10 Signs You May Have an Underactive Thyroid (Hypothyroidism)

If you’ve been feeling “off” but can’t quite put your finger on why, your thyroid may be worth a closer look.

The thyroid is a small butterfly-shaped gland located in the front of your neck. Despite its size, it plays a major role in regulating your metabolism, energy levels, body temperature, heart rate, digestion, mood, and more. When the thyroid isn’t functioning properly, the symptoms can be surprisingly broad and often mistaken for stress, aging, burnout, or simply having a busy life.

Here are 10 common signs that may suggest you have hypothyroidism:

1. Persistent Fatigue

Many patients describe it as a profound lack of energy that doesn’t improve with rest. They wake up feeling unrefreshed, struggle to maintain stamina throughout the day, and often feel as though their physical and mental energy reserves are never fully replenished.

2. Weight Gain and Other Metabolic Changes

Thyroid hormone plays a central role in regulating metabolic function. When levels are low, metabolism slows, which can contribute to gradual weight gain, fluid retention, elevated LDL cholesterol, and, in some individuals, worsening insulin resistance.

3. Increased Sensitivity to Cold

One hallmark symptom of hypothyroidism is increased sensitivity to cold. As metabolism slows, the body’s ability to generate heat becomes less efficient, leaving many patients feeling unusually cold - even in environments that others find comfortable.

4. Hair Thinning and Dry Skin

Many patients first notice subtle changes in their appearance. Hair may become thinner, more brittle, or shed more than usual, while the skin often becomes dry, rough, and less resilient. These changes occur because thyroid hormone is essential for normal skin and hair follicle function.

5. Brain Fog

Hypothyroidism can affect cognitive function, leading to difficulty concentrating, forgetfulness, slowed mental processing, and a feeling that tasks require more effort than they once did.

6. Constipation

Thyroid hormone helps regulate gastrointestinal motility. When levels are low, digestion slows, often resulting in persistent constipation that may not respond to the usual dietary interventions.

7. Depression or Low Mood

Thyroid hormone influences multiple neurotransmitter systems involved in mood regulation. Some individuals experience low mood, decreased motivation, emotional blunting, or symptoms that closely resemble depression.

8. Muscle Aches, Weakness, or Reduced Exercise Tolerance

Low thyroid hormone can affect both muscle metabolism and cardiovascular performance. Patients may notice muscle aches, stiffness, reduced strength, slower recovery after exercise, or a decline in physical endurance that feels disproportionate to their activity level. A slower-than-normal heart rate may also occur.

9. Menstrual Changes or Difficulty Getting Pregnant

Thyroid hormone plays an important role in reproductive health. Hypothyroidism may contribute to irregular or heavy menstrual periods, ovulatory dysfunction, difficulty conceiving, and an increased risk of miscarriage.

10. Puffy Face, Voice Changes, or Neck Swelling

In more significant cases, hypothyroidism can lead to fluid accumulation in the tissues, resulting in facial puffiness, swelling around the eyes, hoarseness, a deeper voice, or enlargement of the thyroid gland (goiter).

If you’re experiencing symptoms that may be related to hypothyroidism, would like your thyroid evaluated, or need ongoing management of an existing thyroid condition, schedule an appointment at Evora Women’s Health. We offer comprehensive thyroid evaluations and evidence-based treatment tailored to your individual needs.

My Thyroid Labs Are Normal… So Why Do I Still Feel Awful?

When people experience fatigue, weight gain, brain fog, hair thinning, or low energy, the thyroid is often the first thing they think about - and for good reason. Thyroid disorders are common and can cause many of these symptoms. However, even when thyroid testing is completely normal, many patients continue to struggle because other disorders can produce very similar symptoms.

Phrases I hear frequently in clinic are:

“My thyroid tests were normal, but I’m still exhausted.”
“I’m gaining weight despite eating one meal daily.”
“My hair is thinning.”
“My workouts feel harder than they used to.”
“I’m sleeping 7 hours every night, but I still wake up tired.”

