10 Red Flags of a Hypothyroidism Flare

by Mary Shomon Patient Advocate

Are you tired and sad? Are you reaching for the moisturizer and a sweater … but you can't remember where you left them? You might be having a flare-up of your hypothyroidism. Here are 10 common red flags that strongly suggest you're in the throes of a hypothyroidism flare, and what steps you can take to feel better.

Yawning from exhaustion.
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You’re exhausted

Are you unable to make it through the day anymore without a nap? Are you sleeping more than usual — but you’re still tired? Are you hitting the snooze bar too many times to count? Feeling more tired than usual is a common sign that you’ve become more hypothyroid.

"OMG!" displayed on bathroom scale.
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The number on the scale doesn’t make sense

Are you gaining weight — with no change to your diet or exercise? Are you working out and dieting rigorously, and the scale is staying the same … or you’re even gaining weight? Weight issues are alerts that you may be in the midst of a hypothyroidism flare.

Help written in heavy moisturizing cream on hand.
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Your skin feels especially dry

If you are reaching for the moisturizer because your skin is dry, itchy, flaky, and rougher than usual, this is an indication that your thyroid may be falling down on the job.

Washing hair in shower.
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Your drain is clogged with hair

If you are buying drain cleaner in bulk supply and cleaning hair out of your drains and off your pillow and brush, your hypothyroidism may be flaring up. Hair loss — from the head, body, and even your eyebrows — is a common sign of an underactive thyroid.

Bundled up inside.
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You feel colder than usual

Are you reaching for a sweater when everyone else is cranking up the air conditioning? Are you bundling up for an Arctic trek every time you go outside? Are your hands and feet as cold as ice? These are red flags that signal that your hypothyroidism is not under control. Feeling cold, especially when others are warm, is a common sign of an underactive thyroid.

Can't remember what he forgot.
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You’re forgetful

Did you leave your keys in the car? Forgot your cellphone? Get to the kitchen and totally forget why you’re there? If you’re having more episodes of forgetfulness and brain fog, this is a red flag that your hypothyroidism treatment is less-than-optimal.

Constipated and in pain.
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You’re “irregular”

Are you spending more time in the bathroom, with less to show for it? If you notice that you’ve become constipated lately, this is a sign that you may have become more hypothyroid than you realize. Constipation is a common sign of an underactive thyroid.

Trying to squeeze swollen feet into shoes.
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Your shoes or rings don’t fit

Is it impossible to get your rings off to wash your hands? Are you noticing that your shoes feel unusually tight? Swollen hands and feet — known as edema — are common symptoms of hypothyroidism.

Hoarse teather worried about next class.
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Your voice is hoarse

Are you a woman … but people think you’re a man on the phone? Has your voice become deeper and scratchier, and you sound hoarse? These kinds of changes are red flags that you may have become more hypothyroid.

No drive in bed.
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You’ve lost that loving feeling

If you’ve lost your sizzle between the sheets, that’s a hypothyroidism red flag. A lower — or even nonexistent — sex drive is common with an underactive thyroid.

Wondering why.
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Why are you having a flareup?

If you've been well-regulated on thyroid hormone replacement medication, why are you having a flare-up? There are a few common reasons:

  • Cold temperatures can increase your need for thyroid hormone. Some doctors even schedule a dosage increase for their patients with hypothyroidism as soon as cold weather begins.
  • A medication refill or change in your prescription may be to blame. You could have gotten a generic instead of a brand, a different generic, a bad batch, or the wrong dosage or medication.
Wonder why the flare up.
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More causes of a hypothyroidism flare

  • You started or stopped a high-fiber diet. Fiber can reduce your absorption of thyroid medication, so fluctuations are common after starting or stopping a high-fiber diet.
  • You’re drinking coffee and/or milk close to your medication time. Both coffee and milk — if you drink them within an hour of taking your thyroid medication — can reduce your absorption of the drug.
Question marks, why the flare-up.
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More causes of a hypothyroidism flare

  • You’re taking calcium and/or iron too close to your medication. Calcium and iron supplements — and calcium-fortified drinks and juices — can affect the absorption of thyroid medication. (You need to wait at least three hours between calcium/iron and thyroid meds.)
  • You’re overdoing it with iodine supplements, raw goitrogenic foods — like spinach, broccoli, and cabbage — or soy foods. These supplements and foods all can slow down your thyroid.
Doctor making patient feel better about handling flare up.
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What should you do if you’re having a flare?

If you have one or more red flags that you’re in a hypothyroidism flareup, here are two essential steps to take:

  1. Make sure that you’re taking your medication correctly, and are not ingesting anything that could interfere with your absorption.
  2. Get your thyroid levels checked: thyroid stimulating hormone (TSH), free thyroxine (Free T4), and free triiodothyronine (Free T3). If your levels aren’t optimal, it’s time to discuss a change of dosage with your healthcare provider.
Mary Shomon
Meet Our Writer
Mary Shomon

Mary Shomon is a patient advocate and New York Times bestselling author who empowers readers with information on thyroid and autoimmune disease, diabetes, weight loss and hormonal health from an integrative perspective. Mary has been a leading force advocating for more effective, patient-centered hormonal healthcare. Mary also co-stars in PBS’ Healthy Hormones TV series. Mary also serves on HealthCentral’s Health Advocates Advisory Board.