Your thyroid gland is part of your endocrine system. It secretes the hormones thyroxine (T4) and triiodothyronine (T3), which regulate your body’s metabolic rate. But thyroid function is very complex. And your overall body chemistry and the smooth functioning of nearly every organ in your body depends on the health of your thyroid gland.
Today an estimated 20 million Americans have some form of thyroid disease. And women are five to eight times more likely than men to have thyroid problems. Statistics show that one in eight women will develop a thyroid disorder in her lifetime including Hashimoto’s thyroiditis, Grave’s disease, and goiter. However, the vast majority of perimenopausal women with thyroid conditions have what’s known as “subclinical hypothyroidism.”
The term “subclinical” refers to the fact that the standard tests come back within the normal range even though a woman has symptoms. Part of the reason why this occurs is that the symptoms associated with subclinical hypothyroidism are vague and difficult to diagnose.
Healthcare practitioners often disagree about whether to treat subclinical hypothyroidism. If you are told you have normal thyroid function and feel symptomatic, then I suggest you seek treatment.
14 Symptoms of Hypothyroidism
Hypothyroidism is the result of not making enough thyroid hormone. The average age of diagnosis for this condition used to be 60. However, it is becoming more common for women at midlife. 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 Thyroid-Stimulating H (TSH). 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:
Thyroid Stimulating Hormone (TSH) Ranges:
Normal = 0.3-1.5 mU/L.
High–Normal = 3.0–5.0 mU/L. NOTE: 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.
Borderline = 5–10 mU/L. NOTE: I believe that borderline is anything over 1.5 mU/L.) High = >10 mU/L.
TSH following Thyroid-Releasing Hormone (TRH) stimulation:
Normal =9–30 mU/L.
Normal =80–180 ng/dL.
Free Triiodothyronine (Free T3):
Normal = 230–619 pg/dL.
Normal = 4-12 mg/dL.
Free Thyroxine (Free T4):
Normal = 0.7–1.9 ng/dL.
Thyroid Peroxidase Antibodies (anti-TPO):
Normal = < 2 IU/mL. NOTE: If your anti-thyroid antibodies are positive, your problem is NOT subclinical hypothyroidism, but rather an autoimmune condition where your body is making antibodies against your thyroid.
Remember these ranges are the standards used by conventional doctors who often treat the lab test as more important than the patient! The truth is even if your TSH, T3, and T4 are normal, your thyroid may still need help. Fortunately, many experts now realize that the numbers don’t always paint a clear picture.
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:
1. 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 progestin, 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.
2. 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.
3. 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 hormones. 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.
4. Iodine deficiency. Hypothyroidism has also been linked to iodine deficiency. Given that many people limit their salt intake or use sea salt, iodine deficiency is becoming quite common. In fact, most of us don’t get enough iodine in our diets. And there are other reasons for iodine deficiency as well. For example, fluoride interferes with iodine metabolism. So does bromine, a known endocrine disruptor found in commercially made bread and bakery goods (potassium bromate), sodas (sodium bromate), certain medications, plastics, pesticides, and even some pool and hot tub treatments. Chlorine can also disrupt the body’s ability to absorb and utilize iodine. Soy can interfere with iodine uptake in the thyroid gland.
Iodine Patch Test for Hypothyroidism
Iodine is needed for the production of thyroid hormone. Too little iodine can result in goiter, or enlargement of the thyroid gland. If you’ve had your thyroid function checked and everything is “normal” or your TSH is a bit on the high side, I suggest you check your iodine levels.
A quick and relatively accurate way to test it yourself is a skin test. Simply put several drops of Iodine on your wrist in the morning. Iosol or povidone iodine will work. Rub the iodine around with an applicator until you have an iodine patch that is about two inches by two inches. Monitor this patch every 30 minutes and note how long it takes for the iodine to be absorbed into your skin.
If your iodine level is adequate, you’ll still have some iodine visible on your skin when you go to bed in the evening. If you absorb the iodine in under 10 hours, you may want to take a supplement for a month and then do the iodine patch test again. I recommend taking the iodine daily until it stays on your skin for 10 hours or more.
The Health Medium Ray Veilleux 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.
Despite the fact that many (if not most) women are iodine deficient, iodine supplementation should be approached in a balanced and judicious way—especially if you are already on thyroid medication. If you’re already on thyroid hormone, you may find that you only need a low dose of supplemental iodine. Eventually, you may be able to discontinue your medication altogether.
If you decide to supplement with iodine I recommend you look for a health care practitioner who has been trained in Functional Medicine. Check out the Institute for Functional Medicine’s Web site to find someone near you.
Finally, when you start taking iodine, you might get a reaction in the form of a rash, headaches, or a general feeling of malaise. This is because the iodine can cause a detox reaction as it displaces excess chlorine, fluoride, bromine, and even heavy metals from your body. Don’t panic. This sort of detox reaction is common when you start taking a good supplement.
Just cut way back on the amount of iodine you are taking then gradually increase it.
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.
Of course, 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. Just be aware that medications may not alleviate symptoms such as fatigue, weight gain, and inattentiveness. In fact, they may result in side effects, including palpitations and irritability.
2 Easy Ways to Support Your Thyroid Naturally
Eat for thyroid health. Seaweed helps restore iodine levels and is an excellent way to remove heavy metals such as mercury and lead. One particularly good source, known as modifilan, is made from dehydrated kelp juice from organically processed seaweed. Taking these supplements often helps people lose weight too. Other foods that stimulate thyroid health include organic vanilla extract (add to water or shakes) and unsulfured, unsteamed dates. Eat these with a bit of healthy fat such as a few macadamia nuts or walnuts. You can also benefit from eating alkalinizing foods such as lemons, limes, tomatoes, parsley, figs, and pineapple. Choose organic foods as much as possible since pesticides interfere with thyroid function.
Enjoy vigorous exercise. It is well documented that a single bout of vigorous exercise increases the metabolism by 20 percent. And it stays that way for hours thereafter. Exercise vigorously at least 5 days a week for at least 30-60 minutes to help “reset” your metabolism. Include weight training in your routine. Increased muscle equals a faster metabolism!
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.
Have Your Say to Maintain Thyroid Energy
From an energy standpoint, thyroid disease is related to expressing your feelings—something that for thousands of years society has deterred women from doing. Women would stifle their self-expression to preserve harmony and live as relatively helpless members of their families or social groups. 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 they are aching to say.
In order 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 empathetically say what is on your mind regarding the decisions that affect your life. Make sure 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 her new boyfriend’s character 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, 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.