Although these symptoms may seem unrelated, they often have overlapping underlying causes. Fatigue, brain fog, hair thinning, weight changes, and poor exercise recovery rarely occur in isolation and are not always explained by a single diagnosis or lab value. Sometimes the most important clues come from stepping back and looking at the bigger picture. Nutritional deficiencies, sleep disruption, hormonal changes, chronic stress, medication effects and subtle metabolic issues can all contribute, and many of these factors are easy to overlook.

Iron deficiency is one of the most commonly missed examples. Many patients are told they are “not anemic” because their hemoglobin is normal, but iron depletion can begin long before anemia develops. Ferritin reflects the body’s iron stores, and low levels may contribute to fatigue, hair shedding, reduced exercise tolerance, brain fog, shortness of breath with exertion and restless legs, even when a routine blood count appears normal.

Inadequate nutrition is another common cause of fatigue. Vitamin D and B12 deficiencies, inadequate caloric intake, dehydration and especially insufficient protein intake can quietly contribute to fatigue and poor recovery. Even mild dehydration can affect energy levels, concentration, physical performance, and overall well-being. Protein becomes increasingly important with age, not only for preserving muscle mass, but also for metabolism, recovery, body composition, and maintaining function. Many adults, particularly women, consume significantly less protein than they realize.

Beyond nutritional deficiencies, sleep and recovery deserve equal attention. Sleep is not simply “rest”; it is an active biologic process involved in metabolic regulation, hormone signaling, muscle recovery, memory, and energy balance. Poor sleep quality, frequent nighttime awakenings, sleep apnea, and inconsistent sleep schedules can affect appetite regulation, insulin sensitivity, mood, exercise recovery and cognitive performance. Seven hours of interrupted sleep and seven hours of restorative sleep are not biologically equivalent.

Then there is stress, which is often misunderstood. Stress is not simply a feeling; it is a physiologic state. Persistent activation of stress pathways can alter cortisol and sympathetic nervous system signaling. Over time, this can influence sleep architecture, glucose regulation, cravings, concentration, blood pressure, and recovery. Many patients describe feeling “tired but unable to shut off,” which is often a reflection of a body that remains activated long after it should be recovering.

Hormonal shifts can further complicate the picture. In women, perimenopause and menopause can affect sleep architecture, thermoregulation, body composition, cognition, and energy levels long before classic hot flashes appear. Declining estrogen levels may contribute to nighttime awakenings, changes in body fat distribution, and reduced muscle preservation. In men, low testosterone can contribute to reduced exercise recovery, lower energy, decreased muscle mass, changes in body composition, and reduced libido. However, symptoms alone do not necessarily indicate testosterone deficiency, and hormone levels should always be interpreted within the broader clinical picture.

If you are experiencing persistent symptoms and looking for a more comprehensive approach, schedule an appointment at Evora with Dr. Mehdia Amini. Sometimes the most important answers come from taking a step back, looking at the broader picture, and understanding how hormones, sleep, nutrition, metabolism, and overall health may be interacting together.

Why PCOS/PMOS Is More Than “Irregular Periods”

Polycystic Ovary Syndrome (PCOS) was never just about the ovaries. PCOS is a complex endocrine and metabolic disorder linked to insulin resistance, weight dysregulation, infertility, cardiovascular risk, and mental health conditions. Ironically, many women diagnosed with PCOS do not actually have ovarian cysts and having ovarian cysts alone does not mean someone has PCOS.

Medicine simply took nearly a century to acknowledge it. After more than a decade of international discussion and advocacy, experts have now renamed the condition to Polyendocrine Metabolic Ovarian Syndrome (PMOS), a name that better reflects what the disorder truly is: a systemic metabolic and hormonal condition.

