The most characteristic and most frequently reported symptoms of Hashimoto’s disease include constant fatigue and sleepiness. Fatigue experienced with the co-occurrence of Hashimoto’s disease may not be related to lack of sleep or intense physical or mental effort.
Decreased muscle metabolism, slower heart rate, and slower brain function lead to reduced exercise capacity. It is because thyroid hormones (thyroxine and triiodothyronine), whose production and secretion to the blood drops in this disease, are responsible for regulating metabolism. With a deficiency of hormones, the metabolic rate can decrease by up to 30%.
Additionally, there is a link between hypothyroidism and depression, with bad mood and depressive states being able to occur even when the thyroid secretory function is normal – physical changes have been found, but the concentration of hormones in the blood is normal.
2.
In Hashimoto’s disease, various changes occur in the body’s functioning, particularly related to hormonal imbalances. One significant aspect affected is the skin, which experiences disrupted blood supply. Patients often have skin that feels cool to the touch, as well as dry and rough in texture.
Thyroxine (the T4 hormone produced by the thyroid gland) plays a crucial role in the proper functioning of the sebaceous glands. A deficiency in this hormone leads to flakiness and dryness of the skin. As a result, the epidermis tends to flake and undergo keratinization due to increased production of keratin and intercellular lipids, which contribute to transepidermal water loss. Keratinization is particularly noticeable on the feet, elbows, and knees. On the feet, this keratinization often occurs in areas that experience the most pressure, such as the heels, leading to brittle and cracked heels accompanied by flaking skin.
In addition to paleness, the skin may exhibit a yellow tint due to impaired metabolism of carotene by the liver. When carotene is not properly metabolized, it can accumulate in the stratum corneum of the epidermis. This excess carotene is then excreted through sweat and can be reabsorbed by the skin, often depositing in areas where sebaceous glands are present. Furthermore, when the temperature drops in the environment, bluish-red streaks may appear on the skin. These streaks are characterized by a reticular pattern that resembles marble. This symptom, associated with hypothyroidism, is skin marbling.
3.
Weight gain with hypothyroidism mainly concerns situations when there is overt hypothyroidism with unbalanced hormonal disorders. When hypothyroidism is properly treated and hormone levels are balanced, it ceases to be a cause of obesity. Unfortunately, many people do not pay attention to their diet and explain weight gain with hypothyroidism, regardless of whether the hormone levels are balanced or not.
Untreated or improperly treated hypothyroidism leads to weight gain for several reasons. First, generalized edema occurs. Water retention in the body contributes primarily to weight gain. Another problem is a slower metabolism. The caloric demand of a person with hypothyroidism decreases. Therefore, if a person consumes the same number of calories as before the disease, it may turn out that their body weight begins to increase.
Weakness and lethargy translate into a decrease in physical activity. It, in turn, is also a factor in increasing the risk of weight gain. Hypothyroidism causes menstrual disorders through an indirect effect on hormonal dysregulation. Disturbances in sex hormones are also a significant factor that impairs metabolism and makes it difficult to lose weight.
4.
Hashimoto’s disease can lead to a decrease in free thyroid hormones (FT3 and FT4), which play a crucial role in nourishing hair. When the levels of these hormones are insufficient, it can negatively affect hair health. In a situation where the concentration of thyroid hormones is insufficient, sebum secretion from the sebaceous glands decreases and the hair dries out.
Moreover, the rate of hair growth is delayed. In the case of hypothyroidism, taking hormonal drugs or antibiotics can cause hair to become brittle. Vitamin and mineral deficiencies also adversely affect their condition. Hair thins, shortens, and becomes thin, soft, and dry. In the course of hypothyroidism – as a result of too low concentration of the hormones T3 and T4, thyroid alopecia may occur, in the course of which there is atrophy of hair follicles.
It also happens that women suffering from Hashimoto’s may complain of excessive hair growth, which is characteristic of men. This abnormality is called hirsutism. This condition arises from a reduced concentration of sex hormone-binding globulin (SHBG), which normally binds androgens (male hormones) and estrogens (female hormones). Excessive hair growth may occur on the nipples, back, arms, chin, inner thighs, hands, cheeks, and jawline.
5.
Hashimoto’s disease can lead to brittleness of the nails, making them more susceptible to cracking and breaking. Individuals may also notice vertical lines along the length of the nail, a condition known as nail plate furrowing.
Furrows can vary in appearance, presenting as many fine lines or as a single deep line. It is important to note that furrows are not exclusively caused by hypothyroidism; they can also result from other thyroid diseases. Additionally, factors such as aging, iron deficiency, genetic predisposition, psoriasis, and mechanical injuries can contribute to the development of nail furrows.
In cases of hypothyroidism, the outer part of the nail plate may separate from the nail bed. This separation typically starts at the distal (tip) part of the nail and progresses toward the proximal (closer to the hand) area. As a result, air gets trapped between the nail plate and the nail bed. The separated portion of the nail plate may take on a distinct color, often white, but it can also appear brown or yellow. This condition is known as onycholysis and can affect not only those with hypothyroidism but also individuals with hyperthyroidism.
