Vertigo (the sensation that the room is spinning or rotating), tinnitus (noises that seem to come from the ear that no one else hears), and hearing loss often occur in hypothyroid patients. In fact, the incidence of vertigo, tinnitus, and hearing impairment correlates with the severity of hypothyroidism. There have been times where I would hear a sound like a tuning fork in my ear that faded away. My hearing is also not perfect. I had my first experience of vertigo when I was only taking ½ grain of desiccated thyroid and grossly undermedicated. I woke one morning, headed to the bathroom as usual, but could not walk in a straight line, and had to tilt my head sideways to compensate for the tilted world I saw. Otherwise, everything was tilted about 45 degrees to the right, and spinning. With a little more thyroid hormone, my world straightened out again.
Much later, even though I could walk normally again with my head upright, there would be times, if I my head was subjected to any movement (like rolling over in bed or tilting my head up), that the room would start to spin again. It was incredibly annoying because no one likes feeling off balance.
Fluid in the inner ear contains electrolytes such as sodium, potassium, calcium, chloride, hydrogen, hydroxide, bicarbonate, and a few others. These ions can conduct electricity, hence the name electrolyte. Deficiencies in any of these may compromise hearing and balance. Additionally, hormones such as aldosterone, cortisol, vasopressin, thyroid, estrogen and other enzymes control inner ear ion transporters and channels. Hypothyroid patients often exhibit abnormalities in levels of these electrolytes and hormones, and bringing thyroid levels back up restores them. Aldosterone and vasopressin levels affect potassium transport systems; hearing loss results when there are disorders in the movement of potassium. Sodium tends to drop in hypothyroid patients due to relative adrenal insufficiency. Another study noted a negative correlation of TSH with calcium, sodium, and potassium; in other words, the higher the TSH (the more hypothyroid the patient), the lower the serum values of calcium, sodium, and potassium. Vasopressin also falls in those who are hypothyroid, and rises in those who are hyperthyroid. In contrast, aldosterone may be high in those who are hypothyroid due to the stimulating effect of TSH.
Vasopressin is also known as anti-diuretic hormone or ADH. A diuretic rids the body of fluid, while an anti-diuretic helps retain fluid. Since vasopressin falls in hypothyroid patients, they become somewhat dehydrated. In fact, diabetes insipidus (caused by extremely low ADH levels) results in both excessive thirst and urine production. What happens when you boil a salt solution until the liquid evaporates? You end up with sodium chloride (salt) crystals once the liquid disappears. This is analogous to what probably happens in the ears. My theory is that particles form in the inner ear because hypothyroid patients tend to be dehydrated. Then, whenever the head rotates, these particles move around and confuse the inner ear, resulting in vertigo. Of course, correcting the hypothyroid state often relieves the tinnitus and may improve hearing loss. But the particles in the ear would remain and cause vertigo unless they could be removed.
Fortunately, there’s a way to reposition these particles using something called the Epley maneuver. The Canalith Repositioning Procedure (CRP) is another term for the Epley maneuver, and benign paroxysmal positional vertigo (BPPV) is the medical term to describe the sensation of movement. One study reported a 100% success rate using CRP for BPPV, although 10% continued to have atypical symptoms, which suggests another co-existing cause. Because CRP is a non-surgical procedure, repeat procedures are not problematic, and may contribute to complete symptom resolution.
Moving your head into a series of different positions forces the ear particles (otolithic debris) to move so they no longer cause the vertigo. For me, the vertigo stopped after I had this procedure. However, if the patient has any form of disease in the neck area, or is very elderly and frail, the procedure may be risky. Also, be aware that there are other causes of vertigo (such as brain tumors); patients should explore other conditions if the vertigo persists after repeated Epley maneuvers.
 Bhatia, P. L., Gupta, O. P., Agrawal, M. K., & Mishr, S. K. (1977). Audiological and vestibular function tests in hypothyroidism. The Laryngoscope, 87(12), 2082-2089.
 Hamid, M. A., Trune, D. R., & Dutia, M. B. (2009). Advances in auditory and vestibular medicine. Audiological medicine, 7(4), 180-188.
 Koide, Yoshinobu, Oda, Kanji, Shimizu, Kurakazu, Shimizu, Akihiko, Nabeshima, Ieharu, Kimura, Satoshi, & Yamashita, Kamejiro. (1982). Hyponatremia without inappropriate secretion of vasopressin in a case of myxedema coma. Endocrinologia japonica, 29(3), 363-368.
 Liamis, George, Haralampos J. Milionis, and Moses Elisaf. “Endocrine disorders: causes of hyponatremia not to neglect.” Annals of medicine 43.3 (2011): 179-187.
 Murgod, Roopa, and Gladys Soans. “Changes in electrolyte and lipid profile in hypothyroidism.” Life Science Bio Chemistry 2.3 (2012): 185-194.
 Arnaout, M. A., Awidi, A. S., El-Najdawi, A. M., Khateeb, M. S., & Ajlouni, K. M. (1992). Arginine-vasopressin and endothelium-associated proteins in thyroid disease. Acta endocrinologica, 126(5), 399-403.
 Nicolini, G., Balzan, S., Morelli, L., Iacconi, P., Sabatino, L., Ripoli, A., & Fommei, E. (2013). LH, Progesterone, and TSH can Stimulate Aldosterone In Vitro: A Study on Normal Adrenal Cortex and Aldosterone Producing Adenoma. Hormone and metabolic research= Hormon-und Stoffwechselforschung= Hormones et metabolisme.
 Epley, J. M. (1992). The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngology–Head and Neck Surgery,107(3), 399-404.
 Jose, P., Rupa, V., & Job, A. (1999). Successful management of benign paroxysmal positional vertigo with the Epley Manoeuvre. Indian Journal of Otolaryngology and Head and Neck Surgery, 52(1), 49-53.