Hypothyroid Signs/Symptoms and Differential Diagnosis

• Low basal body temperature (almost all);
• Dyslipidemia (High Cholesterol/Triglycerides) (hallmark sign);
• Chronic Fatigue (84%);
• Cold intolerance (59%);
• Hyporeflexia (diminished reflexes) and delayed relaxation of deep tendon reflexes, particularly Achilles tendon (53%);
• Weight gain(40%);
• Elevated TSH (before treatment with T4) (21%) [Note how small a percentage of hypothyroidism cases is associated with elevated TSH!].
• Diabetes Mellitus Type I (Insulin Dependent) or Diabetes Mellitus Type II (Insulin Resistance) (21%);
• Hypoglycemia, hyperinsulinemia (7%);
• Premature aging;
• Internal myxedema;
• Hormone imbalances;
• Infertility;
• Goiter.

• Crepitus felt in joints ("resembling the crackling of crushed snow"), especially at the knee (almost pathognomonic);
• Chronic pain (50%);
• Ligamentous laxity, e.g., flat feet, hyper-flexibility, scoliosis (3%, more common females), stooped posture, knock-kneed, tendency to sprain or strain, dislocated kneecaps;
• Joint pain, Arthritis, Rheumatoid pains (common);
• Skeletal changes such as scoliosis and general contraction of the pelvis (narrow hips), (common);
• Chronic deforming changes in the joints (common);
• Muscle Weakness;
• Gout;
• Muscle cramps [Domino2017].

• Dry skin (85%);
• Brittle, soft, yellow, ridged, or striated nails (81%);
• Myxedema (non-pitting edema), especially around eyes (periorbital) and jaw-line (55%, pathognomonic), hands and feet;
• Cold, clammy extremities, pale nail beds, peripheral cyanosis and mottling (44%);
• Hair loss, (alopecia), especially the lateral eyebrows, arms, and legs (38%);
• Tendency to fat deposits, especially around the hips, above the pubic bone, and above the clavicles (common);
• Slow wound healing;
• Excess cerumen in the ears;
• Osteoporosis;
• Decreased perspiration;
• Malar flush;
• Sallow complexion (carotenemia, yellow due to failure of liver to convert beta-carotene to vitamin A);
• Acne;
• Eczema;
• Psoriasis.

• Menstrual disturbances and PMS (68% of females);
• Hysterectomy (32% females);
• Endometriosis;
• Cystic breast/ovaries;
• Loss of libido (male, female);
• Infertility;
• Premature or delayed menopause;
• Retroflexion of uterus.

• Low systolic blood pressure with high diastolic blood pressure;
• Bradycardia (slow heart rate);
• Heart disease (16%)[
• Oppressive feelings and convulsive pains in the cardiac region (common);
• Poor circulation and numbness in hands and feet;
• Congestive Heart Failure;
• Myocardial Infarction (heart attack);
• Stroke;
• Heart palpitations, irregular heartbeat.

• Depression & mental disorders (58%);
• Slow movements, slow speech, lethargy, general indolence and inertia, lassitude, apathy, listlessness (32%);
• Paresthesias (abnormal sensations such as tingling, burning, etc.) (25%);
• Headaches (23%), especially morning headaches that wear off as the day progresses;
• Decreased appetite, Anorexia (common);
• Carpal tunnel syndrome [Domino2017];
• An excessive amount of sleep is required to function well;
• Sleepiness;
• Mental/memory impairment;
• Slow thinking;
• Hearing impairment [Domino2017];
• Deaf-mutism;
• Alcoholism;
• Various derangements and psychoses, including depression, mania, obsessions, delusions, hallucinations, and frank insanity;
• The diminished amplitude of EEG theta and delta waves;
• Prolonged evoked potentials;
• Alzheimer's Disease;
• Fibromyalgia.

• Constipation (26%);
• Prolonged transit time in the bowels may increase the development of food allergies or intolerances.
• Swelling and pallor of the mucus membranes (common);
• Chronic digestive problems, such as hypochlorhydria;
• Protuberant abdomen (common in infants);
• Nutritional imbalances;
• Scant intestinal secretions;
• Enlarged or irritated gums, gingivitis, hyperplasia;
• Enlarged tongue (macroglossia) and scalloping;
• Thickened lips;
• Downturned corners of the mouth;
• Difficulty swallowing;
• Gallbladder disease;
• Liver congestion;
• Dysbiosis (gut infections).