The evolution of this diagnosis also reflects a larger issue in medicine: the longstanding underrecognition of women’s health conditions. From the historical dismissal of hormonal symptoms to inadequate approaches to menopause care, women’s health has too often been minimized, oversimplified, or treated symptom-by-symptom rather than comprehensively. For decades, PCOS/PMOS was reduced to “irregular periods.” Treatment frequently focused on managing visible symptoms while overlooking the underlying metabolic dysfunction driving the condition.

What Is Actually Happening in the Body?

At the center of PCOS/PMOS is often insulin resistance - a condition in which the body becomes less responsive to insulin. To compensate, the pancreas produces increasingly higher levels of insulin. These elevated insulin levels stimulate the ovaries to produce excess androgens, including testosterone. The hormonal imbalance interferes with ovulation. As a result, patients may experience irregular or absent menstrual cycles, difficulty conceiving, acne, excess facial or body hair growth and scalp hair thinning. These symptoms are not isolated cosmetic or reproductive concerns; they are outward signs of a deeper metabolic and endocrine imbalance.

Beyond reproductive symptoms, PCOS/PMOS is also associated with:

• Weight gain and difficulty losing weight

• Prediabetes and type 2 diabetes

• Fatty liver disease

• Sleep disturbances and obstructive sleep apnea

• Increased long-term cardiovascular and metabolic risk

In many cases, the reproductive symptoms are simply the first visible manifestation of a much broader systemic disorder.

Why It Matters

When PCOS is treated solely as a menstrual disorder, patients often receive incomplete care. But when it is recognized as a metabolic and hormonal condition, treatment can focus on the underlying drivers, particularly insulin resistance and hormonal dysregulation, rather than merely suppressing symptoms. Early recognition allows for earlier intervention - not only to improve symptoms, but also to reduce long-term risks related to metabolism, fertility, and cardiovascular health.

At Evora, we take a whole-body approach to PCOS/PMOS and offer a comprehensive approach including nutritional and lifestyle interventions, management of insulin resistance, hormonal therapy when appropriate, fertility evaluation and treatment and screening/treatment for metabolic and cardiovascular complications. Schedule a free 15 minute meet and greet with Dr. Amini to learn more and see if she would be the right fit for you!

Metabolic Syndrome: Where Cardiovascular Disease Begins

Metabolic syndrome rarely makes an obvious entrance. It develops slowly and quietly, often hidden behind reassuring lab results, a “normal” weight, and symptoms that are easy to dismiss. Yet under the surface, early changes are already taking place. The body becomes less efficient at handling sugar, fat begins to accumulate around vital organs, and the health of blood vessels gradually declines—all quietly increasing the risk of heart disease over time.

What’s Really Going On

The main driver in metabolic syndrome is insulin resistance. This means your body isn’t responding to insulin as well as it should. To keep blood sugar normal, your body makes more and more insulin. Higher insulin levels over time can lead to weight gain, more fat stored around the organs, changes in cholesterol that increase plaque buildup, higher blood pressure and damage to the walls of blood vessels, which eventually increases the risk of type II diabetes, heart disease, heart attack and stroke.

How It’s Diagnosed

You may have metabolic syndrome if you have three or more of the following:

• Increased waist size

• High triglycerides

• Low “good” (HDL) cholesterol

• Elevated blood pressure

• Elevated fasting blood sugar

Why Weight Alone Doesn’t Tell the Full Story

A common misconception is that a “normal weight” means you’re metabolically healthy. That’s not always true. Some people carry more fat around their organs which increases risk, even if they don’t look overweight. This is why someone can appear healthy but still have underlying metabolic issues.

Risk tends to be higher with:

• Low physical activity

• Diets high in processed foods and sugar

• Chronic stress or poor sleep

• Family history of diabetes or heart disease

• Hormonal changes (like menopause)

Why “Normal Labs” Can Be Misleading

Standard lab tests don’t always catch early metabolic problems. For example:

• Blood sugar can stay normal for years because the body is working overtime

• Liver tests can look normal even when fat is building up in the liver

• Cholesterol numbers may appear okay while more harmful particles are increasing

In other words, things can look “normal” on paper while the body is under strain.

