Thyroid Disease

by Christiane Northrup, M.D.

Women's Health

Statistics show that one in eight women between the ages of 35 and 65 and one in five women over the age of 65 have some form of thyroid disease. Hyperthyroidism results from the body producing too much thyroid hormone, but far more common is hypothyroidism, the result of not making enough thyroid hormone. About 26 percent of women in or near perimenopause are diagnosed with this condition.1 

The thyroid is a butterfly-shaped gland located in the area of your neck just below the Adam’s apple. It’s part of the endocrine system, and it secretes the hormones thyroxine (T4) and triiodothyroxine (T3), which regulate the body’s metabolic rate. Thyroid function is very complex and exerts a profound effect on the function of nearly every other organ in the body. Therefore, smooth functioning of the overall body chemistry depends on the health of your thyroid gland.

It is not uncommon for women with thyroid problems to suffer from depression. One explanation for this is that the most biologically active form of thyroid hormone, T3, is actually a bona fide neurotransmitter that regulates the action of serotonin, norepinephrine, and GABA (gamma aminobutyric acid), an inhibitory neurotransmitter that is important for quelling anxiety. Even if supplemental thyroid hormone does help alleviate the existing hypothyroidism in a depressed patient, the symptom of depression often persists for a separate and rather surprising reason: depression itself can result in thyroid dysfunction. Treating the hypothyroidism, in other words, may be treating a symptom rather than the underlying cause.

T3 is found in large quantities in the limbic system of the brain, the area that is important for emotions such as joy, panic, anger, and fear. If you don’t have enough T3, or if its action is blocked, an entire cascade of neurotransmitter abnormalities may ensue and can lead to mood and energy changes, including depression.

Hypothyroidism and depression are related on many levels. The main building block for the neurotransmitter serotonin and for thyroid hormone (both T3 and T4) is the amino acid tryptophan, the same amino acid needed for the neurotransmitter norepinephrine, which stabilizes mood and anxiety. This means it is quite possible that low thyroid function can deplete your body of serotonin and other mood-stabilizing neurotransmitters. It also means that chronic depression and sadness may deplete your body of tyrosine stores and T3, which is also necessary to maintain healthy mood and energy.

Which comes first, the depression or the low thyroid? I suspect they occur simultaneously. While one does not cause the other, per se, it appears that similar emotional or behavioral patterns—such as learned helplessness or not believing you can have your say—may predispose you to both low thyroid and depression. (On the other hand, an overdeveloped will and the exertion of one’s intellectual will without acknowledging “higher will” or “higher power” can result in hyperthyroidism; an example is the mindset, “I don’t care what my body is telling me, I’m going to do it anyway.”)

For many individuals, the depression and the thyroid have to be treated at the same time in order for thyroid function and mood to return to normal. But it can be a vicious cycle. Psychiatrists say that over time many patients who are treated for depression or anxiety with medications can eventually develop thyroid problems. No one knows why this is so (I suspect it is because antidepressants deplete neurotransmitter levels over time), but scientists are beginning to realize that thyroid disease is really a mind–body disease—its symptoms occur simultaneously in the mind (in the form of depression and lack of concentration) as well as in the body. This is why depression so often persists in women with thyroid disease, even after their thyroid hormone levels are corrected.

Iodine deficiency is also very common in women. And that alone can lead to hypothyroidism, especially subclinical hypothyroidism—a situation in which you have all the signs of hypothyroidism but your lab tests are essentially normal. The key is to understand conditions related to the thyroid. I cover this subject in great detail in my article “The Secret Ingredient to Jumpstart Thyroid Health.”

Listen to Your Body

While many women with these problems are completely asymptomatic, others may have a wide variety of symptoms (most commonly mood disturbances, such as depression and irritability, as well as low energy level, weight gain, mental confusion, and sleep disturbances). Here are more symptoms of clinical and subclinical hypothyroidism:

  • Weight gain (minimal)
  • Intolerance to cold or heat
  • Hair loss or dry hair
  • Decreased heart rate
  • Constipation
  • Problems with attention and concentration
  • Shortness of breath
  • Fatigue
  • Heavy menstrual periods, especially early in the disorder
  • Scanty or absent menstrual flow, especially later in the disorder
  • Tingling in the fingers
  • Muscle cramps
  • Impaired hearing
  • Dry skin and puffiness in the face, hands, and feet

Further complicating the issue, many symptoms of hypothyroidism are the same as those commonly associated with the hormonal fluctuations of perimenopause. Therefore, it is entirely possible to have many of the symptoms of hypothyroidism yet have completely normal thyroid function.

