15 Signs of HYPOTHYROIDISM You Can See: Doctor Explains

there's a small gland in your neck that could be responsible for your fatigue dry skin and weight gain and when it's not working properly everything falls apart including your hair nails and skin it's called the thyroid gland and millions of people have an underactive thyroid without even knowing it so today I'm going to show you the top 15 signs of hypothyroidism so you know exactly what to watch out for let's start by looking directly at the thyroid gland for this test you need a mirror and a glass of water your thyroid gland is located low on the neck just above the collar bones and when you swallow it moves up and down making it easier to see so take a sip of water and hold it in your mouth then tilt your head back a little bit and swallow while looking at the base of your neck and a pro tip don't get confused by the thyroid cartilage in the middle of the neck for men that's the atoms Apple your thyroid gland will be below that if you can't exactly see where the thyroid is that's actually completely normal some people with healthy thyroids who are really Slim and have a long neck might be able to make it out of the mirror but usually if it's big enough to see that means your thyroid is enlarged and that's called a goer and people with hypothyroidism can develop a huge goer and the physiology is actually pretty cool basically your brain monitors how much thyroid hormone is circulating in your body and it sends a signal to your thyroid gland when it needs to produce more that signal is called thyroid stimulating hormone or TSH for short as the name suggests TSH stimulates the production ction of thyroid hormone and also tells it to get bigger and stronger but if there's a problem with the thyroid or a nutritional deficiency like iodine deficiency no matter how big the thyroid gets it just can't physically produce enough thyroid hormone and this becomes a vicious cycle where the brain keeps releasing more TSH and the thyroid gland just keeps getting bigger and bigger at a certain point the thyroid will become so large that it will compress important structures in the neck making it difficult to swallow and even hard to breathe now let's move on to your largest and most visible organ your skin think of it like a brick wall with dead flattened skin cells forming the bricks and like any good brick wall a natural mortar made of oils and fats holds the bricks together and locks in moisture but an underactive thyroid dramatically reduces the amount of healthy oils your skin produces which can lead to dry rough skin over time moisture escapes from the deeper layers of the skin and eventually that wall literally starts to crack and fall apart this is called atic eczema or eczema crack lay this distinctive pattern is often called crazy Paving not that kind of crazy this actually refers to a type of pavement with a mosaic of irregular tiles your skin is constantly shedding and regenerating and this process is disrupted in hypothyroidism did you know the average person sheds about 3 and 1/2 lbs of dead skin per year for my fellow millennial Nails that's about 10 avocados worth of dead skin which just sounds like a weird salad that nobody asked for this process of shedding and regenerating is carefully regulated by enzymes that break down proteins holding together the outer layer of your skin however when your thyroid is underactive these enzymes don't work properly leading to a buildup of skin cells and proteins and the results can be dramatic this is a 43-year-old woman who had Progressive skin thickening in her hands and feet over 3 months this is actually a massive buildup of a protein called keratin you can think of keratin like the body's natural armor it's a tough protective protein that gives structure and strength to your skin sometimes that's protective and healthy like the calluses that build up on a construction workers hands but what we're seeing on this woman's foot is clearly excessive in this case it was her underactive thyroid that was preventing her skin from shedding properly causing a condition called palmo planter catod Derma and amazingly after just 9 months of treatment with thyroid replacement hormone her skin was back to normal while we're on the subject of keratin did you know that this protein makes up 90% of your nails and 95% of your hair so it's no surprise that an underactive thyroid can have a major impact on your hair and nails these are real images of a 41-year-old woman with hypothyroidism this poor lady lost almost all of her hair over the course of Just 4 months and to understand what happened you need to understand the life cycle of a hair each hair is created by special cells within the hair follicle at some point that hair will stop growing and enter a resting phase before it eventually falls out and at any given time about 10% of your hairs are in that resting phase just waiting to fall out but when your thyroid hormone levels are low all of that gets disrupted first the production of hair slows down and becomes disorganized and that leads to dull brittle thin hair but even more distressing the follicles will enter that resting phase prematurely and

