Thyroid health

Just a thyroid problem? Or is it hormonal imbalance?

by Marcy Holmes, Women’s Health NP & Marcelle Pick, OB/GYN NP

Millions of women suffer from low thyroid function (medically referred to as hypothyroidism), especially in the perimenopausal and post-menopausal years. Unfortunately the conventional approach to thyroid problems is to treat the thyroid in isolation from the rest of the body. But that just isn’t how your body works.

The thyroid gland has an intimate relationship with the other glands in your endocrine system, and interacts with them continuously. This is why thyroid dysfunction doesn’t always originate in the thyroid gland, and why thyroid health depends on the health of your entire endocrine system.

When we take this holistic approach to thyroid problems, we can often address the problem before it becomes permanent. Even after the development of full-blown thyroid disease, the natural approach can help slow its progress and make conventional treatments more effective, allowing some women to reduce their medication.

Let’s take a look at how thyroid problems in women develop, and what you can do to support your thyroid health, naturally.

There’s more to hypothyroidism than low thyroid activity

Hypothyroidism is commonly described as an underactive or sluggish thyroid, but there is more to it than just thyroid activity. Sometimes the problem is thyroid hormone imbalance, primarily underproduction of the thyroid’s main hormone, thyroxine (T4). But T4 also has to be converted into its active form, triiodothyronine (T3), by the liver. It then has to be efficiently utilized by the body. Disruption in any one of these processes can contribute to hypothyroidism symptoms.

Hypothyroidism is usually diagnosed by measuring levels of thyroid stimulating hormone (TSH), which is produced by the pituitary gland. High levels of TSH indicate that the pituitary gland senses insufficient thyroid activity and is attempting to stimulate the thyroid gland. In an effort to coax the thyroid into increasing its activity, more and more TSH is produced.

Unfortunately TSH levels don’t tell the whole story. Abnormally high TSH levels indicate a problem, but they don’t indicate whether the problem is in T4 production, conversion to T3, or in the body’s inability to utilize thyroid hormones efficiently. What’s more, TSH test results sometimes come back “normal” despite an existing thyroid imbalance.

The connection between hypothyroidism and menopause is often overlooked

Notably, women are far more likely than men to be afflicted with thyroid problems. The risk of hypothyroidism is greatest in women over 35.

Over 20% of menopausal women in the US are diagnosed with thyroid dysfunction. Recent studies suggest that millions more suffer from subclinical thyroid problems but are undiagnosed. For women in their late 30’s or 40’s, hypothyroidism is often a good indication that they are in perimenopause — the five, ten, or even 15 years of hormonal change preceding menopause.

Symptoms of hypothyroidism include fatigue, weight gain, depression, irregular periods, hair loss, and more. Many of these symptoms are also common symptoms of menopause or perimenopause, and may be mistaken as such. Likewise, women with a known thyroid problem may not realize that perimenopause or menopause is contributing to their symptoms.

What’s the cause of this epidemic of thyroid problems? And what accounts for the connection between hypothyroidism and menopause?

Before answering these questions, let’s remember that the thyroid can’t be viewed in isolation from the rest of your endocrine system. On the contrary, it sits at the very center of action. And it is just as vulnerable to stress and lack of support as every other part of your body. Understanding how those stressors create illness and thyroid disease will also show us how to create balance and wellness. It will also illuminate why problems with your thyroid gland are so likely in menopause and perimenopause.

Hormonal imbalance triggers hypothyroidism in women

Hypothyroidism is more common in women than in men, probably because hormonal imbalance acts as a trigger for thyroid problems. Women’s bodies have a delicate balance of hormones such as estrogen and progesterone, which can be upset when your body is under stress and not receiving enough support. Perimenopause, menopause, and pregnancy are times in a woman’s life when hormonal imbalance is particularly common, and are also associated with hypothyroidism.