To find out if you have a thyroid disorder, work with a physician who understands thyroid problems. Ask for a full panel of tests, including TSH, free T4, free T3, T3 uptake, and T4 uptake. These tests are considered a complete battery of thyroid function tests. If you can afford only one, however, make it a TSH (thyroid-stimulating hormone). This is the most sensitive test. The following are the conventional lab values for various thyroid hormone markers:

  • TSH: “Normal” / Random 0.3 – 5.0 mU/L (Newer data suggests that the TSH level should be between 0.3 and 1.5. And that 5.0 is far too high. I agree!)
  • TSH: High–Normal 3.0–5.0 mU/L
  • TSH: Following Thyroid-Releasing Hormone (TRH) stimulation at 20–30 min 9 – 30 mU/L
  • TSH: Borderline Increased 5 – 10 mU/L (I believe that borderline is anything over 1.5)
  • TSH: High >10 mU/L
  • Triiodothyronine (T3) 80 – 180 ng/dL
  • Free T3 230 – 619 pg/dL
  • Thyroxine (T4) 4 – 12 mg/dL
  • Free Thyroxine (Free T4) 0.7 – 1.9 ng/dL
  • Thyroid Peroxidase Antibodies (anti-TPO) < 2 IU/mL

Hypothyroidism can be difficult to diagnose, because there is a continuum between overt and subclinical hypothyroidism, with a great deal of overlap between the two. Depending upon which expert you talk with and which criteria are used for the diagnosis, as many as 25 percent of perimenopausal women have some kind of thyroid problem. Most of these are cases of subclinical hypothyroidism: Although symptoms may be present, tests of thyroid function are only slightly abnormal; for example, thyroid stimulating hormone is slightly elevated, with normal levels of T3 and T4. Some argue that the “normal” range for TSH in most labs (0.5–5.0 mU/L) is too broad and that normal should be only 0.50–2.0 mU/L. I completely agree and would use 1.5 as the cut off.

In contrast, 4 out of every 1,000 women have been diagnosed with overt hypothyroidism, defined as a TSH level of 10.0 or greater with concomitant abnormal values of T3 and T4. The average age of diagnosis for this condition is 60, and its prevalence increases with advancing age.

If you have a family history of hypothyroidism, fit the symptom profile for hypothyroidism, or suspect you have a thyroid problem, give yourself the thyroid neck-check. Hold a mirror in your hand and focus on the area of your neck just below the Adam’s apple. Take a drink of water and swallow. As you swallow, look at your neck and check for any bulges or a protrusion in this area. If you see any bulges, contact your physician.

Related Podcast: Thyroid Disease

What Causes This

According to the late clinician John R Lee, M.D., estrogen dominance is behind many cases of midlife hypothyroidism, in which there are inadequate levels of thyroid hormone. When estrogen is not properly counterbalanced with progesterone, Dr. Lee surmised, it can block the action of thyroid hormone, so that even when the thyroid is producing normal levels of the hormone, the hormone is rendered ineffective and the symptoms of hypothyroidism appear.

In this case, laboratory tests may show normal thyroid hormone levels in a woman’s system, because the thyroid gland itself is not malfunctioning. This problem is compounded when a woman is prescribed supplemental estrogen, which then leads to an even greater imbalance. Prescribing supplemental thyroid hormone in that case will fail to correct the underlying problem: estrogen dominance.

Common drugs can block thyroid function, including steroids, barbiturates such as Seconal, cholesterol–lowering drugs, the antiepileptic drug Dilantin, and beta blockers such as propranolol.

