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Hypothyroidism – What Are the Symptoms and How to Diagnose It

Do you think you have a thyroid issue?

If you have found this blog, I suspect you are searching for answers.  You probably haven't felt good in years.

You ask friends for their opinions.  They each have their ideas, but no real solutions.

You might have read an article in a magazine, or on the internet, or maybe even on a Facebook post that discussed thyroid issues, and you thought "That is describing me exactly!"

You probably even went to see a doctor.  You told him or her your complaints, they took a quick history, performed a simple physical exam, and then ordered some lab tests.

You might have even left hopeful, thinking that maybe this would be the time that someone finally figured out what was going on in your body.

Your hope was soon dashed, however, when you received a call from the doctor's office telling you that all of your labs were "normal."


The doctor probably offered a prescription for an antidepressant, or a sleep aid, or a pain medication, or some other type of prescription to treat one of your symptoms.

You might have even been prescribed a thyroid medication, but you were disappointed when you didn't really feel any better after taking it for awhile.

Even though you don't know what is going on, you know that something isn't right.

Perhaps you have even thought that this was your new "normal" and you would just have to learn to live with how you feel.

Unfortunately, that doctor could have been me until a few years ago.

Countless patients have come into my office over the years complaining of things such as unexplained fatigue, weight gain, depression, hair loss, mood swings, cold intolerance, headaches, dry skin, lack of libido, etc., or any combination of the above.

Doctors are taught in conventional training that if you want to assess the thyroid, just check a TSH level.  If it is high, the patient has hypothyroidism.  If it is low, the patient may have Grave's Disease or Hashimoto's Thyroiditis.  If it is normal, then the patient does not have have thyroid disease.

Simple, little to no thinking involved.

Unfortunately, nothing is ever that simple, especially when dealing with the human body.

Doctors are aware of a vast array of other thyroid tests that are available, but most don't believe they are necessary.  

To be honest, they may not know how to interpret the results or know what to do with them even if they did order them!  I know I didn't until I learned a better way - the correct way.

The vast majority of patients with these symptoms will have TSH levels in the "normal" range.  Doctors often don't know what to do with those patients, so they typically resort to prescribing medication for depression, or insomnia, or pain, or headaches, or even weight loss medication.

In other words, the downstream symptoms are treated instead of looking upstream to find the root cause of the problems.

Some experts estimate that up to 40% of the population has hypothyroidism.  That's one out of every 3 people!  Yet only a small fraction of them are diagnosed and even fewer are treated adequately.

What is the Thyroid and What does it do?

What exactly is the purpose of this butterfly-shaped gland at the base of our neck?  What does it do?

The answer is a lot, actually.  

It influences almost all of the metabolic processes in the human body.  That includes metabolism, growth, development, and body temperature.

It is essential for normal brain development in infants and children.

The hypothalamus secrets the hormone thyroid releasing hormone (TRH) which stimilates the pituitary gland to secrete thyroid stimulating hormone (TSH). 

TSH then stimulates the thyroid gland to produce primarily T4 (and small amounts of T3).  

The liver and muscles metabolize T4 into T3 (active thyroid hormone).  

In the presence of inflammation, stress, nutrient deficiency, etc., higher amounts of reverse T3 (rT3) may be produced which works to block T3 activity in the body.

Symptoms of Hypothyroidism

  1.  Fatigue - even after sleeping all night.  You may constantly feel like you need to take a nap during the day.
  2. Weight gain or the inability to lose weight.
  3. Mood changes - anxiety, depression, or mood swings
  4. Hormone imbalances - irregular periods, PMS, infertility, low sex drive
  5. Muscle or joint pain - includes tendinitis, carpal tunnel syndrome, etc.
  6. Cold intolerance - feeling cold when other people don't, cold hands and feet, body temperature consistently below 98.5 degrees.
  7. Dry or cracking skin, brittle nails, excessive hair loss
  8. Constipation
  9. Brain fog - poor concentration, poor memory
  10. Neck swelling, snoring or hoarse voice

This is an extremely compact list - the actual list of possible symptoms is MUCH longer.  An extensive list can be found here.  However, if you have several of the ones listed above, the chances of you having hypothyroidism is extremely high.

By the Way - It is important to understand that symptoms of hypothyroidism often overlap with other hormonal problems in the body.

Adrenal fatigue, peri-menopause, and menopause (andropause in men) often present with very similar symptoms to hypothyroidism.

It takes an experienced practitioner who can perform a thorough history, physical, and some targeted laboratory tests to distinguish what exactly is going on.

It may even be a combination of several conditions!

Diagnosing Hypothyroidism

Prior to the 1970s, hypothyroidism was a purely clinical diagnosis - doctors made the diagnosis after taking a thorough history and performing a physical exam.

After the TSH lab test was developed, it became the gold standard in diagnosing hypothyroidism.

Many doctors have now stopped looking for symptoms or clinical signs of the disease and almost solely depend on the lab for the diagnosis.

