Vertigo, Dizziness and Hypothyroidism by Jeffrey Dach MD

Sarah is a 56 year old bank loan officer who presented to my office with months of disabling vertigo, frequent dizziness, neck stiffness and trigger-point pain, fatigue, cold hands and feet, and unexplained weight gain. She had been seeking relief and had gone through three previous doctors. Her first doctor dismissed her symptoms and gave her an SSRI antidepressant. The next doctor gave her nausea (vertigo) medications and vestibular therapy providing only partial relief. The third doctor recognized she needed thyroid medication and gave her Levothyroxine (T4 only medication), again providing only partial relief. Finally, a friend recommended my office.

Header Image: Medical illustration depicting Semicicular canals of the inner ear. Author : BruceBlaus. Creative Commons Attribution-Share Alike 4.0 International license. Link to image on Wikimedia Commons.

Typical Signs of Hypothyroidism

In my office, Sarah’s physical examination showed low body temperature, puffy face, and thickened skin suggesting myxedema. Sarah’s Achiles tendon reflex showed delayed relaxation. Sarah’s Thyroid lab panel, TSH, Free T3, Free T4, reverse T3, and anti-thyroid antibodies showed normal Free T4 of 0.9 , reverse T3 which was 8, at the low end of the normal range, Free T3 was 240, at the low end of normal. Sarah’s thyroid antibodies were elevated indicating Hashimoto’s autoimmune thyroiditis. Sarah’s labs, along with the clinical history and physical findings were highly suggestive of a low thyroid condition with classic signs of tissue puffiness, low body temperature and delayed Achilles reflex indicates possible Type 2 hypothyroidism with myxedema.

Sarah began treatment by switching from the T4-only levothyroxine to a combination T3 and T4, natural desiccated thyroid (NDT) medication. Within six weeks Sarah’s vertigo episodes resolved completely, neck muscle tension eased dramatically, energy returned, and her other symptoms improved steadily. This outcome is described in Dr. Mark Starr’s book, Hypothyroidism Type 2: The Epidemic (2013)

Left Image: Courtesy of Dr. Mark Starr, Book cover for Hypothyroidism Type 2: The Epidemic (2013)

Mark Starr, MD, is a board-certified specialist in pain medicine. Drawing on Broda Barnes’s research and his own clinical work in pain management, Dr. Starr describes hypothyroidism, especially the common but often missed Type 2 form, as an epidemic condition. In Type 2, circulating thyroid hormone levels may appear normal on standard tests, yet cells (particularly mitochondria) cannot utilize it effectively due to receptor defects, mitochondrial dysfunction, toxins, or other factors. This leads to widespread metabolic slowdown and diverse symptoms, including vertigo, dizziness, neck muscle issues, and chronic pain, which are frequently treated in isolation rather than as interconnected manifestations of one underlying problem. In 1976, Broda Barnes pioneered the use of natural thyroid with his book, Hypothyroidism the Silent Epidemic.

Type 1 versus Type 2 Hypothyroidism: Understanding the Difference

To make this clearer, think of the thyroid gland as a factory that produces hormones, and your body’s cells as the workers who need those hormones to run properly.

Type 1 hypothyroidism is like a factory that isn’t producing enough thyroid hormone. The thyroid gland itself makes too little thyroid hormone. Doctors can often spot this with standard blood tests that show low hormone levels or high TSH level, thyroid-stimulating hormone, which goes up when the thyroid gland is dysfunctional.

Type 2 hypothyroidism, which Starr highlights as far more common than most people realize, is different. Here the factory produces enough hormone, but the workers (i.e. your cells) can’t use the thyroid hormone effectively. This happens because of problems at the cellular level, such as damaged thyroid hormone receptors on cell surfaces, poorly functioning mitochondria, the tiny “power plants” inside cells that create energy, or interference from environmental toxins. The result is the same as Type 1 Hypothyroidism with slowing metabolic rate, but blood tests often look normal, so the condition is frequently missed by mainstream medicine.

Left Image: Mitochonria electron microscope image of normal mitochondria courtesy of the NIH National Institute of Health, a US Government Agency. 

What Does Thyroid Hormone Do?

Thyroid hormone increases both the number and activity of mitochondria to speed up energy production throughout the body. When this process is blocked, energy drops everywhere, creating the wide range of hypothyroid symptoms.

Myxedema: The Swelling and Tissue Problem Caused by Hypothyroidism

A central idea in Starr’s work is myxedema, a buildup of a myoid, mucus-like substance called mucin within the body’s connective tissues and interstitial spaces. This is a finding in about 55–60% of people with hypothyroidism and causes swelling, puffiness, and reduced function in tissues.