within a few months you can develop massive hair shedding here are some examples of hair thinning that are less severe but are also caused by hypothyroidism now let's look at the nails of that same woman a similar process happens where nail growth slows down and becomes disorganized and sometimes this leads to thicker nails like we can see here but although they're thicker the nail quality is actually poor and they're quite prone to splitting it turned out this patient had Hashimoto thyroiditis a condition where your IM immune system attacks your thyroid gland she was immediately started on treatment with thyroid hormone replacement and she made an incredible recovery this is her 5 years later with a thick head of hair and normal nails thick vertical ridges can also appear on the nails which typically crumble and break easily although I will note that vertical ridges can be benign and just develop with age one other nail change you might see in hypothyroidism is Onis where you get separation of the nail from the nail B bed and when the nail lifts up air gets under the nail which gives it disappearance of course hair loss and hypothyroidism isn't just limited to the scalp it can also affect the eyebrows eyelashes and body hair this is a 72-year-old man with hypothyroidism who decided to stop taking his thyroid replacement medication about 6 months earlier if you look closely you can see some obvious findings of hypothyroidism that we've already talked about flaky dry skin and thinning of his hair but let's FOC Fus on his eyebrows notice how the outer third of his eyebrow is so thin that it's almost completely disappeared this is a classic finding of hypothyroidism that we call Queen an sign which is named after the eyebrows of Queen Anne of Denmark although truthfully nobody really knows if she actually had hypothyroidism if you love this kind of information and you want your questions answered in a monthly live stream then click the link up here to become a channel member let's look at that image again do you see that swelling under his eyes this is called periorbital edema and yes some people are more prone to bags under their eyes like parents of a newborn but it can also be a striking sign of hypothyroidism but this isn't your typical swelling and if you push on it the texture will be firm maybe even a little bit doughy that's because it isn't just water it's actually a buildup of gelatinous material in the skin called mix edema it might sound kind of gross but in the right quantities this gel is actually part of an essential substance known as The extracellular Matrix which is kind of like the scaffolding or cushion between your cells in fact one of the major components of this gel called hyaluronic acid is commonly used in lip fillers the trouble is when you don't have enough thyroid hormone that gel starts to get overproduced and builds up we usually see this around the eyes on the hands and the feet but it can really build up anywhere as you'll see in this next case this is a 35-year-old man who suffered a 2-year history of progressive weakness in his arms and legs before he was finally diagnosed with hypothyroidism notice how his tongue and calf muscles are strikingly large you guessed it that swelling is caused by mix edema fortunately everything went back to normal with treatment but this also highlights how hypothyroidism can lead to obstructive sleep apnea basically when your tongue gets this big and swollen it can easily block off your Airway when you're sleeping not only does this lead to excessive daytime sleepiness but it also increases your risk of cardiovascular disease stroke and dementia while hypothyroidism is a rare cause of sleep apnea the good news is that if it's treated properly it's often reversible this gelatinous swelling doesn't just abstract your Airway but it can also compress your nerves okay try this test with me if you can put the backs of your hands together like this is called failin test and you want to hold it here for about 30 to 60 seconds what it's doing is applying pressure on the inside of your wrist right over the median nerve and so if you develop numbness tingling or pain in your fingers then you may have carpal tunnel syndrome the carpal tunnel is a narrow passage in your wrist where the median nerve and the tends that control your fingers are located it's a pretty tight space so any swelling in that area can very quickly compress the median nerve and lead to those classic symptoms like numbness and tingling of the fingers while it's not the most common cause some sources say that up to 5% of all cases of carpal tunnel are caused by hypothyroidism that's actually quite a lot of cases and that's a big deal because it'll often resolve with the proper treatment of the thyroid so identifying the root cause can prevent years of suffering and even prevent the need for surgery but it's not just the median nerve that's at risk of compression the facial nerve which controls the muscles of your face also passes through a narrow opening called the facial Canal this is a rare but fascinating case of a 40-year-old man who presented with a right-sided facial

droop on physical exam it was clear that this wasn't a stroke instead his doctors determined that the facial nerve was being compressed due to swelling from hypothyroidism he was started on treatment right away and he made a complete recovery absolutely incredible but remember if you or someone that you know ever develops a facial droop I want you to assume that it could be a stroke and get to the hospital as quickly as possible don't stop to think about hypothyroidism your doctor can always think about rare causes later all right now I'm sure we all know someone who's always cold they bundle up in a hoodie in the summer and bring a blanket into the movie theater and they wear socks to bed maybe that person's you some people just tend to run cold but it can be a Telltale sign of a slow Metabolism from an underactive thyroid basically your cells