Despite its critical importance, many people don’t even know where their thyroid gland is located or what exactly it does. Wonder no more. The thyroid is a small gland shaped like a butterfly that drapes over the front of your windpipe. It releases two hormones, nicknamed T3 and T4, which direct how your cells use energy. The thyroid also regulates growth and metabolism.

Disorders of the thyroid are very common, with about 12% of people worldwide experiencing a problem at some point. Unfortunately for females, women are about eight times more likely to have thyroid issues than men. But the risk increases with age for everyone.

Thyroid disease happens when the levels of hormone are too high or too low for proper function. When levels are too low, it is called hypothyroidism, levels too high indicate hyperthyroidism. It is important to nip either one of these conditions in the bud. They are quite treatable, but left unchecked, can lead to infertility, heart disease, and kidney disease.

Because one condition involves too much thyroid hormone and one involves too little, the symptoms of each are like two sides of a coin. Following are 8 pairs of symptoms to watch out for and 2 that are actually the same for both conditions. You’ll be fascinated by these last two, which cause the same symptom in very different ways.

1. Feeling Tired vs. Feeling Jittery

The hormone released by the thyroid controls energy levels and signals cells when it is time to wake up or to sleep. The most common symptom of hypothyroidism is feeling tired and worn out, no matter how much you rest, because you don’t have enough hormone to properly signal cells. You may also experience low motivation and mental exhaustion on top of physical sluggishness.

On the flip side, people with too much thyroid hormone feel nervous and jittery. You may not be able to stay seated or to focus on any one task. That’s because your cells are flooded with the message to go-go-go. This can also manifest in anxiety, tremors, or difficulty sleeping.

2. Gaining Weight vs. Losing Weight

When your thyroid hormone levels are low, you are likely to move less due to exhaustion. On top of that, your metabolism switches tracks. Rather than burning calories for energy and growth, the amount of energy used at rest decreases and your body begins to store more calories as fat. Even if you don’t eat more calories, people with newly diagnosed hypothyroidism gain an average of 15-30 pounds in the first year!

Too much thyroid hormone has the opposite effect. You are more likely to be moving a lot and your metabolism speeds up. As a result, you may lose weight despite having a bigger appetite. However, don’t rely on weight loss as confirmation of hyperthyroidism. Eating more can increase your weight even with an overactive thyroid.

3. Feeling Cold vs. Feeling Hot

When your body burns calories, heat is the byproduct. When you have hypothyroidism, your basal metabolic rate goes down and you produce less heat.

Approximately 40% of people with low thyroid hormone report that they feel colder than others in the same room. This is an important symptom to note if it has come on suddenly – if you are always colder than everyone else, it could simply be your norm.

It stands to reason, then, that people with too much thyroid hormone feel hotter than usual. A ramped-up metabolism and high rate of calorie burn produces a lot of heat. Additionally, thyroid hormone bumps up the thermostat on a type of specialized fat called brown fat, which generates heat and is meant to assist survival in cold climates.

4. Dry, Itchy Skin vs. Swollen, Moist Skin

Skin changes can be caused by a lot of things, so don’t jump right to thyroid disorder if you experience this symptom. However, having either too much or too little thyroid hormone can definitely affect the texture and quality of your skin.

Much like hair follicles, skin cells typically have a high turnover. When that turnover slows due to hypothyroidism, cells hang around longer before being shed and replaced. That leads to dry and irritable skin. But when the cells are turning over too quickly, you’ll find your skin thickens and appears swollen and moist.

5. Depression vs. Anxiety

Depression and anxiety often go together, but they are different things. People can have both, but depression is more often linked with fatigue and low mood, while anxiety is a restless feeling of discord that makes it hard to calm down. Depressed people may struggle to get out of bed while people with anxiety may have trouble going to bed at all.

Hypothyroidism is commonly linked with depression because of its connection with low energy, while anxiety is a frequent side effect of hyperthyroidism. But because depression and anxiety represent opposite ends of the same pendulum, you can’t necessarily rely on having either one as a proof of a thyroid disorder.

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