Does hypothyroidism cause nausea


Are Thyroid Patients More Prone to Getting Sick?

Those with thyroid disease are familiar with its symptoms including inhibited cognitive function, fluctuations in weight, fatigue, and many others – check out our comprehensive thyroid symptom checklist here. One symptom that can easily be overlooked is reduced immune function.

There are multiple reasons why you may experience thyroid and immune malfunction but one that often goes unnoticed is Vitamin A deficiency.

Deficiencies and Thyroid Disease

In order to keep the body running at its best, it must be supplied with the appropriate vitamins, minerals, and nutrients. Unfortunately, those with thyroid disease are frequently deficient in multiple areas including vitamins D, E, K, and A. These vitamins all play important roles in maintaining various bodily functions.

Levels of Vitamin A in particular are negatively impacted by thyroid disease. This is unfortunate because this essential vitamin is a critical element of healthy immune function.

Poor thyroid function and Vitamin A deficiency are frequently seen among those with autoimmune conditions such as Hashimoto’s thyroiditis. In fact, many symptoms of Vitamin A deficiency and thyroid disorders overlap. This may be due to the fact that both conditions influence and promote the other.

Symptoms of Vitamin A deficiency include:

  • Inflammatory bowel disease
  • Frequent sickness such as colds or respiratory issues
  • Reduced sperm count
  • Poor vision
  • Dry eyes
  • Brittle or dry hair
  • Skin conditions such as acne or dry, scaly skin
  • Thyroid disease
  • Poor digestion and nutrient absorption
  • Infertility or miscarriage

Because thyroid function and Vitamin A deficiency are so often found together, many studies have been done to investigate their connection. One such study conducted in 2012 was composed of pre-menopausal women ranging from obese to non-obese. The data acquired from this research found that supplementation and treatment with Vitamin A improved lab results regarding thyroid function. Notable improvements in the areas of TSH and T3 were presented after Vitamin A treatments were administered. Both TSH and T3 are notable factors for those with thyroid disease because increased TSH and reduced T3 often indicates the presence of thyroid malfunction.

Vitamin A

Like other vitamins, Vitamin A interacts with the body on a cellular level by directly interacting with the cell’s DNA. This action helps regulate production of proteins and dictates certain functions.

Vitamin A is also an antioxidant that supports vision, neurological function, skin health, reproduction, cellular growth, thyroid function, and regulates immune response.

Without enough Vitamin A, the body can experience significant immune dysfunction. Those with a deficiency frequently suffer from poor nutrient absorption and digestion. This may contribute to the development of leaky gut syndrome and other autoimmune disorders that negatively impact the thyroid and overall health. If the immune system is regularly exhausted, is constantly stressed, or is not supported with appropriate nutrients such as Vitamin A, the chance of developing autoimmune disorders like Hashimoto’s increases.

The regulatory effect of Vitamin A was the focus of a study conducted in 2010. Research showed that Vitamin A reduced the occurrence of overactive or unhealthy immune response, which is responsible for a great deal of inflammation and increased risk of developing major health conditions.

Ensuring that your body has adequate levels of Vitamin A may help improve immune function and fend off harmful autoimmune disorders.

Multiple aspects of immune function rely on Vitamin A. Various genes responsible for immune response are regulated by this essential vitamin. The same genes also play an important role in combating serious conditions such as cancer and autoimmune disease.

Supporting these genes with proper nutrition also improves your ability to fend off less serious afflictions such as colds or the flu. Disease prevention is always beneficial but those with thyroid disease should be particularly interested because they are more likely to get sick due to the inhibited immune function.

Naturally Counteracting Colds and Other Sickness

Those with a thyroid condition are more prone to infections and common illnesses such as colds and the flu, partially because the thyroid interacts with the immune system. Recognizing that your immune function may be compromised is an important step in maintaining good health and preventing disease.

The following methods can help prevent disease and may be of particular benefit for those with a thyroid condition.

Those with hypothyroidism frequently have difficulty dealing with colder temperatures. This can further contribute to reduced immune function. By keeping bundled up and wearing warm clothes like scarves, sweaters, or slippers, those with thyroid disease can keep their body temperature up and their immune system active.

Getting enough sleep is also a key element in keeping healthy. Without adequate sleep the body cannot maintain proper function in many different systems. Immunity is particularly affected by lack of sleep. Sleep allows multiple areas, including the thyroid, to reset, which can help restore immune function. As sleep quality and duration reduces, immune function declines.

Keeping track of your diet while limiting sugar and gluten intake also helps keep immunity up and running – find out how gluten can impact your thyroid function here. Consuming high quantities of these inflammatory foods forces the immune system to remain active and combating your own diet rather than threats caused by disease or infection. Rather than exhaust the immune system by consuming sugary, gluten-filled foods try to maintain a healthy diet composed of whole foods containing high levels of Vitamin A.

The following foods contain notable amounts of naturally occurring Vitamin A, which can help resolve deficiency and support thyroid and immune function.

  • Beef liver
  • Sweet potato
  • Spinach
  • Apricots
  • Butter
  • Winter squash
  • Red peppers
  • Mango
  • Carrots
  • Kale
  • Romaine lettuce
  • Broccoli
  • Eggs
  • Cantaloupe
  • Tuna

Many of the foods listed above also contain many other heart, brain, and immune boosting nutrients. Incorporating some or all of these foods into your diet can improve more than just Vitamin A levels!

Keeping the Body on Its “A” Game

Multiple studies have found that Vitamin A and other antioxidants are a necessary component of good health and greater longevity. It is recommended that Vitamin A be acquired primarily through your diet by including a high amount of fruits, vegetables, and other whole foods.

Supporting the body with better nutrition and appropriate amounts of Vitamin A can help keep the thyroid and immune system working at its best to provide greater disease prevention.

Learn about other common vitamin and nutrient deficiencies in thyroid patients here.





When I Catch an Illness, It’s On Top of My Chronic Illness

When the average person gets ill – catches a cold, a sickness bug, virus etc. – it can feel rubbish enough. Having to take a day or two off work, cancel plans with friends or family and put up with a messy house is all part and parcel of being ill. Everyone gets ill from time to time, even those with the best immune system.

But what is it like for those of us who already live with a chronic illness?

When someone already lives with a health condition (or possibly multiple) that causes symptoms such as heavy fatigue, muscle pain, insomnia, etc., catching a cold, virus or bug can not only introduce new symptoms, such as sickness, diarrhea, fever and chills for example, but it can generally worsen preexisting ones, too.

