Thyroid · Understanding thyroid

Thyroid Symptoms: Signs of Hypothyroidism and Hyperthyroidism, Causes and Treatment

Written by · Registration TSMC/FMR/36195 · Published: 29 September 2026 · 17 min read · 37 references
Neoclassical white marble bust of a woman gazing upward, hair gathered in a classical bun and one shoulder draped: an oval window is cut into her throat, revealing the thyroid gland picked out in gold leaf, its two lobes joined across the front of a pale, ribbed windpipe, warmly side-lit against a near-black background.
The thyroid sits low at the front of the neck, its two lobes wrapped around the windpipe. Which way the gland goes wrong is what sets the symptoms: too little hormone slows the body down, too much speeds it up. That is why one small gland can leave you cold and tired, or hot and racing.

Thyroid symptoms depend on which way the gland goes wrong. An underactive thyroid (hypothyroidism) slows you down, with tiredness, constipation and weight gain; an overactive one (hyperthyroidism) speeds you up, with palpitations, weight loss and shaky hands. About 1 in 10 adults in eight Indian cities had hypothyroidism.1 A blood test tells you which one you have.

The same complaints are common in people whose thyroid is fine. In one Danish study, 41% of people with no thyroid disease reported tiredness.2

What are the symptoms of an underactive thyroid? Copy link

Tiredness is the commonest symptom of an underactive thyroid, reported by 68% to 83% of people who have it.3 Most of the rest follow from a body running slower: feeling cold when others are comfortable, constipation, dry skin and weight that creeps up.4,5

Common symptoms include:

  • Tiredness and low energy.
  • Feeling cold, with dry skin and dry, thinning hair.4
  • Constipation.
  • Weight gain.
  • Poor memory or concentration, reported by 45% to 48%.3
  • Low mood, joint and muscle aches, and a slower pulse.4
  • Heavy or irregular periods.
  • A puffy face and a hoarse voice.5

These symptoms build slowly. You may not notice them for months or even years,4 and they are easy to put down to work, age or a new baby. Thinning hair is part of the same picture.4

Treatment does less for thyroid-related weight gain than most people hope, and among 101 adults followed after diagnosis, median weight changed by −0.1 kg once their thyroid blood test was back to normal.6 That is almost nothing.

What are the symptoms of an overactive thyroid? Copy link

An overactive thyroid runs everything fast, so the usual symptoms are anxiety, poor sleep, palpitations, weight loss you didn't plan, loose motions and trouble coping with heat.7

Your hands may shake. You may sweat in a cool room, or eat more than usual and still lose weight. Muscle weakness and tiredness are common too, which surprises people who expect an overactive thyroid to feel only restless.8 Graves' disease, an autoimmune condition and the commonest cause, can also change the eyes, with a fixed stare or eyes that bulge forward.7 In one large clinic series, those eye signs were more likely in smokers, in women, in older patients and in people who had had symptoms for longer.9

Age changes the picture. In the same series of 3,049 patients at one thyroid clinic, most classic symptoms became less likely with age, while atrial fibrillation, an irregular heart rhythm, became more likely.9 In an older parent, an overactive thyroid can look like depression, withdrawal or a poor appetite.8

Hypothyroidism and hyperthyroidism: the difference in symptoms Copy link

Direction is the quickest way to tell them apart. Hypothyroidism slows your pulse and your gut and leaves you feeling cold; hyperthyroidism speeds both up and leaves you hot.4,8

Typical differences between an underactive and an overactive thyroid4,8,10,11,3,7
Underactive (hypothyroidism)Overactive (hyperthyroidism)
EnergyTired, slowed downRestless, yet often tired and weak
HeartSlower pulseFast or irregular heartbeat
TemperatureFeels coldFeels hot, sweats
WeightGain, usually modestLoss, even when eating more
BowelsConstipationFrequent bowel movements
MoodLow mood, slow thinkingAnxiety, irritability, poor sleep
PeriodsIrregular in 23.4%Irregular in 21.5%
Commonest causeHashimoto's thyroiditisGraves' disease
TSH in primary diseaseUsually highUsually low

Some symptoms appear in both. Tiredness, period changes and a goiter, meaning an enlarged thyroid, can come with either direction.4,8,5 Thyroiditis, an inflammation of the gland, sits on both lists too, because it can cause an overactive thyroid or an underactive one.4,8

How can you tell whether symptoms come from your thyroid? Copy link

Usually, you can't tell from symptoms alone. A blood test decides it. The classic thyroid symptoms are also common in people with a healthy gland.

