• Thyroid Disorders
• Hormone Replacement Therapy

What are the Symptoms of Hypothyroidism in Women?

Medically reviewed and edited by Kerri Louati, MS, RD, LD, CDE

Published: September 03, 2025
Updated: January 13, 2026
4 mins

Hypothyroidism is one of the most common thyroid disorders in women, especially during midlife and beyond. It develops when the thyroid gland does not produce enough thyroid hormones, which affects everything from metabolism and energy to mood, digestion, fertility, and temperature regulation.

Symptoms often come on slowly and can easily be mistaken for stress, aging, lack of sleep, or busy schedules. Many women live with thyroid symptoms for years before receiving a diagnosis. Understanding why hypothyroidism happens and what you can do about it can help you regain your energy and overall well-being.

What is Hypothyroidism?

The thyroid produces the hormones T4 and T3. T4 is the storage form, while T3 is the active form that powers metabolism and cellular energy. The body must convert T4 into T3 for thyroid hormones to work properly.

If the thyroid cannot make enough hormone, or if the body cannot effectively convert or use those hormones, hypothyroidism develops.

Thyroid hormones influence:

• Energy production and stamina • Metabolism and weight regulation • Mood, focus, and memory • Temperature control • Menstrual cycles and fertility • Heart rate and circulation • Gut motility and digestion • Immune system balance

When thyroid hormone levels fall, each of these systems slows down.

What Causes Hypothyroidism in Women? 

Hypothyroidism can develop for several reasons, and many women have more than one contributing factor. 

Autoimmune processes

The most common cause of hypothyroidism in the United States is Hashimoto’s thyroiditis. In this autoimmune condition, the immune system mistakenly attacks thyroid tissue, gradually reducing hormone production.

Autoimmunity can be influenced by genetics, stress, gut health, infections, nutrient status, and hormonal changes.

Hormonal shifts across the lifespan

Women undergo several hormonal transitions that influence thyroid function. These include:

• Pregnancy and postpartum changes • Perimenopause and menopause • Fluctuations in estrogen and progesterone that alter thyroid-binding proteins • Cortisol imbalances due to chronic stress

These shifts can reduce thyroid hormone production, affect immune system balance, and change how much thyroid hormone is available to the body.

Nutrient deficiencies and metabolic factors

Certain nutrients are essential for making and activating thyroid hormones. Deficiencies are common and may contribute to hypothyroidism or worsen symptoms.

Key nutrients include:

• Selenium and zinc for T4-to-T3 conversion • Iron (ferritin) for thyroid hormone synthesis • Vitamin D for immune regulation • B12 and folate for cellular energy and nervous system function • Omega 3 fats for inflammation control • Adequate protein for tyrosine, the amino acid backbone of thyroid hormone

Blood sugar instability and insulin resistance can also interfere with hormone conversion and increase inflammation.

Gut and immune system imbalances

Gut health plays a direct role in thyroid function. Digestive issues such as dysbiosis, low stomach acid, constipation, or inflammation can:

• Reduce absorption of thyroid-supportive nutrients • Increase systemic inflammation • Trigger immune dysregulation • Impair the conversion of T4 into T3

Because most of the immune system resides in the gut, imbalances here can contribute to both autoimmune thyroid disease and worsening hypothyroid symptoms.

Environmental and lifestyle factors

Several external factors can reduce thyroid function or hormone availability.

These include:

• Endocrine-disrupting chemicals such as BPA, phthalates, and pesticides • Chronic infections such as EBV or H. pylori • Medications that interfere with thyroid hormone production • Past neck radiation or treatment for hyperthyroidism • Poor sleep, chronic stress, and overtraining • Impaired liver detoxification, which reduces T4-to-T3 conversion

Each of these factors can disrupt thyroid hormone pathways and contribute to hypothyroidism.

Common Symptoms of Hypothyroidism in Women

Hypothyroidism can affect nearly every organ system. Symptoms are often varied and may include:

• Fatigue or low stamina • Weight gain or difficulty losing weight • Feeling unusually cold• Constipation • Dry skin, brittle nails, or hair thinning • Brain fog or memory changes • Mood changes such as depression or anxiety • Puffiness, especially around the face and eyes • Slowed heart rate • Menstrual irregularities • Reduced fertility or ovulation changes • Joint and muscle pain

In advanced cases, cholesterol levels may rise, and a condition called myxedema can develop.

How Hypothyroidism is Diagnosed

A thorough evaluation typically includes both clinical assessment and laboratory testing.

Physical examination

A provider may check the thyroid gland, skin, reflexes, heart rate, and signs of swelling or slowed metabolism.

Blood tests

A complete assessment often includes: • TSH • Free T4 • Free T3 • Thyroid antibodies (TPO and TG antibodies)

Testing antibodies helps detect autoimmune thyroid disease, even in early stages when TSH may still be within the standard range.