You can picture myxedema as a skin and soft tissue thickening making muscles and joints stiff and less flexible. Myxedema typically affects the face, creating the classic puffiness of the face that is easily recognizable in crowds. Myxedema also invades muscles, and connective tissues and fascia around the muscles and joints. This swelling reduces elasticity, slows healing, and contributes to stiffness and joint pain. Starr sees myxedema as a key reason why hypothyroidism shows up in unexpected places like chronic pain and balance problems, rather than only in obvious symptoms like fatigue or weight gain.

Vertigo, Dizziness, and Neurological Effects

In Dr. Mark Starr’s book, the section on “Dizziness and Vertigo” connects hypothyroidism to problems in the nervous system. Dr. Starr writes:

Neurological impairment, including but not limited to ear conditions (deafness, tinnitus, and vertigo), headaches and migraines, Multiple Sclerosis, and paresthesia…

Vertigo here refers to a spinning or whirling sensation, while dizziness is a broader feeling of unsteadiness. Starr notes that these can stem from direct effects on the inner ear’s balance system, changes in fluid pressure inside the ear, or slowed nerve signaling because cells lack enough energy. He also mentions related muscle coordination problems (ataxia), which can make balance worse.

Neck Muscles, Chronic Pain, and Musculoskeletal Issues

Because of his background treating musculoskeletal pain, Dr. Starr pays close attention to how hypothyroidism affects muscles and joints. Commonly reported issues include muscle spasm, generalized weakness, fibromyalgia-like widespread pain, joint inflammation, and temporomandibular joint problems. Note: TMJ is the jaw joint that often links to neck tension.

Myxedema causes swelling and stiffness in the neck and shoulder muscles and their surrounding fascia. This creates tight spots called trigger points, poor posture, and chronic tension. When neck muscles and fascia are swollen or dysfunctional, they can send faulty signals about head position to the brain. This leads to “cervicogenic dizziness”, a type of vertigo or unsteadiness that originates from the neck rather than the inner ear alone.

How Myxedema Contributes to Vertigo

To understand the connection between myxedema and vertigo, picture the inner ear as a tiny, fluid-filled gyroscope that helps you stay balanced. This gyroscope is called the semi-circular canals. It contains delicate sensors that detect movement and position. Thyroid hormone plays a crucial role in keeping the fluid, called endolymph, at the right volume, pressure within the semi-circular canals.

When hypothyroidism and myxedema occur, several things can go wrong in sequence:

1. Thyroid hormone maintains fluid levels in the semicircular canals which contain the stria vascularis, this is like a pumping system which maintains fluid levels using a Sodium/K-ATPase pump.

2. Without enough effective thyroid hormone, this pumping system slows down or becomes imbalanced.

3. In the hypothyroid condition, abnormal fluid buildup occurs inside the inner ear, the semicircular canals. This is called endolymphatic hydrops. Myxedema’s mucin buildup adds to tissue swelling and pressure changes in these delicate areas.

4. The increased pressure stretches or displaces membranes, such as Reissner’s membrane, damages tiny hair cells that sense movement, and disrupts signals sent to the brain.

5. The brain receives confusing or exaggerated messages about motion and position, resulting in vertigo, the sensation that the room is spinning, or general dizziness.

Supportive Animal Study in 2026

In 2026, Dr. G. M. Kantarci provided direct experimental support for this process using rats. They surgically removed the thyroid gland to create hypothyroidism and found that every treated animal developed endolymphatic hydrops in multiple inner-ear structures, including the vestibular apparatus responsible for balance. They observed membrane changes, hair-cell damage, and swelling, exactly the kind of pathology that produces vertigo in humans. The researchers concluded that thyroid hormone deficiency directly causes these inner-ear changes, offering a clear mechanistic explanation for why treating hypothyroidism often improves vertigo.

Other factors can worsen the situation, such as reduced blood flow to the inner ear, increased inflammation, or oxidative stress. When neck muscle myxedema is also present, the faulty position sense nerve signals from neck muscles is additive, making vertigo even more likely.

How All These Problems Connect

Dr. Starr’s most important contribution is showing how everything links together. Reduced mitochondrial function and tissue myxedema create muscle stiffness, especially noticeable in the neck, fluid problems in the inner ear, and reduced or slowed nerve function. The outcome is often a group of symptoms that seem unrelated, neck pain and tightness, trigger points, jaw problems, fibromyalgia-style pain, and vertigo, until the shared metabolic cause is addressed. In his pain clinic, Starr treats the thyroid issue alongside physical therapies, and finds good outcomes.

Diagnosis and Treatment According to Dr. Starr

Dr. Starr argues that relying only on blood tests misses many cases of Type 2 hypothyroidism. Instead, he recommends looking at the full clinical picture: detailed symptom history, basal body temperature (taken first thing in the morning; a healthy average is at least 97.8°F or 36.6°C), physical signs like puffiness or slow reflexes, and, when appropriate, a carefully supervised trial of thyroid hormone medication.

