Do any of these sound familiar? You drag yourself through the day chronically tired, even though you’ve had enough sleep. Your hair is falling out more than it used to, your skin is dry and flaky, and your fingernails have vertical ridges and are brittle.

Despite eating healthy and exercising, you keep gaining weight—and the pounds just won’t budge. You’re constantly cold and often complain about cold hands and feet. Maybe you’re also dealing with constipation, feeling unmotivated and down, or noticing water retention in your body.

All of these symptoms are signs of hypothyroidism, also known as an underactive thyroid.

The most common signs of hypothyroidism are chronic fatigue, weight gain, sensitivity to cold, dry skin, hair loss, depression, and digestive issues.

Many people suffer from these symptoms for years without knowing the true cause.

• What exactly hypothyroidism is
• How common hypothyroidism is
• Which symptoms are typical for hypothyroidism
• A guide to early detection of hypothyroidism
• Why a holistic treatment approach is important
• Your next steps

Whether you’ve just been diagnosed or suspect that your symptoms might be related to your thyroid, this article will help you better understand your situation.

Hypothyroidism occurs when your thyroid produces too little thyroid hormone. These small but vital messengers—primarily triiodothyronine (T3) and thyroxine (T4)—are responsible for nearly all metabolic processes in your body.

Think of the thyroid as a conductor leading the orchestra of your body. When the conductor isn’t performing well, the whole symphony falls out of sync.

The causes can vary and include:

• Autoimmune diseases (e.g., Hashimoto’s thyroiditis)
• Iodine deficiency
• Thyroid surgery
• Side effects of certain medications

You’re not alone—In Anerica, about 2–3% of the population has hypothyroidism, with women being around four times more likely to be affected than men.

The condition is most common between the ages of 30 and 50, but it can occur at any age. (1)

Hashimoto’s thyroiditis is the most common cause of hypothyroidism in America and other industrialized countries. In this autoimmune disease, the immune system attacks the thyroid tissue, which over time leads to reduced production of thyroid hormones.

The symptoms usually develop gradually over months or years and match the typical signs of hypothyroidism, such as chronic fatigue, weight gain, sensitivity to cold, dry skin, and brittle hair.

Unlike other forms of hypothyroidism, Hashimoto’s can sometimes cause temporary phases of hyperthyroidism when the destruction of thyroid tissue releases an excess of hormones. (2)

Hypothyroidism can present with a wide variety of symptoms, which makes diagnosing it quite complex.

So let’s first look at the symptoms in detail and then highlight the most common ones:

• Chronic fatigue that doesn’t improve with sleep
• Increased need for sleep (more than 8–9 hours)
• Difficulty getting going in the morning
• Feeling exhausted even after minor exertion
• Difficulty concentrating and experiencing “brain fog”

• Dry, flaky, or cracked skin
• Slow wound healing
• Increased hair loss
• Brittle, splitting hair
• Vertical ridges in fingernails
• Brittle, soft nails
• Dull, pale complexion
• Puffy face

• Unexplained weight gain
• Difficulty losing weight despite dieting
• Slowed basal metabolic rate
• Cravings, especially for carbohydrates
• Water retention (edema)
• Puffy face

• Increased sensitivity to cold
• Chronically cold hands and feet
• Low body temperature (below 36.8°C / 98.2°F)
• Poor circulation
• Difficulty warming up

• Chronic constipation
• Slowed digestion
• Bloating and feeling of fullness
• Irritable bowel syndrome
• Food intolerances
• Bloated abdomen

• Depressed mood
• Lack of motivation
• Mood swings
• Anxiety
• Inner restlessness
• Memory problems
• Difficulty concentrating

• Irregular menstruation
• Heavy menstrual bleeding
• Infertility or difficulty conceiving
• Increased risk of miscarriage
• PCOS (polycystic ovary syndrome)
• Premenstrual syndrome (PMS)

• Disrupted glucose metabolism
• Insulin resistance
• Increased risk of diabetes
• Hormonal imbalances
• Cortisol dysregulation

• Low blood pressure
• In some cases, high blood pressure
• Heart arrhythmias
• Weak heart
• Elevated cholesterol levels

• Muscle and joint pain
• Morning stiffness
• Arthritis-like symptoms
• Carpal tunnel syndrome
• Tendon sheath inflammation

A particularly characteristic symptom of hypothyroidism can also be seen in the eyebrows—specifically, hair loss in the outer third of the brows.

Did you know? This specific eyebrow hair loss was first observed and documented in Queen Anne (1665–1714). The British monarch suffered from hypothyroidism, which, among other symptoms, showed as this distinctive hair loss in the lateral (outer) portion of her eyebrows.

Even today, this characteristic eyebrow thinning is considered an important diagnostic clue for a possible underactive thyroid. It often appears alongside general scalp hair loss and brittle hair. (4)

Another symptom of hypothyroidism can be a puffy, swollen face—medically referred to as myxedema. This occurs due to fluid retention in the tissues, caused by a slowed metabolism and changes in connective tissue.

The swelling is often most noticeable around the eyelids, cheeks, and chin, giving the face a mask-like appearance. These changes usually develop gradually over several weeks or months, but they typically subside once thyroid hormone therapy begins.

