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Symptoms, References & Risk Factors

The symptoms, references, and risk factors for thyroid disease are shown below, but not everyone with abnormal thyroid hormones gets all of the symptoms. To add further confusion, the symptoms don’t seem to fit everyone, and 10% of people with hyperthyroidism gain rather than lose weight!

Thyroid disorders are diagnosed by testing hormone levels; however, usually, it’s just the TSH and thyroxine (T4) hormones that are tested, but T3 is four times more biologically active than T4. The symptoms below are possibilities rather than definites, and the longer hormones have been abnormal and further from the norm, the worse symptoms usually become.

Hypothyroidism

Hyperthyroidism
Subclinical Overt Subclinical

Overt

Thyroid stimulating hormone (TSH)

Slightly Raised

Raised

(above 10 mIU/L)

Normal

Low

(below 0.3 mIU/L)

Thyroxine (T4)

Normal

Low High

High

Triiodothyronine (T3)

Normal

Low High

High

Temperature

Intolerance to cold and feeling cold

Intolerance to cold and feeling cold Intolerance to heat and feeling hot

Intolerance to heat and feeling hot a lot

Digestion

Constipation

Constipation Frequent movements, possibly diarrhoea

Frequent movements, possibly diarrhoea

Energy

Fatigue

Fatigue Fatigue

Fatigue

Skin

Dry, itchy

Reduced sweating

Dry, itchy

Reduced sweating

Increased sweating, itching and hives

Increased sweating, itching and hives

Nails

Thin and brittle

Thin and brittle Thickened

Thickened

Hair

Thinning of the outer third of the eyebrows

Thinning of the outer third of the eyebrows Fine hair that’s thinning and falling out

Fine hair that’s thinning and falling out

Emotional

Rapid thoughts

Depression

Rapid thoughts

Depression

Anxiety, irritability, moodiness

Anxiety, irritability, moodiness

Voice and lungs

Hoarse and breaking

Hoarse and breaking Difficulty breathing, even at rest

Difficulty breathing, even at rest

Fertility

Infertility, abnormal menstrual cycles, reduced libido for men

Infertility, abnormal menstrual cycles, thin endometrium, reduced libido for men Abnormal menstrual cycles, infertility

Abnormal menstrual cycles, infertility

Blood serum

High cholesterol

High cholesterol

Heart

Low heart rate: below 60 bpm, hypertension

Low heart rate: below 60 bpm, hypertension Palpitations, increased pulse rate

Palpitations, increased pulse rate

Body

Weight gain, poor muscle tone, water retention, muscle cramps, goitre

Weight gain, poor muscle tone, water retention, muscle cramps, carpal tunnel syndrome, goitre Weight loss, muscle weakness, tremor or shakiness, dizziness, goitre

Weight loss, muscle weakness, tremor or shakiness, dizziness, goitre

Sleep

Sleep apnea

Sleep apnea Insomnia

Insomnia

Reference ranges

There are variations in the reference guidelines for thyroid tests, but the main ones are:

  • For adults, the standard reference range (TSH) is between 0.3 and 3.0 mIU/L i
  • The reference range issued by the Association for Clinical Biochemistry in the UK is between 0.4 and 4.5 mIU/L ii
  • The American Association of Clinical Endocrinologists (ACEE) revised their reference range in 2012 for women during pregnancy into trimester-specific ranges for TSH with the following upper normal reference ranges recommended: iii
    • First trimester: 2.5 mIU/L
    • Second trimester: 3.0 mIU/L
    • Third trimester: 3.5 mIU/L

The ACEE suggests the first trimester upper limit of 2.5 mIU/L of TSH for women trying for a baby.

Risk factors for thyroid disease

  • A family history of thyroid disease
  • A personal history of thyroid disease
  • The presence of anti-thyroid antibodies
  • Autoimmune diseases such as Type 1 Diabetes, pernicious anaemia, primary adrenal failure (Addison’s disease), myasthenia gravis, celiac disease, rheumatoid arthritis, systemic lupus erythematosus
  • Surgery or radiation to the head, neck or chest
  • Medications include sedatives, iodine, metformin, opiates
  • Exposure to stresses of environmental, emotional or physical origin
  • Iodine deficiency
  • Treated Graves’ disease

References