Your Thyroid|
• The Bottom Line|

The most common early warning signs of a thyroid problem include unexplained tiredness, constipation, dry skin, body temperature problems, weight gain, hoarseness, hair loss, and mood imbalances. These symptoms may seem unrelated, but when taken together, can amount to thyroid concerns. 

That being said, while symptoms of an illness, condition, or disease are usually the motivator to get you to the doctor, they’re not always the best indicator for what may actually be ailing you. Looking out for particular symptoms and getting regular checkups if you have a family history of a particular disease, such as thyroid problems, GI disorders, high blood pressure, or certain cancers, is most certainly a good idea. But in the case of thyroid issues specifically, blood tests are the most accurate way to get a truly reliable picture of what’s going on.

In other words, although it’s important to recognize and understand the symptoms, they’re not very predictive when it comes to diagnosing hypothyroidism — low levels of thyroid hormone production in the butterfly-shaped gland at the front of your neck. (In this article, we’re focused on hypothyroid, or underactive thyroid, rather than hyperthyroid, or overactive thyroid/too much thyroid hormone.)

There are a number of different possible symptoms of hypothyroidism, but having one or two of those symptoms is not a reliable indicator that you have a thyroid problem, largely because many hypothyroidism symptoms overlap with symptoms of other conditions (some of which, like IBS and other digestive disorders, are more common or more likely). In fact, hypothyroidism only affects about 1% of the population, while IBS (irritable bowel syndrome) affects closer to 15% of the population [1, 2].

So what are early warning signs of thyroid problems? Let’s go over what to look out for, the tests that will be most indicative of a problem, and what to do if your levels are normal but you’re still experiencing symptoms of hypothyroid.

What Are Early Warning Signs of Thyroid Problems?

As we already mentioned, many of the symptoms we’re about to enumerate can also be symptoms of other diseases or conditions. So it’s important to understand that displaying one, two, or even three symptoms from this list doesn’t necessarily mean you have a thyroid condition.

Importantly, the more symptoms you have from this list, the greater the likelihood that your issue is in fact with your thyroid, especially if you’re experiencing four or more of these symptoms [3]. Early warning signs of a thyroid disorder or reduced thyroid function, in order of prevalence, include:

• Unexplained tiredness (about 80% of hypothyroid patients) [3, 4, 5, 6, 7, 8]
• Constipation [3, 4, 5, 6, 7, 8]
• Dry skin (about 60-70% of hypothyroid patients) [3, 4, 5, 6, 8]
• Cold intolerance/body temperature problems (about 60% of hypothyroid patients) [4, 5, 6, 8]
• Weight gain (about 54% of those with true hypothyroidism experience weight gain of roughly 15 lbs, and respond well to HRT — hormone replacement therapy — with an average weight loss of about 8 lbs) [4, 5, 6, 8]
• Hoarseness and/or pain at the front of the neck due to inflammation of the thyroid gland itself (about 30% of hypothyroid patients) [3, 4, 5, 6, 8]
• Mood imbalances and mood swings — depression, anxiety, nervousness (about 45% of hypothyroid patients) [3, 6, 7]
• Muscle weakness/pain [3, 6, 7]
• Hair loss (about 30% of hypothyroid patients; not eyebrow thinning, which is mostly due to shifting prostaglandins with age) [7, 9, 10, 11, 12]
• Heart palpitations [3]
• Irregular menstrual periods [7]

The first eight on the list are considered primary symptoms that happen most frequently [3, 4, 5, 6, 7, 8]. Experiencing three or more of these symptoms equates to a 16% higher risk of having hypothyroid. Experiencing four to six of these can lead to up to a 90% risk. If you have an autoimmune condition or a family history of hypothyroid, your risk increases even more [5].

For example, Hashimoto’s thyroiditis is an autoimmune condition that directly affects the thyroid and can lead to hypothyroidism. It’s the most common cause of hypothyroidism in the United States [7].

Your healthcare provider should be looking at your whole picture of health, including family history, other related illnesses, and above all, requesting labs so that you can have a very concrete idea of the state of your endocrine system and whether or not you’re making enough hormones.

