Editing Hypothyroidism (section)

== Signs and symptoms ==
People with hypothyroidism often have no or only mild symptoms. Numerous symptoms and [[medical sign|signs]] are associated with hypothyroidism and can be related to the underlying cause, or a direct effect of not having enough thyroid hormones.<ref name=Longo>{{cite book | vauthors = Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J |title=Harrison's principles of internal medicine.|year=2011|publisher=McGraw-Hill|location=New York|isbn=978-0071748896|edition=18th|chapter=341: disorders of the thyroid gland}}</ref><ref name=Khandelwal2012/> Many symptoms of hypothyroidism are otherwise common and do not necessarily indicate thyroid problem.<ref name=NIH2025/> [[Hashimoto's thyroiditis]] may present with the [[Mass effect (medicine)|mass effect]] of a [[goiter]] (enlarged thyroid gland).<ref name=Longo/> In middle-aged women, the symptoms may be mistaken for those of [[menopause]].<ref name=NICENG145>{{cite web |title=Thyroid disease: assessment and management |url=https://www.nice.org.uk/guidance/ng145 |website=www.nice.org.uk |publisher=[[National Institute for Health and Care Excellence]] |access-date=15 March 2025 |date=12 October 2023}}</ref>

[[File:Signs and symptoms of hypothyroidism.png|thumb|300px|Symptoms and signs of hypothyroidism<ref name=Longo/>]]
{|class="wikitable" style = "margin-left:15px; text-align:center"
! Symptoms<ref name=Longo/>
! Signs<ref name=Longo/>
|-
| [[Fatigue]]
| Dry, coarse skin
|-
| Feeling cold
| Cool extremities
|-
| Poor memory and concentration
| [[Myxedema]] ([[mucopolysaccharide]] deposits in the skin)
|-
| [[Constipation]], [[dyspepsia]]<ref name="Ebert2010">{{cite journal | vauthors = Ebert EC | title = The thyroid and the gut | journal = Journal of Clinical Gastroenterology | volume = 44 | issue = 6 | pages = 402–6 | date = July 2010 | pmid = 20351569 | doi = 10.1097/MCG.0b013e3181d6bc3e | s2cid = 23210397 }}</ref>
| [[Hair loss]], [[Sign of Hertoghe]]
|-
| Weight gain with poor appetite
| [[Bradycardia|Slow pulse rate]]
|-
| [[Shortness of breath]]
| [[Edema|Swelling]] of the limbs
|-
| [[Hoarse voice]]
| Delayed relaxation of [[tendon reflex]]es
|-
| In females, [[Menorrhagia|heavy menstrual period]]s (and later [[oligomenorrhea|light periods]])
| [[Carpal tunnel syndrome]]
|-
| [[Paresthesia|Abnormal sensation]]
| [[Pleural effusion]], [[ascites]], [[pericardial effusion]]
|-
| [[Hearing loss|Poor hearing]]
|
|-
|[[Muscle weakness]]
|}

Delayed relaxation after testing the [[ankle jerk reflex]] is a characteristic sign of hypothyroidism and is associated with the severity of the hormone deficit.<ref name=Garber/>

===Myxedema coma===
{{Multiple image
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| align     = right
| direction = horizontal
| width     = 175
<!-- Image 1 -->
| image1    = Myxedema face.png
| caption1  = Man with myxedema or severe hypothyroidism showing an expressionless face, puffiness around the eyes, and pallor
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| image2    = Myxedema standing.png
| caption2  = Additional symptoms include swelling of the arms and legs and [[ascites]].}}
[[Myxedema coma]] is a rare but life-threatening state of extreme hypothyroidism.<!-- <ref name=Klubo/> --> It may occur in those with established hypothyroidism when they develop an acute illness. Myxedema coma can be the first presentation of hypothyroidism.<!-- <ref name=Klubo/> --> People with myxedema coma typically have a [[hypothermia|low body temperature]] without shivering, [[altered level of consciousness|confusion]], a [[Bradycardia|slow heart rate]] and [[Hypoventilation|reduced breathing effort]].<!-- <ref name=Klubo/> --> There may be physical signs suggestive of hypothyroidism, such as skin changes or [[Macroglossia|enlargement of the tongue]].<ref name=Klubo>{{cite journal | vauthors = Klubo-Gwiezdzinska J, Wartofsky L | title = Thyroid emergencies | journal = The Medical Clinics of North America | volume = 96 | issue = 2 | pages = 385–403 | date = March 2012 | pmid = 22443982 | doi = 10.1016/j.mcna.2012.01.015 }}</ref>