Most cases of hypothyroidism are due to autoimmune disease—the body making antibodies against the thyroid gland. However, it can also be due to the over-treatment of hyperthyroidism or to iodine deficiency. You can tell if yours is the result of autoimmunity because, in addition to changes in TSH, T4, and T3, a marker known as thyroid peroxidase antibodies (anti-TPO) will be elevated.

When a woman has autoimmune hypothyroidism, thyroid function decreases gradually. As the body makes antibodies against the thyroid, the pituitary gland compensates by producing more TSH, which tells the thyroid to pump out more hormone. In the early stages of this process, T4 and T3 levels are normal but TSH is elevated. If the illness progresses, thyroid hormone levels fall and TSH rises dramatically. Symptoms become more severe, then progress from subclinical to clinical hypothyroidism.

In many women thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of “swallowing” words one is aching to say. In the name of preserving harmony, or because these women have learned to live as relatively helpless members of their families or social groups, they have learned to stifle their self-expression.

These women may, in fact, have struggled to have their say, only to discover that it doesn’t make any difference — because in their closest relationships they have been defined as insignificant.

In order for this complex, entangled state of affairs to be resolved, a woman might need to take not only supplemental progesterone and thyroid hormone, but also an unblinking look at what parts of her life and interpersonal relationships need to change.

Healing Alternatives

A variety of prescrition thyroid replacement medications are available. I prefer one that has the correct balance of both T4 and T3, the two hormones that you’re trying to replace. Here are the current choices:

  • ArmourTM Thyroid, made by Forrest Pharmaceuticals, is made from dried (dessicated) pork thyroid glands and contains the correct ratio of T3 to T4. It is prepared according to United States Pharmacopeia (USP) standards, which ensures the potency and consistency of the product.
  • Synthroid (thyroxine) is the most commonly prescribed thyroid replacement hormone. It is T4 only. Most women do better with a little T3 thrown into the mix, so if you’re on Synthroid only and don’t feel up to par, ask your doctor to add some T3.

Within the medical profession, controversy exists about whether someone with subclinical hypothyroidism should be treated, given that the thyroid is compensating for an autoimmune process. If a woman is in her eighties or nineties when first diagnosed, studies suggest that she should just watch, wait, and retest because her own thyroid can probably produce enough hormone for the remainder of her life. However, experts suggest that a younger person will often feel better with a trial combination of T4 and T3.

Some patients who have a high–normal TSH of 3.0 or 4.0 feel symptomatic enough to want treatment. However, medication often doesn’t alleviate symptoms such as fatigue, weight gain, and inattentiveness. Instead, thyroid supplementation in these women may result in side effects, such as palpitations and irritability from too much thyroid hormone—a set-up that also increases osteoporosis risk. The decision whether or not to treat a borderline case with thyroid hormone replacement is ultimately one that a patient and her health care practitioner will need to make together.

No matter what dose of thyroid replacement you take, make sure you are on the lowest dose possible for your situation, and follow a sound program for maintaining bone health. You might also benefit greatly if you supplement with iodine and/or a high-quality seaweed supplement. For more information, refer to my article “The Secret Ingredient to Jumpstart Thyroid Health.”

Spiritual and Holistic Options

Addressing adrenal stress, glycemic stress, and estrogen dominance through modalities such as supplementation, adequate rest, and natural light often helps thyroid levels recover.

If your T4 and T3 levels are normal and your TSH is high-normal or slightly higher than normal, natural progesterone and/or iodine may be all you need to balance your thyroid chemistry, especially if you are taking estrogen only or estrogen with a synthetic progestin. If you have any doubts about whether to take natural progesterone, have your progesterone level tested either via blood or saliva one week before your period is due to see if you are deficient. The dose of natural progesterone that works well for most women is one-quarter teaspoon of a 2% progesterone skin cream, used once to twice per day, or about 20–40 mg/day on days 14 to 28 of your cycle. Once you stop having periods, use this cream daily for three weeks of every month.

Repeat your thyroid function tests within a month or two of starting the natural progesterone. If you are taking HRT, note than when you take natural progesterone, you can often cut your estrogen dose in half and get the same benefits. I’d also recommend substituting natural progesterone for any synthetic progestin you are on. Synthetic progestin can make thyroid deficiency symptoms worse. Common brands of synthetic progestin are Provera, Amen, and the progestin in Prempro. If you are taking Provera, substitute Prometrium instead. It is a prescription–only, natural micronized progesterone.

