The Hypothyroidism Checklist With Dr. John Morris

At the top of the hypothyroidism checklist, you should expect symptoms that range from fatigue to weight gain, increased sensitivity to the cold and hair-loss.

Hypothyroidism is a condition in which the thyroid gland cannot produce a sufficient volume of thyroid hormone. Thyroid hormones are responsible for metabolic processes in the body. Metabolic process refers to chemical reactions that determine the speed at which cell functions can occur.

Thyroid hormones affect every cell in the body which is why you are likely to experience signs and symptoms that affect your overall health as opposed to one set of localized symptoms.

This week, LetsGetChecked is joined by Dr. John Morris of Mayo Clinic to talk you through four of the most common symptoms on the hypothyroidism checklist. The growing importance in knowing the signs and symptoms is mirrored by the fact that 60% of people in the U.S are unaware that they have thyroid issues.


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Hypothyroidism Checklist With Endocrinologist Dr. John Morris


The global rise of thyroid issues, most significantly in women is marked by increased discovery according to Dr. John Morris. Dr. Morris is an endocrinologist and endocrine oncologist based in Minnesota. Morris specializes in hypothyroidism, hyperthyroidism, thyroid cancers of all forms, Graves disease and, pituitary and adrenal disorders.

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“There is an increase in diagnoses and that is related to discovery.”

What is the function of the thyroid gland?

The function of the thyroid gland is to produce thyroid hormones. These hormones impact every cell, every tissues and every organ in the body, controlling the rate of metabolism, and controlling the rate of hormone production. The thyroid gland is responsible for ensuring that all tissues are bathed in the correct amount of thyroid hormones for optimal function.

What hormones are associated with the thyroid gland?

The hormone thyroxine is associated with the thyroid gland. T3 is an active version of thyroxine and circulates all around the body whereas T4 is a prohormone cell, meaning that it is physiologically inactive. T4 acts as a reservoir for T3.

Does the thyroid just affect the body or does it also affect the mind?

Emotionally: it is critical for the brain to have the correct amount of thyroid hormones to manage the mood as can be seen by the high prevalence of anxiety in those who have hyperthyroidism and the incidence of depression in those who have hypothyroidism.

Has the prevalence of thyroid issues increased or decreased in the last decade?

The answer is yes, there are more thyroid diseases being diagnosed. There has been a linear increase of hypothyroidism in the last few years. There is also an increase in the number of diagnoses being made because there is an increase in the number of those who are seeking out testing for thyroid issues.

A broader application of testing has shown a 3-4 fold increase of thyroid cancer in the last 15/20 years.

What are the symptoms associated with an overactive thyroid?

In cases of hyperthyroidism, the metabolism is sped up. The heart rate increases, those who have an overactive thyroid may experience heart palpitations, tremors, diarrhea, nervousness, sleeplessness, anxiety. You will lose weight even though you have an increased appetite. If you have severe hyperthyroidism, you would be able to eat whatever you want and it is unlikely that you would put on weight.

What are the symptoms associated with an underactive thyroid?

In cases of hypothyroidism, those who are living with the condition are likely to experience fatigue, they will feel cold, and tired all of the time. It is likely that they will have dry skin and hair, as well as constipation. As the metabolism slows down, the function of the bowel slows down. It is also likely that those living with an underactive thyroid will experience depressive or anxious tendencies.

Why do thyroid issues affect women more than men?

There’s not a very good answer for that. Most diseases are are autoimmune disorders, including Hashimoto, Graves and underlying autoimmune thyroid disease including lupus and rheumatoid arthritis. There are also genetic cases, where an individual has a genetic predisposition towards suffering from thyroid issues, as well as the differences between male and female hormones.

50% of thyroid cancer cases are incidental findings, caused by something else. Incidental findings are becoming a lot more common with the development of new technology. A patient may be going for a CT or PET scan and the imaging will display cancer cells.

Is hypothyroidism or hyperthyroidism more common?

Hypothyroidism is more common, especially amongst women:

  • 8-10% of women will be affected by an underactive thyroid.
  • 2-3% of women will be affected by an overactive thyroid.

What are the main symptoms that patients experience when they suspect that they are suffering from thyroid issues?

The symptoms associated with thyroid issues are often non-specific, common symptoms that could be due to something else, such as fatigue and weight-gain.

How much can a sufferer attribute weight gain to thyroid issues?

10-20 pounds of extra weight is a reasonable and expected number to attribute to weight gain. There are cases in which sufferers are morbidly obese and would attribute this to thyroid issues but it just doesn’t happen. 200 extra pounds are not associated with an underactive thyroid.

How much can a sufferer attribute fatigue to thyroid issues?

It’s highly variable, it depends on the severity of the condition. There is a huge amount of inter individual reporting on their level of fatigue. Someone who doesn’t have a severely under or over active thyroid may report pretty severe fatigue while someone who has a profoundly under or overactive thyroid may sa that they don’t feel symptoms at all or they can be very subtle. It really does depend and there is a lot of variability in the responses among patients regarding their symptoms.


Hypothyroidism Checklist: Fatigue


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First on the hypothyroidism checklist, we will be discussing fatigue, which may be chronic in nature. It is very common for those with an underactive thyroid to suffer from feelings of weakness or feeling tired all of the time, but, why?

It would be easy to assume that you may face fatigue simply because you are sick but there are chemical processes at play when it comes to understanding why hypothyroidism may cause fatigue.