The Good News: It’s Reversible

When caught early, metabolic syndrome can often be improved or even reversed by:

• Improving insulin sensitivity

• Reducing abdominal fat

• Supporting heart and blood vessel health

• Addressing sleep, stress, and hormonal balance

The goal isn’t just better lab numbers, it’s to optimize quality of life and reduce the long-term risk of heart disease and other complications.

Final Takeaway

Metabolic syndrome develops quietly, often long before disease becomes obvious. But with early attention and the right approach, it’s possible to change that path and significantly reduce long-term health risks. If you are concerned about your metabolic health, schedule an appointment with Dr. Mehdia Amini for a thorough evaluation and personalized management plan.

Fueling Your Holiday Shopping Season

By: Audrey Miller MS, RD/LD

The holiday season is officially here and with it comes long shopping days, packed schedules, and countless tempting treats around every corner! Between gift lists, travel plans, and festive events, it’s easy to let healthy eating slide. But a little preparation can keep your energy (and your mood) steady through the busiest time of year. Don’t let your wellness goals take a holiday! Here are some simple and satisfying ways to stay fueled and balanced!

1. Pack Smart Snacks

When hunger strikes, it’s easy to make impulsive food choices—especially when you’re surrounded by drive-thrus and complimentary holiday sweets. Having non-perishable, nutrient-dense snacks on-hand helps you skip the sugar crash and stay on track.

Great grab-and-go options include:

• Nuts and seeds: Almonds, walnuts, pistachios, sunflower seeds, or pumpkin seeds.

• Dried or Freeze-dried fruit: Choose unsweetened varieties like apricots, cranberries, or raisins (pair with nuts for balance!).

• Whole-grain snacks: Whole-grain crackers, popcorn, or oat-based snack bites

• Bars: Look for those with minimal added sugar and at least 3g of fiber

• Protein choices: Single-serve tuna packs, roasted chickpeas, edamame or jerky

RD Tip: Keep a small “snack kit” in your bag or car with shelf-stable favorites. You’ll save time, money, and unnecessary calories from impulse buys at the checkout counter.

As pictured, I love the small Stasher ‘Pocket Bags’ for snacks on-the-go!

2. Choose Wisely when Dining-Out

If you’re refueling mid-shopping spree, look for meals that provide protein, fiber, and color (hello, veggies!).

Better choices include:

• Grilled chicken on salad with olive oil or light vinaigrette dressing

• Burrito bowl with beans, rice, and veggies

• Turkey or veggie wrap on whole grain or lettuce wrap

• Soup and half-sandwich combo on whole-grain bread

RD Tip: Ask for dressing and sauces on the side—they often pack more calories than you think.

3. Hydrate Throughout the Day

Dehydration can feel like hunger, leading to extra snacks or sugary drinks you didn’t plan for. Keep a reusable water bottle with you, while you shop, and aim for 8–10 cups of water daily. Add lemon, cucumber, or mint for a flavor boost without added sugar.

4. Make Coffee Stops Work for You

A coffee break can quickly turn into a dessert if you’re not careful. Choose smarter sips:

• Lattes with nonfat milk, almond, or soy milk

• Skip whipped cream and flavored syrups (or ask for half pumps)

• Pair your drink with a protein-rich bite, like oatmeal or an egg white bite, instead of pastries.

5. Plan Ahead for Post-Shopping Meals

After a full day of errands, it’s tempting to grab fast food on the way home. Avoid the drive-thru trap by keeping easy, ready-to-eat options stocked at home:

• Rotisserie chicken with bagged salad

• Veggie omelet with whole grain toast

• Frozen shrimp stir-fry or veggie bowls

• Pre-made soup with whole-grain crackers on the side

RD Tip: Start a crockpot meal before leaving the house!

This Season, Give Yourself the Gift of Balance

Healthy choices don’t have to be complicated or time-consuming, just intentional. A little planning helps you feel your best, keep energy levels stable, and truly enjoy the season.

