Thyroid health

Hypothyroidism in menopause — a whole-body perspective

by Marcelle Pick, OB/GYN NP

• What does the thyroid do?
• Hormonal imbalance and its effect on the thyroid
• Adrenal imbalance and thyroid health
• Solving the cause of thyroid dysfunction

I talk to women daily about hypothyroidism in my practice, and one thing I hear over and over from those who have been diagnosed is, “I thought I was healthy. How did this happen?” Many women with hypothyroidism are struggling with weight gain, fatigue, poor concentration, hair loss, even depression — and they want answers about how to feel better.

About one in five of the midlife women we see at our practice have abnormal TSH levels. So it isn’t just a problem for women who don’t pay attention to their health — even Oprah Winfrey, who’s extremely health conscious, has talked about her hypothyroid condition. The fact is, women are often diagnosed with hypothyroidism during perimenopause and menopause, but few conventional practitioners talk about this connection. And even fewer offer solutions beyond synthetic thyroid hormone replacement medications like levothyroxine (Synthroid, Levoxyl, Levothroid, Unithroid) to bring TSH levels down.

I know women want to support their thyroid health. One way to start is by realizing that hypothyroidism is rarely an isolated condition. There could be several factors leading to your thyroid disturbance, especially during the menopause transition, and these vary from woman to woman.

Let’s look at the other pieces to thyroid imbalance — because there is so much more to the story than elevated TSH. When these surrounding issues are resolved, it’s amazing how much better you can feel! So whatever your lab results may be, let’s take a look at what might be leading to your hypothyroidism and how you can feel better naturally.

A natural desire for balance: how the thyroid steadies us

Our bodies strive continually for a dynamic balance that shifts according to positive and negative feedback messages from the brain and cells of the body. No matter what the disruption, the human body has amazing capabilities in terms of reverting to this dynamic balance. Centrally located between the brain and rest of the body, the thyroid is like a “transfer station” for that balance.

The thyroid carries heavy responsibilities. Its hormones affect how you metabolize food, store and use energy, think, talk, sleep, and more! So it makes sense that when the thyroid isn’t functioning properly, life can seem entirely off-kilter.

The hormones of the thyroid, thyroxine (T4) and triiodothyronine (T3), influence the metabolism of every cell in our bodies. Because T3 is the form our cells recognize best, it is used more readily and considered much “stronger” than T4. The more slow-acting T4 can be converted into T3 in the liver, kidneys and elsewhere.

When T3 and T4 are low in the bloodstream, the hypothalamus — the “command center” for hormones in the brain — sends TRH (thyrotropin-releasing hormone) to the pituitary gland. A sort of “halfway house” between the brain and the endocrine system, the pituitary gland interprets the message to secrete more TSH (thyroid-stimulating hormone), which in turn prompts your thyroid gland to take up iodine and the amino acid tyrosine to produce more T3 and T4.

Nature has created an elegant system of set points, feedback loops, and checks and balances to support the thyroid’s dynamic equilibrium. So as long as things haven’t gotten too far out of whack, it will always move toward its default “normal” state if you support it. And support becomes increasingly important as we age, as many women who are approaching menopause come to realize.

Hypothyroidism and menopause — how hormonal imbalance affects the thyroid

Most women agree that menopause is accompanied by profound changes on both emotional and physical levels. This transition and the years leading up to it, known as perimenopause, can cause the body to temporarily shift its balance while hormones recalibrate and readjust to a new set of demands. With childbearing over, the body intelligently conserves energy and slows production of reproductive hormones. In many cases, progesterone is the first to decline, which temporarily leaves estrogen as the dominant hormone.

Some researchers and practitioners feel that an imbalance between estrogen and progesterone (often called “estrogen dominance”) is a key factor in decreased thyroid function. The combination of normal estrogen levels and decreased progesterone may block the action of the thyroid hormone and lead to symptoms of hypothyroidism, even when thyroid hormone levels appear normal on lab results.

Hormonal imbalance contributes to perimenopausal and menopausal thyroid problems, but I’ve found that there are additional factors to consider as well. The bodies’ systems are intimately connected, and a disease or disorder may not always begin with the tissue or organ exhibiting the problem. And a disorder in the thyroid may very well originate somewhere else in the body. Let’s begin with how the adrenal glands influence thyroid function.

