Thyroid Concerns At Menopause
Each day, thousands of middle aged women visit their doctors with complaints of infrequent periods, weight gain and fatigue. In most cases, these women are diagnosed with symptoms of menopause and sent home with information about lifestyle modifications and treatment options to alleviate the symptoms. However, what many of these women don’t know is they could be suffering from thyroid disease.
Women are more subject to thyroid disease than men and it is particularly prevalent in menopausal women. Menopausal women should be routinely screened for thyroid disease as part of their annual examination.
According to the American Association of Clinical Endocrinologists (AACE), millions of women with unresolved menopausal-like symptoms, even those taking estrogen, may be suffering from undiagnosed thyroid disease. While symptoms such as fatigue, depression, mood swings, and sleep disturbances are frequently associated with menopause, they may also be signs of hypothyroidism, a condition in which the thyroid gland fails to produce enough thyroid hormone.
The thyroid gland is one of the major endocrine (hormone secreting) glands of the body. It is a small butterfly-shaped gland located near the Adam’s apple. Unless enlarged, it can barely be felt or seen. The thyroid gland secretes hormones that play a role in regulating metabolism and influences the heart, brain, kidney, and reproductive system, along with muscle strength and appetite. Thyroid hormones regulate our body’s metabolism. Your metabolism controls the speed at which chemical processes occur in the body, which affects many functions such as heart rate, temperature, and stamina/energy. Thyroid hormones also regulate the consumption of oxygen and the production of heat in our bodies.
In the U.S., between 7-10% of the population over the age of 55 are affected by a thyroid disorder, with Caucasians more commonly affected than African-Americans. Females are 5-8 times more likely to have a thyroid disorder compared to men. Hypothyroidism can be due to a variety of causes, including history of thyroid radiation, treatment for an overactive thyroid (Graves’ disease), removal of the thyroid gland, and certain medications, such as lithium, amiodarone and iodine. The most common cause of hypothyroidism is a medical condition called Hashimoto’s thyroiditis.
Since women over the age of 55 are more commonly affected with hypothyroidism, it is important to understand the effects of menopause on the thyroid. Symptoms for both hypothyroidism and menopause are similar and can include depressed mood, and decreased energy and memory. The similarities that occur are often the same reason there is a delay in the diagnosis of hypothyroidism. Hypothyroidism is when you have too little thyroid hormone from an underactive thyroid gland. The body’s metabolism slows and many physical and mental processes become lethargic.
- cold intolerance
- weight gain (unintentional)
- joint or muscle pain
- thin, brittle fingernails
- thin and brittle hair
- slow speech
- dry flaky skin
- thickening of the skin
- puffy face, hands and feet
- decreased taste and smell
- thinning of eyebrows
- abnormal menstrual periods
Diagnosis and Treatment
A variety of tests can be done to assess thryoid function. A physical examination that includes an evaluation of vital signs would reveal significant symptoms. In addition, a chest x-ray may reveal an enlarged heart. However, laboratory tests like the T4 test or the serum TSH (thyroid stimulating hormone) are the most common and effective ways of diagnosing hypothyroidism.
Levothyroxine is the most commonly used medication to replace the deficient thyroid hormone. The lowest effective dose is typically prescribed and life-long therapy is needed. Medication must be continued even when symptoms subside. Thyroid hormone levels should be monitored yearly after a stable dose of medication is determined.
For those of you taking estrogen, or changing the dose of the estrogen you are taking, it is important to realize that the more estrogen you take, the more thyroid hormone your body needs and vice versa. This is because estrogen increases a protein in the blood called thyroid binding globulin (TBG). The higher the TBG levels, the lower your “free” thyroid hormone levels. Free hormone means the hormone is free to carry out its biologic affect in the body as opposed to being bound up by TBG which causes it to be biologically inactive.
As aware women (in control of your healthcare), you should be aware of the signs and symptoms of hypothyroidism and let your doctor know if you have concerns about your thyroid function. In addition, if you are experiencing symptoms of menopause, do not hesitate to discuss them with your doctor – that’s why he/she is there. If you feel that your symptoms are persisting despite the recommended therapy, you may want to have your TSH checked. A blood sample is all that is needed to make the initial diagnosis of hypothyroidism and treatment is easily achieved with the proper medication. Thyroid medication needs may change with changes in your estrogen level. Remember that good communication and a simple test may be the key to improving your quality of life at menopause and beyond!
Hyperthyroidism is usually caused by Graves’ Disease or diffuse toxic goiter. However, Graves’ Disease is the most common type of hyperthyroidism. It is a condition when the body has too much thyroid hormone and the cause is unknown. This autoimmune disorder tends to run in families. Graves’ Disease affects more women than men (about an 8.1 ratio) and it occurs more frequently in women in their 30’s and 40’s.
Symptoms of Graves’ Disease:
- weight loss
- rapid heart rate
- feeling hot
- perspiring a lot
- muscle weakness
- swelling in neck
- eye symptoms
Diagnosis and Treatment
Your healthcare provider will take a medical history, do a physical examination, including eye exam, and measure your level of thyroid hormone in your blood and check for antibodies in the blood that attack the thyroid gland. Additional tests may be recommended: a radioactive iodine scan or RAI uptake and a scan of the thyroid gland with ultrasound.
Treatment includes commonly used anti-thyroid drugs: PTU (propylthiouracil) and methimazole (Tapazole). Beta blockers are sometimes used to control symptoms. Sometimes steroid medicine (predisone) is used to treat eye problems.
If symptoms are severe, your healthcare provider may suggest radioactive iodine to kill some of the cells in the thyroid. Surgical removal of the thyroid gland is sometimes performed in severe cases of hyperthyroidism. Graves’ disease can be brought under control; however, the disease may come back again. For this reason, your healthcare provider will need to see you on a regular basis to check your thyroid hormone levels.
Lifestyle and Prevention
You should be taking necessary healthy lifestyle measures to include, eating a healthy diet, exercising regularly, getting enough sleep, and taking steps to manage stress.
Your clinician should provide you information about thyroid conditions and if you have one, you should:
- Know the how to properly take your thyroid hormone medication
- Be able to identify if you are getting too much, or not enough thyroid hormone by the symptoms that may develop
- Go for regular health checkups. Your clinician will order blood tests to measure thyroid hormone levels, and check for possible nodules
Discuss with your clinician any other medications you are taking to ensure they are not interacting with your prescribed thyroid medication.