For many of us living with a chronic health condition, our bodies aren’t as strong as an average person’s and they already struggle to function as they should – hence the medical condition/s we have, so they often take the blow of a cold, virus or stomach bug harder than a healthier person.

This can be especially true for those of us with a not-so-good immune system, such as those with an autoimmune health condition (like myself, with Hashimoto’s thyroiditis, an autoimmune thyroid disease). My immune system has already mistaken an organ, my thyroid gland, for an invader and is obsessed with trying to destroy it, so I guess you could say it’s preoccupied. Therefore, when I come down with a cold, bug or virus, which I seem to catch fairly easily, I tend to come down with it worse than my healthier other half or colleagues at work and I take much longer to recover from it. My body is already struggling and somewhat fragile, and catching an illness is just too much for it.

When I say I come down worse with the illness, I mean that symptoms tend to be rather severe compared to other people’s experiences. My chronic health condition, something I will live with for the rest of my life, already gives me some degree of fatigue, muscle weakness, pain and sleeping difficulty among other symptoms, but it’s as if these get amplified when I contract an illness. I may get sickness added on top or a bad cough and sore throat, but I feel extra hypothyroid and my body slows down until it comes to a halt. I become bed-bound and need assistance moving around. And I may be like this for a solid week, just from a cold that other people may be able to work through and carry on as normal with.

Whereas a regular person may need just a day or two at home to recover, I tend to need at least double and I can still be reeling from the effects of it weeks later. My body doesn’t “bounce back.” It’s another issue my already not-so-great body and immune system have to deal with.

If you hired someone to fit you a new kitchen and they were doing a rubbish job, instead getting confused and flustered and deciding to knock your bathroom down instead, would you give them another job? Ask them to also fit you a fireplace in the living room? That’s the best analogy I can give about my immune system. The cold, virus or bug I catch is just like the fireplace. It’s another job my immune system, which is already doing a bad job, is given to do. And so what do you expect to happen? My body responds in a poor way.

I just want you to be aware that for those of us who live with a chronic health condition, when we get ill, it’s on top of the other health stuff we’re battling and it’s different to a healthy person’s experience. It’s more intense, it’s more draining, it’s frustrating and we can’t help it.

Follow this journey on The Invisible Hypothyroidism.

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Thinkstock photo via monkeybusinessimages.

Hypothyroidism: Potential Symptoms and Causes of an Underactive Thyroid Gland

Hypothyroidism is a thyroid disease that affects people globally. Two- to three-percent of Americans have hypothyroidism; 10-15% mild hypothyroidism. Hypothyroidism affects women more than men. The thyroid gland is located in the neck and secretes hormones into the blood, which are then carried into the body’s tissues. The thyroid gland mainly produces a hormone called thyroxine (T4), which is then converted by each of the body’s organs to the active form triiodothyronine (T3). They both work to keep the body’s organs functioning properly. Thyroid hormone is important for regulation of body temperature, heart rate, blood pressure, and metabolism.

Underactive Thyroid
Hypothyroidism is a disease where the person affected has an under-functioning thyroid. When you have hypothyroidism, certain body functions slow down and may lead to fatigue, dry skin, and memory problems. Hypothyroidism is diagnosed with a blood test. You may experience a variety of symptoms—some resembling other health issues. Some symptoms you might be aware of and some you may not notice at all.

The most common and noticeable symptoms may include:

  • Loss of energy, fatigue
  • Feeling cold
  • Dry skin and hair
  • Hair loss
  • Mild weight gain
  • Loss of appetite
  • Memory loss
  • Feeling pins and needles in hands and feet
  • Constipation
  • Carpal tunnel syndrome
  • Heavier or worsening menstrual periods and cramps
  • Irritability
  • Depression
  • Goiter
  • Growth delay (in children)

Some symptoms are considered severe, although the ranges of severity differ from person to person. The symptoms listed below can be caused by hypothyroidism and may affect other health problems (eg, worsen a condition).

More severe symptoms associated with hypothyroidism may include:

  • Slow than normal (for the patient) heart rate
  • High blood pressure
  • High cholesterol

Potential Causes of Hypothyroidism

Hypothyroidism, an under-performing thyroid, may have many different causes—and some are more prevalent than others. The most common cause of hypothyroidism is an autoimmune disease.

About Autoimmune Disease
Our bodies’ immune systems are charged with protecting us from bacterial and viral invaders. The immune system attacks invaders (eg, cells). People with autoimmune hypothyroidism are at a disadvantage because their immune system attacks the normal thyroid gland. These attacks cause the thyroid hormone producing cells to malfunction, and inhibit the thyroid gland’s ability to synthesize thyroid hormone. Eventually, there are not enough cells left to meet the body’s need for thyroid hormone. This is more common in women than men—and can begin at any point in a person’s life, but tends to become more common as people age.

Hashimoto’s Disease
The most prevalent type of autoimmune hypothyroidism is a disease that causes the thyroid to shrink—it is called Hashimoto’s disease and may cause Hashimoto’s thyroiditis.

Thyroiditis means that the thyroid gland is inflamed. In addition to Hashimoto’s disease, viral infections can occasionally cause thyroiditis. In the case of a viral infection, the thyroid gland may release its entire supply of stored thyroid hormone at once into the blood. In turn, this causes the thyroid to become over-active (or, hyperthyroidism) for a short amount of time. After all the thyroid hormone is released, then the thyroid becomes underactive. Fortunately, about 75% of patients who suffer from viral thyroiditis regain proper thyroid function. Approximately 25%, however, are left with permanent hypothyroidism.

Other Causes

There are several other causes of hypothyroidism that are less common than autoimmune-related disorders, but still somewhat prevalent.

Partial or Complete Removal of the Thyroid
When a portion of the thyroid gland is surgically removed (eg, patients with thyroid nodules, thyroid cancer, Graves’ disease), this causes the remaining thyroid tissue to stop working properly—and may result in hypothyroidism. In some cases, such as patients with thyroid nodules, thyroid cancer, or Graves’ disease, the entire thyroid may even require removal.

Radioactive Therapy
Some patients undergo radiative iodine therapy as part of treatment for thyroid cancer, Graves’ disease, or a nodular goiter. Radioactive iodine destroys the thyroid tissue resulting in hypothyroidism. Some diseases treated using radioactive iodine lead to hypothyroidism (eg, Hodgkin’s disease or lymphoma, cancers of the head and neck).