Some researchers and practitioners argue that an excess of estrogen combined with low progesterone — the estrogen dominance typical of early perimenopause — triggers hypothyroidism symptoms by blocking the action of thyroid hormones. Strong synthetic estrogens, such as those in Premarin, may exacerbate estrogen dominance. Supplemental progesterone may be recommended to counter estrogen levels.

Our take is a little different; we believe that it is more about balancing the ratios among all your hormones — estrogen, progesterone and testosterone — rather than targeting the level of any single hormone. Each woman’s ideal hormone ratios are slightly different, and we advocate a natural approach that supports the body’s own ability to make and balance its hormones. Most women can restore hormonal balance with targeted nutritional support, simple lifestyle changes, and phytotherapy.

It comes down to this: hormonal balance is vital to optimal thyroid function. If you have thyroid symptoms, take a look at your hormonal health. Chances are you are also suffering from hormonal imbalance. And healing one is nearly impossible without healing the other, too.

Support your thyroid, naturally

So what can you do to restore your thyroid health? The basic approach we take at our medical clinic is to start with a foundation of support to the endocrine system, and add thyroid medications only if necessary. Here’s what we recommend:

• Nutritional support. Your body uses a wide range of nutrients to manufacture and metabolize all its hormones, including thyroid hormones. Nearly every patient we see with thyroid problems is not getting enough nutrition from diet alone. A pharmaceutical-grade multivitamin/mineral along with essential fatty acids can help fill the gaps.
• Have your iodine levels tested. This is one specific nutrient that’s especially important to thyroid health. Some women are iodine deficient — particularly women who don’t use iodized table salt. Getting your levels tested is an easy way to know if you have enough iodine on board.
• Endocrine support. We recommend phytotherapy (the use of medicinal herbs) to gently restore balance to the ratios of estrogen, progesterone and testosterone in your body. Balance among these hormones will support the healthy functioning of your entire endocrine system, including the thyroid.
• Stress relief. Chronic stress has powerful, detrimental effects on your endocrine system. Hormones released as part of the stress response interfere with the production, metabolism and/or utilization of sex hormones and thyroid hormones. You may not be able to eliminate the causes of stress in your life, but do your best to minimize their impact. Meditation and moderate exercise may help.

What if you need thyroid medication?

Hypothyroidism treatment is the subject of recent debate. What your healthcare provider chooses to do is a function of training and experience. Most practitioners just prescribe synthetic T4 (Synthroid, Levoxyl, or levothyroxine) for hypothyroidism. But that works only if the patient has no difficulty converting T4 into T3. For women who are poor converters, synthetic T3 (Cytomel) is sometimes added to improve low T3 levels and their related symptoms.

Not every practitioner believes in using T3 since it is very short-acting, somewhat a matter of trial and error, and difficult to monitor. There is also desiccated thyroid taken from pigs (Armour Thyroid), which provides both T4 and T3. Armour was the most common form of replacement until the 1970’s, when practitioners largely abandoned it for synthetic T4, under the argument that a synthetic version was better because it was produced in a laboratory. Armour Thyroid is still available and often yields excellent results. The overall goal with any supplemental formulation should be to tailor dosage to symptom relief, achieving levels of TSH less than 2.0 along with optimal levels of T3 and T4.

A final word on healing your thyroid

The bottom line is that nutrition, hormonal health, and stress management are the keys to your well-being — and optimal thyroid function is not likely without them. Beyond this foundation, some women still need thyroid medication, and this is something you should discuss with your healthcare provider. We can tell you that we’ve seen in our practice patients who improve using natural thyroid interventions, and we encourage all women to give it a try, whether to avoid thyroid medications or to improve the effectiveness of drug therapy.

Remember, your thyroid doesn’t do its work alone. Natural thyroid health depends on a delicate balance among all your body’s hormones. Fortunately, providing yourself with a foundation of support can go a long way in promoting natural thyroid health.

 

Original Publication Date: 01/23/2004
Last Modified: 08/16/2010
Principal Authors: Marcy Holmes, NP, Certified Menopause Clinician & Marcelle Pick, OB/GYN NP