Treatment usually involves giving thyroid hormone, and Dr. Starr often prefers natural desiccated thyroid preparations that contain the full range of thyroid hormones (T4, T3, and others) rather than synthetic T4 alone. The goal is to “flood” the system enough for even resistant cells in the periphery to start using the hormone properly. Additional support may include reducing exposure to toxins, improving nutrition (ensuring adequate iodine, selenium, and other nutrients), and addressing related issues like adrenal fatigue if present. Progress is tracked mainly by how the patient feels, not just repeat lab tests. We are looking for improvement in energy and resolution of the puffy face (myxedema).

Supporting Evidence from the Medical Literature

In 2016, Dr. U. P. Santosh and Sudhakar Rao studied 35 patients diagnosed with Meniere’s disease withrepeated vertigo attacks, tinnitus, and hearing changes. Twelve of them, about 34% also had hypothyroidism. All twelve received thyroid hormone replacement (thyroxine) in addition to their usual care. After just 12 weeks, every single patient reported improvement in all their symptoms. Specifically, vertigo scores dropped sharply, from an average of 1.42 to 0.5 on their scale, and similar gains occurred in tinnitus, hearing, and ear fullness. Objective balance tests also improved, and thyroid levels returned to normal. The doctors concluded that hypothyroidism and Meniere’s disease are linked and suggested that doctors should check thyroid function in patients with vertigo-related ear problems.

In 2020, Dr. So Young Kim found higher rates of thyroid disease among people with Meniere’s disease. They also pointed to a smaller group of cases where giving thyroxine to patients who had both conditions led to symptom improvement in all 12 participants (100%).

In 2025, Dr. Rui Lai, Liwen Tang did a 2025 systematic review and meta-analysis published in Clinical Otolaryngology, finding 18 studies linking Ménière’s disease to hypothyroidism, and thyroid hormone treatment improved both the hypothyroidism and the vertigo symptoms of Ménière’s disease.

Left Image: Book Cover, Courtesy of Broda Barnes Hypothyroidism the Silent Epidemic.

Conclusion: Dr. Starr’s view that for many vertigo patients, the metabolic root cause is hypothyroidism. Mainstream medicine often dismisses these patients when mainstream vertigo medications fail to provide relief. These patients should not be dismissed. These patients should be properly evaluated and  treated with NDT, natural desiccated thyroid. This is often more effective than addressing individual symptoms one by one.

Natural thyroid medication cannot be patented. This explains why there is no money for large scale randomized trials. Most of the studies are observational rather than large randomized controlled trials, which is why mainstream doctors may insist on further research, but the consistent pattern across studies is overwhelming that restoring proper thyroid function helps normalize inner-ear fluid balance and reduces tissue swelling linked to myxedema.

If you or someone you know has a combination of fatigue, cold sensitivity, neck stiffness, trigger points, and unexplained vertigo or dizziness, especially with “normal” thyroid labs, it may be worth exploring a full clinical evaluation for hypothyroidism. Improvement often comes when thyroid function is restored, allowing tissues to reduce swelling and regain normal fluid balance and energy production. Sadly, for most patients complaining of vertigo, the connection to hypothyroidism is missed, or under-treated with T4 only medications. In my office we will treat with thyroid medication containing both T3 and T4 (NDT) with superior results, and greater chance for complete resolution of symptoms.

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References:

1) Kantarci, G. M., et al. “Thyroid Hormone Deficiency Induces Endolymphatic Hydrops: Neurological and Histopathological Evidence from an Experimental Rat Model.” *Frontiers in Neurology*, vol. 17, 2026, article 1774666. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2026.1774666/full.

2) Kim, So Young, et al. “Association between Ménière’s Disease and Thyroid Diseases: A Nested Case–Control Study.” *Scientific Reports*, vol. 10, 2020, article 18224. https://www.nature.com/articles/s41598-020-75404-y.

3) Lai, Rui, et al. “Association Between Ménière’s Disease and Thyroid Disease: A Systematic Review and Meta-Analysis.” *Clinical Otolaryngology*, vol. 50, no. 4, 2025, pp. 633–43. https://onlinelibrary.wiley.com/doi/10.1111/coa.14308.

4) Santosh, U. P., and M. S. Sudhakar Rao. “Incidence of Hypothyroidism in Meniere’s Disease.” *Journal of Clinical and Diagnostic Research*, vol. 10, no. 5, May 2016, pp. MC01–MC03. https://pmc.ncbi.nlm.nih.gov/articles/PMC4948427/.

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
my web site: https://drjeffreydachmd.com/
my personal blog: www.jeffreydachmd.com 
Bioidentical Hormones 101 Second Edition
Menopausal Hormone Replacement, Health Benefits
Natural Thyroid Toolkit by Jeffrey Dach MD
Cracking Cancer Toolkit ebook
Cracking Cancer Toolkit print version
Heart Book by Jeffrey Dach MD
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www.bioidenticalhormones101.com
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Published on July 22nd, 2026 by Jeffrey Dach MD