are running on low power mode doing only the basics to survive without the extra energy and heat that comes from an Active Metabolism in severe cases this can quickly turn into a life-threat ing medical emergency called madema coma and that's exactly what happened to this 56-year-old woman who presented to the emergency department with fatigue and confusion at this point in the video you can probably just look at these images and make a spot diagnosis of hypothyroidism hair thinning mix edema causing swelling in her face Queen an's eyebrows palmo planter cat Derma and thick brittle nails but what makes this case so life-threatening are things you can't see in the photo she was conf fused her heart rate was slow her respiratory rate was slow and she was hypothermic with a core body temperature of 34° cius or 93° F her body was shutting down personally I've seen two cases like this of mixed deacom and both patients were so critically ill they ended up in the ICU requiring life support and even with the best medical treatment up to 60% of people with mix ademac coma will die the best chance they have is if doctors make the diagnosis quickly and start giving thyroid hormone directly through the IV but even IV thyroid hormone doesn't start working immediately and these patients will often need intensive care and even life support until the treatment starts to take effect this woman got lucky and beat the odds making an incredible recovery this is her one year after starting treatment and she looks like a different woman okay let's pivot and focus on something completely different skin color notice how the hand on the left has an orangey yellow color to it this is called kermia and it means there's a buildup of keratin in the body kerene is the orange pigment found in carrots sweet potatoes and pumpkins it's also a precursor to vitamin A usually when you eat these Foods your body converts most of the Keratin into Vitamin A but in hypothyroidism that enzyme doesn't work as well so this orange pigment builds up in the bloodstream and eventually deposits into the skin and it's most noticeable in areas with thick skin like the palms and the soles fortunately the buildup of beta carotene in itself is harmless in fact even with a healthy thyroid if you eat enough of this pigment you can give your skin an orange glow check out this Tik tocker who's promoting eating lots of carrots to change the undertone of her skin not make me say it again three large carrots a day and you can change your natural undertone this is literally the skin that I was born with and this is me with no fake Tanner I have been eating three large carrots a day but low thyroid hormones can also have a serious impact on your brain decreasing levels of your feel-good neurotransmitters like serotonin and dopamine and decreasing activity in the parts of the brain involved in emotional regulation memory and motivation this can have a huge impact on your mental health and it's the reason why a workup for depression should always include blood work screening for hypothyroidism and for women changes to your period can also be a clue low thyroid hormone can lead to high levels of estrogen and low levels of progesterone both of which can affect your uterine lining the result more buildup leads to heavier longer periods or irregular periods and while hypothyroidism has a big impact on your reproductive system it has an even bigger impact on a baby's development this is such an important topic that I think we need to talk about more and I actually published a paper about five things to know about subclinical hypothyroidism in pregnancy Okay so we've covered the more dramatic and obvious signs to watch out for but some of the most common symptoms of hypothyroidism are also vague like chronic fatigue constipation and weight gain and since they're such common things that people experience I think they easily get overlooked and don't necessarily get connected to hypothyroidism so what causes hypothyroidism well historically the leading cause was iodine deficiency which is why iodine was added to table stall to the 1920s and this largely resolved the issue in developed countries but believe it or not today cases of iodine deficiency are on the rise in developed countries thanks to the popularity of restrictive diets and natural non iodized salts in areas where

iodine deficiency isn't an issue the leading cause is Hashimoto's thyroiditis an autoimmune disease where the body attacks and slowly destroys the thyroid gland and this is particularly common in women of course there are many other causes but we would need a whole other video for that okay so now if you think you have some of these symptoms how do we make the diagnosis fortunately it's simple we do a blood test to check your TSH level which as you'll remember is the signal your brain releases to tell your thyroid to make more thyroid hormone and if your TSH level is too high it normally means your thyroid is underperforming and we can confirm this by measuring the actual thyroid hormone circulating in our body called T4 and T3 the good news is that hypothyroidism is very treatable we have a medication called levothyroxin which is a thyroid hormone replacement doctor will titrate the dose based on your TSH level and when your TSH is normal then we know that your brain is happy with the amount of thyroid hormone that Circ culating in your body so if you enjoyed this video and you want to learn about the liver next then I'd recommend checking out this video next stay curious stay healthy and I'll see you in the next video so bye for now