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Q&As Do You
Have Signs
of Hypothyroidism or
Thyroid Hormone Resistance?
On February 24, 2003, we posted to drlowe.com a
list of the most common symptoms of hypothyroidism and thyroid hormone
resistance. Since we posted the list, it's been one of the most visited pages on
drlowe.com.
The popularity of the symptom list has prompted us to now provide a list of the
most common "signs" of hypothyroidism and thyroid hormone resistance. Some
readers may not be familiar with the distinction doctors make between "symptoms"
and "signs," so we’ll briefly explain.
Both symptoms and signs are abnormalities that suggest that a patient has a
particular disorder, or one of several possible disorders. But what we consider
a symptom differs from what we consider a sign.
A symptom is an abnormality the patient is experiencing but that others can’t
observe and independently verify. For example, fatigue is a symptom. It's an
inner or subjective experience of the patient. Other people may have the
impression that the patient is lacking in energy, but they can’t directly
observe the fatigue and confirm that the patient is experiencing it.
In contrast, a sign is an abnormality the patient is experiencing and that
others can observe and independently confirm. Dry, scaly skin is a sign. The
patient can show it to her doctor, and the doctor is likely to remark, "Yes,
your skin is dry and scaly, isn’t it."
Beware, however: There's a good chance your doctor won't know that dry, scaly
skin and numerous other signs are characteristic of hypothyroidism or thyroid
hormone resistance. You may have to teach him what the signs are. And you'll
most likely have to describe tests he can do to detect signs, such a slow
relaxation phase of the ankle reflex, and low voltage on the QRS complex of your
electrocardiogram.
The possible need to educate your doctor about symptoms and signs is a
disgraceful legacy of the endocrinology specialty of the last 30 years. The
specialty is responsible for abbreviating most doctors’ knowledge of
hypothyroidism to three false beliefs: (1) the only form of thyroid hormone any
patient should take is T4 (thyroxine), (2) doctors should adjust their patients’
dosage according to their TSH levels, and (3) symptoms and signs are of no value
in diagnosing or treating hypothyroidism.[1]
But alas, you can correct the problem: You can enlighten your doctor about
symptoms and signs, and by doing so, lead him from the dark age of medicine
wrought by the endocrinology specialty.
Keep in mind that other disorders can cause signs typical of hypothyroidism and
thyroid hormone resistance. Because of this, it’s important not to rush to
judgment and conclude that a thyroid disorder is the cause of your signs. Your
doctor should help you distinguish the cause of your signs. For most patients,
if no other disorder appears to be the cause, it’s reasonable to do a trial of
thyroid hormone therapy anyway. Except for the rarest patient, a trial is
justified, for even if it doesn’t relieve the patient’s signs, it's harmless
when done with reasonable precaution. And, of course, the trial may confirm the
diagnosis by relieving the patient’s signs.
As I wrote in The Metabolic
Treatment of Fibromyalgia,[1,p.837&839]
you should keep in mind that some signs may be extremely subtle. They may be so
subtle that your doctor and you are certain you had them only in their absence
after you reach an effective dose of thyroid hormone. An example is the dull,
listless appearance of some patients’ eyes, replaced after therapy with a bright
radiance.[2]
In the list below, we’ve used researchers’ wording as much as possible, but
we've reworded terms for some signs to make them more understandable. We
hope you find the list helpful.
41 Most Commonly
Reported
Symptoms of Hypothyroidism*
o
Dry skin
o
Weight gain unexplainably
o
Thick, scaling skin
o
Hoarseness
o
Coarse skin
o
Low basal & activity level
temperature
o
Fineness of hair
o
Protrusion of one or both eyeballs (exophthalmos)
o
Dry, coarse, brittle hair
o
Slow speech
o
Sparse eyebrows, especially outer ends
o
Slow pulse rate despite low physical fitness
o
Hair loss
o
Slow thinking
o
Brittle nails
o
Sluggish movement
o
Dry ridges down nails
o
Slow relaxation phase of
the knee or ankle reflex
o
Cold skin
o
Listless, dull look to eyes
o
Swelling of face (edema)
o
Wasting of tongue
o
Swelling around the eyes (edema)
o
Nervousness
o
Swelling of eyelids (edema)
o
Rapid heart rate with weak force of contraction
o
Nonpitting edema of ankles
o
Slow heart rate despite low
aerobic fitness
o
Fluid accumulation in abdomen (ascites)
o
Pounding heart beat
o
Thick tongue
o
Cardiac enlargement on x-ray
o
Swelling of ankles
o
Indistinct or faint heart tones
o
Paleness of skin
o
Low QRS voltage on ECG
o
Paleness of lips
o
Long-normal intervals on ECG
o
Bluish or purplish coloration of the skin, nail beds, lips, or mucous membranes
(cyanosis)
o
Fluid around heart (pericardial effusion)
o
Changes at the back of the eye
(at fundus oculi)
*
After
L.J. DeGroot, P.R. Larsen, S. Refetoff, and J.B. Stanbury, The
Thyroid and Its Diseases, 5th
edition. New York, John
Wiley & Sons, Inc. 1984, pp.577-578.
* R.L. DeGowin and E.L. DeGowin, Bedside
Diagnostic Examination, 3rd edition. New York,
MacMillan Publishing Co., Inc., 1976, p. 860.
* From J.C. Lowe: The Metabolic
Treatment of Fibromyalgia. McDowell Publishing Co., L.C.,
Boulder, 2000, p. 839.
We provide educational
consulting to both patients and clinicians. Phone us at 603-391-6061, or
preferably, write to us at
Tammy@drlowe.com. Our fax number is
303-496-6200. —Tammy Lowe
