5 Signs of Hypothyroidism, Plus How To Find Symptom Relief - Dr. Michael Ruscio, DNM, DC

5 Signs of Hypothyroidism, Plus How To Find Symptom Relief

Discover What Symptoms Correlate with Thyroid Disorders, When To Get A Thyroid Test, And How To Identify True Hypothyroidism Or Not

Getting the right diagnosis of any condition is critical in order to heal. With thyroid conditions, 30-60% of patients have been incorrectly diagnosed and are instructed to take lifelong medication. Not only does this lead someone down the wrong path, but it also often leaves them with unresolved symptoms like fatigue, brain fog, and anxiety. In this video, I break down the five most reliable signs of hypothyroidism, offer what to do about a positive and negative thyroid test, and how to find true relief of symptoms.

In This Episode

Intro… 00:00
The reliable markers that suggest you could be hypothyroid… 01:08
What increases your risk of hypothyroidism?… 02:29
Unreliable symptoms of hypothyroid… 04:36
One common symptom to be wary of… 05:45
When to get a second opinion... 06:19
Where your symptoms could really be coming from... 09:18
Final thoughts… 10:46
Outro… 11:53

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➕ Full Podcast Transcript

Dr Ruscio:

What are the five most reliable signs that you could be hypothyroid? What are the signs that are not accurate and you should be wary of? Getting this right is crucially important because recent evidence has found that 30-60% of patients have been incorrectly diagnosed, meaning they’ve been told they need lifelong thyroid hormone medication when they don’t. Getting this right is very important. This is Dr. Michael Ruscio and let’s jump in.


Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio:

The reliable markers that suggest you could be hypothyroid are as follows: tiredness (exhibited in roughly 80% of individuals), dry skin (exhibited between 60-70% of individuals), mood imbalances, depression, anxiety, (in about 45% of individuals), cold intolerance (in about 60% of individuals) and hair loss (in roughly 30% of individuals). Additionally, difficulty swallowing—perhaps due to inflammation in the thyroid gland itself—has been found in roughly 30% of patients. And also, as you may have heard before, weight gain. One analysis found that 54% of those with hypothyroidism had weight gain. It’s also important to clarify that those with low thyroid had a weight gain of roughly 15 pounds. So important to clarify, this is a significant amount of weight gain. And when starting thyroid hormone replacement therapy, estimates average that about eight pounds of weight loss can be expected.

Dr Ruscio:

One other crucially important factor here to keep in mind is that one symptom does not equal a risk of hypothyroidism. The more symptoms you have, the higher the risk. And we can quantify this even further based upon research that’s attempted to examine or quantify your risk. Three or more of the symptoms we outlined a moment ago equates to roughly a 16% risk. So this is something, but it shouldn’t moor us and prevent people from getting too swept up in the possibility that they could be hypothyroid. Now, if you have four to six of the symptoms we discussed, that can lead to up to a 90% risk. So again, important to clarify, if you are just fatigued or you’ve just gained weight, that’s not a very high probability that hypothyroidism will be the underlying cause. But if you have three or four or six of these symptoms, then we’re starting to see a substantial risk quantification there.

Dr Ruscio:

It’s also important to clarify that if you yourself have an autoimmune condition that puts you at higher risk of having a thyroid autoimmunity and potentially the subsequent hypothyroidism. If you have a family history of hypothyroidism, this would also increase your risk. [It is] important to keep these things in mind so that you can look to build a case for or against the probability of being hypothyroid. And just to echo this one more time, the more symptoms equals the more risk or the higher risk. So tiredness, dry skin, mood imbalances, cold intolerance, hair loss, trouble swallowing, and weight gain—three of these [means] about a 16% risk, four to six [means] up to a 90% risk. So I just want to echo that again because sometimes a patient will come into the office saying something like, “I have thinning hair,” and thinking that that in and of itself equates to hypothyroidism. Now we could, right, but we wanna look at the complete picture of the individual so that we can quantify risk.