How your adrenals can affect your thyroid function

If patients come to see me with symptoms of hypothyroidism, one thing I do after thyroid testing is evaluate their adrenal function. Many women are surprised to learn there’s a connection between the two (that is, if they’ve even heard of the adrenals!) But I’ve found overstressed adrenal glands to be one of the most common contributors to hypothyroidism in my patients.

If you take a look at the diagram above, you can see that stress of any kind — mental, emotional, or physical — stimulates the hypothalamic-pituitary-adrenal (HPA) axis, the dynamic feedback system between the brain and the adrenal glands. Overstimulation of this axis has huge implications throughout the body.

The short-term result of a stimulated HPA axis is higher cortisol production from the adrenals. High cortisol (hypercortisolism) in the bloodstream can directly inhibit production of TSH (thyroid-stimulating hormone) as well as conversion of T4 to T3. But cortisol can’t remain high forever. Eventually, the adrenal glands reach exhaustion and not enough cortisol is produced (known as hypocortisolism), which comes with another set of problems. For more on this topic, see our article on the adrenal spectrum.

Either way, with lower levels of T3 in the blood, your cells can’t produce a healthy biological response. This is when women begin to see hypothyroidism symptoms like fatigue, cold intolerance, weight gain, memory loss, poor concentration, depression, infertility, hair loss, and more.

The prescription drug levothyroxine acts by replacing the body’s T4 with a synthetic form. Though some women feel better on some form of levothyroxine, many do not. As you can see from the diagram, when overstressed adrenals are at the root of your thyroid trouble, feeding the body more T4 is a stop-gap solution that eventually teaches the thyroid to stop producing its own T4. If you’re not already on synthetic T4, it may be worthwhile to find out why thyroid function declined in the first place — an important step toward correcting it.

The adrenal glands are one piece to the thyroid equation, but for other patients, there may be something entirely different causing a sluggish thyroid. My experience has shown me that looking deeper into the origins of a thyroid disorder can be much more helpful in bringing TSH down, while at the same time creating whole-body wellness.

Other factors in the hypothyroidism equation

On top of the physical and emotional stress women feel at menopause, there are several very real biological stresses on the thyroid to consider.

Low iodine levels. Iodine is the central ingredient in thyroid hormones T3 and T4. Trying to produce T3 and T4 without iodine is like trying to make an omelet without the eggs! We need about one milligram of iodine a week to form the required amount of thyroxine.

But iodine is not all that widely distributed in nature. Despite iodine being added to our commercial table salt, American iodine status was recently deemed “marginal” by the World Health Organization. Given that many of the world’s crop-growing soils lack iodine, fewer people eat foods naturally rich in iodine, and more and more avoid iodized table salt, iodine deficiency is on the rise.

Exposure to environmental toxins — including halides, heavy metals, pesticides, and antibiotics in our air, food, and water — can also interfere with thyroid function. We all know it’s best to limit our toxic exposure wherever possible, but increasing iodine intake and implementing a regular detox program to support the body’s natural detoxification pathways can also make a difference.

Food allergies and sensitivities — including those to gluten — can place tremendous stress on thyroid function. Many of my patients with hypothyroidism see positive results when they eliminate gluten from their diets. You, too, may want to give an elimination diet a try. I’ve noticed the gluten connection for several years, and research around the world is bearing this out.

Food sensitivities may also promote autoimmune reactions in which the body’s immune system attacks the thyroid as though it were a foreign invader. More research is needed in this area, but it’s now clear that the food we eat “talks” to our genes. And when we have food intolerances occurring in the gut, the resulting chemical signals influence our DNA — including the DNA in our immune cells. Unfortunately, the messages carried by food stressors turn off the default “healthy” pathways and turn on those that lead to disease.

A long list of prescription medications can also impair thyroid function. Drugs like lithium, amiodarone, somatostatin, inhalers, and others have the potential to disrupt thyroid hormone balance at any level — from synthesis, secretion and transport, to how thyroid hormones act in our organs to regulate metabolism — with an the unintended outcome of hypothyroidism or hyperthyroidism. I acknowledge that prescription medications save lives, but we have to be mindful that their benefits often come at the expense of other systems in the body. Sadly, the targeted strength provided by many drugs can be overwhelming — in some cases destructive — to the thyroid.