Blood Tests for Thyroid Health

Because the most common symptoms of hypothyroidism overlap with other health challenges, it’s important to dig a little bit deeper than the symptoms to get to the root cause. Screening for symptoms can be useful in younger populations, but for the elderly, especially for women over 60 — which represent 47.4% of all autoimmune hypothyroid patients — it’s not a useful tool [3].

Importantly, no individual symptom can help predict whether or not a person is in need of HRT or other thyroid meds. Measuring TSH (thyroid-stimulating hormone), free T4 (thyroxine), and TPO (thyroid peroxidase) antibodies through bloodwork is the best way to verify if your symptoms could be attributable to thyroid dysfunction. From there, you can determine whether or not your levels are low enough to merit taking medication, or if something else might be going on that’s affecting your energy levels, skin, and digestion.

While medical tests like blood work aren’t always the best predictors for every disease, in the case of thyroid hormone levels, blood work is actually the gold standard and very reliable. It’s worth getting labs done if you have any suspicion at all that you might have hypothyroidism. This type of blood work is relatively inexpensive, and knowing your levels is an important jumping-off point for next steps. It’s also a great way to avoid taking unnecessary medication.

What if It’s Not Your Thyroid?

Recent evidence has found that 30-60% of patients have been misdiagnosed as hypothyroid and prescribed lifelong thyroid medications for hypothyroid when they don’t actually need them [13, 14]. This is not only a waste of time and resources, it’s also missing the root cause of a collection of symptoms that have been misattributed to thyroid disease.

Furthermore, all prescription drugs come with potential side effects, and thyroid medications are no different. Taking them when they’re not actually needed increases your risk of experiencing side effects, and for no good reason.

If you’re truly hypothyroid, you will benefit from thyroid medications and should take them. But if you have normal thyroid levels or subclinical hypothyroidism, there’s no reason for a healthcare professional to shoehorn you into a diagnosis and over-treat the problem with meds just because some of the symptoms line up.

Often, there’s actually a gut health issue behind the symptoms we tend to associate with thyroid problems. Nutrient deficiencies, including of iron, zinc, vitamin B12, and vitamin D, can also lead to many of the same symptoms, so it’s always worth exploring the nutritional balance of your diet, and whether or not you are properly absorbing nutrients (gut imbalances can lead to weakened absorption).

The Gut-Thyroid Connection

Digestive imbalances or dysfunction may be the cause of your thyroid-like symptoms. Mood imbalances, fatigue, and dry skin can all be results of a gut imbalance [15, 16]. IBS affects 10-20% of the western population, while hypothyroidism affects less than 1% [17]. It’s a lot more likely you’re having a gut problem than a thyroid problem if your labs don’t indicate clinically low thyroid hormones.

There’s also a connection between hypothyroidism and two types of gut infections: Helicobacter pylori infection and SIBO [18, 19, 20, 21]. In both cases, probiotics have been documented as successfully treating symptoms of hypothyroidism that may have actually stemmed from gut imbalances [22]. Subclinical hypothyroidism has been associated with higher rates of SIBO, which, again, can be treated with probiotics and a low-FODMAP diet.

Probiotics have also successfully yielded significant improvements in the mood of individuals with mild to moderate depressive symptoms (meaning that the mood issue was gut-related, not thyroid-related) [23]. Studies have also shown a connection between leaky gut and chronic fatigue syndrome and linked a low FODMAP diet with reduced fatigue in patients with IBS and fibromyalgia [24, 25, 26].

The Bottom Line

It’s important to know your body and to notice if symptoms begin to crop up that don’t have an obvious explanation. Many symptoms point to more than one disease or dysfunction, so while knowing which symptoms to look out for is a good idea, it’s also critical to know when it’s time to ask your doctor for blood work.

What are early warning signs of thyroid problems? The big ones to look out for are unexplained tiredness, constipation, cold intolerance, weight gain, hoarseness, mood imbalances, and muscle weakness. The more of these you have, the more likely it is that you have a thyroid problem. But blood work is the only way to know for certain if you have clinically low levels of thyroid hormone.

If you’ve been told that your thyroid hormone ranges are normal or subclinical but you still have lots of symptoms, you should seek a second opinion before beginning HRT or other thyroid med regimens. It’s not only possible but likely that your symptoms are gut-related and could be addressed with dietary changes and probiotics. If you’re looking for assistance to get you on the right track toward better understanding your whole health picture, reach out to our clinic. We’d love to help you.

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