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Can Hypothyroidism Cause Puffy Face and Cankles? (TTE91) – Rejuvagen Center

Can hypothyroidism cause you to have a puffy face and cankles? Absolutely! In Episode #92 of Thyroid Thursday, Dr. Eric Balcavage describes four ways cellular hypothyroidism can lead to a puffy face and cankles!

The four way hypothyroidism can result in a puffy face and cankles:

  • Reduced kidney function
  • Enzyme deficiency
  • Reduced circulation
  • Reduced energy production

Watch this short video to learn how cellular hypothyroidism, the hidden cause of hypothyroid symptoms, can be the cause of your puffy face and cankles.


Hey everybody, it’s Dr. Eric Balcavage and we’re back for another edition of Thyroid Thursday. Today we want to answer a viewer or listener question, which was could my puffy face and my cankles be a sign or be caused by hypothyroidism? The short answer, is yes. There are four ways that hypothyroidism, whether it’s cellular hypothyroidism (decreased T3 reaching the nuclear receptors in your cells) or glandular hypothyroidism (the gland just can’t make enough thyroid hormone), could impact your body’s physiology and cause you to have swelling and edema in your tissues.

The first is when you have hypothyroidism and anytime you have cellular hypothyroidism, these are going to be the mechanisms that kick into play. Let me just make sure I get this clear. If you have a gland not making sufficient thyroid hormone and you’re not supporting it appropriately with thyroid hormone medication or a glandular product, then the result is going to be cellular hypothyroidism. Because if there’s not enough being produced by the gland and there’s not enough in the bloodstream, there’s not enough getting to the tissue.

You can also have normal gland function or normally supported thyroid hormone in blood via thyroid hormone, but still not have sufficient T3 in your cells. That’s a state we call cellular hypothyroidism. So anybody who’s got hypothyroid symptoms still has some level of cellular hypothyroidism regardless of whether they have a healthy gland or they have an unhealthy gland and they’re being supported by thyroid hormone.

If you still have hypothyroid symptoms, there’s a level of cellular hypothyroidism going on. So let’s get into this.

The first mechanism is decreased glomerular filtration rate. Your kidneys are constantly filtering fluid through the day. Thyroid hormone helps regulate the health of your kidneys and how well this glomerular filtration system works. So if you get a blood panel done and you show signs of decreased GFR below 60, and even if it’s in the low 80’s or even 70’s, this could be a sign that your kidneys are struggling a little bit to do filtration. If your kidneys can’t filter and keep up with the amount of filtration they need to do in a given day, then fluid accumulates in the body. This can lead to this swelling and edema in your extremities.

The second way is that when you have glandular hypothyroidism or cellular hypothyroidism, you have decreased production of enzymes that breakdown mucopolysaccharides. Mucopolysaccharides are produced from proteins and sugars. We can get the accumulation of this product called mucopolysaccharides, and that can build up in the tissues just underneath the skin.

When this stuff builds up, we should have enzymes that actually breaks it down. But, if we have cellular hypothyroidism in those tissues, then we’re not able to make sufficient levels of those enzymes. Therefore, the mucopolysaccharides accumulate in the soft tissues. The mucopolysaccharides act like a sponge absorbing fluid, pulling fluid in, pulling sodium in. This can cause the, what we call, non-pitting edema.

We typically see this in hypothyroidism and definitely in the more severe cases of hypothyroidism; this accumulation of these mucopolysaccharides. The more severe condition is called Myxedema. So that’s a second way.

The third way is when you have cellular hypothyroidism or glandular hypothyroidism, you are going to have reduced circulation. Your blood pressure’s going to be low. Your pulse is typically down. If you’re not pumping fluids around the body as well, that can impact both your glomerular filtration rate, the rate that you push fluids around the body, and can lead to these fluids accumulating in the tissues.

The fourth is decreased energy. When you have hypothyroidism, you have typically decreased energy. Your tissues just aren’t generating the same level of ATP, the same level of energy. So that leads you to be less active. And when you’re less active, then you have decreased lymph flow and lymph circulation because muscle movement and muscle activity actually creates the lymph to contract and the tissues to move and pump fluid through the body.

These are four ways that hypothyroidism, (whether you’ve been diagnosed with glandular hypothyroidism or you just have cellular hypothyroidism or hidden hypothyroidism), can cause you to have swelling and edema in the body. Remember this swelling is called edema. There’s two forms. The pitting form was where you push in on the tissue and you can see your finger indent. That can be caused by a number of conditions, but decreased renal physiology and thyroid physiology are two of the most common causes.

Then we can have this non-pitting edema where the mucopolysaccharides are building up underneath the soft tissue. What happens is is that it just absorbs fluid. This is like dispersed fluid accumulation throughout the body. It’s one of the main reasons that people who have hypothyroidism gain weight and why when we start to improve them, they can lose weight rather quickly because they’re losing a lot of fluid quickly. It may be one of the reasons why as they’re starting to get healthy, they may have to pee a little bit more, especially at night.

So what could you do? Well, if you do not have a diagnosis of hypothyroidism, but your eyes are puffy, you have periorbital puffiness, if your face is puffy, if you have swollen hands, you have carpal tunnel, you have nervous system issues like numbness and tingling in the body, especially when you lay down at night, you should get checked for hypothyroidism. You should get checked by your medical doctor. You should get checked by your functional medicine practitioner to find out if you have a problem with thyroid physiology. Now your medical doctor’s going to run a TSH. If your TSH is normal, nothing else will get run and you might be told you don’t have a thyroid problem.

Remember, you can still have a thyroid physiology problem, but a healthy gland. Your doctor’s really looking for destruction of the gland for which they can then treat. So if your primary care says, “Hey, TSH is normal. You don’t have a thyroid problem,” you definitely need to go see a functional medicine practitioner like myself so we can help you identify if you have cellular hypothyroidism, decreased T3 reaching the nucleus. That’s a state where we have to figure out what’s causing the thyroid hormone that’s being made by the gland being deactivated once it gets into the cell.

We have to take a look at what’s causing this cellular hypothyroidism? Is it trauma? Is it injury? Is it some type of organism? Is it toxin? Is disrupted sleep? Is it hypoxia. Is it drugs? Is it emotional stress? Is it poor respiration? There’s a number of causes that may cause your cells to perceive danger. And when your cells perceived danger, one of the things they do is start deactivating thyroid hormone.

Hopefully this video helps. Why do you have a puffy facing and cankles? Could it be a sign of hypothyroidism? It absolutely could be. If you have any questions, put those below wherever you watch these videos. You can always reach out to me at Rejuvagencenter.com. All right, take care.

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Hi, I’m Dr. Eric Balcavage, owner and founder of Rejuvagen. If you’re struggling with health issues or have questions, let’s chat. You can schedule a 15-minute call with me to get started.