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 factors 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 continually strive 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.

Typical thyroid hormone ranges

It’s a good idea to have your thyroid hormones checked once a year. Your practitioner should also check levels after two months if you’re starting a new thyroid medication or dose. Here are the typical ranges:

T4: 4.8–13.2 mcg/dL

Free T4: 0.9–2 ng/dL

T3: 80–200 ng/dL

TSH: 0.4–4.0 mIU/L (if you have no hypothyroid or hyperthyroid symptoms) 0.3–3.0 mIU/L (if you’re being treated)

Keep in mind that “normal” ranges vary by laboratory and that anyone with a TSH >2.0 mIU/L and no other “abnormal” levels should be followed closely to watch for symptoms of hypothyroidism. I strive to keep TSH levels below 2.0 mIU/L in my patients, even though the normal range goes up to 4.0 mIU/L.

Reference

The thyroid carries amazing 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 more readily used 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 with decreased progesterone may block the action of the thyroid hormone and lead to symptoms of hypothyroidism, even as 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.

 

Diagram of interconnections between the HPA and HPT axes

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 too little 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 finding 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 our 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 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. This is a connection I’ve noticed 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 called for 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.

Natural hypothyroid relief — from WomentoWomen.com

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 causes.

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

Nutrient-rich foods to replenish thyroid health

Iodine (I): seaweed (e.g., nori), clams, shrimp, haddock, oysters, salmon, sardines, pineapple, eggs.

Selenium (Se): smoked herring, smelt, wheat germ, Brazil nuts (just one nut provides ~139 mcg), apple cider vinegar, scallops, barley, lobster.

Zinc (Zn): fresh oysters, ginger root, pecans, dry split peas, Brazil nuts, egg yolk, whole wheat, rye, oats, peanuts.

Vitamin E: wheat germ oil, olive oil, sunflower seeds, almonds, peanuts.

Vitamin A: dark green leafy veggies, liver, winter squash, cantaloupe, stone fruits, papaya, and cod liver oil.

B vitamin complex: brewer’s yeast, wild rice, brown rice, whole wheat, beans, peanuts.

Vitamin C: Red chili, guava, parsley, dark green leafy veggies, strawberries, papaya, citrus fruits.

 

References

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 of 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 changes and your thyroid hormone levels still aren’t right (or you’re still experiencing symptoms despite “normal” TSH), then it is worth considering using 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 levels 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 it 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 physical as well as 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.

 

More on natural health and other articles from WomentoWomen.com at

Health-Nutrition-Wellness.com

Ever wonder why you are so tired all of the time?  Do you have trouble concentrating?  Are you cold and achy?  Are you finding that you do not enjoy the things that used to make you happy?  Why they heck have you been gaining weight even though you eat right and exercise daily?  Are you depressed?  If you are having these feelings it is important to know that you are not alone.  There are literally thousands of people with symptoms of hypothyroidism with blood tests that do not reveal anything out of the ordinary.  Why is this happening to so many people and what can be done for those who have no explanation for their symptoms?

Basic Anatomy & Physiology

The thyroid gland resides in the neck just in front of the larynx.  It produces hormones that play a role in just about every bodily function. One of the reasons why it is so hard to diagnose a thyroid condition is because it is only a small part of a complex and intricate matrix called the endocrine system. The endocrine system consists of 8 main glands and secondary sex glands.  The hypothalamus, pituitary, adrenal, thyroid, parathyroid, pancreas, pineal, thymus, ovaries in women, testes in men, and the placenta in pregnant women are all apart of the endocrine matrix. The endocrine system is responsible for regulating hormones.  If there is a shift in balance in any part of the endocrine system, then all of the endocrine structures will be affected.  The key is targeting where the glitch in the system lies.

Hypothyroidism: The Western View

Hypothyroidism is defined as the circumstance of having inadequate thyroid function.   Persons with hypothyroidism have a slow or under active thyroid gland in which little or no hormones are produced. The thyroid produces 2 main hormones, Thyroxine T4 and Triiodothyronine T3.   Both T4 and T3 direct cellular metabolism (4. p18).  T4 is the most abundant thyroid hormone in the blood stream.  It is large and slow acting.   It is broken down in the liver to T3.  T3 is faster acting and smaller so it can easily pass through the nuclear pores and bind to DNA (4. p34).  Thyroid hormones regulate how your cells use oxygen as an energy source.  Other important hormones include Thyrotropin-releasing hormone (TRH) and thyroid stimulating hormone (TSH).  TRH is released from the hypothalamus, which directs the pituitary gland to release TSH.

Symptoms of hypothyroidism are high cholesterol, fatigue, lethargy, headaches, moodiness, slow weight gain, feelings of cold, and memory and cognition difficulties. A regular allopathic western doctor will use a thyroid panel that includes anywhere from 1 – 10 thyroid related hormone test.   Proper western drug therapies include administration of synthetic or natural hormone replacement therapies.  Hypothyroidism is not easy to diagnose because most patients will not have all of the symptoms.  What makes it even harder to diagnose is that some people have symptoms but their blood test do not reveal an under active thyroid.  In fact so many people are wrongly diagnosed as having chronic fatigue syndrome or fibromyalgia who actually have a thyroid imbalance.  Doctors call this “subclinical disease” in which there are no detectable clinical characteristics of the disease.

