The heyday of woman’s life is the shady side of fifty.
—Elizabeth Cady Stanton
Let’s start by taking a look at the endocrine system, and the thyroid, and the risks and symptoms of thyroid disease.
The Endocrine System
First, it’s important to understand that the thyroid and the reproductive system are all part of what’s known as the endocrine system. The endocrine system is made up of organs, some of which are also known as glands, whose primary purpose is to release hormones. The major endocrine organs and glands in women, their location, and the key hormones they release are the
The hypothalamus, located in the brain, functions as part of both the endocrine system and the nervous system and acts as a link between them. The hypothalamus acts as the endocrine system’s primary coordinator and command center, releasing hormones to help control the other glands’ activities and coordinating the various glands and hormonal cycles. Another key role of the hypothalamus is as the starting point for the female menstrual cycle. The hypothalamus releases gonadotropin-releasing hormone (GnRH), which causes the pituitary to stimulate the ovaries to develop egg follicles and set the process into motion. The hypothalamus also releases thyrotropin-releasing hormone (TRH), growth hormone–releasing hormone (GHRH), corticotropin-releasing hormone (CRH), somatostatin, and dopamine.
Because the endocrine organs and glands operate in similar ways and are interconnected, they are viewed as one system.
In addition to the key endocrine organs and glands, other organs play a part in the endocrine system by releasing hormones. These include the stomach, which releases gastrin, ghrelin, neuropeptide Y, and secretin; the small intestine, which releases secretin and cholecystokinin; the heart, which releases atriopeptin; and the placenta, which releases human chorionic gonadotropin (HCG). Fat tissue itself can become like an endocrine gland, releasing leptin and estrogens.
The Thyroid and Thyroid Hormone
The thyroid is a small bow tie- or butterfly-shaped gland that normally weighs about an ounce. It is situated in the lower part of the neck, in front of the windpipe, and slightly behind and below the Adam’s apple area. The two “wings” of the butterfly-shaped gland are known as the lobes of the thyroid, and the area connecting the two lobes is known as the isthmus.
The thyroid’s most important purpose is to produce, store, and release two key thyroid hormones: triiodothyronine, abbreviated as T3, and thyroxine, abbreviated as T4. The 3 and the 4 refer to the number of iodine molecules attached to each hormone.
The thyroid is able to produce this hormone by absorbing iodine, an essential nutrient, from food, iodized salt, and supplements. Iodine is then combined with the amino acid tyrosine to produce T4 and T3. Of the thyroid hormone produced by a healthy thyroid gland, about 80 percent is T4, and 20 percent is T3. T3 is the biologically active hormone that is used by the cells and is several times stronger than T4. The body converts the inactive T4 to active T3 by removing one iodine molecule (known as T4-to-T3 conversion, or monodeiodination). This conversion of T4 to T3 can take place in the thyroid or other organs, including the hypothalamus, a part of the brain.
T4 and T3 exist in two forms: free/unbound and bound. Free or unbound T4 or T3 refers to that part that is biologically active, and the bound part is attached to the thyroxine-binding globulin (TBG) protein. When measured in the blood, the free or unbound T4 and T3 levels tend to give the most accurate picture of the actual thyroid hormone available for use by the body.
Once it gets to the cells, what does thyroid hormone do? The role of thyroid hormone is to control metabolism. That means, thyroid hormone controls the process by which oxygen and calories are converted to the energy your cells and organs need. Specifically, thyroid hormone helps
Cells convert oxygen and calories into energy
The heart pump properly and effectively
The nervous system function properly
The intestinal system properly digest and eliminate food
The brain function properly
Strengthen hair, nails, and skin
Process carbohydrates
In the proper functioning of muscles
In the proper functioning of the immune system
With sexual development and functioning
With normal bone growth
As you can see, the thyroid has an impact on every aspect of your health.
THE THYROID FEEDBACK LOOP
When the thyroid is working properly, it produces and secretes the amount of T4 and T3 your body needs to function. The thyroid works, however, as part of a bigger system—a feedback loop that includes the pituitary gland and the hypothalamus. Here’s how the system works.
The hypothalamus monitors and reacts to a number of body functions, as well as environmental factors like heat, cold, and illness. When the hypothalamus senses that the body is facing a stressor, it produces TRH.
TRH is sent from the hypothalamus to the pituitary gland. The pituitary gland is stimulated to produce a substance called thyrotropin, better known as TSH. The pituitary gland is also monitoring the circulating levels of thyroid hormone in the body and releases (or stops releasing) TSH based on the thyroid hormone levels circulating in the blood.