Congenital Problems: Born Without a Thyroid Gland
Some babies are born without a thyroid or the thyroid is malformed (about 1 in 4,000 babies each year). A smaller number of babies are born with the thyroid intact, but in the wrong place. When the thyroid is in the wrong place, it is called an ectopic thyroid. In some patients with an ectopic thyroid gland, the thyroid cells or enzymes malfunction.

Furthermore, there are other cases where the thyroid works properly for months or years, but stops functioning later in the child’s life. The United States tests all children at birth for hypothyroidism.

Medication-related Causes of Hypothyroidism
Additionally, there are certain medications that can cause a thyroid to lose its ability to produce thyroid hormone. Medications that trigger hypothyroidism onset include lithium, amiodarone, interferon- alpha, interleukin-2, and some medications used to treat cancers.

Iodine-related Causes
Iodine levels can also affect thyroid hormone production. The thyroid needs iodine to make thyroid hormone. An imbalance in iodine—too much or too little—can cause or make hypothyroidism worse. Iodine comes into the body, mostly via diet, such as dairy, chicken, beef, pork, fish, and iodized salt.

In the United States, iodine deficiency is a rare cause of hypothyroidism due to supplementation of salt with iodine. The most common reason a person can have a high iodine level is due to the use of dietary supplements containing kelp. These supplements may be marketed for weight loss.

Pituitary Gland Dysfunction
The pituitary gland works together with the thyroid gland. The pituitary gland tells the thyroid how much thyroid hormone to produce via a hormone called thyroid stimulating hormone (TSH). If the pituitary gland doesn’t produce TSH properly (eg, due to injury, radiation, tumor, surgery), the thyroid gland may not produce thyroid hormone adequately.

Updated on: 06/20/14 Continue Reading How Doctors Diagnose Hypothyroidism View Sources

American Thyroid Association. Hypothyroidism. A Booklet for Patients and Their Families. 2013.

3 Hashimoto’s Thyroiditis Symptoms

If you want to know if you might have thyroiditis, autoimmune hypothyroidism or Hashimoto’s thyroiditis, Then this video is for you.

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If you pay attention to these three signs of thyroiditis you’ll be able to get the help you need to get your thyroid back in balance .

First, did you know that inflammation of your Thyroid affects its function?

Phase #1: Flu-like Symptoms Affect Your Thyroid

The little butterfly shaped gland right in your throat chakra produces hormones that controls your metabolism and energy production. –“.. ITIS” is the term we use in medicine that means inflammation of a body part.

Hashimoto’s thyroiditis is named after the doctor who discovered this type of inflammation. Thyroiditis is when your thyroid becomes inflamed. The first signs and symptoms feel like the flu. Body aches, fatigue, fever, difficulty swallowing because your thyroid gland is swollen and even tender and painful. That’s because thyroiditis is an autoimmune condition meaning your body is attacking itself. Your immune cells attack your thyroid and interfere with normal thyroid hormone production. It’s believed that thyroiditis may be triggered by a viral infection.

Phase #2 Tremulous Overheated Anxious Signs of Hyperthyroidism

When your thyroid first becomes attacked, it over responds by producing too much thyroid hormone. This makes your heart race,, so you feel shaky, tremulous and anxious. You can’t tolerate heat and you sweat a lot and get overheated easily. Your bowels move frequently because everything is running too rapidly. You may even lose weight in the beginning. For up to 6 weeks, you feel really wired and out of of sorts.

Phase #3 Tired, Sluggish, Low-functioning Thyroid

After a brief period of feeling somewhat normal, you start noticing that you get tired easily. If you keep moving you seem to be ok, but if you sit down you may just fall asleep. That’s a low functioning thyroid. And after being attacked by your immune system and over functioning for weeks, your thyroid can poop out. Everything slows down. You’re cold, constipated and lethargic. You may even notice swelling especially your eyelids. This may last for months. A low functioning thyroid is called hypothyroidism and may become permanent in up to 15% of people. So it’s really important to get a check up and bloodwork done. At this stage your hypothalamus is screaming at your thyroid to produce more hormones so your Thyroid Stimulating Hormone or TSH will be elevated.

Now you know what symptoms of thyroiditis are, don’t worry in my next video, I’ll show you how to treat thyroiditis Naturally. In the meantime sign up for my Hormone Reboot Training so you can get the support you need to balance your thyroid and all your hormones naturally. It’s free!

My internist prescribed sedatives, but I didn’t react well. When my best friend called every afternoon, I tucked the phone between my ear and the pillow because my arms were too exhausted to hold it.

With my last shred of self-preservation, I called a psychiatrist in Berkeley, who was holistic and cautious in his approach. He reminded me how sick I had been with iritis, and that given my resilience the depression might lift on its own. Eventually, though, we settled on an antidepressant and waited for relief.

Through early winter, my eyes and mood improved, but each night I laid out sets of pajamas, put a towel in the bed and tucked socks, heating pad and extra blankets near me. Each night I drenched the clothes and shivered under layers of goose down. By day I was too cold and weak to function. A hot bath or heated car seats offered my only relief.

I returned to my internist and said that I had read on a Web site about hormones called T3 and T4, more specific indicators of thyroid function. He said that the test for TSH — the pituitary hormone that stimulates the thyroid to produce those two hormones — was the only one necessary. This was not so much arrogance as standard practice among primary doctors and many endocrinologists. With a normal TSH, many doctors will not consider more esoteric thyroid problems as the source of symptoms like mine. My tests showed normal thyroid and adrenal gland function. My doctor gently reminded me that I had one of the best psychiatrists in Berkeley.

Weeks later, I sank into the chair in the psychiatrist’s office. He noted my four layers of clothing.

“Something is really wrong,” I said, starting to cry.

“I know,” he replied. He said he suspected Hashimoto’s disease. It turned out that for years he had closely followed research at the University of California, San Francisco, on thyroid disease and depression. He broke down the standard blood test into components: free (soluble and active) T3 and T4 levels, thyroid-stimulating immunoglobulin and antibodies called antithyroglobulin and peroxidase. I reminded him that my TSH was normal. But he speculated that if antibodies were present, some of the hormones might not be getting to the tissue, thereby gumming up the works.

I lumbered off to the lab. Once again, my TSH came back normal. But my peroxidase antibodies, indicating Hashimoto’s thyroiditis, were significantly elevated. He recommended treatment before my condition progressed.

Click here to listen to a reading of this blog:

The Thyroid Books You Need: “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”. Get them on Amazon now! This post may contain affiliate links, to find out more information, please read my disclosure statement.
Originally published on 12th May 2016 Last updated on 12th July 2019

I refer to days when my hypothyroid or Hashimoto’s symptoms are particularly bad as a ‘bad thyroid day’. Also called ‘flare ups’, I’ve had these days when my thyroid condition hasn’t been under control and when it has. My Hashimoto’s is currently in remission, yet I can still experience them from time to time.