• Emphysema (7%);
• Hoarsening or deepening of voice;
• Mouth breathing and noisy respiration due to swollen nasal passages, respiratory distress;
• Sleep Apnea.

• Disturbances in pregnancy: premature or prolonged gestations, babies over 9 pounds at birth;
• Congenital disabilities (birth defects);
• Hypotonia (decreased muscle tone) (33%, infants);
• Umbilical hernia (29%, infants);
• Prolonged neonatal jaundice (29%);
• Poor suckling, failure to thrive (23%, infants);
• Delayed closing or enlarged fontanels (22%, infants);
• An enlarged tongue (macroglossia) and scalloping (19%, infants);
• Delayed dentition, tooth decay, and mis-spacing of teeth (common);
• Abnormalities in the shape of the pinna of the ear (common);
• Cretinism;
• Delayed puberty or hypoplasia (smallness) of breasts and genitals;
• Deep depression of the root of the nose (where the nose meets the ridge between the eyebrows) and deep-set eyes due to faulty growth of the sphenoid bone;
• Short stature (DDX growth hormone deficiency, treat hypothyroid first);
• Disproportionate development (early or premature closure of growth plates);
• Malformation of the ends of the long bones;
• Cataracts (infants).

• Low immune function: (functional immune deficiency) Candida and other frequent infections, cancer (cardinal sign);
• Allergies (44%);
• Cancer (11%);
• Autoimmune diseases (7%), such as Systemic Lupus Erythematosus (SLE);
• Adrenal insufficiency (Schmidt's syndrome);
• Inflammatory bowel disease, Gluten sensitivity, Celiac Disease, or Pernicious anemia; Multiple Sclerosis.

Possible paradoxical signs and symptoms exhibited by some patients with low body temperature who respond well to treatment of hypothyroid condition include:

• Attention Deficit (Hyperactivity) Disorder (ADD/ADHD) (72% of males, 43% of females);
• Insomnia (52%);
• Anxiety, nervousness, irritability (35%);
• Hypertension (High Blood Pressure) (30%);
• TMJ (due to muscle dysfunction), teeth clenching (23%);
• Heat intolerance (20%);
• Tremor (20%);
• Elevated basal metabolic rate;
• Elevated heart rate;
• Underweight;
• Tall stature, prolonged growth period;
• Precocious (premature) puberty or hyperplasia (enlargement) of breasts and genitals;
• Abnormal muscle enlargement;
• Excessive perspiration.

The Differential Diagnoses are a list of possible diagnoses that might explain the observed signs and symptoms. They may be an alternative to the diagnosis of hypothyrid disorder, or may be concomitant or contributing conditions that must also be addressed (or ruled out).

• Hashimoto's thyroiditis;
• Mitochondrial dysfunction;
• Iodine deficiency;
• Chronic fatigue syndrome;
• Anemia;
• Euthyroid sick syndrome;
• Depression;
• Congestive heart failure;
• Adrenal Deficiency (leads to intolerance of thyroid supplements)[Starr2005, pg 184];
• Adrenal Excess (shuts down thyroid) [Hill1950  🕮 ], [Starr2005, pg 184];
• Primary Amyloidosis [Domino2017];
• Dementia not due to hypothyroidism [Domino2017];
• Thyrotropin-secreting pituitary adenoma [Domino2017];
• Selenium deficiency [Pelter1999];
• Magnesium deficiency [Starr2005, pg 183];
• Zinc deficiency [Spectracell seminar 5/2010];
• Iron deficiency [Barnes_Research_Foundation], [Starr2005, pg 182], [Spectracell seminar 5/2010];
• Estrogen causing overproduction of thyroid binding globulin, which reduces free-T3 [Kharrazian2010, pg 5];
• Myxedema (hydrated mucin) must be distinguished by palpable texture from subcutaneous fat in skinfold measurements, e.g. on the lateral arm;
• Copper toxicity can cause hypothyroidism; This may be a problem in "red-rock" areas of Arizona, where the soil/water may be high in copper.