Unfortunately, this misses the vast majority of patients that are suffering from the condition!

The purpose of the lab tests should only be to confirm what the provider has already found after talking to and examining the patient.

As a wise old doctor told me when I was in medical school, "If you listen to the patient long enough, they will tell you what is wrong with them."

Thyroid Lab Tests

1. Thyroid Stimulating Hormone (TSH)

  • This hormone is produced by the pituitary gland in the brain. Its function is to stimulate the thyroid to produce thyroid hormone.  Conventional medical training has taught doctors that it is an inverse measurement of the amount of thyroid hormone in the body. However, it really is only a measurement of the amount of thyroid hormone present in the pituitary gland itself. The pituitary contains a different type of deiodinase (an enzyme that converts thyroid hormone to another type of thyroid hormone) than the rest of the body, so it is really not a true indicator of cellular levels of thyroid hormone in the rest of the body.
  • Ideal range should be 0.4 – 1.0. Anything higher than 2.0 indicates a problem (usually hypothyroidism). Anything less than 0.4 (if you aren't on thyroid medication) could indicate hyperthyroidism, such as Grave’s Disease. 

By the way - some experts suggest that the normal range for TSH should be lowered to 0.4-2.5.  This is because when the reference ranges were established for the TSH, the highly sensitive TSH test was not available, and the reference populations included people with various degrees of thyroid disease such as Hashimoto's.  The National Academy of Clinical Biochemistry indicates that over 95% of normal individuals have a TSH level below 2.5.

2. free T4

  • T4 is the primary thyroid hormone made by the thyroid gland. However, it doesn’t do much if anything in the body. In order to become “active thyroid,” it must go through deiodination which removes an iodine molecule and converts it to T3. A free T4 level is an indicator of how much thyroid hormone is not bound to protein and is available in the body.
  • Ideal range should be in the upper 1/3 or so of the reference range.

3. free T3

  • This is the measurement of how much active thyroid hormone is in your blood that isn’t bound to protein.  This may be the most important test to assess thyroid health.
  • Ideal range should be from the upper 3s to 4.4.

4. Reverse T3

  • This is sort of a default hormone that is produced if the body is under stress, or has inflammation from chronic disease, or if there is a nutrient deficiency of some kind.
  • Levels >15 are indicative of thyroid resistance and what we call cellular hypothyroidism.

5. Thyroid Peroxidase Antibody (TPO)

  • This is the measurement of antibodies to an enzyme that plays a part in the production of thyroid hormone.
  • Levels >35 are diagnostic of Hashimoto’s or autoimmune thyroiditis. It is important to monitor these antibody levels when you have been diagnosed with Hashimoto’s.
  • A level <35 does not necessarily rule out the presence of autoimmune thyroid disease.

6. Thyroglobulin Antibody

  • Another antibody that is produced when you have Hashimoto’s thyroiditis.
  • Levels >35 are diagnostic of the disease.

7. Sex Hormone Binding Globulin (SHBG)

  • This is the protein that binds to thyroid and the sex hormones in the blood. It is an indicator of thyroid function in the cells of the body. The higher the thyroid level, the higher the SHBG goes.
  • Ideal range is 70-80 in women, 20-30 in men. This level is also affected by estrogen.
  • If this level is low, treatment with T4 only thyroid medication made be inadequate.

8. Ferritin

  • Iron must be present in normal levels in order for the thyroid to operate properly. Ferritin is the primary test used in thyroid patients.
  • Ideal ferritin range is 70-80.

Okay, So Now What?

If you have many of the symptoms listed above and you have lab tests that confirm your suspicions, you can officially be diagnosed with hypothyroidism.

I discuss treatment options in my blog here.

Now It's your turn...

Do you think you have hypothyroidism?

Have you had problems getting a definitive diagnosis?

Anything in this article that you learned?

Leave your comments below.

About the Author Dr. Jeff Whelchel

Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.

Leave a Comment:

Jessica Sutterfield says June 10, 2017

Wonderfully crafted article for all of us non-doctors out there. Great read!

    Dr. Jeff Whelchel says June 10, 2017

    Thank you, Jessica! I’m glad you found it useful.

Reba Hayes says August 5, 2017

Jeff do I need this and does medicare cover it?

    Dr. Jeff Whelchel says August 5, 2017

    Hi Reba. I’m not sure exactly which part you are asking. The article on Leptin resistance would definitely apply to you. Come in and see me and we can discuss.

Louise Gallagher says August 10, 2019

I do think I have thyroid trouble. I have cold hands a lot and temp usually runs 97.7. I am tired and normally do not sleep through the night averaging 5 hrs sleep on a good night.

    Dr. Jeff Whelchel says February 10, 2020

    I hope you can find a medical provider that can help you.

Jo (short for Josehine) says June 21, 2020

very informative and educational, thank you for posting and helping to clarify my suspicions….

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