Even now, with optimal TSH, Free T3 and Free T4 levels, as well as low thyroid antibody levels, I can still have flare ups.

What Is a ‘Flare Up’?

A Hashimoto’s or thyroid flare up is defined by an increase in symptoms of these conditions. A flare usually occurs for a few days but up to a few weeks. However, if you’re feeling that they’re going on much longer than this, it could actually not be a flare up, but a permanent dropping of your thyroid hormone levels. After all, flare ups are not associated with a drop in thyroid hormone levels, but are more a reaction to overexertion which takes your body a day or two to recover from. Read more here.

Symptoms can differ from person to person, though the most commonly reported in a flare up are:

  • Increased fatigue
  • Heaviness (as if your body is being weighed down)
  • Worsened mental health
  • Brain fog
  • Migraines
  • Flu-like symptoms (aches and pains)
  • Dizziness
  • Switching between feeling really cold and really hot

Related post: Thyroid Patients Explain How Their Flare Ups Feel

What Causes a Flare Up?

These are the most common triggers according to thyroid patients:

  • Drinking alcohol
  • Eating poorly (such as a lot of sugary or processed food, not giving your body good nutrition)
  • Consuming a known food allergen or sensitivity (such as gluten, dairy, soy etc.)
  • Overexertion (mentally and/or physically) – See the spoons post
  • Stress
  • Not sticking to a good sleep routine
  • Viral, bacterial, fungal etc. infections
  • Being on your period or due to start on your period (hormone fluctuations)
  • Pregnancy

I asked the thyroid community to share the many causes of their flare ups here.

How Can I Avoid Flare Ups in Future?

Each time you experience one, try to pinpoint what things (such as those listed above) have contributed to it. Obviously the main thing to do here is then avoid them in future if possible, so as to reduce the chances of another flare.

Some people find relief from flare-ups when they eliminate a food allergy or sensitivity, such as gluten. Around 90% of people with hypothyroidism have the autoimmune disease Hashimoto’s, which is the cause for their hypothyroidism.

Many don’t even know it, though, and for these people, cutting out gluten from their diet is often cited to help control thyroid antibodies and ease symptoms, helping them reduce the amount of future flare ups.

You can also look at quieting the immune response by lowing your thyroid antibodies if you have Hashimoto’s, which can even lead to the condition being in remission. By lowering thyroid antibodies, we’re told that this puts the condition under control and means it is better managed, reducing symptoms and flare ups. See this article for ways to do this.

Supporting your immune system and body as a whole with good nutrition, supplements such as Vitamin C, D and Selenium, adequate sleep and keeping stress levels low can also help.

Ensuring you are also addressing any adrenal dysfunction is also very key, as adrenal fatigue (though it is more accurately referred to as hypothalamic-pituitary axis dysfunction) often goes hand in hand with hypothyroidism and can cause many of the same symptoms.

Having your thyroid levels tested regularly and ensuring they are all optimised is also key to feeling well with thyroid disease.

What Should I Do in a Flare Up?

First and foremost, it is important to say that if you’re feeling incredibly unwell, then you should always see your doctor in case something more serious is going on. If what you initially think is a flare up actually carries on for weeks or months, it is probably more likely a sign of a thyroid medication dosage adjustment or need for other investigations.

How To Manage Flare Ups When They Happen

The bad thyroid days are a part of having hypothyroidism that I have learnt to accept with time, but I did, at one point, think I would be able to make a 100% recovery back to full health, without any flare ups ever again. But you know what? No one person is in perfect health every single day of their lives. And so it’s perfectly normal to expect flare ups in symptoms from time to time.

Now I realise it’s OK and normal to have bad health days. My health is always going to require close monitoring to try and keep it on track as much as possible.

As thyroid patients, we do often expect a bit too much from ourselves, too. And I’m very guilty of this!

On a bad thyroid day or flare up day, I like to rest, keep warm, put on some films or a TV boxset, and drink lots of warm drinks such as hot water and lemon, or herbal tea, keeping myself well hydrated. I eat nourishing food, enjoy bone broths and might even call a friend or two for some company. But if I don’t feel sociable, then that’s OK too.

I listen to my body and let it have whatever it needs to get over this flare. I often like to try and get in the bath (if I have the time) as this helps my body loosen up, but hot water bottles can also really help with this too.

On days where I have had to work or otherwise didn’t have the luxury of just resting in front of the TV or in bed, I have compromised. I can try to limit how much work or other commitments impede my recovery from a flare up. For example, seeking permission to work from home, working altered hours until the flare has passed, replacing walking to and from work with transport to save energy, or otherwise speaking to my line manager about suitable adjustments.

If making changes surrounding my work isn’t an option, at the very least I can support recuperating outside of work as much as possible. I limit how much unnecessary activity I do and maximise resting and recuperation time instead. Learn to say “no”. I avoid sugar and caffeine and other stimulants that place additional stress on the endocrine system, and eat nutrient dense food to nourish me and aid my recovery.

It’s OK to not be 100% well everyday. It’s OK to look after yourself.

If I can, I’ll take a bath and relax, listen to music… anything that helps me feel well cared for.

But most importantly: take it easy.

Don’t over-do anything, as you’ll just make it worse, so instead listen to your body and do not in anyway overexert it during a flare up. Don’t do anything requiring too much from you mentally, physically or emotionally. Just rest and look after your body. After all, you only get one.

What are thyroid flare ups like for you?

You can click on the hyperlinks in the above post to learn more and see references to information given.

Please remember that if you’re a thyroid patient living with poor mental health or lingering physical symptoms, that you don’t have to live this way. To address why you may still be feeling unwell (often despite being on thyroid medication too), please see this article and go through each suggestion, putting your thyroid jigsaw back together.

See also:

The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired, which builds on this article in detail.

The online thyroid course ‘Freedom From Thyroid Fatigue’, also walks you through how to overcome thyroid fatigue and flare up days with a personalised approach.

