The Overlooked Link Between Thyroid Disease and Urinary Symptoms

When people think about thyroid disease, symptoms like fatigue, weight changes or temperature sensitivity often come to mind. But according to Aleece Fosnight, PA-C, a urology and women’s health specialist and medical advisor at Aeroflow Urology, thyroid health can also have a major, and often overlooked, impact on bladder function.

The thyroid acts as a master regulator for metabolism and the nervous system. When thyroid hormones are out of balance, they affect multiple systems at once, including the bladder, kidneys and pelvic floor. Thyroid hormones influence the autonomic nervous system, which controls how the bladder fills and empties, as well as smooth muscle function in the bladder wall and overall fluid balance in the body.

In hypothyroidism, when thyroid hormone levels are low, many processes slow down. Fosnight explains that nerve signaling to the bladder becomes less effective, which can reduce bladder muscle contractions. As a result, people may feel like they need to urinate but struggle to start or fully empty their bladder. This can lead to incomplete emptying, overflow incontinence, difficulty initiating a urine stream and even recurrent urinary tract infections. Fatigue and slowed movement (common in hypothyroidism) can also contribute to functional incontinence, where someone simply can’t get to the bathroom fast enough.

Hyperthyroidism, on the other hand, turns the system up too high. Increased sympathetic nervous system activity can irritate the bladder, leading to urgency, frequent urination, nighttime bathroom trips and urge incontinence. Some studies suggest people with hyperthyroidism may also face a higher risk of urinary tract infections, likely due to disrupted bladder emptying and signaling.

Fosnight emphasizes that treating the root cause (optimizing thyroid hormone levels) is the first and most important step. However, bladder symptoms may take time to improve even after thyroid levels stabilize. During that transition, supportive strategies can make a meaningful difference. Pelvic floor physical therapy is often a cornerstone of care, helping restore muscle coordination and strength. Behavioral approaches like timed voiding and bladder retraining can help regulate bladder signaling, while addressing constipation, hydration and bladder irritants is also key.

Hormonal changes during perimenopause and menopause can further complicate symptoms, and Fosnight notes that local vaginal estrogen may be helpful for some patients. Above all, she stresses a whole-person approach: recognizing that sleep disruption, mood changes and overall quality of life are deeply connected to both thyroid and bladder health.

Perhaps most importantly, Fosnight wants patients to know that bladder symptoms should never be dismissed as “normal,” especially if they’re new, worsening or interfering with daily life. If symptoms began after a thyroid diagnosis or medication change, that’s a critical clue worth discussing with a health care provider.