Once released, TSH is sent to the thyroid gland, where it stimulates the thyroid to produce, store, and release more T3 and T4 thyroid hormones.
The released thyroid hormones move into the bloodstream, carried by a plasma protein known as TBG.
Now in the bloodstream, the thyroid hormone travels throughout the body to the various organs. Upon arriving at a particular tissue in the body, thyroid hormone interacts with receptors located inside the nuclei of the cells. Interaction of the hormone and the receptor will trigger a certain function, giving directions to that tissue regarding the rate at which it should operate.
When the hypothalamus senses that the need for increased thyroid hormone production has ended, it reduces production of TRH. The reduced production of TRH in turn causes the pituitary to decrease production of TSH, and the reduced TSH levels send the message to the gland itself to slow production of thyroid hormone.
Like the thermostat in your house set to a particular temperature, your body is set to maintain a certain level of circulating thyroid hormone. It is when disease or damage to the thyroid gland takes place, or the feedback process malfunctions, that we see thyroid problems developing.
THYROID CONDITIONS
Thyroid problems are widespread, and the European Thyroid Association estimates that more than 200 million people around the world have thyroid disease. The most extensive problems are seen in areas covered in the past by glaciers, where there is not enough iodine in the soil and the crops grown in that soil. (Iodine is necessary for proper thyroid function.)
There are a number of conditions that can affect the thyroid, its function, and its structure.
Hypothyroidism/Underactive Thyroid
Hypothyroidism is a condition of too little thyroid hormone. This lack of hormone can be due to a thyroid that isn’t producing enough hormone, a thyroid that has been radioactively treated (which effectively makes it nonfunctional), a thyroid that is affected by drugs and nutritional deficiencies, or a thyroid that is incapable of functioning properly due to nodules, infection, or atrophy. In some cases, the thyroid is surgically removed—all or in part—as a treatment for cancer, nodules, goiter, or hyperthyroidism, leaving most patients permanently hypothyroid. A small number of people have congenital hypothyroidism, meaning they were born without a functional thyroid.
Symptoms of hypothyroidism tend to mirror the slowed metabolism that results from insufficient thyroid hormone. They include fatigue, weight gain, constipation, fuzzy thinking, depression, body pain, and slow reflexes.
Conventional hypothyroidism treatment typically involves replacing the missing thyroid hormone, using prescription thyroid hormone replacement drugs, such as levothyroxine (brand names Synthroid, Levoxyl, Levothroid, and Unithroid), or natural desiccated thyroid drugs, such as Armour and Nature-Throid. Holistic and integrative treatments often focus on nutritional support, supplementation with thyroid precursors like tyrosine and iodine, and adrenal support.
Hyperthyroidism/Overactive Thyroid: Thyrotoxicosis
Thyrotoxicosis refers to the various effects of exposure to too much thyroid hormone. Hyperthyroidism implies that this excess of hormones originated in the thyroid gland itself (and not, for example, from taking an excess of thyroid medication). Hyperthyroidism can be caused by a number of thyroid problems, including autoimmune thyroid disease, nodules that independently produce thyroid hormone, infection, and other causes.
Symptoms of hyperthyroidism tend to mirror the rapid metabolism that results from an oversupply of thyroid hormone. They include anxiety, insomnia, rapid weight loss, diarrhea, high heart rate, high blood pressure, eye sensitivity/bulging, and vision disturbances.
Conventional treatment in the United States focuses on disabling the thyroid permanently, by administering radioactive iodine (RAI) treatment, which renders most patients hypothyroid for life. Some physicians in the United States use prescription antithyroid drugs such as propylthiouracil (PTU) and methimazole (brand name Tapazole) and beta blockers to calm down the thyroid and the immune system, with the hope of remission of the disease, which occurs in as many as 30 percent of patients. Antithyroid drugs are the first choice, however, for doctors outside the United States. In rarer cases, and more commonly outside the United States, surgery to remove the thyroid is used to treat an overactive thyroid. Ultimately, most people with Graves’ disease and hyperthyroidism treated conventionally end up hypothyroid for life as a result of RAI or surgery.
Holistic and integrative treatments prior to RAI or surgery focus on supplementing antithyroid drug approaches with natural antithyroid foods, supplements, and herbs that have no side effects, as well as calming and rebalancing the immune system through nutrition, herbs, supplements, movement therapy such as yoga, and energy work.