As we know, the thyroid gland controls the rate at which thyroid hormones are released into the blood and circulated around the body. If you have hypothyroidism or an underactive thyroid, chemical reactions in the body will slow down in response to an insufficient volume of thyroid hormones being produced by the adrenal glands.

The slow down of these chemical reactions, also known as your metabolism may have impacts on your physical and emotional state.

When it comes to energy levels and fatigue, it’s important to know that your thyroid gland has a significant say in your overall vitality. When the metabolic processes in your cells slow down, you slow down. Lower thyroid function commonly results in a lower mood, energy levels and fatigue.

In one study that looks at the connection between Chronic Fatigue Syndrome (CFS), thyroid issues, physical inflammation, gut health and overall nutrition. In the sample group of 98 participants, it was found that the majority of those who suffer from CFS have low levels of T3. T3 is the active thyroid hormone which is circulated throughout the body, whereas T4 is the inactive form of thyroxine.


Hypothyroidism Checklist: Weight Gain


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Energy is another way of describing calories. Your energy balance refers to your consumption of calories versus the amount of energy you expend through exercise.

If you have an underactive thyroid, your required calorific intake may lower as fewer calories are being expended as energy. Your appetite may also decline. As your body converts fewer calories into energy, it is more likely that you will not burn off excess calories, and will store excess weight as fat leading to overall weight gain.

To explain this process, it is may be useful to explain what it means to gain and lose weight from a calorie in and out perspective.

When you eat and drink, you consume calories. When you move your body, your expend energy, also known as calories.

Each and everyday, we burn a certain number of calories just by being alive, it might surprise you to know that even while you sleep, you burn calories at an average rate of 46 calories per hour.

To simplify the above:

  • Equal Calories In + Equal Exercise Out= Weight Maintenance
  • Higher Calories In + Lower Exercise Out= Weight Gain
  • Lower Calories In + Higher Exercise Out= Weight Loss

If your thyroid gland is not producing a sufficient volume of thyroid hormones, your metabolism may slow down, meaning that the chemical reactions that maintain fat burning processes also slow down. This is compounded by the fact that you may also suffer from fatigue, low energy and low mood.

As Dr. Dominic Rowley explains in a previous interview, thyroxine acts on every cell in the body, which is why it is known as the powerhouse of all cell functions, if you have a low mood and low energy, this can also lead to a cycle of comfort eating which may become a cycle in itself in causing weight gain.

It is important to remember that no more than 10-20 pounds of weight-gain may be attributed to thyroid issues. If you are worried about weight-gain associated with your thyroid function, you should ask your doctor for tips on how you can balance your levels from a medical and holistic standpoint.


Dr. Dominic Rowley Explains Some Reasonings Behind Unexplained Weight Gain



Hypothyroidism Checklist: Sensitivity To The Cold


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While an overactive thyroid may cause an individual to feel too hot, an underactive thyroid may increase a person's sensitivity to the cold.

Thyroid hormones have the ability to influence how much our blood vessels dilate and the dilation of blood vessels influences how much heat can escape the body.

Thyroid hormones regulate the basal metabolic rate. The basal metabolic rate refers to the amount of energy per unit of time that a person requires to function while resting. Traditionally, it is said that those who live with hypothyroidism will experience less control when it comes to vascular restriction at room temperature.

This results in the body rapidly losing heat and becoming more hyper-sensitive to the cold.

If you have an underactive thyroid, your basal metabolic rate slows down. In one study using mice, it was found that mice with thyroid issues were more likely to have an increased sensitivity to the cold as heat was lost through their tails, their underactive thyroid meant that they could not regularly regulate the constriction of their blood vessels.

In one testing instance in which mice were losing heat through their tail, and using energy found in fat cells as an attempt to stay warm, researchers gave the mice drugs that would cause vascular constriction as opposed to dilation, heat loss from the tail was reversed, and the use of fat cells was "switched off".

If you notice that you feel cold at warm temperature or colder again when you're outside, you should talk to your doctor about this symptom as it is prominent in cases of hypothyroidism.


Hypothyroidism Checklist: Hair Loss


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Hair loss can occur in instances of an under or overactive thyroid.

Dr. John Morris explains: "Hair loss can happen with many illnesses, including the flu. Subsequent to thyroid issues, hair follicles may stop growing. The scientific answer for why it occurs is varied. With a hypo or hyper thyroid, the hair can enter a cycle where it falls out and grows back in."

When hair loss does occur, it generally affects the entire scalp as opposed to patches. Hair loss usually becomes apparent following several months of living with the condition and often times, the treatment of hypothyroidism or hyperthyroidism using anti-thyroid drugs is blamed as the culprit for hair becoming thin or falling out, however, the use of anti-thyroid drugs is rarely to blame and the withdrawal of treatment can cause hair loss issues to worsen.

"Generally, the hair cycle has a nice steady range and continuously grows over a period of time. Hair follicles are dependant on thyroid hormones to the grow the hair at a normal rate."

Solutions:

  • Don't panic, hair loss associated with thyroid issues is temporary.
  • Be patient, re-growth of hair may take some time but know that the anti-thyroid medication will stimulate your hair to grow.
  • Be wary of certain hair supplements as many of them contain iodine and will tamper with the function of your medication.
  • Know that each case is different, each instance of hypothyroidism is unique, always follow the personalized guidelines set for you by a qualified medical practitioner.
  • Try not to stress, believe that your treatment plan will work and that is half the battle, you are not alone.

Read: Living with Hypothyroidism: The Symptoms Of An Under-active Thyroid Explained



Written by Hannah Kingston | Approved by Medical Director Dominic Rowley