I’m here to support your wellness goals through every busy season! For personalized nutrition strategies or meal ideas tailored to your lifestyle, we can create a plan, together. One that fits you so you can stay nourished, confident, and balanced all holiday long! To schedule online click here, or email me at audrey@evoramed.com.

The Ins and Outs of Nutrition: How to Have a Healthier Relationship with Food

Having a healthy relationship with food isn’t about rigid rules or moralizing what’s on your plate. It’s about ease, balance, and connection—with your body, your emotions, and your community. The truth? Building that relationship takes effort, but it isn’t impossible. In fact, it can start at any age. Here’s how we’re guiding both kids and adults at Evora toward more mindful, balanced eating habits in 2025.

For Kids: Start Small, Think Big

Nurturing a healthy relationship with food early on can shape how kids view eating for life. The key is to build a food environment based on curiosity, not control.

Skip the “Good vs. Bad” Labeling

Labeling foods as “good” or “bad” can create shame or confusion. Instead, talk about foods in terms of how they help us grow, fuel us, or give us energy. All foods can fit—some nourish the body, others nourish the soul.

Prep, Cook, and Eat Together

Getting kids involved in the kitchen creates positive, hands-on experiences with food. It’s a fun way to build skills and appreciation while reducing picky eating tendencies.

Rethink Rewards

Avoid using food as a reward (“you get dessert if you finish your veggies”) or as a punishment (“you were bad, so no treat”). This can distort how children associate emotions with eating.

You Model, They Mirror

Kids learn far more by what you do than what you say. Instead of lecturing them about food, demonstrate balance by showing how you enjoy veggies and still have dessert without guilt.

For Adults: Food Freedom Starts with Awareness

Many of us have inherited confusing or restrictive messages around food—whether from diet culture, childhood habits, or the pressure to “eat perfectly.” But there’s a better way to rebuild trust with our bodies and create a more peaceful relationship with food.

Practice “Relaxed Eating”

Relaxed eating encourages tuning into your body's natural hunger and fullness signals. This means eating when you’re hungry, stopping when you feel satisfied, and letting go of guilt or the need to “make up” for eating. It also recognizes the emotional and social roles that food plays—because eating isn’t just about fuel; it’s also about connection, comfort, and culture.

Choose Preference Over Position

Rigid food “rules” often create more stress than success. Rather than holding firm positions like “I never eat dessert” or “I must avoid carbs,” consider shifting toward preference—what feels right in the moment, based on your environment, needs, or mood. This makes space for flexibility, which is a key part of long-term well-being.

Redefine Balance

True balance doesn’t mean perfect portions or eating “clean” all the time—it means embracing variety without fear. In fact:

“In order to fulfill your body’s nutritional needs, you need to consume adequate portions of protein, fats, and carbohydrates. Some or all of these macronutrients are present in every food group, so there is no biological or chemical need to cut any group out (unless instructed by a doctor).”

“Everything in moderation” isn’t just a cliché—it’s a grounded approach to meeting your nutritional and emotional needs. This includes eating for both nourishment and pleasure.

Flexibility Is Key

A flexible approach to food allows you to adapt—whether you’re at home, out with friends, managing stress, or traveling. It helps you stay connected to your body’s needs rather than clinging to strict food ideals. Flexibility brings sustainability, and sustainability builds long-term health.

Relationships with Food Are Built Over Time

Whether you're helping a child build food confidence or unlearning old habits yourself, the goal is the same: creating a relationship with food that feels balanced, nourishing, and free of shame. At Evora, we believe that food should bring ease—not anxiety. By modeling calm, flexible, and inclusive eating habits, we set the stage for healthier generations to come—starting with ourselves.

Remember: it's not about being perfect. It's about being present, aware, and kind to yourself at every stage of the journey.Some concepts in this post were inspired by the National Eating Disorders Association. Learn more atnationaleatingdisorders.org.