6.
Feeling that we are cold, often quite intensely, is common among individuals with an improperly functioning thyroid. The thyroid is referred to as the body’s thermostat because it plays a key role in regulating temperature.
Those suffering from hypothyroidism or Hashimoto’s disease tend to have a reduced tolerance for colds, and their body temperature is often lower than standard.
Feeling cold can be one of the first signs that the thyroid is not functioning correctly.
7.
Progressive hypothyroidism associated with this disease causes an increased accumulation of sugar derivatives called glycosaminoglycans in the skin. These compounds, including hyaluronic acid, attract water. Over time, excess fluid can accumulate in the skin, leading to swelling, a condition known as myxedema. This swelling is called myxedema, and one of the most common places where it appears is on our faces.
In advanced Hashimoto’s disease, people with hypothyroidism experience swelling of the face, especially around the eyes. The skin can also become dry and scaly. The complexion can also become pale or even take on a yellowish hue due to the development of hypercarotenaemia — excessive accumulation of carotene derivatives in the skin. Additionally, proptosis, or bulging eyes, can also occur.
Furthermore, individuals with severe hypothyroidism associated with advanced Hashimoto’s disease may exhibit a widened nose, thickened lips, and an enlarged tongue. They may also experience hair loss, including hair loss in the outer part of the eyebrows. Facial swelling typically occurs in the advanced stages of Hashimoto’s disease. However, it can also happen in patients who have stopped taking their thyroid medication. Moreover, in cases of facial swelling, it is essential to consider other possible causes for such skin changes, including allergic reactions, cellulitis (a bacterial skin infection), or sinusitis (a viral or bacterial infection of the paranasal sinuses), among others.
8.
Hypothyroidism can be accompanied by pathological bradycardia, which is a slowing down of the heart rate in adults below 50-60 beats per minute. Slowing down the heart rate makes even the simplest activities very tiring.
Symptoms of bradycardia caused by hypothyroidism increase gradually, making it difficult for both the patient and the doctor to make a proper diagnosis. The most common symptoms of bradycardia:
In more severe cases, bradycardia can lead to fainting and even death. If the patient suspects that the heart is beating too slowly, they should see a doctor. In the case of bradycardia associated with the risk of asystole or severe symptoms, pharmacological treatment is used. If bradycardia persists, transvenous stimulation should be considered, which involves inserting an electrode through the vessels directly into the heart. The causes of the heart beating too slowly should always be sought because eliminating it may prevent the implantation of a pacemaker.
9.
Scientists are not entirely sure why thyroid-related problems occur. Still, they believe hypothyroidism affects memory because thyroid hormones are essential for areas of the brain that are crucial for memory and cognitive abilities. People suffering from so-called brain fog often have problems with chronic fatigue, concentration, and focus.
They also often notice difficulties finding words and following the conversation threads during conversations. It happens that in people who complain of brain fog, it also manifests itself in memory problems, including, for example, problems with remembering names, surnames, or simple tasks to perform.
The above symptoms can significantly reduce the quality of everyday functioning in the professional and private sphere. In addition to the above symptoms, there may also be difficulties in processing information, slower than usual thinking, a sense of being overwhelmed by simple tasks, and regularly forgetting to do simple things, such as turning off the stove or closing the door.
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Neuropsychiatric symptoms include e.g. regular mood swings, memory disorders, chronic feelings of sadness and depression, low mood, increased anxiety, and concentration disorders.
Disturbances in the proper functioning of the nervous system as a consequence of Hashimoto’s may result from the role of thyroid hormones in the maturation of the nervous system and enabling its physiological functioning.
In some sources describing this problem in more detail, you can find the statement that often, the psychological symptoms in patients with Hashimoto’s can be much more severe for patients than the physical symptoms. It gives an idea of the difficulty they can pose in the daily functioning of patients.
11.
The co-occurrence of depressive disorders is frequently observed, particularly among women with autoimmune thyroiditis (Hashimoto’s disease). These disorders often emerge during the postpartum period and around menopause.
Scientific studies indicate that individuals with Hashimoto’s have a risk of developing depressive disorders that is up to six times higher than those without the condition.
Alarmingly, the presence of depressive symptoms in people with Hashimoto’s may lead to the development of depression that is more resistant to standard pharmacological treatments.
12.Another typical mental health problem among people with Hashimoto’s is anxiety conditions, especially obsessive-compulsive disorders. According to scientific studies, they are much more common in Hashimoto’s than in the general population.
In patients with Hashimoto’s disease, the symptoms of neurosis may be as follows:
When it comes to the treatment of Hashimoto’s disease, it is mainly based on taking L-thyroxine preparations. The dose of the preparation is always determined individually depending on the condition of the patient and co-occurring diseases. In patients with a severe course of Hashimoto’s disease, hospitalization may be necessary.