If you’re feeling a bit overwhelmed by all these lists—don’t worry, we’ve got you.

Do you want to learn more about your symptoms and find out if hypothyroidism could be the cause? In our free online course, “Thyroid Guide,” we walk you step-by-step through the most important topics in 5 modules.

You’ll learn to recognize the typical signs of hypothyroidism, understand possible causes, and discover what you can do yourself. Sign up now for the free course and start your journey toward a better understanding of your thyroid health. (3)

1. Unexplained fatigue that doesn’t improve even with enough sleep
2. Slight but steady weight gain without any changes to your diet
3. You get cold more easily than others, especially in your hands and feet
4. Your hair is thinning and falling out more than usual
5. Your skin is getting drier and your fingernails more brittle

You should be especially alert if:

• Several of these symptoms occur at the same time
• The issues persist for more than 3 months
• Thyroid disease runs in your family
• You are a woman over the age of 35
• You are in the postpartum period

A simple self-check that can give you an initial clue is measuring your body temperature right after waking up. If it regularly falls below 36.5°C (97.7°F), it could be a sign of hypothyroidism.

Important: If you notice these early signs in yourself, talk to your doctor. A simple blood test can provide clarity.

The wide range of symptoms can be explained by the thyroid hormones’ complex three-step activation system:

1. Production in the thyroid: The thyroid produces T4 (inactive hormone) and, in smaller amounts, T3 (active hormone).
2. Conversion of T4 to T3: T4 is converted into the active hormone T3 in the liver, kidneys, and other tissues. This step is essential because T3 is the biologically active form.
3. Transport of thyroid hormones: T3 binds to receptors in the cells and regulates processes such as metabolism, energy production, and cell repair.

In hypothyroidism, either T4 is lacking or its conversion to T3 is impaired. This explains why so many different symptoms appear—the entire metabolism slows down (5).

• Regulates energy metabolism
• Controls growth and development
• Influences body temperature
• Controls protein synthesis
• Regulates fat burning
• Governs heart and circulatory functions
  
  When there’s too little T3, all of these processes slow down—leading to far-reaching effects throughout the entire body.

Maybe you’ve already tried different treatments for individual symptoms:

• Diets to combat weight gain
• Creams to address dry skin
• Supplements to fight fatigue
• Antidepressants to manage mood issues

But the real key to success lies in recognizing that all these symptoms share one common root cause: a deficiency in thyroid hormones. Without optimizing thyroid function, individual treatment attempts will only have limited effectiveness.

A definitive diagnosis of an underactive thyroid is made through a blood test at your doctor’s office. This test measures various thyroid levels, with the most important being:

• TSH (thyroid-stimulating hormone): The key marker, and the first to rise
• fT3 (free triiodothyronine): The active thyroid hormone
• fT4 (free thyroxine): The precursor to T3
• TPO-AK and TAK: Important for diagnosing Hashimoto’s disease

An elevated TSH level is usually the first sign of an underactive thyroid. In this case, your body tries to stimulate the thyroid to produce more hormones by increasing TSH—like pressing harder on the gas pedal in a car when the engine isn’t responding properly.

In addition to the blood test, your doctor will:

• Take a detailed medical history of your symptoms
• Palpate (feel) your thyroid
• Possibly perform an ultrasound examination

Important: It’s best to have your thyroid levels tested in the morning on an empty stomach, as these values can fluctuate throughout the day.

The treatment of an underactive thyroid is based on several key components. At its core is usually hormone replacement therapy, which can be supported by additional measures.

The most important treatment is taking thyroid meds. These are:

• Taken in the morning on an empty stomach
• Taken at least 30 minutes before breakfast
• Prescribed in a dosage tailored to your individual needs
• Taken regularly and for life

In addition to taking hormones, the following measures can help:

• Adjusting your diet (getting enough iodine, selenium, and iron)
• Reducing stress and getting adequate sleep
• Engaging in moderate, regular exercise
• Supporting gut health (since this is where T4 is converted into T3)

Key factors for successful treatment include:

• Regular blood tests (initially every 6–8 weeks)
• Adjusting the medication dosage if needed
• Monitoring improvement of symptoms
• Keeping a record of how you feel

Finding the right hormone balance often takes time and patience. Symptom improvement usually appears only after a few weeks. It’s essential to take your medication consistently and never adjust the dose on your own.

Additionally, the following can also help:

• Relaxation techniques such as yoga or meditation
• Naturopathic treatments
• Acupuncture
• Heat therapy

Note: All alternative therapies should always be discussed with your treating physician and used only as a complement to hormone therapy.

1. Diagnosis: Have your thyroid levels checked by a doctor. Key values include:
2. Documentation: Keep a symptom diary to track changes. Take your temperature regularly.
3. Holistic Approach: Seek additional support—many patients feel their concerns aren’t taken seriously by their doctors. Look into scheduling an appointment with an endocrinologist near you, and feel free to explore our blog for more insights on the topic. It’s important to view your situation as a whole (6).

An underactive thyroid can affect your life in many ways. Understanding the connection between your symptoms and thyroid function is the first step toward improvement. With the right diagnosis and treatment, many symptoms can significantly improve.

Remember: You’re not alone in what you’re experiencing, and there are ways to feel better. With the right knowledge and proper support, you can regain your energy and quality of life.