A Danish population study showed how common. Researchers compared 140 people newly diagnosed with an underactive thyroid against 560 matched people from the same population with no thyroid disease.2 Tiredness was reported by 81% of the first group, and by 41% of the second. Four in ten, with a normal thyroid.

Hypothyroid symptoms reported by people with and without the condition Paired bar chart from a Danish population study comparing 140 people newly diagnosed with hypothyroidism against 560 people with no thyroid disease. Tiredness 81% vs 41%, dry skin 63% vs 29%, breathlessness 51% vs 29%, constipation 39% vs 17%, hair loss 30% vs 9%. SAPIENS · THYROID Hypothyroid symptoms in two groups % reporting each symptom newly diagnosed hypothyroidism, 140 people no thyroid disease, 560 people Tiredness 81% 41% Dry skin 63% 29% Breathlessness 51% 29% Constipation 39% 17% Hair loss 30% 9% Source: Carlé et al., Eur J Endocrinol 2014 · ref 2
Chart. Share of people reporting each symptom in a Danish population-based study: 140 adults newly diagnosed with autoimmune hypothyroidism and 560 matched adults with no thyroid disease (ref 2).

The other gaps had the same shape: dry skin 63% vs 29%, breathlessness 51% vs 29%, constipation 39% vs 17%, hair loss 30% vs 9%. The authors' practical conclusion was that even a minor suspicion should lead to a blood test, since no symptom on its own could rule thyroid failure in or out.2

Sex and age skew it further. Among Danish women with a healthy thyroid, 73.7% reported at least one classic hypothyroid symptom, against 51.1% of men.12 Age pulls the other way. People diagnosed before 50 reported 6.2 symptoms on average; those aged 60 or older reported 3.6.13 Symptoms thin out with age.

So what do you do with a list of symptoms? Treat it as a reason to test. The first blood test is usually TSH, the pituitary's signal to the thyroid. If it comes back high, the lab measures free T4, the thyroid hormone itself, in the same sample, and if it comes back low, free T4 and free T3; when a pituitary problem is suspected, TSH and free T4 are checked together from the start.14 A thyroid function test covers both.

In most adults without suspected pituitary disease, a normal TSH makes primary thyroid dysfunction unlikely. If pituitary disease is suspected, TSH and free T4 need to be interpreted together.14 A normal result also tends to stay normal: in a five-year follow-up of over 400,000 people, 98% of normal results were still normal on retesting.15 So when yours is normal, look elsewhere for the tiredness. Iron-deficiency anemia, for one, brings fatigue, breathlessness and cold hands and feet,16 and a low ferritin or hemoglobin can explain what a normal thyroid can't.

A mildly raised TSH with a normal free T4, called subclinical hypothyroidism, is its own trap. Across 21 trials and 2,192 adults, thyroid hormone brought TSH down but did not improve quality of life or thyroid-related symptoms, tiredness included.17,18 Treating the number didn't help. A 2019 BMJ guideline panel went further and recommended against thyroid hormone for most adults with it, although women trying to conceive and anyone with a TSH above 20 were left out.18

Thyroid symptoms in women, and what changes in men Copy link

Women carry most of the burden. Across 5,360 adults tested in Bangalore, Chennai, Delhi, Goa, Mumbai, Hyderabad, Ahmedabad and Kolkata, hypothyroidism turned up in 15.86% of women and 5.02% of men.1 That is roughly a threefold gap. The study tested city dwellers, so rates in smaller towns and villages may differ.