Dr Ruscio:

Relating to unreliable symptoms, it’s quite important to clarify that testing is significantly more accurate than our symptoms. And testing will show thyroid hormone imbalances long before symptoms actually arise. In quoting the European journal of endocrinology in 2014, “neither the presence nor absence of any individual hypothyroid symptoms was reliable in the decision regarding who should have their thyroid function tested. Therefore even minor suspicions should lead to a blood test.” So thankfully this is an area where the testing’s quite accurate. We can’t make this claim for all realms of medicine, but as it pertains to diagnosing hypothyroidism, the testing here (again, thankfully) is quite accurate.

Dr Ruscio:

And one symptom I’d like to point out to be wary of is eyebrow thinning. This does not in and of itself appear to be a reliable marker. But rather prostaglandins, which naturally shift as you age, are more likely what is leading to eyebrow thinning. And this is something that a surprising number of individuals are quite suspicious [that] they’re hypothyroid just based upon eyebrow thinning. However, a degree of this is normal [and] to be expected as one ages.

Dr Ruscio:

One other word of caution, which is very, very important, if you’ve been told that your thyroid tests are normal according to the conventional ranges but you still have a thyroid problem, I would be very, very suspicious and consider seeking out a second opinion. The reason for this, again, one of the facts that I opened with is that two recent studies have found either a 33 or up to a 60% likelihood that one will be incorrectly diagnosed with hypothyroidism. A meta-analysis appearing in the journal Thyroid from 2021 [found] about 33% of individuals were incorrectly told they were hypothyroid, went on lifelong thyroid medication, only to years and years later (in some cases) have this incorrect diagnosis identified, they came off the thyroid hormone, their symptoms did not change, and they maintained normal thyroid levels. And this was really initially put on the radar by Lavas in the journal of Thyroid in 2018, who found a roughly 60% incorrect diagnosis.

Dr Ruscio:

Why this is important is because if you are truly hypothyroid, you will benefit from thyroid hormone medication. And that’s something that you should do. However, if you’re having symptoms and you’re looking for why—firstly, I understand how frustrating that can be—but we don’t want to shoehorn someone into a diagnosis that they don’t really have because it feels good or it seems to line up with some of your symptoms. So just a word of caution, because this is something that I and we at the clinic see fairly frequently and we’d love to see less people on medication that don’t need to be.


Hi, everyone. If you are in need of help, we have a number of resources for you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Dr Ruscio:

Now, something to also point out here is that digestive symptoms can often be the cause of thyroid-like symptoms. Coming back to our list, things like mood imbalances, fatigue, and dry skin can be caused by problems in the gut. And this is fairly often overlooked. And if you consider the fact that IBS (irritable bowel syndrome)—gas, bloating, constipation, diarrhea, loose bowels—affects about 15% of the population, whereas hypothyroidism impacts just 1%, you can see that it’s about 15 times percent more likely that if you’re experiencing some of these symptoms and you have any digestive symptom, it could be the problem in the gut that’s leading to those symptoms. So just to be careful and to be cognizant of that.

Dr Ruscio:

And again, this is something that is seen quite frequently by myself and the other doctors at our office. And Paige’s example is a great case illustrating how in her case she was correctly diagnosed as hypothyroid, she went on medication, but only saw a minimal improvement in her symptoms and did not see full symptomatic resolution until she also did some work to improve the health of her gut.

Dr Ruscio:

So I just wanna make sure that you achieve two things: 1) understand what symptoms flag and should prompt a blood test for hypothyroidism 2) if that test comes back normal, according to the conventional ranges, you don’t go down the rabbit hole of going on thyroid medication even though your tests are normal because you’re working with a clinician who’s probably trying to help you but being too generous in how they interpret your lab values.

Dr Ruscio:

So in close, the more symptoms you have, the more likely you could be hypothyroid. However, remember that symptoms are not the best indicator and if there’s any degree of suspicion, get a blood test. If the blood test comes back normal, don’t forget the importance of your gut. And for guidelines about our perspective on gut and the gut-thyroid connection please see the link to our Thyroid Health Guide in the description below. This is Dr. Michael Ruscio, and I hope this helps.


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