===Pregnancy===
{{Main|Thyroid disease in women}}
Hypothyroidism when untreated may lead to [[infertility]] and an increased risk of [[miscarriage]] or [[perinatal mortality|infant death around the time of birth]], mostly in severe cases of hypothyroidism.<ref name=NIH2017>{{cite web|title=Thyroid disease in Women|url=https://www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease|publisher=Office on Women's Health, U.S. Department of Health and Human Services|access-date=15 March 2025|date=December 2017|url-status=live|archive-url=https://web.archive.org/web/20250304231739/https://www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease|archive-date=4 March 2025}}{{PD-notice}}</ref><ref>{{cite web | title =Postpartum Thyroiditis | publisher = American Thyroid Association | access-date = 20 July 2017 | date = 2014| url = http://www.thyroid.org/wp-content/uploads/patients/brochures/Postpartum_Thyroiditis_brochure.pdf}}</ref> [[Thyroid disease in pregnancy|Women are affected by hypothyroidism]] in 0.3–0.5% of pregnancies.<ref name=Vissenberg2012>{{cite journal | vauthors = Vissenberg R, van den Boogaard E, van Wely M, van der Post JA, Fliers E, Bisschop PH, Goddijn M | title = Treatment of thyroid disorders before conception and in early pregnancy: a systematic review | journal = Human Reproduction Update | volume = 18 | issue = 4 | pages = 360–73 | date = July 2012 | pmid = 22431565 | doi = 10.1093/humupd/dms007 | type = Review | doi-access = free }}</ref> Subclinical hypothyroidism during pregnancy is associated with [[preterm birth|birth of the baby before 37 weeks of pregnancy]].<ref>{{cite journal | vauthors = Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S | title = 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum | journal = Thyroid | volume = 27 | issue = 3 | pages = 315–389 | date = March 2017 | pmid = 28056690 | doi = 10.1089/thy.2016.0457 | pmc = 3472679 | doi-access = free }}</ref>

===Children===
Newborn children with hypothyroidism may have normal birth weight and height (although the head may be larger than expected and the [[posterior fontanelle]] may be open).<!-- <ref name=Counts> --> Some may have drowsiness, [[Hypotonia|decreased muscle tone]], poor weight gain, a hoarse-sounding cry, feeding difficulties, constipation, an [[macroglossia|enlarged tongue]], [[umbilical hernia]], [[Xeroderma|dry skin]], a [[Hypothermia|decreased body temperature]], and [[Neonatal jaundice|jaundice]].<ref name=Counts>{{cite journal | vauthors = Counts D, Varma SK | title = Hypothyroidism in children | journal = Pediatrics in Review | volume = 30 | issue = 7 | pages = 251–8 | date = July 2009 | pmid = 19570923 | doi = 10.1542/pir.30-7-251 | s2cid = 29460139 }}</ref> A [[goiter]] is rare, although it may develop later in children who have a thyroid gland that does not produce [[thyroid dyshormonogenesis|functioning thyroid hormone]].<ref name=Counts/> A goiter may also develop in children growing up in areas with [[iodine deficiency]].<ref name=Pearce>{{cite journal | vauthors = Pearce EN | title = Update in lipid alterations in subclinical hypothyroidism | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 97 | issue = 2 | pages = 326–33 | date = February 2012 | pmid = 22205712 | doi = 10.1210/jc.2011-2532 | doi-access = free }}</ref> Normal growth and development may be delayed, and not treating infants may lead to an intellectual impairment (IQ 6–15 points lower in severe cases).<!-- <ref name=Counts/> --> Other problems include the following: difficulty with large scale and fine [[motor skill]]s and [[ataxia|coordination]], reduced muscle tone, [[Strabismus|squinting]], decreased [[attention span]], and [[speech acquisition|delayed speaking]].<ref name=Counts/> [[Tooth eruption]] may be delayed.<ref>{{cite journal | vauthors = Chandna S, Bathla M | title = Oral manifestations of thyroid disorders and its management | journal = Indian Journal of Endocrinology and Metabolism | volume = 15 | issue = Suppl 2 | pages = S113–6 | date = July 2011 | pmid = 21966646 | pmc = 3169868 | doi = 10.4103/2230-8210.83343 | doi-access = free }}</ref>

In older children and adolescents, the symptoms of hypothyroidism may include fatigue, cold intolerance, sleepiness, muscle weakness, constipation, a delay in growth, overweight for height, pallor, coarse and thick skin, [[Hypertrichosis|increased body hair]], [[Irregular menstruation|irregular menstrual cycles]] in girls, and [[delayed puberty]]. Signs may include delayed relaxation of the ankle reflex and a [[bradycardia|slow heartbeat]].<ref name=Counts/> A goiter may be present with a completely enlarged thyroid gland;<ref name=Counts/> sometimes only part of the thyroid is enlarged and it can be knobby.<ref name=Brown2013>{{cite journal | vauthors = Brown RS | title = Autoimmune thyroiditis in childhood | journal = Journal of Clinical Research in Pediatric Endocrinology | volume = 5 Suppl 1 | issue = 4 | pages = 45–9 | year = 2013 | pmid = 23154164 | pmc = 3608006 | doi = 10.4274/jcrpe.855 | type = Review }}</ref>