Hypothyroidism among adults tested in eight Indian cities Bar chart from a study of 5,360 adults in eight Indian cities. Hypothyroidism in 10.95% overall, made up of 7.48% who already knew and 3.47% newly found by the study; 15.86% of women and 5.02% of men. SAPIENS · THYROID Hypothyroidism in eight Indian cities % of adults tested, n = 5,360 All adults 10.95% 7.48% already knew 3.47% newly found Women 15.86% Men 5.02% 0% 5% 10% 15% 20% Source: Unnikrishnan et al., Indian J Endocrinol Metab 2013 · ref 1
Chart. Hypothyroidism among 5,360 adults in eight Indian cities, split into cases already diagnosed and cases the study found, with women and men shown separately (ref 1).

The overall rate was 10.95%. Of that, 7.48% of adults already knew they had it, while 3.47% were picked up by the survey itself, which means roughly one hypothyroid adult in three was hearing the diagnosis for the first time.1

In women, a thyroid problem often shows up in the menstrual cycle; in one clinic series, 23.4% of women with hypothyroidism had irregular cycles, against 8.4% of matched women without it.10 With an overactive thyroid, 21.5% of 214 women had irregular cycles and none had stopped menstruating, even though textbooks of the time put the figure at almost 50%.11

An underactive thyroid can also push up prolactin, the hormone behind breast milk, and treating the thyroid can bring it back down.19 Untreated hypothyroidism is linked with disrupted ovulation, infertility and a higher risk of miscarriage.3

Men get thyroid disease less often. Their symptoms can be sexual. In a study of 48 men, low desire, erectile dysfunction and delayed ejaculation were each present in 64.3% of the 14 with hypothyroidism. Half of the 34 men with hyperthyroidism had premature ejaculation, and that fell to 15% after treatment.20 The groups were small. Read these as signals rather than rates.

Thyroid symptoms in pregnancy and after birth Copy link

Pregnancy blurs thyroid symptoms. Tiredness and weight gain come with a normal pregnancy anyway, of course, so blood results do most of the work. The American Thyroid Association's 2026 pregnancy guideline notes that normal pregnancy symptoms overlap with thyroid disease, and that hypothyroidism in pregnancy often causes no symptoms at all.21

The same guideline found too little evidence to test every pregnant woman. It supports testing when risk factors are present, such as thyroid antibodies, other autoimmune disease, earlier neck radiation or thyroid surgery, or a family history of autoimmune thyroid disease.21

Pregnancy shifts the numbers. It needs pregnancy-specific interpretation of thyroid tests. Laboratory- and trimester-specific TSH and free T4 ranges are preferred; the first-trimester TSH range is usually shifted lower than the non-pregnant range.21

If you already take levothyroxine, pregnancy can raise the dose you need.22 Tell your doctor as soon as the test is positive, so your TSH can be checked and the dose adjusted as the pregnancy goes on.

About 5% of women develop postpartum thyroiditis, an autoimmune inflammation of the gland in the first year after delivery.23 Women who have had it are more likely to get it again after a later pregnancy, and more likely to develop permanent hypothyroidism.23

Thyroid symptoms in the neck: swelling, lumps and goiter Copy link

A thyroid problem can show in your neck as a goiter, meaning an enlarged gland, or as a nodule, a lump within it. Most nodules are harmless.24

They turn up often. About 5% of women and 1% of men have one large enough to feel, and ultrasound finds them in 19% to 68% of people scanned.24 Between 7% and 15% turn out to be cancer, depending on age, sex, radiation exposure and family history.24

Have a neck lump checked soon if it grows quickly, if your voice turns hoarse, if a lymph node swells nearby or if the lump feels fixed in place. Radiation to the head or neck in childhood and a family history of thyroid cancer both raise the stakes.24 A large nodular goiter can also press on the food pipe or windpipe, making swallowing harder, causing breathlessness when you lie flat or changing your voice.7