If you found this article beneficial, please take a moment to share it so we can help others get better with hypothyroidism and Hashimoto’s, whilst also raising awareness. “Be Your Own Thyroid Advocate.” 2K Shares

Written by Rachel, The Invisible Hypothyroidism

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Rachel Hill is the highly ranked and award-winning thyroid patient advocate, writer, blogger, speaker and author behind The Invisible Hypothyroidism. She has two books: ‘Be Your Own Thyroid Advocate‘ and ‘You, Me and Hypothyroidism‘. Her thyroid advocacy work includes writing, speaking on podcasts and co-creating Thoughtful Thyroid courses. Rachel has worked with The National Academy of Hypothyroidism, BBC, The Mighty, Yahoo, MSN, ThyroidChange and more. She is well-recognised as a useful contributor to the thyroid community and has received eight 2019 WEGO Health Award Nominations.

Hypothyroidism and Relationships: What You Need to Know

With symptoms ranging from fatigue and depression to joint pain and puffiness, hypothyroidism isn’t an easy condition to manage. Still, hypothyroidism doesn’t have to become the awkward third wheel in a relationship.

Regardless if you’re married, in a long-term relationship, or navigating the dating scene, here are five tips from people living with the disease.

1. Share information.

Hypothyroidism is a difficult condition to explain. While you may feel like you’re explaining yourself well, there may be times when your partner just nods their head or offers their sympathy. This, of course, can be frustrating and can lead to intense, strained conversations. Instead of going at it alone, share with your partner.

Email them links to great articles, blogs, or websites about the condition. Also, sharing with them what others who have the disease have to say might give them a better perspective. Ask them to explore some hypothyroidism community pages. Share with them any great books or pamphlets you’ve read about the disease. Consider asking them to come to a doctor’s visit. The more they know about hypothyroidism, the more they can help you.

2. Ask for help.

Hypothyroidism can affect not only how you feel, but how you function too. Going to work, doing the dishes, going to the grocery store, or picking up the kids from school may have been relatively easy before, but now those tasks may seem like insurmountable feats.

If this is the case, ask your partner for a helping hand. Freeing up your schedule will give you the time you need to relax, or — at the very least — relieve some unnecessary stress.

3. Do something active together.

Having an underactive thyroid increases your chances of developing cardiovascular problems. Exercising regularly can help reduce these risks, but sticking to a plan can be difficult, particularly if you’re feeling tired. Use this as an opportunity to enlist your partner to help you stay on track.

This doesn’t mean you have to sign up for a marathon together! Going for a walk after dinner, swimming a few laps in the community pool, or playing a few games of tennis are all good choices. These activities can leave you feeling energized, and even facilitate some meaningful conversations between you and your partner.

4. Find other ways to be intimate.

You may not think having an underactive thyroid will affect your sexual relationship with your partner, but it might. Fatigue and tiredness can lead to a lower sex drive and a lower libido.

But don’t automatically assume that your quest for intimacy is out of the picture. This is simply a chance for you and your partner to find other ways to be intimate. Cuddle together while watching your favorite movie, hold hands while you’re shopping, or give each other a relaxing massage with fragrant oils and creams. With time, and with the proper treatment, you’ll likely see your drive and libido level return to normal.

5. Be patient.

Being patient can be difficult and tricky at times –- even for those without thyroid problems. But patience is key, and it’s how you should try to approach dating with hypothyroidism.

Your body, mind, and spirit may not be up for going out and socializing all the time. Rather than pushing yourself too far, communicate your needs. If you’ve already agreed to go on a date and you’re not up for it, ask if you can reschedule instead.

Consider asking your friends for help. They may know someone that’s right for you or may have suggestions for meeting others. And remember, finding a partner takes time. For everyone.

Most of the patients that participated with healthy, middle-aged women. Approximately 2/3 of the patients had TSH in the normal range at 6 months, but 1/3 still had mild hypothyroidism, meaning that their levothyroxine dose was too low. Before starting levothyroxine, quality of life was lower in patients with hypothyroidism compared to healthy Danish controls on all measured scales, with the largest difference in the degree of tiredness. Most quality of life scores improved by 6 weeks after starting medication, and scores for depression and cosmetic concerns continued to improve over the entire 6 months. However, at 6 months, many quality of life measures were still worse than the healthy population controls. There was no association between quality of life and thyroid hormone blood levels.


Patients with untreated hypothyroidism had worse quality of life, predominantly fatigue, compared to healthy patients without hypothyroidism. Quality of life improved after treatment but remained not as good as the control population. There are many reasons for this, including having to take a pill every day and having a medical diagnosis. Also, there is consideration as to whether levothyroxine therapy alone is the best treatment for hypothyroidism. None of these possibilities were addressed by this study and should be examined in the future. Although the way the study was done could be improved upon, patients and their physicians should set realistic goals for improvement at the start of treatment, and especially discuss that some level of decreased quality of life may remain beyond 6 months despite adequate treatment.

— Melanie Goldfarb, MD



Thyroid Hormone Treatment:

Thyroid Function Tests:

Let’s be real here. Having a chronic illness like hypothyroidism is no fun. It’s something that you have to constantly think about and manage, making choices that are healthier or, at the very least, not harmful. Throw in a menstrual cycle and you’ve got quite the task. Hypothyroidism has a lot of side effects like weight gain, fatigue, depression, and a heavy and/or painful period. While you may not be able to make your illness go away, you can do things to manage it. The five lifestyle changes below can boost your mood, energize you, make your period go a bit more smoothly, and even work to heal your thyroid.

Maintain a Healthy Body Weight

This might seem challenging, especially because hypothyroidism can make it hard to lose weight. It’s an important factor in having a healthy life, though. Having too much body fat can make your body resistant to insulin and this can affect your hormone levels. It’s a vicious cycle because people who are overweight need more thyroid hormone for their thyroid to work correctly. The following tips can help you get to or maintain a healthy body weight which can improve thyroid function and reduce your risk for thyroid cancer. Win win!

Eat a Balanced Diet

One of the kindest things you can do for your body, regardless of health conditions, is to eat a balanced and nutritious diet. This is especially true if you have hypothyroidism. Choosing certain foods with nutrients that can counteract the effects of your chronic illness can leave you feeling more energized, boost your mood, and give you an overall sense of wellness. Clean eating is something that many professionals recommend for those with a thyroid disease. This means ditching the pre-packaged foods and choosing healthier options like fresh fruits and vegetables, lean meats, and a moderate amount of whole grains. Your diet should include plenty of Selenium, Omega-3s, calcium, magnesium, and Vitamins B6 and E.

Exercise in Moderation

Exercise goes hand in hand with a balanced diet if you have hypothyroidism. Walking, running, or lifting weights are all powerful ways to take control of your health but make sure you’re listening to your body. Hypothyroidism can worsen if you overexert yourself because it removes an iodine molecule from your inactive thyroid hormone (T4), making it so that your body can’t convert it to T3, your active thyroid hormone.