It’s no coincidence that so many more women than men have thyroid problems. Thyroid disease is related to expressing your feelings, something that until relatively recently had been societally blocked for women for thousands of years. In order to have your say—and maintain your thyroid energy—you must take a fearless inventory of every relationship in which you feel you don’t have a say. Ask yourself why you don’t. Are you a silent partner in a relationship? Does your partner make all the major decisions? Is it worth it? Did your mother have her say? In what ways are you like her?

Depending on your answers, I would urge you to skillfully and empathetically begin to say what is on your mind regarding the decisions that affect your life. Make sure that when you say what’s on your mind, you do so at the right time and remain detached from the effects. In other words, try not to force your will on others. For example, it’s okay to tell your best friend that you are worried about the character of her new boyfriend, but be aware that she may not necessarily be ready to hear your remarks. It’s not appropriate to “turn up the volume” as she’s rushing out the door to meet this new man.

As you begin to have your say (which becomes increasingly common during midlife and perimenopause), don’t expect everyone to be happy about your newfound voice. If you used to be silent and submissive, some individuals may not be thrilled about sharing some of the decision-making in your relationship. Be patient. All the natural energy that surrounds this rite of passage favors it.

One more thing, thyroid disorders are also related to our relationship to time. The thyroid is adversely affected by feeling as though there’s never enough time or that you are running out of time. This feeling also results in adrenal burnout (which is related to thyroid disorders.) Our culture’s relationship to time is very unbalanced. And this is taking a toll on many. A starting point here is to realize that you have all the time there is. Literally. And all the time that anyone else has—24 hours in a day.

You can change your relationship to time by changing the way you pay attention. Stop for a moment and put your attention in your feet. Now put it in your heart. Breathe deeply and really feel your lungs. Take regular moments during the day to simply put your attention on something. Notice a beautiful flower. Or a tree. Or the sky. Slow down and pay attention. Eventually this little practice will improve your relationship to time. Delegate. And say the following affirmation:

I have all the time in the world to do what really matters. I am the source of time. And I can change my relationship to time and rebalance my body.

Learn More — Additional Resources

References

  1. Massoudi, M. S., et al. (1995). Prevalence of thyroid antibodies among healthy middle-aged women. Findings from the thyroid study in healthy women. Annals of Epidemiology, 5 (3), 229–233.

Christiane Northrup, M.D.

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.

Comments

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  1. Sandra
    2 weeks ago

    I’m wanting info about hyperthyroid . I have been on replacement pills for 40 years.
    Now it’s hyper and going higher. I went down on dosage but it’s not helping. Can you help?

  2. Jen
    2 months ago

    Can you recommend anyone in the Philadelphia area who specializes in treating young women with hypothyroid? I’m 25 and have been symptomatic for a few years – fatigued, cold, depressed, etc. I thought by doing personal work on myself, these symptoms would get better, and at times they certainly have, but they haven’t completely resolved and I think it’s time to seek medical help in addition to the spiritual and emotional avenues I am already persuing. I love your incorporation of both western and eastern philosophy, as I prescribe to both, being a nurse and a reiki practitioner. If you know of anyone in my area, I would greatly appreciate the recommendation!

  3. Cathy
    2 months ago

    Hello Dr. Northrup. I need some help. I am taking WP Thyroid. Here are my lab results:

    On 97.5 mg. On 81.25 mg. Alternating 97.5 & 81.25
    TSH: 0.08. TSH: 0.79. TSH: 1.81
    FT4: 64. FT4: 0.54. FT4: 0.54
    FT3: 3. FT3: 2.5. FT3: 2.7
    RT3: 7.5. RT3: 9.0
    I am wondering why my TSH and RT3 would increase. I can’t lose weight. My hair is falling out again. Any response would be greatful. Thank you.

