Posted on: April 22, 2016 at 10:30 am
Last updated: August 3, 2019 at 1:31 pm

Did you know that bipolar disorder and medication-resistant depression can both be caused by thyroid resistance in the brain?

It may not make sense until you consider that your thyroid affects literally every single cell in your entire body!

Let’s talk about the signs and symptoms of hypothyroidism

Because the thyroid has an effect on every cell the in the body, the symptoms of low thyroid can be almost anything! This also means that some cells can get enough thyroid hormone while others are left deficient – resulting in tissue specific hypothyroidism while the rest of the body is fine. This is how some people can have severe depression without other signs or symptoms of hypothyroidism. If you want to know more about the specific causes of hypothyroidism, then check out this guide!

To help you find if you are having issues with your thyroid I’ve compiled the most up to date and thorough list of signs and symptoms that people with hypothyroidism have:

Remember that you can have completely “normal” lab tests and still have hypothyroidism!

  1. Fatigue, lethargy, low endurance
  2. Swelling of eyelids
  3. Easily upset
  4. Dry skin and mucous membranes (like inside mouth and nose)
  5. Choking sensation, shortness of breath
  6. Thinning hair, hair loss, sparse eyebrows
  7. Slow speech
  8. Constipation
  9. Brain fog, poor concentration
  10. Weight gain unexplainably
  11. Blueness/paleness of skin and lips
  12. Poor memory
  13. Dry, brittle hair
  14. Depression
  15. Swelling, inflammation (especially ankles)
  16. Nervousness, anxiety
  17. Hoarseness
  18. Puffy skin, face, eyelids
  19. Loss of appetite
  20. Prolonged or heavy menstrual bleeding
  21. Painful menstruation
  22. Brittle or thin nails
  23. Low motivation, low energy
  24. Low sex drive
  25. Dry ridges down nails
  26. Dizziness
  27. Difficulty in swallowing
  28. Feeling cold
  29. Sensitivity to high and low temperatures
  30. Hearing loss
  31. Weakness
  32. Rapid heart rate
  33. Muscle pain, joint pain, body aches & pains
  34. Decreased sweating
  35. Non-restful sleep, insomnia
  36. Pain at front of chest
  37. Numbness or tingling
  38. Poor vision
  39. Protrusion of one or both eyeballs
  40. Thick tongue
  41. Weight gain unexplainably
  42. Slow pulse rate despite low physical fitness
  43. Slow relaxation phase of the  knee or ankle reflex
  44. Listless, dull  look to eyes
  45. Fluid accumulation in abdomen (ascites)
  46. Cardiac enlargement on x-ray
  47. Indistinct or faint heart tones
  48. Low QRS voltage, long-normal intervals on ECG
  49. Fluid around heart (pericardial effusion)
  50. Changes at the back of the eye (at fundus oculi)

Because of this I highly recommend treatment for hypothyroidism if you have symptoms, even if all labs are normal. I have found many patients to get considerable relief from their symptoms with this approach.What to do if you have symptoms of hypothyroidism

If you find yourself with one or more of these symptoms ask yourself the following questions:

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  1. Does my diet consist of natural whole foods with lots of fruits and vegetables?
  2. Do I avoid sugar, caffeine and artificial sweeteners?
  3. Do I take action to reduce my stress levels on a daily basis?
  4. Do I focus on getting 7-8 hours of quality deep sleep every night?
  5. Do I exercise to maximum intensity on a regular, weekly basis?
  6. Do I take medications that slow down my metabolism? (beta blockers, muscle relaxers or narcotics)

If you answered no to any questions above then that’s the first place to start. Changing your lifestyle will definitely improve your overall thyroid function but it may not be enough for everyone.


When making changes to your life stay away from the bad advice that most doctors and nutritionists give:


Not only will following these recommendations help with weight loss, but it will also help to reduce inflammation in your body and balance your hormones.

You can also find more information about how to eat healthy here.

If you’ve tried all the above and are still having symptoms then it’s time to see a practitioner who is skilled in interpreting thyroid lab studies.