Another benefit to exercise for people with hypothyroidism that experience period cramps are the boost in endorphins you get when you get your heart pumping. These endorphins can act as natural painkillers, making PMS symptoms milder or eliminating them completely.

Get Enough ZZZ’s

We all wish there were a few more hours in the day so we could get everything done. It can be tempting to skimp on sleep in favor of tackling your to-do list but sleep is a critical function, especially if you have hypothyroidism. When you’re sleeping, your body has a chance to repair tissues and lower the stress hormone cortisol. If you have trouble sleeping, exercise and stress management can help.

Manage Your Stress Levels

We live in a world where stress is sometimes glorified and misunderstood as success. When you’re living with hypothyroidism, it’s really important to manage stress because it can wreak havoc on your thyroid by increasing the resistance of your thyroid receptor cells to your thyroid hormone and weakening your immune system. Yoga, meditation, and, of course, exercise can all help you to keep your stress levels at bay.

Living with a chronic illness isn’t easy. When you also have a period to deal with, it can be even more challenging. The good news is that, between medication and lifestyle changes, you can live a very healthy and happy life. All it takes is making a few tweaks to your routine and you could be feeling better in no time.

11 Things You Only Understand If You Have Hypothyroidism


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Hypothyroidism is a condition that influences the release of your body’s thyroid hormones — in this case it doesn’t produce enough. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), thyroid hormone plays a vital role in metabolism; brain, heart, and liver function; reproductive health and fertility, and more. So, even subtle fluctuations in your thyroid can contribute to some big changes in your body. And that’s why living with a thyroid condition like hypothyroidism can be challenging on a daily — and even hourly — basis.

While nearly 20 million people in the United States have some type of thyroid disorder, according to the American Thyroid Association (ATA), hypothyroidism can be a misunderstood condition. Your coworkers, friends, and loved ones may not realize how much it can impact your everyday life.

Here, people with hypothyroidism describe what it’s really like to live with the condition. Share this list with the people in your life to help them better understand what you’re going through:

1. Coffee isn’t the answer. “I am tired … all the time. It hits me around 2PM,” says Christina Nicholson, 33, from Coral Springs, Florida. She was diagnosed with Hashimoto’s disease — an autoimmune disorder that can cause hypothyroidism — at age 27. “Some people say, ‘oh yeah’, I get tired around then too and brush it off like I need a cup of coffee or something.” Talia Mariani, 27, from New York, also finds that other people don’t understand her fatigue. “I’ll get asked often why I don’t just drink more caffeine,” she says. “What people fail to recognize is that caffeine is an additional stressor on the system, so for me, caffeine ultimately becomes more of a threat than a blessing.”

“The best way to combat fatigue is to do things to promote good health, such as eating healthy, getting regular exercise, and getting a good night’s sleep,” says Alan P. Farwell, MD chief of the section of endocrinology, diabetes, and nutrition and director of endocrine clinics at Boston Medical Center.

2. Going to bed on time doesn’t necessarily mean you’ll get a good night’s sleep. Getting enough sleep at night can be easier said than done. There are a number of factors that can affect your ability to get good sleep, including your thyroid medication. According to the Cleveland Clinic, taking too much thyroid medication can cause difficulty sleeping. “ When I was first treated, I would have to take a mix of different doses on different days to help find the right dose,” says Trish Hoffman from Laguna Beach, California, who was diagnosed at 34 and has many family members who also have hypothyroidism. “One time I was overmedicated and couldn’t sleep for three days.”

“If you’re unable to sleep through the night, you’re likely to be tired the following day,” Dr. Farwell says, so this can make symptoms of fatigue even more intense. “Sleep problems such as sleep apnea are becoming recognized as very common and can be evaluated with a sleep study that your doctor can order.”

3. To-do lists are your best friend … your brain fog is not. An underactive thyroid can cause problems with concentration and memory, according to the University of Maryland Medical Center. You may have difficulty concentrating at work or even at home while you’re talking to your kids. You may seem forgetful to your friend while chatting at lunch, or absent-minded to your boss at your yearly review. If you’re experiencing these issues, there are a number of strategies you can try to help improve memory and concentration, such as focusing on one task at a time, using written lists and reminders, and sticking to a schedule.

4. Your mind isn’t the only thing that’s blocked. Constipation is another common symptom of hypothyroidism, according to the NIDDK. You may find that even eating a fiber-rich diet or taking the latest probiotic pill doesn’t help you — you’re still constipated and uncomfortable. If this becomes a constant issue, work with your doctor to find ways to remedy and prevent constipation.

5. Even if you eat right and exercise, you may have trouble losing weight. “Keeping weight off is a challenge, even with exercising regularly and eating right as I do,” says Suzanne Andrews, a licensed occupational therapy practitioner from Ormond Beach, Florida. Mariani agrees. “I’m a personal trainer in New York and I was diagnosed with Hashimoto’s thyroiditis about four years ago,” she says. “People often ask me if I have ever thought about eating less and moving more. It’s a super frustrating and even an offensive question on its own, but to throw in the fact that I’m a professional in this field takes it to another level.”

“The inability to lose weight in people with hypothyroidism doesn’t follow the standard rules of cutting calories or exercising more,” says Westin Childs, MD, an integrative doctor who focuses almost solely on hypothyroidism. “Low thyroid leads to a decreased metabolic rate (which lowers overall metabolism) and can make weight loss very difficult without appropriate intervention.”

“One mistake many people make is to set an unachievable weight loss goal (for example, to lose 50 pounds in 3 months) — that sets you up to fail,” Farwell says. “It’s better to set several smaller goals (for example, to lose a pound a week, or 2-3 pounds per month). This also allows diet changes that can continue long term.”

6. It can feel like you just ran a race … but you just woke up from a nap. “I know if I wake up sweating or with heart palpitations, my medication dose is too high,” says Barbra Watson, 43, from Boston. “Changes in thyroid medication dosing take several weeks to get your thyroid levels to the new level,” Farwell says. “Some people have acute symptoms after changing their dose, but these subside over a few weeks.”

7. You miss the person you used to be. If you have hypothyroidism, you may find that you can’t fit into your old clothes, you don’t have the energy to play with your children like you once did, or you’re just not able to do the things you used to do. “The difficult thing about this condition is that the symptoms are often explained away — as if being a woman, a working mom, or in your 40s, is a reason these things are happening,” says Hollie Geitner, from Pittsburgh, Pennsylvania. Hollie was diagnosed in her mid-20s with Hashimoto’s thyroiditis and will soon be 42. “I suppose it has become a way of life for me.” But she goes on to share that the reality for her is that she’s had to learn to work through these changes — for better or worse. And with proper treatment, many of these hypothyroidism symptoms can be controlled, according to the ATA.

