Why facial swelling happens with hypothyroidism and what to do

Why facial swelling happens with hypothyroidism and what to do

Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormone the body requires for proper function.


Thyroid hormones take part in a number of functions, and that's exactly why the insufficient amounts induce a wide range of symptoms that vary from mild to severe complications.


Some symptoms of hypothyroidism are widely discussed, but others are, not although it's important to address them.


We're going to address that!


In this article, you can learn more about hypothyroidism and facial swelling.


What is facial swelling?

We’ve all heard of facial swelling or puffiness, but have you ever wonder what it is actually?


Facial swelling is the accumulation of fluid in the tissues of the face.


What many people don’t realize is that facial swelling oftentimes involves more than the face; it may extend to the neck or throat.


People experience facial swelling or puffiness due to a number of reasons.


Some of the many causes of facial swelling include allergic reaction, angioedema, blood transfusion reaction, cellulitis, conjunctivitis, drug reactions, obesity, disorders of the salivary glands[i], among others.


How hypothyroidism causes facial swelling?

Hormonal imbalances act as a catalyst for a number of changes in our body, and lower production of thyroid hormones is not the exception.


Hypothyroid people experience various symptoms that affect their quality of life, and facial swelling is one of them.


It's perfectly natural to wonder how hypothyroidism leads to puffiness in the face, but it would be difficult to pinpoint a single mechanism.


Facial edema and thyroid autoimmunity

Puffiness in the facial region can be a result of a wide range of health problems, including thyroid dysfunction.


That being said, the relationship between thyroid disorders and facial swelling are poorly studied.


One of the rare studies on this subject was carried out by Miralles et al. who investigated the case of a 42-year-old woman with a two-month-long evolution of edema or swelling in the right side of her face.


 Swelling, in this case, was associated with higher levels of thyroid antibodies i.e., thyroid autoimmunity caused the puffiness. One of the most common autoimmune thyroid diseases is Hashimoto's thyroiditis which is also the biggest cause of hypothyroidism.


Scientists found that treatment with thyroxine helped manage facial swelling[ii].


Hypothyroidism increases the risk of prolonged edema after facelift

Hypothyroidism can cause facial swelling, but it can also make it last longer after surgical procedures such as a facelift.


Bearing in mind that a growing body of evidence pointed to the presence of edema in patients with hypothyroidism undergoing facelift a team of scientists decided to get a deeper insight into this problem.


Langsdon et al. analyzed data of adult patients ages 40 and older undergoing a facelift with documented hypothyroidism and prolonged postoperative facial edema.


Of 198 subjects, four women with prolonged facial puffiness after facelift surgery were identified. In their case, swelling lasted for almost four months. All four women were diagnosed with hypothyroidism and received levothyroxine treatment.


Scientists found that people with hypothyroidism have a higher risk of developing postoperative edema.


One mechanism through which this could happen is the fact that hypothyroidism impairs wound healing through the reduced synthesis of collagen. There could be a strong relationship between decreased wound healing and prolonged swelling within the tissues.


Interestingly, not all hypothyroid patients will develop facial swelling or have prolonged puffiness after surgery, such as a facelift.


Scientists explain there may be a subset of patients with hypothyroidism who are more prone to swelling than others despite the adherence to levothyroxine treatment.


For example, higher-level antithyroglobulin and antithyroid peroxidase antibodies could be the factor that makes some people more likely to have this uncomfortable symptom.


Although they are not a representative of thyroid disease per se, both indicate the presence of an autoimmune state that could indirectly decrease wound healing through the inadequate activity of thyroid hormones[iii].


Hypothyroidism contributes to weight gain

One potential reason why hypothyroidism causes facial swelling is through its ability to contribute to weight gain. Thyroid hormones have a major influence on body composition.


They regulate metabolism, take part in thermogenesis, and also participate in the metabolism of glucose, lipids (fats), food intake, and fat oxidation. That explains why problems with the thyroid gland manifest themselves through weight-related changes.


For example, hypothyroidism decreases thermogenesis, lowers metabolic rate, and is associated with higher BMI and increased prevalence of obesity. Even mild dysfunction of the butterfly-shaped gland can cause significant changes in body weight[iv].