Hypothyroidism: The Eastern View

In Traditional Chinese Medicine, symptoms of a thyroid imbalance are indications of an imbalance of yin & yang in the body.  Yin qualities are darker, heavy, night, moon, feminine, inactive, slow, moist, cold, and receptive.  Yang qualities are lighter, warmer, daytime, masculine, fast, active, and dry.   What makes the Chinese Medical system work so well is that it’s the entire person that is being treated, not just the disease.   An oriental medical doctor does not need to read lab tests in order to diagnose a patient.   Instead, the patient’s color, tongue, pulse, scent, signs, and symptoms are all carefully observed by the practitioner.  In general, hypothyroidism can be diagnosed as an over abundance of Yin with Yang Deficiency.  According to diagnosis, we would use formulas such as Jin Gui Shen Qi Wan to warm the yang and tonify qi, Si Ni Tang which warms the interior, Zhen Wu Tang to tonifiy kidney yang, or Tou Gui Wan to nourish kidney yang. In laboratory studies, certain yang tonic herbs were proven to the raise body temperature of mice (3.).  Using tonification technique and or moxibustion, points on the San Jiao and Pericardium channel are commonly used for hypothyroidism.  Herbs and acupuncture are particularly useful for symptoms such as feelings of cold, cold hands & feet, fatigue, body aches, poor memory & concentration, foggy thinking, melancholy, depression, insomnia, trouble waking up in the morning, weight gain, constipation, and dryness.   Hypothyroid patients will often have faint, slow, and weak pulses.  Their tongues could be wet, swollen, and pale.  Some research has shown that acupuncture can stimulate the release of TSH and ACTH and other pituitary hormones (4. p140).  Other research has shown moxibustion was able to reduce antibodies in the peripheral blood of patients with Hashimoto’s disease and bring their thyroid back into balance (1. p14).

Hyperthyroidism, being the opposite of hypothyroidism, would generally be diagnosed as an overabundance of Yang with Yin Deficient Heat.   According to diagnosis, good herbal remedies include Liu Wei Di Huang Wan to tonify liver and kidney yin, Zhi Zi Qing Gan Tang or, Tian Wang Bu Xin Dan to nourish heart and kidney yin.  Using the dispersion technique, acupuncture is incredibly useful in treating hyperthyroid symptoms such as racing heart, palpitations, anxiety, feelings of heat, weight loss, and jumpy moods like anger and irritability.  Hyperthyroid patients generally have red tongues with rapid and big or rapid and thin pulses.

Integrative Medicine

The future of medicine will be a combination of both western and eastern medicine.  Persons with clinical hypothyroidism in which their blood test reveal a thyroid imbalance would do best by taking a western thyroid supplement along with chinese herbs and a weekly acupuncture treatment (2.).    Patients who have symptoms of a thyroid imbalance with normal blood results may not need to take a hormone replacement.  These patients may improve just by using traditional Chinese medicine and alternative therapies.  A weekly acupuncture treatment can help balance hormones and alleviate stress.  Alternative therapies such as herbs, acupuncture, dietary modifications, and engaging in stress relieving activities such as yoga, meditation, or exercise have already been proven to be beneficial.

Simple dietary habits that could improve the thyroid’s function include increasing your intake of selenium, including foods that contain iodine like fish and sea veggies, eating foods like meat and fish that contain the amino acid l-tyrosine, restricting raw cruciferous vegetable intake, taking a good multivitamin that includes A, C, D, E, Zinc, and the B vitamins, and of course eating plenty of fiber rich fruits, veggies, and whole unprocessed grains.

It is my belief that we must educate the patient on the importance of life long proper dietary habits, the importance of exercising daily and having good stress relieving tools, and most importantly the power of positive thinking.   We must first educate the patient to take control of their own health by using preventative measures now to keep their bodies functioning optimally as long as possible, and to not leave their destinies up to a stranger in a cold and sterile operating room.

As always consult your primary health care physician before making any major health decisions.

Dawna Ara is a licensed acupuncturist, herbalist, and massage therapist in the state of California.  Her office is located in South Pasadena but she is available for in home treatments in Los Angeles, Orange County, and Coachella Valley.  She offers both private and community or group style acupuncture.  Contact Dawna at 310.363.0039 or DawnaAra@gmail.com for more details.

References

1. A study on the clinical effects and immunololgical mechanism in the treatment of Hashimoto’s thyroiditis by Moxibustion. Hu G., Chen H., Hou Y., Cheng Z., Wang R. Shanghai research Institute of Acupuncture & Meridian. Journal of Traditional Chinese Medicine. March 13, 1993 pg 14 – 8.

2. Chinese herbal medicines for hyperthyroidism. Zen XX., Yuan Y., Liu Y., Wu TX., Han S. Cochrane Database Systematic Reviews.  April 18, 2007. Pg. CD005450

3. Effects of yang-restoring herb medicines on the levels of plasma corticosterone, testosterone, and triiodothyronine. Kuang A., Chen J., Chen M. Zhong Xi Yi Jie He Zi Zhi.  December 9, 1989. Pg 710, 737-8.

4. Thyroid Balance: Traditional and alternative methods for treating thyroid disorders. Rothefeld G., Romaine D. Adams Media Publishing Co. 2003