8. Gloves are a year-round accessory — so are socks and scarves and sweaters. Another symptom of hypothyroidism is the constant feeling of being cold. “People think I’m nuts when I say I’m cold,” Andrews says. “How can they relate when it’s 74 degrees in the room and my hands are like ice?” In these situations, make yourself comfortable and forgo worrying about what others are thinking — gloves can be considered a classy fashion statement after all. Taking your thyroid medication can also help control cold intolerance and other symptoms of hypothyroidism.

9. You constantly feel like you have to prove you’re not lazy. “I think the biggest misconception is that those around you may just feel like you use this condition as an excuse for being tired or they may even think you’re lazy,” Hoffman says.

Dr. Childs agrees. “I think the stigma surrounding weight and being lazy is a big one that wears on people with hypothyroidism,” he says. “This can be made worse by the fact that they almost always have fatigue with the weight-loss resistance.” Don’t let others get you down, do what you can, and be open with those you care about. Instead of making excuses for feeling tired or run down, explain that fatigue is a symptom of your condition.

10. Moody is your middle name. “I can tell if I feel like I’m moody all month long, it’s probably my thyroid,” Watson says. According to the British Thyroid Foundation, an underactive thyroid can cause emotional symptoms, such as mood swings. Try to keep mood swings from becoming a problem by explaining your situation to your loved ones and asking for compassion and understanding when you do experience them.

11. You feel sick, but look “fine.” While some hypothyroidism symptoms are obvious to the naked eye, like weight gain and hair loss, others, like joint pain and depression, are invisible. “I believe the most deceiving thing about this condition is that, for the most part, other people can’t see your pain,” says Kylie Wolfig, 46, from Perth, Western Australia and founder of Thyroid School, who has lived with Hashimoto’s thyroiditis for over 25 years. “They can’t see your anxiety, your confusion, or that you’re overwhelmed.”

“I never appreciated how much your thyroid does for you,” Watson says. “It regulates so much.” Focus on taking care of yourself and let go of worries about other people’s judgements of you. Work on communicating with your friends and family so they have a better idea of the challenges you face. Chances are, they’ll do their best to treat you with compassion.

If your hypothyroidism symptoms are very persistent, “Seeing an endocrinologist can help if you’re not feeling fine after your first dose of medication, if there is some disagreement on whether you should be treated in the first place, if you are considering a pregnancy (or are pregnant), or if you simply want to know more about the condition,” Farwell says.

It’s here again. But then it never really goes away.

My bones creak as I slump onto the sofa. The rest of the country is sleeping soundly but once again it’s the night shift for me. Five visits to the osteopath. A month-and-a-half of basically no sleep whatsoever. Today is Day 41 of what the doctor has routinely been calling sciatica. He has no idea what’s causing it, but I do.

The signs

Just over three years ago I was diagnosed as hypothyroid – in simple terms my thyroid gland was not producing the hormones that my body needed in order to function. The diagnosis was the cherry on top of a raft of symptoms that had systematically turned a robust, hard-working, hard-living writer into somebody who spent most of his time in bed thinking about death.

It’s difficult to remember the exact order of their arrival but – excuse the cheap pun – off the top of my head it must have been the psoriasis that came first; that sprinkling of white dust on my collar that always proved to be so attractive under the ultraviolet lights of the night club. Then came the fainting spells: usually in the middle of the night but always spectacular affairs when the dead weight of my body hit the bathroom tiles. Gashed chins, chipped teeth, broken noses and third-degree burns on my back (after collapsing beside a red hot radiator) were war wounds that I learned to live with. I gotta cut out the drinking, I used to tell myself back then.

Ian Probert

Then there was the weight gain: the 42 pounds of blubber that seemed to appear overnight; the pain in my hip due to a condition known as avascular necrosis, in which the blood supply to the femur is inexplicably cut off, causing the bone to crumble away and the hip to collapse; the facial eczema; the mysterious backaches such as the one I am suffering right now; the insomnia; carpal tunnel; the continual colds caused by an immune system that had gone AWOL. The inability to concentrate – fellow sufferers call it brain fog – and, therefore, the end to a writing career that had been ticking along quite nicely thank you very much. And finally, after more than a decade of symptoms such as these overpowering my life, came the depression. Indescribable debilitating depression that sucked out the soul and spat it out into a bucket. I gotta cut out the living, I used to tell myself then.

But, I tell myself nowadays thanks to that thing they call hindsight, I was a special case. What happened to me shouldn’t really have happened to anybody. For some reason nobody thought to join the dots and the picture was left incomplete. When I saw the doc about hip pain he gave me anti-inflammatories; when I saw him about my skin he gave me steroids. When I mentioned my depression he told me to keep smiling. For some reason it never occurred to anybody that my symptoms might be part of a greater whole.

Science Photo LibraryGetty Images

A revealing blood test

As it happened it was an Irish friend who took a look at what was left of me one morning maybe 15 years after first experiencing symptoms and told me to get my thyroid checked out. Her tone of voice seemed to suggest that this was something one usually did after flossing one’s teeth. It was only when a message was left on my phone by a panicky GP the morning after blood had been taken from me that things got a little more serious.

And serious is what it was and still is. Because from the moment you are diagnosed as hypothyroid you have no choice but to take things very seriously indeed. You are the unwilling inhabitant of a world of constant blood tests, a domain in which nobody but yourself has responsibility for your own destiny. To survive as hypothyroid is to learn. To understand why your body is misfiring in the many ways that it can and will do is down to you and you alone. To trust nobody because no matter how many doctors you see, how many experts you visit, no two opinions will ever be the same.

Essential medication

For me the saviour has been three little white pills that I take very day. I say saviour but levothyroxine is a drug that only does a half-decent job of alleviating one’s symptoms.

When you are hypothyroid your life is governed by a butterfly-shaped organ at the base of the neck that most people have never heard of. And to survive you had better quickly learn what makes it tick. You must educate yourself to understand the various hormones that the thyroid produces in order that you may live; you must learn to feed the thyroid with the correct foods and avoid the ones which do it harm. It’s not rocket science: fish and nuts and fruit and veg are in. Soya, corn, broccoli and – oh yes – alcohol are best avoided.

But it never goes away. Thyroid disease sufferers quickly learn to understand that when something goes wrong with their body there is usually only one culprit. Small or large, major or minor the thyroid is always ready to punish you.