Goiter/Enlargement
Goiter is the term used to describe an enlargement of the thyroid gland. The thyroid gland can enlarge as a response to insufficient or excessive iodine, thyroid inflammation or infection, or autoimmune disease. The thyroid becomes large enough so that it can be seen on ultrasounds or x-rays and may visibly thicken the neck. Symptoms of goiter include a swollen, tender, or tight feeling in the neck or throat, hoarseness or coughing, and difficulty swallowing or breathing.
Treatment for goiter depends on how enlarged the thyroid has become, as well as other symptoms. It can include observation and monitoring of a smaller goiter that isn’t causing symptoms, thyroid hormone replacement medication to help shrink the goiter, aspirin or corticosteroid drugs to shrink thyroid inflammation, and surgery for a goiter that is affecting breathing or swallowing or is cosmetically unattractive.
Nodules/Lumps
Many people have nodules in the thyroid, but you typically can’t feel most of them externally. In many cases, nodules aren’t functioning and cause no symptoms, and they require only periodic monitoring. Some nodules impair the thyroid’s ability to function properly and cause hypothyroidism. Others can become overactive and produce thyroid hormone on their own; these are called “toxic nodules” and can trigger hyperthyroidism. Very large nodules can compromise breathing or swallowing. A very small percentage of nodules are cancerous.
Symptoms of nodules depend on function, size, and location. Nodules that are producing thyroid hormone can trigger hyperthyroidism symptoms, such as palpitations, insomnia, weight loss, anxiety, and tremors. Nodules that are impairing thyroid function can also trigger hypothyroidism symptoms, such as weight gain, fatigue, and depression. Larger nodules that are pressing on the windpipe (trachea), esophagus, or vocal cords can cause difficulty swallowing, difficulty breathing, pain or pressure in the neck, a hoarse voice, or neck tenderness. Some nodules cause no symptoms at all.
Nodules that aren’t causing symptoms may be left alone and periodically monitored, or they can be treated with thyroid hormone replacement to help shrink them. Typically, nodules are surgically removed if they are causing difficulties with breathing, swallowing, or speaking or if test results indicate a suspected malignancy.
THYROID DISEASES
A variety of diseases can affect the thyroid and trigger thyroid conditions, such as hypothyroidism, hyperthyroidism, nodules, and goiter.
Hashimoto’s Disease and Thyroiditis
There are two different autoimmune diseases in which an immune system dysfunction targets the thyroid: Hashimoto’s disease and Graves’ disease. In the United States, the vast majority of thyroid conditions are the result of an autoimmune disease.
Hashimoto’s disease is the most common form of thyroiditis, an inflammation of the thyroid, so the condition is also often referred to as Hashimoto’s thyroiditis. It is the most common thyroid problem and is the cause of most hypothyroidism in the United States. In Hashimoto’s, antibodies react against proteins in the thyroid, causing gradual destruction of the gland. Occasionally, before the thyroid is destroyed, it has thyrotoxic periods—known as hashitox-icosis—during which the thyroid overproduces thyroid hormone. Eventually the gland is destroyed and becomes unable to produce thyroid hormones.
Symptoms of Hashimoto’s disease can include pain and tenderness in the thyroid area, neck, and throat, difficulty sleeping, and, usually, hypothyroidism. Typically, treatment is for hypothyroidism and involves lifelong thyroid hormone replacement. Holistic and integrative approaches tend to look at healing the underlying autoimmune imbalance and may include nutritional support for the thyroid (selenium, tyrosine, B vitamins, etc.), elimination of toxins and stress, and overall support for the immune system.
Graves’ Disease
Graves’ disease (sometimes referred to as diffuse toxic goiter because of the typical presence of a goiter) usually causes hyperthyroidism. In the United States, it’s thought that Graves’ disease and hyperthyroidism affect slightly less than 1 percent of the population, or slightly less than 2.9 million people. Some experts believe, however, that as many as 4 percent of Americans, or 11.8 million people, may have a mild form of Graves’ disease, with few symptoms.
In Graves’ disease, antibodies bind to the gland, causing the thyroid to overproduce thyroid hormone and resulting in hyperthyroidism. Treatment for Graves’ disease follows hyperthyroidism treatment and usually includes antithyroid drugs, radioactive iodine ablation, or surgical removal of the thyroid. Most Graves’ disease patients end up hypothyroid over time, requiring lifelong thyroid hormone replacement. Holistic and integrative treatment approaches to Graves’ disease often include herbal remedies, nutritional support for the thyroid and immune system, elimination of toxins, and stress reduction approaches.