What causes thyroid problems? Copy link

Where people get enough iodine, most thyroid problems are autoimmune. Hashimoto's thyroiditis, where the immune system slowly damages the gland, causes up to 85% of primary hypothyroidism where iodine intake is adequate.3 Graves' disease, where antibodies switch the gland on, is the commonest cause of an overactive thyroid and affects about 2% of women and 0.5% of men worldwide.7

Thyroid antibodies were found in 21.85% of the adults tested across the eight Indian cities.1 India made salt iodization mandatory to fight iodine deficiency, and by the India Iodine Survey of 2018-19, 76.3% of households were using adequately iodized salt, with women's urinary iodine in the adequate range.25

Other causes of an underactive thyroid include thyroiditis, thyroid surgery, radiation, and medicines such as amiodarone, a heart-rhythm drug, lithium, a mood stabilizer, and immune checkpoint inhibitors, a type of cancer immunotherapy.3,4,5 An overactive thyroid can also come from nodules that make hormone on their own, from too much iodine, or from taking too much thyroid medicine.8

Is it genetic? Partly. A parent, brother or sister with hypothyroidism raises your risk, and relatives with any thyroid condition make an overactive thyroid more likely too.3,8

Some babies are born with an underactive thyroid, called congenital hypothyroidism. It is picked up by a heel-prick blood test after the first 24 hours of life, and an ICMR study of over 100,000 Indian newborns found it in 1 in 1,130, excluding temporary cases.26

How are thyroid problems treated? Copy link

Treatment follows the direction. An underactive thyroid gets hormone replacement; an overactive one gets antithyroid tablets, radioactive iodine or surgery.4,7

Treating an underactive thyroid

An underactive thyroid is treated with levothyroxine, a daily tablet identical to the hormone a healthy thyroid makes.4 In younger, otherwise healthy adults who need full thyroid-hormone replacement, an initial dose around 1.6 micrograms per kilogram of body weight per day is often used.14,22 The starting dose is individualized according to age, heart disease, severity of hypothyroidism and how much thyroid function remains.3,27,28 After that, the dose is adjusted according to your TSH level, usually in steps of 12.5 to 25 micrograms.22

How you take it matters, because it changes how much reaches your blood.

  • Swallow it on an empty stomach with water, 30 to 60 minutes before breakfast, or 3 to 4 hours after dinner.22
  • Keep calcium, iron and antacids at least 4 hours away from it.22
  • Wait before your coffee. In a small study, coffee taken with the tablet cut absorption by 27% to 36% compared with water, while coffee an hour later made no difference.29
  • Expect a TSH check 6 to 8 weeks into treatment or after any dose change, then once a year when it is steady.3
Levothyroxine timing and TSH retest schedule Two timelines. Each morning: levothyroxine with water, breakfast 30 to 60 minutes later, calcium or iron at least 4 hours apart. First months: TSH checked 6 to 8 weeks after starting or changing the dose, then yearly once steady. SAPIENS · THYROID Levothyroxine: timing and retests EACH MORNING Tablet, water only Calcium or iron Breakfast 30–60 min later at least 4 hours apart FIRST MONTHS Start or dose change TSH check Yearly TSH 6–8 weeks once steady Sources: StatPearls 2023; Chaker and Papaleontiou, JAMA 2025 · refs 22, 3
Timeline. Levothyroxine timing and spacing from StatPearls (ref 22); TSH retest schedule from the 2025 JAMA review (ref 3). The morning strip is drawn to scale; the months strip is not. Your doctor may set a different schedule.

Medicine for hyperthyroidism

An overactive thyroid is treated with antithyroid tablets, radioactive iodine or surgery. The choice depends on the cause, and on you.7 Under NICE's guideline, adults with an overactive thyroid are assessed by a specialist, and antithyroid tablets can be started while they wait.14 Methimazole is the usual tablet.8 Carbimazole, another common prescription, is converted by the body into methimazole.30 A first course usually runs 12 to 18 months, and propylthiouracil is preferred when you are planning a pregnancy or in its first three months.31

Beta-blockers, a type of heart medicine, help in the meantime, calming the tremor and racing heart while the main treatment takes hold, though they don't lower hormone production.8 Almost everyone treated with radioactive iodine later develops an underactive thyroid and moves onto levothyroxine.8

Can thyroid be cured? Copy link

Some thyroid problems settle or go into remission, and others are controlled long term with treatment. It depends on the cause.

