Thyroid disease is one of the most common endocrine disorders in women at midlife between the ages of 40-60. Many of the symptoms overlap with those of peri-menopause which makes it difficult to diagnose unless testing is performed. Although sometimes, as in the case of subclinical hypothyroidism, even lab work can look normal and complicate the clinical picture of women as they age.
If you have a family history of thyroid disorders, a personal history of postpartum thyroiditis, previous treatment for Graves disease, or any autoimmune disorders such as diabetes type 1, ask your practitioner to get your thyroid level checked. In the Study of Women’s Health across the Nation, almost 1 in 10 mid-life women had some thyroid abnormality. Hoshimoto thyroiditis is the most common underlying cause of thyroid disorders. Yes…this is an autoimmune disease. So it goes through the same cycles as other autoimmune diseases with exacerbation and remission stages. The goal of course is to stay in remission and get to the underlying cause of what started this problem which in most cases is an overwhelmed immune system.
The symptoms of hypothyroidism may sound familiar if you are between the ages of 40-60. They include fatigue, sluggishness, menstrual cycle changes, sleep disturbances, changes in mood, skin and hair, constipation and cold intolerance. Lab abnormalities that suggest hypothyroidism include high cholesterol, high triglycerides, high prolactin levels, low sodium level, anemia and elevated creatine phosphokinase levels.
Hyperthyroidism gives us a different picture. These patients feel “revved” with symptoms of palpitations, heat intolerance, loose stools, anxiety and menstrual irregularities. This condition is most often caused by Graves disease (autoimmune), toxic multinodular goiter, or a solitary hyperfunctioning (hot) nodule. If untreated, this condition can lead to osteoporosis and fractures, atrial fibrillation, heart failure, and possibly excess risk of coronary heart disease.
Both hypothyroidism and hyperthyroidism can be “subclinical” meaning that lab levels are slightly abnormal. Some experts feel that subclinical hypothyroidism is a product of aging. This condition occurs in 4%-8% of the population and as many as 15% of the elderly. It’s best to repeat testing and find a practitioner that really listens to your concerns and symptoms. A TSH (thyroid stimulating hormone) is not enough to see the whole picture. A free T4 and free T3 level in addition to TPOAb (antithyroperoxidase antibodies) is important in testing. The optimum TSH level should be between 1-2 mIU/L.
There are many thyroid replacement medications to choose from which include Levothyroxine (Synthroid), Armour, Naturthroid, or a compounded thyroid replacement that individualizes a patients dose if what they need is not in a commercial standardized dose. I don’t have a preference to any certain type of medication…it’s what works best for you. Once medication is started, lab work should be repeated in 6-8 weeks until you feel better and levels look normal.
Thyroid nodules are another issue that may or may not effect function. They are palpated in 5% of women and detected by ultrasound in up to two thirds of the general population. Between 5%-15% of nodules are malignant. Risk factors for malignancy include history of head and neck irradiation, family history of thyroid cancer, growing or changing consistency of a nodule, enlarged lymph nodes, change in voice, difficulty swallowing, or shortness of breath. It’s best to see an endocrinologist who can further evaluate a nodule and determine a diagnosis and treatment plan for you.
As my patients are getting treated, I am looking for underlying causes of their hypothyroid condition. Many things can overwhelm the immune system, but the most common things I see are food allergies and other reactants, malabsorption, gut pathogens such as Candida, parasites, or bacterial infections, heavy metal toxicity and adrenal fatigue. Certain medications (ie., oral estrogens, Lithium) can lower free T4 or elevate TSH necessitating a change in their medications.
Maintaining a high level of suspicion for thyroid disorder is important for women entering midlife transition. Blood work is simple and important in helping your symptoms, quality of life and preventing long-term health problems.
Reference: Stuenkel, C. Journal Watch: Women’s Health, “Thyroid Disease in Women at Midlife”, August 2014, Vol. 19 No. 8, pg 61-62.