Hypothyroidism Tinnitus: Why Your Ears Might Ring (and what to do)

You are in a quiet room and once again, that persistent thin ring, buzz or hiss returns, will not go away completely, is frustrating, occasionally frightening, and makes you think your body has a secret about what is going on.

The unexpected link: hypothyroidism tinnitus is a possibility for some people. In addition to affecting their energy and weight when their thyroid function decreases, the decrease in thyroid function also affects their blood circulation, nerves and other tiny systems which help us to hear and maintain our sense of balance.

By the end of this article I would like you to have a little less fear about the tinnitus, to have practical things you can do today to reduce the tinnitus, and to know if and how often it is necessary to speak with a clinician about the tinnitus. One thing that is very important to understand; tinnitus is caused by many different factors and therefore it is unlikely that your hypothyroidism tinnitus is the only reason why you experience tinnitus.

Can Hypothyroidism Cause Tinnitus, What Science Says and Why It Happens

While I’m not aware of research on the issue, there does appear to be a relationship in some individuals between tinnitus (ringing) and hypothyroidism. Many studies have shown that hypothyroidism appears to contribute to tinnitus, hearing loss or balance disorders in some individuals. That being said, thyroid problems do not result in tinnitus for all patients; and that improving a patient’s thyroid status will eliminate their tinnitus for all patients.

Clinicians also look at this area because thyroid hormone impacts metabolic activity in a variety of tissues and cells, including those in the inner ear and those responsible for transmitting sound signals from the ears to the brain. When thyroid hormones are decreased, the body works at a level of decreased metabolic activity (much like a cell phone operating at a reduced power setting), so while the cell phone still performs the minimum amount of necessary functions, everything else about its operation seems “fuzzy” or “off.”

In my experience, finding a connection between seemingly unrelated symptoms like hypothyroidism tinnitus is very soothing to many patients. Therefore, the objective is simple: Treat what can be treated and decrease the extent to which the tinnitus controls a patient’s daily life.

3 Ways Low Thyroid Hormone Could Trigger Ringing in Your Ears

The most common explanations of hypothyroidism tinnitus are as follows: (explained simply)

• Inner Ear Blood Flow & Fluid: Lowered levels of thyroid hormone can cause issues with circulation in addition to your body’s ability to regulate fluid. Since the inner ear is very small and extremely sensitive, even slight changes can be noticeable enough to allow for recognition of ringing in the ears.
• Nerve Signaling: Thyroid hormone is responsible for the support of proper nerve function. If this hormone is at a lower level, then sound processing and sensitivity can be changed, and the brain will “turn-up the volume” on all internal noise.
• Greater Hearing Loss Risk: There is an increased risk for hearing loss associated with individuals that have thyroid issues. If hearing loss occurs, tinnitus may become apparent because of the presence of external noise such as a refrigerator humming, which one cannot “un-hear” after noticing it.

These are theories and patterns, not guaranteed truths for every person with hypothyroidism.

Why It Might Get Worse Before It Gets Better (Stress, Sleep, and Medication Timing)

Your mental and physical condition can be very sensitive to tinnitus. Tinnitus can seem louder when you are tired, nervous, or sleep poorly. This is just one of many reasons why hypothyroidism tinnitus may worsen during difficult periods in your life.

Additionally, the timing of medication intake can greatly affect how you are feeling. Irregular dosing of levothyroxine, missing doses, a change in dose size, or a different brand name generic can lead to large fluctuations in your symptoms. When you do experience these types of changes, it can increase your anxiety, tighten your jaw and neck muscles, draw your focus back to the tinnitus, etc.

One thing that has been helpful is to keep track of your tinnitus patterns over two weeks, and then share this information with your health care provider. The time of day that your tinnitus occurs, sleep quality, amount of coffee consumed, and time of medication can provide your health care provider with a great deal of valuable information.

Symptoms to Watch For: Hypothyroidism Tinnitus, Vertigo, and Other Clues Your Thyroid Could Be Involved

You do not have to diagnose yourself, but you may notice a pattern. “The symptoms of hypothyroidism tinnitus” essentially translate to: ringing (in your ears), plus your body running at a slower pace in many different areas. This is a pattern; think of it as a series of signs and symptoms rather than a single symptom that would prove something is wrong with you.

Also pay attention to what’s happening beyond your ears. If the ringing is accompanied by fatigue that will not improve, feeling cold all of the time, constipation, dry skin, brain fog, depression, or unexplained weight gain, then your thyroid is likely in need of further investigation. Additionally, some ear-related symptoms such as a sensation of fullness or blockage in the ears, dizziness, or a feeling of instability while standing are also possible.