Hashimoto's hypothyroidism can be completely controlled with levothyroxine, as long as the dose is right and you take it as instructed. Don't stop the tablet without talking to your doctor first.4

A mildly raised TSH often corrects itself. In that same primary care follow-up, 62.1% of those whose first TSH read between 5.5 and 10 mIU/L had a normal result within five years, without thyroid medicine.15 Above 10, the figure was 27.2%.15

Graves' disease stays in remission after a course of tablets in roughly half of people; a 2020 meta-analysis of 3,242 patients put the relapse rate at 51.9%.32 Radioactive iodine or surgery usually ends the overactivity for good, and most people then need daily levothyroxine.8 An overactive phase caused by thyroiditis is often simply watched, or managed with symptom relief.7 So can hyperthyroidism be cured? Often, in the sense that the overactivity ends, through remission or through definitive treatment.

Thyroid diet: foods to eat and foods to avoid Copy link

Very few foods need to go. For most people with a thyroid problem, the changes that matter are about iodine and about keeping food away from the tablet.

Iodine, and the hyperthyroidism diet

Keep using iodized salt. India's national survey found women's urinary iodine in the adequate range.25 More is not better, though. Kelp, seaweed and iodine supplements can trigger or worsen an overactive thyroid in people with autoimmune thyroid disease.8

Hypothyroidism diet: cabbage, soy, gluten and selenium

Cabbage-family vegetables worry many people because they contain goitrin, a compound that can block iodine uptake. The dose is what matters. Broccoli, kale and turnip tops carry too little per 100 g serving to affect the thyroid, while collards and Brussels sprouts carry more.33 Soy doesn't appear to harm thyroid function in people with enough iodine, but it can reduce how much levothyroxine you absorb.34 Soy is mostly a timing issue.

Should you go gluten-free for Hashimoto's? A 2023 meta-analysis found only four studies, 87 patients in all, and the fall in thyroid antibodies did not reach statistical significance.35 That is thin evidence. Unless you have celiac disease, an autoimmune reaction to gluten, it doesn't justify cutting gluten for your thyroid.

Selenium has better data. The effects are small. A 2024 meta-analysis of randomized trials found it lowered TSH slightly in people with Hashimoto's not yet on levothyroxine, and lowered TPO antibodies, while free T4 and thyroid size did not change.36 Those are blood-test markers. Whether a lower antibody count changes how people feel or how the disease runs still needs study, the authors say. Effects on well-being were mixed: two of six trial groups reported more improvement with selenium, and four found no difference.36 Selenium is also absent from the thyroid guidelines of the American, European and South American thyroid associations.36 That has not established selenium as routine treatment for Hashimoto's, so supplements should not be started solely to lower antibody levels.

When thyroid symptoms need urgent care Copy link

Most thyroid symptoms can wait for a planned appointment. A few can't. Learn them now, before you need them.

Severe, untreated hypothyroidism can progress to myxedema coma, with a low body temperature, low blood pressure and confusion, and it needs intensive care; up to 30% of people with it die.3

An overactive thyroid can tip into thyroid storm, often after an infection, surgery, childbirth or suddenly stopping antithyroid tablets. The warning signs are a high fever, a pulse above 140, agitation or confusion, and vomiting or diarrhea. Between 8% and 25% of people with it die even with modern treatment.37 Both of these are emergencies.

If you take antithyroid tablets, call your doctor right away for fever, chills, a constant sore throat, skin or eyes turning yellow, a rash or easy bruising.8 A new, irregular racing heartbeat also needs prompt assessment, particularly if you are older.9

Frequently asked questions Copy link

Is thyroid disease genetic?

Partly. Having a parent, brother or sister with hypothyroidism raises your own risk, and relatives with any thyroid condition make an overactive thyroid more likely too. Autoimmune thyroid disease tends to run in families, so a family history is a good reason to test sooner when symptoms appear.