Finally, insufficient nutrition may also affect thyroid function — but it’s a problem that’s easily addressed! Selenium, for example, is needed for the conversion of T4 to T3, so if you’re selenium deficient, increasing this nutrient in your diet may make a difference in how you feel. And as mentioned above, iodine is essential for making thyroid hormones. Vitamin A, EPA and DHA, and zinc all act to improve T3 binding in your cells. By working with your body’s natural pathways, vitamins, minerals, omega-3 fatty acids, and extra antioxidants can offer great results without the side effects. The bottom line is that when we give our bodies the gentle support they recognize, we often see positive results that last. You can learn more about using nutrition to support your thyroid in two other articles, Eating to support your thyroid and Goitrogens and thyroid health.

Natural hypothyroid relief — from Women to Women

Menopause is a time of profound transition — one that can take its toll on the mind and body, particularly the thyroid. Hypothyroidism may be the manifestation of many different imbalances, and the best way to restore healthy thyroid function (in the present) is by looking into the problem’s past to address the root causs.

After years of clinical experience, I’ve seen women greatly improve by implementing elements of the natural approach I use to give a better future to women with hypothyroidism.

• Support your adrenals. If this is the only thing you do, I promise it will benefit your health on many levels. Not only will supporting your adrenals lighten the burden on your thyroid, it will also help restore your energy levels and overall well-being.
• Introduce a quality multivitamin–mineral complex. I encourage all my perimenopausal and menopausal patients to take a pharmaceutical-grade supplement like our Essential Nutrients. Ensuring a rich foundation of nutrients for the daily production and activity of thyroid hormones may be all you need to get yourself back on track, or to prevent hypothyroidism.
• Consider supplementing with selenium and iodine. Ask your practitioner to test your iodine levels, and talk about boosting your iodine and selenium levels in addition to your multivitamin. You can do this through the foods you eat (see the box) or with supplements, but if you do use selenium or iodine supplements, please work with a professional healthcare provider to monitor your levels appropriately. And when it comes to selenium supplements, I do not recommend taking more than 200 mcg/day.
• Find ways to diminish stress and speak your truth. By the time we reach perimenopause, many of us find we’ve given so much to the world around us there is little reserve for ourselves. This is the time to speak up, to share your opinions, to explore the things that make your life meaningful. Don’t feel guilty about asking for — and receiving — more support. Though easier said than done for many women, this may be the perfect time in life to learn to say “no.” You deserve a break — and so do the cells in your body!

Remember to have your practitioner examine your thyroid and thyroid hormone levels once a year, to stay on top of any changes.

If you make these adjustments and your thyroid hormone levels still aren’t right (or you’re still experiencing symptoms despite “normal” TSH), then it is worth considering thyroid medications. For some women, levothyroxine is all they need to feel much, much better. But others don’t quite get the relief they were looking for with synthetic T4. Should you find you need additional support, ask your practitioner about a prescription for natural thyroid hormones, such as Armour Thyroid, WestThroid, and Nature-Throid. Another alternative is compounded individualized amounts of T3 and T4. The combination of both T4 and T3 often makes a dramatic difference for women suffering from symptoms of severe hypothyroidism. Keep in mind that these natural and compounded forms are somewhat controversial, so some practitioners might be unwilling to consider them as an option, and you may need to seek a second (or a third) opinion.

Your thyroid, your voice

In Eastern medical paradigms, the thyroid is associated with “sacred voice.” As a component of the fifth chakra, thyroid issues are linked with difficulty speaking our truth, following our dreams, or fully expressing ourselves. Anatomically, the thyroid sits right over the voice box, and one of the symptoms of thyroid dysfunction is a gravelly or “muted” voice. When the thyroid is underactive, it doesn’t hurt to step back and evaluate how well you’re expressing your individual needs, wants, and opinions to those around you.

Remember that your voice doesn’t serve to merely communicate — it is connected to your whole being. Likewise, your thyroid doesn’t simply produce thyroid hormone. It is connected to every cell in your body and subject to both physical and psychological influence. My advice is to look at the whole picture when it comes to your thyroid, and you will find the dynamic balance your body is naturally seeking.

Related to this article:

References & further reading on hypothyroidism in menopause

 

Original Publication Date: 06/09/2008
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP