Hypothyroidism is the result of not making enough thyroid hormone. The average age of diagnosis for this condition is 60, and its prevalence increases with advancing age. However, it is increasingly more common for women at midlife.
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 triiodothyronine (T3), which regulate the body’s metabolic rate.
An estimated 20 million Americans have some form of thyroid disease. Statistics show that one in eight women will develop a thyroid disorder in her lifetime. And, women are five to eight times more likely than men to have thyroid problems.
Thyroid function is very complex and exerts a profound effect on the function of nearly every organ in the body. Therefore, smooth functioning of the overall body chemistry depends on the health of your thyroid gland.
14 Symptoms of Hypothyroidism
While many women with hypothyroidism are completely asymptomatic, others may have a wide variety of symptoms, including mood and sleep disturbances, depression and irritability, low energy level, and even mental confusion.
Here are 14 more symptoms of clinical and subclinical hypothyroidism:
- Weight gain
- Intolerance to cold or heat
- Hair loss or dry hair
- Decreased heart rate
- Problems with attention and concentration
- Shortness of breath
- 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
To make matters more complicated, 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.
How to Tell If You Have Hypothyroidism
If you have a family history of hypothyroidism, have any of the symptoms of hypothyroidism described above, have bulges or a protrusion in your neck below your Adam’s apple when you swallow, or suspect you have hypothyroidism, see a physician who understands thyroid problems.
If your doctor recommends testing you for hypothyroidism, be sure to ask for a full panel of tests, including free T4, free T3, T3 uptake, and T4 uptake. Many doctors still test TSH (thyroid-stimulating hormone). However, more recently experts are realizing that TSH is an inaccurate marker of the body’s overall thyroid status.
Here are the conventional lab values for thyroid hormone markers you may be tested for:
- TSH: “Normal” range 0.3-1.5 mU/L
- TSH: High–Normal 3.0–5.0 mU/L (Many doctors still think of this high-normal range as healthy. But, if you don’t feel well, then it’s too high for you.)
- TSH: Borderline Increased 5 – 10 mU/L (I believe that borderline is anything over 1.5 mU/L.)
- TSH: High >10 mU/L
- TSH following Thyroid-Releasing Hormone (TRH) stimulation: 9 – 30 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
Remember, these levels are the standards used by conventional doctors, but many experts now realize that the numbers don’t always paint a clear picture. Most cases of hypothyroidism at midlife are subclinical. In other words, although you may have symptoms, thyroid function tests are often in the normal range.
4 Causes of Hypothyroidism at Midlife
There are a number of theories as to why hypothyroidism is becoming more prevalent at midlife. Most medical practitioners believe the following to be common causes of hypothyroidism at midlife:
- Estrogen dominance. The late clinician John R Lee, M.D., believed estrogen dominance to be behind many cases of midlife hypothyroidism. According to Dr. Lee, when estrogen is not properly counterbalanced with progesterone, it can block the action of thyroid hormone, so your thyroid may produce enough hormone, but it is rendered ineffective and the symptoms of hypothyroidism appear. In this case, laboratory tests may show normal thyroid hormone levels because the thyroid gland itself is not malfunctioning.
This problem is compounded if you take supplemental estrogen, which then leads to an even greater imbalance. And taking supplemental thyroid hormone will fail to correct the underlying problem. In order for this complex, entangled state of affairs to be resolved, you may need to take progesterone and thyroid hormone. I recommend taking natural progesterone instead of synthetic progestins, which can make hypothyroidism symptoms worse. Be sure to repeat your thyroid function tests within a month or two of starting natural progesterone. Also note that when you take natural progesterone, you can often cut your estrogen dose in half and get the same benefits.
- Medications. Prescription drugs may also cause symptoms of hypothyroidism. For example, if you take steroids, barbiturates, cholesterol-lowering drugs, antiepileptic drugs, or beta blockers, you may experience the symptoms of hypothyroidism.
- Autoimmune disease. Autoimmune hypothyroidism is when your body makes antibodies against thyroid tissue. If you have antithyroid antibodies, your thyroid function will likely decrease gradually. As your body makes antibodies against your thyroid, your pituitary gland compensates by producing more TSH, which tells your 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.
However, Medical Medium Anthony William, who receives messages from Spirit, says that autoimmune thyroid problems are due to a pathogen and that the body creates antibodies to attack the invader, not your thyroid. He stresses that our bodies never “attack” themselves, a notion that I find very reassuring. You can learn more by reading his book, Thyroid Healing: The Truth behind Hashimoto’s, Graves’, Insomnia, Hypothyroidism, Thyroid Nodules & Epstein-Barr.
- Iodine deficiency. Hypothyroidism has also been linked to iodine deficiency. Iodine is needed for the production of thyroid hormone. Too little iodine can result in goiter, or enlargement of the thyroid gland. While iodine deficiency is considered rare in developed countries, I have found it to be common in women, especially if you eat a vegetarian or vegan diet or limit your salt intake. So, if you have symptoms of hypothyroidism, but your labs are normal, you may want to supplement with iodine and/or a high-quality seaweed. The Health Medium Ray Veilleux, who is based in Maine, generally recommends 2-7 drops of 2% Lugol’s solution daily. Lugol’s solution is made up of molecular iodine and potassium iodide. You can easily order it online. And this intervention alone can make a huge difference.
Treatment Options for Hypothyroidism
There are a number of thyroid replacement medications you can take that may help you feel better and have more energy. My colleague Kelly Brogan, MD, a holistic psychiatrist and functional medicine doctor, recommends Thyroid Natural Glandular by Allergy Research Group, which is available online without a prescription. She reports that in her practice, as long as women are following a healthy diet, this supplement is enough to balance the thyroid. There is also ArmourTM Thyroid. It is made from dried (desiccated) pork thyroid glands and contains the correct ratio of T3 to T4, the two hormones that you’re trying to replace. It is prepared according to United States Pharmacopeia (USP) standards, which ensures the potency and consistency of the product. You need a prescription for this.
Remember, as with any medication, there is no one-size-fits-all, and many people do better on the standard synthetic T4 replacement alone or with a little synthetic T3 added in. Synthroid (thyroxine) is the most commonly prescribed thyroid replacement hormone. It is T4 only. If you’re on Synthroid and don’t feel up to par, ask your doctor to add some T3.
Healthcare practitioners often disagree about whether to treat subclinical hypothyroidism. If you have a high–normal TSH of 3.0 or 4.0 and feel symptomatic, then I suggest you seek treatment with a trial combination of T4 and T3. Make sure you are on the lowest dose possible for your situation and follow a sound program for maintaining bone health. And, be aware that medication may not alleviate symptoms such as fatigue, weight gain, and inattentiveness. In fact, it may result in side effects, including palpitations and irritability.
According to Medical Medium Anthony William, thyroid medications do not heal the thyroid and can actually be hard on the liver and adrenal glands, which causes weight gain for some people. Anthony recommends weaning off thyroid medications slowly, and with your doctor’s support, while making healthy diet and lifestyle changes.
The Relationship Between Hypothyroidism and Depression
It is not uncommon for women with hypothyroidism to suffer from depression. One explanation is that T3, the most biologically active form of thyroid hormone, is 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.
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 another level as well. The main building block for the neurotransmitter serotonin and for thyroid hormone (both T3 and T4) is the amino acid tyrosine, 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. In other words, depression itself can result in hypothyroidism. If you are taking supplemental thyroid hormone, and it works to alleviate your hypothyroidism but you still feel depressed, this often means that hypothyroidism is the symptom resulting from depression.
It is hard to say 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. And often depression and hypothyroidism need 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 people who are treated for depression or anxiety with medications can eventually develop thyroid problems. I suspect this is because antidepressants deplete neurotransmitter levels. Check out Dr. Kelly Brogan’s book, A Mind of Your Own, for a complete program that addresses this issue.
Speak Up: Mind-Body Support for Thyroid Health
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. And, it’s no coincidence that so many more women than men have thyroid problems.
Thyroid disease is related to expressing your feelings, something that for thousands of years until relatively recently, society has deterred women from doing. So, in the name of preserving harmony, or because these women learned to live as relatively helpless members of their families or social groups, they stifled their self-expression.
Therefore, for many women, thyroid dysfunction develops because of an energy blockage in the throat region—the result of a lifetime of “swallowing” the words one is aching to say. Or, if they did have their say, they may have discovered that it didn’t make any difference because their closest relationships saw them as insignificant.
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.
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 the decision-making in your relationship. Be patient. All the natural energy that surrounds this rite of passage favors it.