  4. Kim
    2 months ago

    Love this. I literally just held back tears as I read this because, well… just… WOW. This resonated with me. I was diagnosed with hypothyroidism a little over a year ago and while I felt a little better once they started me on synthroid, I still wasn’t “right.” I’ve done a lot of reading and trying to learn about my thyroid over the past year and I want to ask the dr to add some T3 to the mix, as you said. But the bits about relationships, finding our voice, and stopping to regain control of the 24 hours I’m allotted every day – thank you. A million times over, thank you!!!!!

  5. Christina
    3 months ago

    Was told 15 years ago I have Hashimotos have been up to 300 mcg Levthyroxine in July 2015 put on Levthyroxin 0.5 which is 8 months I have Moderate sleep Apnea,Excessive Daytime Sleepiness and Excessive Yawning. My test results are like a roller coaster up an down constantly have a high TSH yet normal T4&T3 or low T4&TSH. Numbing /Tingling hands feet. My grown children and Husband say I’m getting forgetful. I’m 56 years old was tested for Narcolepsy I don’t have. They don’t know what’s causing EDS or Yawning or EXHAUSTION ??? Told heart is healthy but have some stiffening. I get heart palpitations and fluttering course 24 hour monitor did not show nothing wish I had it that morning I had to get it because I had the fluttering racing an got dizzy. Have to see a neurologist this may. Family history Mother had MS took nitro for heart. Her mother died of Heart Aneurysm. I also get heavy leg like getting out of a pool feeling. Help need answeres.

    1. Stephanie
      3 months ago

      You sound like me 15 years ago. I fixed all of these symptoms by eliminating gluten and dairy from my diet. Don’t delay this any longer. These foods are poison to bodies like ours. If you want to learn more about Hashimoto’s, thyroid issues and healing with food, I highly recommend that you read Anthony WIlliams’ book, “The Medical Medium.” He shares all of the reasons why this diet works so well at helping our bodies finally heal. Best of luck to you, Christina! <3

  6. Sandra
    3 months ago

    Please help, my TSH is 8.71 (flagged high), my Free T4 1.42 (normal), my Total T3 84 (flagged as low). I got told I’m hypo but why do I keep losing weight unintentionally – I am already underweight with a BMI of 17.7?? I feel tired and exhausted and I’m very ashamed of now needing 12 hours of sleep. My skin and hair got very dry, all signs of hypo but the weight loss does not fit into it. Is it possible to be hypo but very skinny at the same time??

  7. Polina Dencheva
    3 months ago

    I love this article! It is the answer to my years of research! Thank you so much Dr. Northrup!!! Thank you for sharing priceless information and everything you do for women!!!

  8. Beverley
    5 months ago

    Hi Christiane, my daughter is 21 yrs old. She was diagnosed with hypothyroidism at age 17. Along with severe depression (which seems to not be getting better even though she’s on antidepressants). At the time her blood tests showed she has under active thyroid but a ct scan showed her thyroid is over active. Can you explain why? Thanks

  9. Marg
    7 months ago

    What would treatment options be for someone over medicated with synthroid? The dry mucous membranes attributed to over medication can be as severe as under medication due to the dehydrating effect. I have been over medicated for several years by more than one endocrinologist. I know a dose increase is required to use estrogen as it is a dominant hormone and blocks thryoid receptors, but progesterone supports the thyroid. I have tried bio identical estrogen and progesterone but they both impacted my thyroid levels. During the process of finding the right dose of synthroid how can the dry exterior mucous membranes be treated?

  10. Sara
    8 months ago

    2 years ago, I stopped taking synthroid because they wanted to do a RAID test. After being off of synthroid for 6+ weeks I felt tremendously better!! I had been on it for 8 years!! The RAID scan showed that I was actually hyperthyroid. I had been told for 8 years I had Hashimoto’s, after all my Thyroid AB test showed a 280. The doctor after the RAID scan told me I had both Graves and Hashimoto’s. Against all my doctors advice, I felt so good, I just couldn’t go back on it! My bood work went totally haywire! TSH 30+, FT4 dropped to .5, but I felt amazing!! The next year I had my blood work taken again and my TSH was at 17, and my FT had risen to .65 just below normal range, and my Thyroid AB test dropped to 122.. However, I still felt good, so against all my doctor’s advice, I just couldn’t take the synthroid. They never offered me any other option. I got blood work back today and my TSH is at 9.6, my FT4 is at .77 (normal range), and my T3 is also now in normal range, and my Thyroid AB results were 105. I haven’t really changed my diet any, I have used some essential oils, but I haven’t done anything consistent enough to really add up to these changes. Still, through all these tests and 2 years later, my doctors are finally recommending me to take Armour Thyroid…I am concerned with going on to Armour because it seems like my body has gone from extremely Clinical Hashimoto’s to subclinical hypothyroidism without any replacement. Now I am wondering if there is some other reason my thyroid has gone haywire that maybe isn’t quite as directly connected to Autoimmune as they seem to think. Any advice would be great…..Just hoping to get a smart opinion from outside my doctor’s office…