If you find that several thyroid-related symptoms appear along with symptoms related to the functioning of your inner ear or balance, then it is likely in your best interest to pursue testing. Hypothyroidism tinnitus is much simpler to manage if treated within the context of the entire array of symptoms you are experiencing, as opposed to focusing solely on the ringing. Getting stuck in an endless loop of trying new treatments for the tinnitus based on the premise that the ringing itself is the source of the problem can be avoided by finding a connection between your symptoms and the appropriate lab work.

While it is true that tinnitus has a multitude of potential causes (i.e., noise exposure, TMD [temporomandibular joint disorder], medications, ear wax impaction, etc.), this does not necessarily preclude the consideration of the possibility that hypothyroidism could be contributing to your condition. It simply indicates that you should be searching for a correlation between your specific combination of symptoms and the laboratory tests that would provide an accurate diagnosis.

I understand the temptation to search for a single definitive explanation for your tinnitus. However, instead of focusing on finding one particular explanation for your tinnitus, try to focus on identifying the patterns that exist among your symptoms so that your healthcare provider can determine which diagnostic tests would be most beneficial for you and provide you with the proper support. A simple symptom log (listing when the tinnitus is worse, how you feel energetically, how well you’re sleeping, and whether you experience any dizziness) can assist your healthcare provider in quickly connecting the dots between your various symptoms.

Common Hypothyroidism Symptoms That Often Show Up With Ear Ringing

If you’re noticing ringing along with several of these, your thyroid could be part of the story (and hypothyroidism tinnitus becomes a more likely fit):

• Fatigue that is out of proportion to the day’s demands.
• Weight gain or an inability to lose weight.
• Cold intolerance (when others do not feel cold).
• Dry skin.
• Constipation.
• A low pulse rate (slow heart beat).
• Swelling of the face and eyelids.
• Depression or low mood.
• Mental fogginess, poor concentration and memory (brain fog).
• Irregular or heavy menses.
• Hair thinning or loss.

These are often mild at first and develop over time. As a result, you may become accustomed to feeling as though you’ve been “crawling through the mud” for years, and may have no idea just how far you’ve come.

When Hypothyroidism Tinnitus Comes With Vertigo or Dizziness

The search term “hypothyroidism tinnitus and vertigo” is popular because vertigo is not simply a feeling of being “off.” The sensations that people describe as vertigo are similar to those they experience when the room appears to be rotating around them (like they’re on a boat), when their body feels unsteady and unable to be trusted (like they have no solid footing), and when they experience nausea and sweating in addition to dizziness.

While some individuals who develop vertigo may have concomitant thyroid problems, many others will find that their vertigo is independent from their thyroid problems. Some possible causes of vertigo and/or tinnitus may include a change in the fluids in the inner ear; low blood pressure; anemia; migraines; and side effects of medications.

You should seek immediate emergency medical care if you or someone you know experiences the following symptoms: Sudden severe vertigo; One sided hearing loss; Slurred speech; Weakness; Facial droop; Chest pain; Sudden severe headache.

What to Do Next: A Simple Plan to Calm Ringing and Treat the Root Cause

You do not need to treat everything now. Develop a plan which addresses your thyroid health and the stimuli that cause your ear and nervous system to ring: consistent medications; stable food intake; fewer skipped doses of your medication. This will allow you to monitor and address the stimuli that are causing the tinnitus to worsen (i.e., stress, clenching your jaws, lack of quality sleep, excessive volume, too much caffeine).

When treating hypothyroidism tinnitus by addressing both aspects of your condition, you increase the probability of feeling better sooner than if you were relying solely upon finding a single solution.

Keep things as easy and practical as possible. Your goals should be to establish more consistent hormone levels, better quality sleep, and a reduced sense of anxiety regarding the tinnitus. Some days the goal will simply be fewer episodes of worsening symptoms rather than complete silencing of the tinnitus.

Although you may desire rapid improvements in your thyroid function, such changes often take some time, and your brain remains “on high alert” for an extended period of time regardless of how well your lab values begin to reflect your thyroid status improving. This does not indicate that no treatment has been effective, merely that your body requires ongoing consistency.

Do not become discouraged if you experience little initial improvement in your condition. Record all small improvements, i.e., improved morning moods, fewer nighttime exacerbations, reduced anxiety during times when the tinnitus becomes louder. These are all indicators of movement toward your desired outcomes.