Have your doctor to order these tests

I recommend asking for the following blood tests from your doctor:

Thyroid lab tests

  • TSH – if your TSH is > 2 you are hypothyroid, a TSH < 2 does not mean your thyroid is normal
  • Free t3 – Should be in the upper 1/3 of the normal reference range
  • Free t4 – Should be in the upper 1/3 of the normal reference range
  • Reverse t3 – Should be < 15
  • Free t3 to reverse t3 ratio – Should be > 0.2
  • Thyroid antibodies (thyroglobulin antibodies and thyroid peroxidase antibodies)
  • Sex hormone binding globulin – should be > 70 in women and > 30 in males

Your doctor will probably be using the reference ranges that the lab gives them when determining if your labs are “normal” or not.

Using those ranges is terrible because it includes patients in their 70-80’s who probably also have undetected thyroid issues.

There is a difference between “normal” and “optimal” ranges. The values I gave above are what I consider to be optimal ranges and where patients that feel GOOD fall under.

If you fall out of the “normal” range then you have thyroid issues no question. If you fall out of the optimal range and have symptoms then you are likely suffering from thyroid problems.

It’s possible to have optimal ranges and still be hypothyroid though.

The reason for that is, we don’t know what level your body feels the best at. Which is why if you have clear cut symptoms of hypothyroidism, it’s best to at least start a trial of thyroid hormone.

Let’s use this example to clarify:

This patient has thyroid hormone resistance when you calculate the free t3/reverse t3 ratio which in this case is 3.5/18.8 = 0.18.

This patient (not shown) has pre diabetes and several symptoms of hypothyroidism and responded very well to liothyronine (T3 thyroid hormone) very well with a reduction in blood sugar and increased weight loss.

Moral of the story…

Don’t let your doctor tell you your labs are normal if you have symptoms.

What if you are already on thyroid medication but still having symptoms?


If you fall into this category there is a good chance that you are being undertreated, or that you are being treated with the wrong type of medication.

The average doses of thyroid medication that patients need on average to eliminate symptoms:

  • Synthroid (T4 alone)- 200-400 mcg per day
  • Armour thyroid (combination of T4 and T3)- 2-4 grains per day (120-240mg)
  • Cytomel or liothyronine (pure T3) – 75-125 mcg per day

If you are still having hypothyroid symptoms (constipation, cold intolerance, fatigue, etc.) despite being on one of the medications above you should look into having your dose increased.

Your doctor should NOT titrate your dose based on your TSH (which is what most doctors do).

The pituitary gland (part of the brain that pumps out TSH) has unique deiodinase enzymes which make it different than every other cell in the body!

The difference in deiodinase in the pituitary makes it super sensitive to T4 and T3. So it’s possible, and common, that the pituitary is getting enough thyroid other cells in the body aren’t getting enough.

It’s also common for patients on synthroid only to convert that T4 into the inactive reverse T3 which further blocks the action of T3 at the cellular level (this is what was happening in the example I showed you above).

If you’ve been on T therapy (levoxyl or synthroid) and are at 200-400 mcg per day then have your doctor check your reverse T3 levels.

Thyroid hormone metabolism

If your reverse T3 levels are > 15 or your free T3 to reverse T3 ratio is < 0.2 then you are likely suffering from thyroid resistance. In this case you would need to switch from T4 therapy to T3 therapy.

You are more likely to have thyroid resistance if you have any of the following conditions: weight loss resistance, fibromyalgia, depression, bipolar disorder, insulin resistance (diabetes or prediabetes), chronic fatigue syndrome, and high levels of inflammation.


What if your doctor just doesn’t get it?

It may be time to find a new doctor that understands how to properly evaluate thyroid function.

A good place to look is here.

This will help you find a provider that focuses on functional medicine and has a similar approach as me to thyroid related problems.

You can also find helpful information of thyroid related issues at the following places:

  1. National Academy of Hypothyroidism
  2. Stop the thyroid madness
  3. Hypothyroid support group on facebook

If you need help with lifestyle changes, diet, exercise routines or with reducing your stress and improving your sleep then download by weight loss companion guide which includes all of these topics for free.

This article was republished with permission from Author, Dr. Westin Childs, a leading expert in thyroid health. To learn more I highly encourage you to check out his excellent articles at or follow him on Facebook!



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