And for the last 41 days it has been punishing me. The osteopath quietly prods always at me, the doctor tells me this and tells me that. But me and my thyroid know the real reason why life has been temporarily placed on hold. In my case lack of Vitamin D is the probable reason. Vitamin D deficiency is a yet another common symptom of any underachieving thyroid. Without this vital substance bone and muscle health can rapidly degenerate. But sooner or later I will be better, I know that. And for a while I may be able to function normally. Until the next time, that is.

In the meantime, I can only keep on taking the pills and doing the things that one is supposed to do: exercise, regular sleep, everything in moderation all help, as does the knowledge that one is never alone. A simple Google search can put you in touch with thousands who suffer from this insidious disease. Websites, forums and Facebook pages abound… I’ve even started one myself.

When to see your doctor

Symptoms of an underactive thyroid are often similar to those of many other conditions, and they develop slowly, so you may not notice them for years. But you should make an appointment with your GP and ask to have your thyroid tested if you have these signs:

  • Tiredness
  • Weight gain
  • Depression
  • Feeling cold all the time
  • Have dry skin and hair
  • Muscle aches

What It’s Like Living With Hypothyroidism

To be able to speak so publicly about an issue concerning you personally is a feat that not many can conquer. To publish, and mediate what is going on in your personal life takes confidence in the security of what your body cannot do. After searching extensively on the internet as to how people experience and deal with Hypothyroidism, I have found that not many people talk about it. The fact is that Hypothyroidism is a life-long disorder, with no cure; that being said I believe it is time to be more vocal about the disorder and the effects that it has on the body.

I was first diagnosed in 2011, when one day I was wondering why I lose so much hair throughout the day. Soon after that I got my first round of blood work, (nowhere near the last) and it turned out I had a pretty severe case of hypo. I was immediately prescribed Synthroid, and an appointment was set up to see an endocrinologist approximately two hours from where I live.

What some may be asking is what exactly is Hypothyroidism? The term describes an under active thyroid gland which can make you experience:

    • Fatigue
    • Increased sensitivity to cold
    • Dry skin
    • Weight gain
    • Puffy face
    • Hoarseness
    • Muscle weakness
    • Elevated blood cholesterol level
    • Muscle aches, tenderness and stiffness
    • Pain, stiffness or swelling in your joints
    • Heavier than normal or irregular menstrual periods
    • Thinning hair
    • Slowed heart rate
    • Depression
    • Impaired memory
    • Goiter
    • Heart Problems
    • Infertility
    • Birth Defects

    The issue is that with Hypothyroidism, it is all a game of getting the right level dosage given to you to ensure that you don’t experience these symptoms too heavily. Me personally, I would always struggle with fatigue, being constantly cold, thinning hair, and later, goiter.

    Through the years the endocrinologist was not as necessary anymore, however I went to see her about every 6 weeks following my blood work to see if my levels were finally in normal range; this took about four years. On my second last to visit, I had stated that I had noticed that it was a little more difficult to swallow, and after a simple physical, the doctor had ordered an ultrasound to ensure there was no abnormal growth within the thyroid gland. Me being a sophomore in high school, I thought of worse case scenarios, thinking about the fact that what they find could be potentially cancerous. To my best luck, it was only a goiter; and while that doesn’t sound too great, I don’t know one person that would rather go through cancer than a constantly enlarged gland.

    Not many people here at school know about my disorder, seeing that I am not too vocal about it. I figure that everyone has something going on in their life, and that because having a disorder has become part of my everyday life, I have normalized it. The reality is that there are some days that no matter what you do, nothing warms me up, and that I could easily sleep the day away and still struggle to get out of bed after 16 hours. I live in a constant fear of thinning hair and easy weight gain. Having a disorder includes accepting the fact that you will take a pill every single day for the rest of your life. Having a Hypothyroidism makes getting out of bed feel like you’re climbing a mountain, and that three sweaters may not be enough.

    It has been 6 years since I have been diagnosed, I have been poked and prodded and examined too many times to count. I have a disorder that will affect me for the rest of my life, and I fight with it everyday. Having a disorder is sometimes a battle between body and mind, and it’s been 6 years, and my mind has one every single fight.



Hypothyroidism is one of the most common endocrine conditions encountered in the UK, and is more common in females than males (ratio 6:1). In one study, the prevalence of overt hypothyroidism was reported to be 9.3% in women and 1.3% in men, with an annual incidence of 40/10 000 and 6/10 000, respectively.1 It is usually primary, as a result of disease of the thyroid gland itself. The most common cause is autoimmunity, but other causes include iatrogenic (damage from surgery, radiation, radioiodine or drug treatment—for example, amiodarone, lithium and thalidomide), and iodine deficiency. Hypothyroidism due to hypothalamic–pituitary disease, resulting in low thyroid stimulating hormone (TSH, “secondary”) or thyrotropin releasing hormone (TRH, “tertiary”), is rare.

Hypothyroidism may manifest with a multitude of symptoms in adults, including fatigue, excessive somnolence, increased cold sensitivity, pale and dry skin, face puffiness, hoarse voice, unexplained weight gain, myalgia, bradycardia, arthralgia, muscle weakness, menorrhagia, brittle fingernails and hair, and depression. Constipation is the classical gastrointestinal symptom associated with hypothyroidism.

The diagnosis of hypothyroidism can be confirmed by carrying out thyroid function tests (TFTs), which are widely available. In primary hypothyroidism, thyroid stimulating hormone (TSH) values are raised and the total T4 (thyroxine) and free T3 (tri-iodothyronine) and are classically low. Further investigations can be considered in the presence of goitres or nodules, such as ultrasonographc scanning with targeted fine needle aspiration for histology/cytology.

A literature review revealed no similar cases in adults. No reports were found of abdominal pain, vomiting and diarrhoea being associated with hypothyroidism. Theoretically, these symptoms might occur in the presence of hypothyroidism associated severe constipation; however, our patient did not have evidence of this. In the absence of severe constipation, the mechanism by which hypothyroidism might cause abdominal pain, vomiting and diarrhoea is unclear. In the paediatric literature there have been reports of congenital hypothyroidism presenting with recurrent vomiting due to severe intestinal hypomotility.2,3

Learning points

  • Persistent nausea, vomiting, diarrhoea and abdominal pain can be caused by hypothyroidism.

  • Hypothyroidism is a rare cause of these symptoms.

  • Thyroid function tests should be conducted in patients with refractory gastrointestinal symptoms, especially if routine investigations do not reveal a cause.

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