Talk to Your Doctor About the Right Tests and the Right Treatment

Identify and document symptoms of hypothyroidism; request thyroid lab work commonly including TSH& Free T4. Free T3 may be tested along with Thyroid Antibodies in those where Hashimoto’s is suspected. Other possible lab work that could be useful in establishing a diagnosis includes Iron (Ferritin), Vitamin B12, Vitamin D and Lipid Panels.

If hypothyroidism is diagnosed through lab testing, Levothyroxine will typically be prescribed and dosed appropriately for the patient. While some patients report improvement of their hypothyroidism tinnitus symptoms after normalization of lab values, this does not occur for all patients, and may require weeks or months to develop.

Commonly recommended tips to avoid the “ups and downs” from levothyroxine:

• Take Levothyroxine at the same time each day.
• Take Levothyroxine with water on an empty stomach.
• Avoid taking Calcium and Iron supplements near the time you are taking Levothyroxine (as they may interfere with its absorption).
• Do not make changes to your medication without first consulting your physician.

At-Home Steps That Often Lower Tinnitus Volume (Even If Your Thyroid Is Still Stabilizing)

Some of these behaviors may be helpful for managing some cases of hypothyroidism tinnitus and decrease distress associated with it:

• Prevent loud noises from affecting your hearing; however, also avoid complete silence as it may cause ringing to become even more noticeable and sharp.
• Use low volume background sound such as fans, white noise, or rain sounds at night which will provide an alternative for your brain to focus on while trying to fall asleep.
• If the ringing becomes more noticeable take a 2 minute deep breath, slow inhaled breaths followed by slow exhalated breaths, relax your shoulders and calm down.
• Reduce consumption of caffeinated beverages or alcoholic drinks if you observe that they increase the severity of the ringing.
• Create a consistent sleep routine (same wake-up time, dim lighting, etc.) and reduce excessive phone usage prior to bedtime.
• Drink plenty of water; dehydrating yourself may result in an increase in perceived symptoms.
• Stretch out and loosen tight jaw and neck muscles using a warm compress and/or gentle movements to achieve relaxation.

The act of tracking your symptoms (time of day, food/drink consumed, stress levels, sleep quality, medications taken) provides a sense of grounding and enables you to focus on small victories. As a reminder, many small victories added together result in a larger victory.

When to See an Audiologist or ENT (and What They Can Do)

Although an individual’s thyroid gland may be affected by hypothyroidism, they will still require treatment and evaluation of their ears because treatment of hearing and tinnitus problems can occur independently from thyroid issues.

A licensed audiologist can conduct a hearing assessment to identify common hearing loss patterns which could influence tinnitus perception. A physician specializing in ear, nose and throat (ENT) can also assess for potential causes of tinnitus such as wax build up, infections, Eustachian tube dysfunction etc. In some cases, imaging studies may be performed if symptoms are unilateral, new-onset or otherwise atypical.

Treatment may include tinnitus counseling, sound therapy plans, hearing aids for individuals with hearing loss, and cognitive behavioral therapy (CBT)-based interventions to decrease the perceived threat of the tinnitus. Therefore, although there may be treatment for thyroid issues, an individual suffering from hypothyroidism tinnitus should receive additional treatments to address tinnitus specifically.

Conclusion

Many experience ringing in the ears as an intrusive aspect of their lives and it can be distracting for others, such as at work, at rest or during quiet times. For many, hypothyroidism can be a piece of this puzzle and tinnitus becomes worse due to fatigue, stress, poor sleep and other hearing issues that build upon each other. Due to your system being worn down, the tinnitus will generally sound louder and more difficult to tune out.

The first logical action you can do is to assess your thyroid functions, then follow through with consistent use of any prescribed medication and control any environmental factors that may cause your tinnitus to worsen (caffeine, sleep debt, jaw clenching, etc.).

Some expect there to be just one solution to solve all their tinnitus problems, however tinnitus can have multiple causes and while treating your hypothyroidism may improve your tinnitus, it won’t necessarily resolve all symptoms immediately.

If your tinnitus doesn’t resolve, or if your tinnitus changes, includes dizziness or hearing loss, consider having ear testing done. Don’t dismiss unilateral ringing or acute changes in your tinnitus. Take notes about how your sleep, stress levels, medication and your level of noise exposure are changing over time as well as how your tinnitus is improving as these small changes are common in hypothyroidism tinnitus and rarely occur in dramatic leaps forward.