What are the early warning signs of thyroid problems?

Tiredness is usually the commonest sign of an underactive thyroid, often with dry skin, constipation and feeling cold, while an overactive thyroid tends to show as palpitations, weight loss, sweating and anxiety. Both develop gradually, and older adults may notice very few symptoms, so a blood test, usually starting with TSH, is what settles it.

Which doctor should I see for thyroid problems?

A general physician can order a TSH test and treat most cases of underactive thyroid, while an overactive thyroid usually needs a specialist assessment by an endocrinologist, a hormone specialist. A neck lump that grows, or comes with a hoarse voice, needs prompt specialist review.

Is a thyroid problem serious?

Usually not, once it is diagnosed and treated. Left untreated, an underactive thyroid raises the risk of heart failure and, rarely, progresses to myxedema coma; an untreated overactive thyroid can cause irregular heart rhythms, heart failure and bone thinning. Both conditions are treatable.

When should I take my thyroid tablet?

Take levothyroxine on an empty stomach with water, 30 to 60 minutes before breakfast, or 3 to 4 hours after dinner if mornings don't suit you. Keep calcium, iron and antacids at least 4 hours away. Coffee also cuts absorption, so have your first cup after the waiting time rather than with the tablet.

References Copy link

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  2. Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P. Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study. European Journal of Endocrinology. 2014;171(5):593-602. doi:10.1530/EJE-14-0481
  3. Chaker L, Papaleontiou M. Hypothyroidism: A Review. JAMA. 2025;334(19):1750. doi:10.1001/jama.2025.13559
  4. National Institute of Diabetes and Digestive and Kidney Diseases. Hypothyroidism (Underactive Thyroid). NIDDK, National Institutes of Health. www.niddk.nih.gov. Accessed 23 September 2026.
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  7. Lee SY, Pearce EN. Hyperthyroidism: A Review. JAMA. 2023;330(15):1472-1483. doi:10.1001/jama.2023.19052
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  11. Krassas GE, Pontikides N, Kaltsas T, Papadopoulou P, Batrinos M. Menstrual disturbances in thyrotoxicosis. Clinical Endocrinology (Oxford). 1994;40(5):641-644. doi:10.1111/j.1365-2265.1994.tb03016.x
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  13. Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Andersen S, Laurberg P. Hypothyroid Symptoms Fail to Predict Thyroid Insufficiency in Old People: A Population-Based Case-Control Study. The American Journal of Medicine. 2016;129(10):1082-1092. doi:10.1016/j.amjmed.2016.06.013
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  15. Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Levy Y, Surks MI. Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. Archives of Internal Medicine. 2007;167(14):1533-1538. doi:10.1001/archinte.167.14.1533
  16. National Heart, Lung, and Blood Institute. Iron-Deficiency Anemia. NHLBI, National Institutes of Health. Updated 24 March 2022. www.nhlbi.nih.gov. Accessed 23 September 2026.
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  19. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(2):273-288. doi:10.1210/jc.2010-1692
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  29. Benvenga S, Bartolone L, Pappalardo MA, et al. Altered intestinal absorption of L-thyroxine caused by coffee. Thyroid. 2008;18(3):293-301. doi:10.1089/thy.2007.0222
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  36. Huwiler VV, Maissen-Abgottspon S, Stanga Z, et al. Selenium Supplementation in Patients with Hashimoto Thyroiditis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Thyroid. 2024;34(3):295-313. doi:10.1089/thy.2023.0556
  37. Pokhrel B, Aiman W, Bhusal K. Thyroid Storm. StatPearls, NCBI Bookshelf. Updated 6 October 2022. www.ncbi.nlm.nih.gov. Accessed 23 September 2026.

This article is general health information for readers in India and is not a diagnosis or a prescription. Thyroid symptoms overlap with many other conditions, so decisions about testing and treatment belong with a doctor who can examine you and read your results. Never start, stop or change thyroid medicine on your own.

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