  11. Eva Bianca
    8 months ago

    Just wondering what you think as a sleep aid of Forskolin. I started taking it for a thyroid condition, and I Have noticed that it truly makes me tired. It might be because itis a metabolism booster as well, so maybe I’m just getting tired when I’m “coming down” from it. I don’t know. Interested what you believe. Thanks.

  12. Sunny
    8 months ago

    Good morning
    I am taking Synthroid and would like to try A-ma-ta to help with my menopausal symptoms. I would appreciate any information on the interaction of the two taken together.

    Thank you
    Sunny

  13. Helen
    10 months ago

    Patricia, i have gone to Holtorf Medical Group in Torrance since 2010. My THS was always normal. I can highly recommend them. Dr. Wayne Wightman, and all the other doctors there specialize in thyroid and other immune issues. I hope this helps.

  14. Jocelyn Black
    1 year ago

    I think it is so important to look at all the options and express what you are feeling. I think that women hide what they are really feeling to a doctor. They can’t act on information that they don’t have. Doing research and communicating your thoughts are all important. Thanks for sharing.

  15. Kristy
    1 year ago

    What are your thoughts on the correlation between Hashimoto’s and gluten sensitivity?

    1. Janina
      1 year ago

      I am curious if you received any responses or found out any new information to your gluten question? I’ve also heard that gluten free is better and the Hashis also causes fluctuating or high triglycerides.

      1. Mary
        6 months ago

        Dear Dr Christiane
        I have Hasimotos and wonder if it is okay for me to take kelp and
        Sea vegetables.
        Many Thanks
        Mary

  16. Patricia Minkel
    1 year ago

    I am looking for a doctor that specializes in treatment for over active thyroid in Southern California, I live in Palm Springs California. Thank you for your assistance.

  17. bill
    1 year ago

    I have recently been diagnosed with hyperthyroidism. I see load of information on the web about hypothyroidism, but very little about hyperthyroidism. I am interested in the causes for it, and all my doctor wants to do is medicate the symptoms. I’ve recently read about the possibility the an active mycoplasm infection being the cause of my body attacking my thyroid. I have tested positive for the bacterium, but am having trouble finding published protocols for treatment. I am wondering if anyone has any resources or experience with treating hyperthyroidism in this way. Thank you and be well.

  18. priya
    1 year ago

    Hi christine, I am suffering with high TSH level which is 98.96.. T3,T4 are normal. I am a female of 27 years old. just 2years back i got marrried, as now i m trying for pregnancy but it not succeeding. so we went to doctor as she made tests and said TSH is high. Please suggest me is it a very very serious condition. I want to know really i have a chance to get pregnancy my TSH level will come down or not.. Please please help me..

  19. Juanita mejia
    1 year ago

    Dear Christine
    I am 51 year old and I am on menopause I did some blood work for thyroid blood test and the doctor just want to repeat it it not important he said but I am nervous can you explain this to me more .
    Thank you Juanita mejia

  20. Jackie
    1 year ago

    I am in such a state of relief and realize now that there are lights in the world that shine when you need them most. A visit to my doctor rendered me more confused than relief when i finally found out what was happening to my body (low thyroid) with no acknowledgment of my premenipausal sypmtoms. I left without an explanation and no options other than supplements. At least now all the other symptoms that I have been experiencing is explainable and I am not losing my mind. I feel hopeful again, and found.
    Thank You

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