As you're gaining weight on hypothyroidism, your face may become puffier as well[v]. This is particularly the case when hypothyroidism isn’t managed properly or when a patient doesn’t make necessary lifestyle adjustments that would reduce the severity of their symptoms.


Hypothyroidism increases water retention

Water retention occurs when excess fluids accumulate in the body. It takes place in the circulatory system or within tissues and cavities. Various factors can contribute to water retention, and hypothyroidism is one of them.


As seen above in this post, hypothyroidism leads to weight gain and changes in body composition. But not the whole weight gain is due to the buildup of fat. Weight gain in hypothyroidism is a complex process, and most of the extra pounds that people put on are due to excessive buildup of water and salt[vi] i.e., fluid retention.


Therefore, due to the fact that hypothyroidism causes water retention patients will notice swelling in their face. Besides facial swelling, people with hypothyroidism may also notice swelling in their hands, wrists, legs, ankles, and feet.


Why hypothyroidism causes water retention, you're probably wondering. It all comes down to the role of thyroid hormones in metabolism. As seen above, thyroid hormones regulate metabolic rate. In hypothyroidism, the gland produces lower levels of thyroid hormones, and as a result, the metabolic rate slows down.


This causes a chain of reactions that also makes the body hang on to water and salt. The amount of water the body retains depends on the severity of the condition. For example, the more severe hypothyroidism, the more water you retain, the more weight you gain, and facial swelling becomes more noticeable.


What to do about facial swelling

Facial swelling is one of the many symptoms of hypothyroidism. Like other symptoms of this thyroid disorder, facial puffiness is also manageable.


Now you are probably wondering what to do about facial swelling when dealing with hypothyroidism. Let's see what you can do.


Adhere to the treatment of hypothyroidism

The first and most important thing you can do is to adhere to the treatment recommended by your doctor.


In order to treat hypothyroidism and normalize hormone levels doctor prescribes levothyroxine. Proper management of this thyroid disorder and bringing hormone levels up to the normal ratio can help alleviate puffiness in your face.


Maintain weight in a healthy range

People with hypothyroidism tend to gain weight. Throughout this post, we have elaborated how hypothyroidism causes weight gain. Thyroid hormones slow down metabolism, decrease thermogenesis, and it also contributes to water retention.


Due to all these reasons, it is absolutely necessary to slim down or maintain weight in a healthy range in order to tackle facial swelling. Weight loss can decrease swelling in your face and make it less puffy. Bear in mind that weight loss requires lifestyle adjustments i.e., you shouldn't go for quick fixes and unhealthy solutions. The best way to slim down is to adjust your diet, exercise regularly, and move more.


Lower salt intake

We all know that salt intake is tied to water retention, but have you ever wondered why that happens?


You see, salt is made of sodium chloride which binds to water in your body and takes part in the maintenance of fluid balance in and out of cells. High intake of sodium impairs this balance and leads to water retention.


This causes or aggravates facial swelling. Therefore, in order to reduce facial swelling, you need to decrease the amount of salt you consume.


Consume more magnesium

Did you know that magnesium is needed for over 300 biochemical reactions in your body? Some functions of this mineral include maintenance of normal nerve and muscle function, immune system support, keeping heartbeat steady, stronger bones, just to name a few. What most people don’t know is that increased magnesium intake can decrease water retention.


Walker et al. found that 200mg of magnesium a day decreased water retention in women with PMS[vii]. While this study is not related to hypothyroidism, it still confirms that adding more magnesium to your diet can help alleviate puffiness in your face. The good thing is that you can obtain magnesium from your diet without having to take supplements.


Some of the best sources of this mineral include dark chocolate, avocado, nuts and seeds, legumes, tofu, whole grains, salmon, bananas, just to name a few.


Eat more vitamin B6

Vitamin B6 is important for the metabolism of protein and carbohydrates, the creation of red blood cells, and many other functions in the body.


Studies show that, just like with magnesium, eating more vitamin B6 can reduce water retention[viii]. In other words, one way to decrease swelling in your face is to make sure your diet contains more vitamin B6. Some of the best sources of vitamin B6 include milk, ricotta cheese, salmon, tuna, eggs, beef, chicken liver, carrots sweet potato, among others.


Eat more potassium

Potassium is not just a mineral that participates in various functions, but it’s also an electrolyte. An electrolyte carries out electrical impulses through your body. Potassium assists in the regulation of blood pressure, water balance, muscle contractions, nerve impulses, digestion, heart rhythm, pH balance, and many others.


This mineral reduces fluid retention through two mechanisms: by increasing urine production and lowering sodium levels[ix].


Through decreased sodium and higher urine production, you're more able to manage water retention and decrease facial swelling. Fortunately, many foods are abundant in potassium, and some of them are beans and nuts, bananas, whole grains, lean meats, some vegetables, apricots, kiwi, oranges, and pineapples.


Lower consumption of refined carbs

Refined or simple carbohydrates are sugars and refined grains that been stripped of all-fiber, bran, and nutrients. These carbs don't have any nutritional value, and it's smart to lower consumption or avoid them entirely.


Not only do they contribute to weight gain, but they also cause or contribute to water retention. How refined carbs cause fluid retention? Well, they boost blood sugar and insulin levels in the body. Due to high insulin levels, the body retains more sodium through increased reabsorption of sodium in your kidneys[x].


As a result, fluid starts building up, and it can manifest itself via facial swelling. That's why your facial swelling management strategy should also include lowering consumption of refined carbs such as white flour, white bread, pastries, white rice, soda, pasta, snacks, and many others.


Other things you can do

  • Get enough sleep
  • In the morning wash face with cool water
  • Never go to bed with your makeup on
  • Drink plenty of water
  • Limit or avoid alcohol
  • Apply cold cucumbers or cold compress on swollen areas of your face
  • Don’t sleep on your belly
  • Apply a warm compress to promote movement of accumulated fluid


Facial swelling is a common symptom of hypothyroidism, but it is not discussed often.


Patients with hypothyroidism can have facial swelling due to weight gain, water retention, the negative impact of underactive thyroid on collagen synthesis, but also because thyroid autoimmunity is associated with water retention too.




[i] Facial swelling, MedlinePlus. Retrieved from: https://medlineplus.gov/ency/article/003105.htm


[ii] Miralles JC, Soriano J, Negro JM. (2002). Facial edema associated with thyroid autoimmunity. Allergologia et Immunopathologia, 30(1):47-50. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/11888493


[iii] Langsdon PR, Tompkins JJ, Goodman RC. (2016). Hypothyroidism is a risk factor for prolonged postoperative edema following facelift surgery. JAMA Facial Plastic Surgery, 18(4):315-6. Doi: 10.1001/jamafacial.2016.0155. Retrieved from: https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/2514342


[iv] Sanyal, D., & Raychaudhuri, M. (2016). Hypothyroidism and obesity: An intriguing link. Indian journal of endocrinology and metabolism20(4), 554–557. doi:10.4103/2230-8210.183454. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/


[v] Leonard J, 2019. Twelve signs and symptoms of hypothyroidism. MedicalNewsToday. Retrieved from: https://www.medicalnewstoday.com/articles/324535.php


[vi] Thyroid and Weight: The Science. British Thyroid Foundation. Retrieved from: http://www.btf-thyroid.org/information/articles/280-thyroid-and-weight-the-science


[vii] Walker AF, De Souza MC, Vickers MF. (1998). Magnesium supplementation alleviates premenstrual symptoms of fluid retention. Journal of Women's Health, 7(9):1157-65. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/9861593


[viii] Ebrahimi, E., Khayati Motlagh, S., Nemati, S., & Tavakoli, Z. (2012). Effects of magnesium and vitamin b6 on the severity of premenstrual syndrome symptoms. Journal of caring sciences1(4), 183–189. doi:10.5681/jcs.2012.026. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161081/


[ix] Gallen IW, Rosa RM, Esparaz DY, et al. (1998). On the mechanism of the effects of potassium restriction on blood pressure and renal sodium retention. American Journal of Kidney Diseases, 31(1):19-27. Doi: 10.1053/ajkd.1998.v31.pm9428447. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/9428447


[x] Horita S, Seki G, Yamada H, et al. (2011). Insulin resistance, obesity, hypertension, and renal sodium transport. International Journal of Hypertension, 2011:391762. Doi: 10.4061/2011/391762. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21629870

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