SIGNS OF HYPOTHYROIDISM

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Do You Have Signs

of Hypothyroidism or Thyroid Hormone Resistance?

On February 24, 2003, we

posted to drlowe.com a list of the most common symptoms of hypothyroidism and

thyroid hormone resistance. Since we posted the list, it's been one of the most

visited pages on drlowe.com.

The popularity of the symptom list has prompted us to now provide a list of the

most common " signs " of hypothyroidism and thyroid hormone resistance.

Some readers may not be familiar with the distinction doctors make between

" symptoms " and " signs, " so we’ll briefly explain.

Both symptoms and signs are abnormalities that suggest that a patient has a

particular disorder, or one of several possible disorders. But what we consider

a symptom differs from what we consider a sign.

A symptom is an abnormality the patient is experiencing but that others can’t

observe and independently verify. For example, fatigue is a symptom. It's an

inner or subjective experience of the patient. Other people may have the

impression that the patient is lacking in energy, but they can’t directly

observe the fatigue and confirm that the patient is experiencing it.

In contrast, a sign is an abnormality the patient is experiencing and that

others can observe and independently confirm. Dry, scaly skin is a sign. The

patient can show it to her doctor, and the doctor is likely to remark,

" Yes, your skin is dry and scaly, isn’t it. "

Beware, however: There's a good chance your doctor won't know that dry, scaly

skin and numerous other signs are characteristic of hypothyroidism or thyroid

hormone resistance. You may have to teach him what the signs are. And you'll

most likely have to describe tests he can do to detect signs, such a slow

relaxation phase of the ankle reflex, and low voltage on the QRS complex of

your electrocardiogram.

The possible need to educate your doctor about symptoms and signs is a

disgraceful legacy of the endocrinology specialty of the last 30 years. The

specialty is responsible for abbreviating most doctors’ knowledge of

hypothyroidism to three false beliefs: (1) the only form of thyroid hormone any

patient should take is T4 (thyroxine), (2) doctors should adjust their

patients’ dosage according to their TSH levels, and (3) symptoms and

signs are of no value in diagnosing or treating hypothyroidism.[1] But alas, you can correct the

problem: You can enlighten your doctor about symptoms and signs, and by doing

so, lead him from the dark age of medicine wrought by the endocrinology

specialty.

Keep in mind that other disorders can cause signs typical of hypothyroidism and

thyroid hormone resistance. Because of this, it’s important not to rush

to judgment and conclude that a thyroid disorder is the cause of your signs.

Your doctor should help you distinguish the cause of your signs. For most

patients, if no other disorder appears to be the cause, it’s reasonable to

do a trial of thyroid hormone therapy anyway. Except for the rarest patient, a

trial is justified, for even if it doesn’t relieve the patient’s

signs, it's harmless when done with reasonable precaution. And, of course, the

trial may confirm the diagnosis by relieving the patient’s signs.

As I wrote in The Metabolic

Treatment of Fibromyalgia,[1,p.837 & 839] you should keep in mind that some

signs may be extremely subtle. They may be so subtle that your doctor and you

are certain you had them only in their absence after you reach an effective

dose of thyroid hormone. An example is the dull, listless appearance of some

patients’ eyes, replaced after therapy with a bright radiance.[2]

In the list below, we’ve used researchers’ wording as much as

possible, but we've reworded terms for some signs to make them more

understandable. We hope you find the list helpful.

41 Most Commonly Reported

SIGNS of Hypothyroidism*

o

Dry skin

o

Weight gain unexplainably

o

Thick, scaling skin

o

Hoarseness

o

Coarse skin

o Low

basal & activity level temperature

o

Fineness of hair

o

Protrusion of one or both eyeballs (exophthalmos)

o

Dry, coarse, brittle hair

o

Slow speech

o

Sparse eyebrows, especially outer ends

o

Slow pulse rate despite low physical fitness

o Hair loss

o Slow thinking

o

Brittle nails

o

Sluggish movement

o

Dry ridges down nails

o

Slow relaxation phase of the knee or ankle reflex

o

Cold skin

o

Listless, dull look to eyes

o

Swelling of face (edema)

o

Wasting of tongue

o

Swelling around the eyes (edema)

o

Nervousness

o

Swelling of eyelids (edema)

o Rapid

heart rate with weak force of contraction

o

Nonpitting edema of ankles

o Slow heart rate

despite low aerobic fitness

o

Fluid accumulation in abdomen (ascites)

o Pounding heart

beat

o Thick tongue

o Cardiac enlargement on x-ray

o Swelling of ankles

o Indistinct or faint heart tones

o Paleness of skin

o Low QRS voltage on ECG

o Paleness of lips

o Long-normal intervals on ECG

o

Bluish or purplish coloration of the skin, nail beds, lips, or mucous

membranes (cyanosis)

o Fluid around heart

(pericardial effusion)

o Changes at the back

of the eye (at fundus oculi)

* After

L.J. DeGroot, P.R. Larsen, S. Refetoff, and J.B. Stanbury, The Thyroid and

Its Diseases, 5th edition. New York, Wiley & Sons, Inc. 1984,

pp.577-578.

* R.L.

DeGowin and E.L. DeGowin, Bedside Diagnostic Examination, 3rd edition.

New York, MacMillan Publishing Co., Inc., 1976, p. 860.

* From

J.C. Lowe: The Metabolic

Treatment of Fibromyalgia. McDowell Publishing Co., L.C., Boulder,

2000, p. 839.

References

1. Lowe, J.C..: The Metabolic

Treatment of Fibromyalgia. McDowell Publishing Co., L.C., Boulder,

2000.

2. Lowe, J.C., Reichman, A., & Yellin, J.: The

process of change with T3 therapy for euthyroid fibromyalgia: a double-blind

placebo-controlled crossover study. Clin. Bull. Myofascial Ther.,

2(2/3):91-124, 1997.