Imaging

A thyroid ultrasound may be recommended if nodules or structural concerns are present.

Lifestyle Interventions for Hypothyroidism

Thyroid medication is often needed, but it is only one part of fully supporting thyroid health. A functional approach aims to identify and address root causes while improving how the whole body functions.

Below are the key areas of support.

Nutrition and nutrient repletion

Good nutrition is the foundation of thyroid support. Here's what helps:

Getting enough protein gives your body the tyrosine it needs for thyroid hormone production. Make sure you're also getting key nutrients like selenium, zinc, vitamin D, iron (if yours is low), B12, and omega-3 fats.

Eat plenty of fiber-rich vegetables and whole foods to support your digestion and metabolism, and cut back on ultra-processed foods that can trigger inflammation.

If you're dealing with digestive issues or autoimmune symptoms, it might be worth looking into food sensitivities or trying to reduce gluten or dairy for a while to see if it makes a difference.

Gut health support

Your gut health plays a bigger role in thyroid function than you might think. 

Be sure to work on improving your digestion and stomach acid levels, and that you're getting enough fiber in your diet. If you're dealing with constipation or signs that your gut bacteria are out of balance, address those issues. If gut symptoms stick around, stool testing can help figure out what's going on. Probiotics or other targeted gut therapies might be helpful depending on what you need.

When your gut is healthy, you absorb nutrients better and your body does a better job converting thyroid hormones into their active forms.

Stress management and nervous system support

Chronic stress can actually mess with how your body processes thyroid hormones – it reduces the conversion of T4 to T3 and increases reverse T3, which can leave you exhausted even when your labs look normal.

Here are some strategies that can help:

Try gentle movement like walking, yoga, or stretching. Practice breathwork and other relaxation techniques, or spend time in nature. Prioritize consistent sleep patterns and don't be afraid to set boundaries or lean on emotional support when you need it. Mind-body therapies like meditation or acupuncture can also make a real difference.

Taking care of your nervous system isn't just nice to have – it's essential for getting your hormones back in balance.

Sleep optimization

Sleep is when your body regulates hormones and detoxifies. Better sleep can help stabilize your metabolism, reduce inflammation, and improve how your body converts thyroid hormones.

Try these strategies:

Go to bed and wake up at the same time each day. Dim the lights in the evening and put away screens before bed. Keep your bedroom cool and dark – your body will thank you.

Environmental toxin reduction

Small lifestyle tweaks can help you avoid endocrine-disrupting chemicals that interfere with thyroid function.

Here's what you can do:

Use a water filter and swap plastic containers for glass or stainless steel. Choose fragrance-free personal care products and wash your fruits and vegetables thoroughly. Improving your home's air quality also makes a difference.

These changes support not just your thyroid, but your overall hormone balance too.

Treatment Options for Hypothyroidism

Medication is often necessary and works best when combined with supportive lifestyle measures.

Thyroid hormone replacement

Medications include T4 only therapy or combined T4 and T3 therapy. The best option depends on symptoms, labs, and how well the body converts T4 into T3.

Monitoring and adjusting dosage

A provider typically rechecks labs six to eight weeks after any dose change. Hormone needs may shift during pregnancy, postpartum, or perimenopause.

Moving Forward with Hypothyroidism

With proper diagnosis and a comprehensive treatment approach, most women feel significantly better and regain energy, mental clarity, and emotional balance. Addressing both thyroid hormone levels and the factors that influence thyroid health allows the body to heal more completely.

Partnering with a provider who understands both thyroid physiology and whole person care can help you find the right balance of medical treatment and lifestyle support.

Where Can I Learn More About Managing Hormonal Imbalances?

Hypothyroidism is a lifelong health condition. LifeMD can help you understand any health changes you may experience in your daily life associated with hypothyroidism and the best next steps to take. 

LifeMD offers treatment for anyone needing support for thyroid complications. With LifeMD+, you can get quality testing and lab options for thyroid treatment and other health concerns. A LifeMD-affiliated healthcare provider can also prescribe hypothyroidism treatments for those who qualify.

Become a LifeMD+ member today to balance your hormones for an optimal health outcome.

For menopausal women with thyroid concerns, the LifeMD Women's Health Program may be more suitable for your individual health needs. It provides not only thyroid support like levothyroxine, but also estrogen replacement therapy and other care to help you manage hormonal changes through different stages of menopause.

Kerri Louati, MS, RD, LD, CDE

Kerri Louati, MS, RD, LDN, CDE, is a registered dietitian and certified diabetes educator specializing in nutrition, integrative medicine, functional laboratory interpretations, and functional medicine. She is also the Director of Women's Health Clinical Operations at LifeMD. She previously served as the Director of Nutrition and Coaching with the telehealth platform Optimal Human Health MD.

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