Thyroid Cancer
Thyroid cancer is one of the least common cancers in the United States but is the most common of endocrine cancers. It is also one of the only cancers whose incidence in the United States has been on the rise in recent years. The American Cancer Society estimates that there are more than 37,000 new cases of thyroid cancer diagnosed each year and more than 1,500 thyroid cancer deaths annually.
Treatment and prognosis depend on the type of thyroid cancer. An estimated 80 to 90 percent of thyroid cancers are papillary or follicular in nature, and most can be treated successfully when discovered early. Medullary thyroid carcinoma makes up 5 to 10 percent of all thyroid cancers and has a good cure rate if discovered before it spreads. Anaplastic thyroid carcinoma is quite rare, accounting for only 1 to 2 percent of all thyroid cancers, and tends to be aggressive and the least likely to respond to treatments.
Although many thyroid cancer sufferers have no symptoms at first, some develop a lump in the neck, voice changes, difficulty breathing or swallowing, or swelling in the lymph nodes.
Treating thyroid cancer almost always involves surgery to remove the thyroid and cancerous lymph nodes. RAI therapy is also given after surgery to kill any remaining cancer cells. Hormone therapy, using thyroid hormone drugs, is frequently used to stop cancer cells from growing.
Because the entire thyroid is removed as treatment for most thyroid cancers, almost all thyroid cancer survivors end up hypothyroid and need to take thyroid replacement hormone for life. Their medication needs to be at a high enough dose to ensure that their TSH levels remain low (nearly undetectable, actually) to help prevent a relapse of cancer. Survivors are regularly checked for reoccurrence.
Risk Factors for Thyroid Conditions
AGE
Thyroid problems become more prevalent as women age. The American Association of Clinical Endocrinologists (AACE Web site) states that thyroid problems affect one in eight women ages thirty-five to sixty-five and one in five women—20 percent—over age sixty-five. Some experts believe that the prevalence is much higher, and recommendations to narrow the TSH range could qualify as many as sixty million Americans, most of them adult women, as having thyroid conditions.
GENETICS/HEREDITY/MEDICAL HISTORY
There is a greater risk of developing a thyroid condition if you have a parent, sibling, or child with any thyroid condition, including autoimmune thyroid problems like Hashimoto’s and Graves’ disease, nodules, goiters, or thyroid cancer. Up to 50 percent of first-degree relatives of people with autoimmune thyroid disease will themselves have thyroid antibodies that may predispose them to develop autoimmune hypothyroidism. In addition to thyroid issues, a personal or family history of other autoimmune or endocrine diseases also slightly increases your risk of developing autoimmune thyroid disease. In particular, there are higher risks for thyroid conditions among people who have a personal or family history of
Left-handedness, ambidextrousness, and prematurely gray hair are considered genetic markers for an increased risk of autoimmune disease, including thyroid problems.
CIGARETTE SMOKING
Women who are current or former smokers have an increased risk of hypothyroidism. Cigarettes contain a chemical, thiocyanate, that adversely affects the thyroid gland and acts as an antithyroid agent, slowing down the thyroid. Smoking can also aggravate some Graves’ disease and hyperthyroidism symptoms, especially thyroid eye-related problems.
RECENT PREGNANCY OR MISCARRIAGE
Having had a baby in the past year puts women at an increased risk of developing thyroid problems, including the short-term condition known as postpartum thyroiditis. Some doctors estimate that as many as 10 percent of women develop a thyroid problem after delivery. While some postpartum cases of hypothyroidism are temporary and resolve within six months to a year after delivery, the period after pregnancy is also a common time for permanent thyroid problems to surface.
Pregnancy that ends in miscarriage can also be associated with an increased risk of the onset of thyroid problems.
IODINE DEFICIENCY/EXCESS
Both a deficiency and an excess of iodine are risk factors for thyroid disease. Iodine deficiency can cause an enlarged thyroid (goiter) and hypothyroidism; it is most common in areas that do not add iodine to salt (that is, iodized salt) and in areas with insufficient iodine in the soil known as “goiter belts.” Goiter belt areas include the St. Lawrence river valley; the Appalachian mountains; the Great Lakes basin westward through Minnesota, South Dakota, North Dakota, Montana, Wyoming, southern Canada, the Rockies, and into noncoastal Oregon, Washington, and British Columbia; and the Alps, Pyrenees, Himalayas, and Andes.
Mild iodine deficiency in a pregnant woman can cause cognitive and developmental problems in her children that may reduce a child’s IQ by as much as fifteen points. Serious iodine deficiency in a pregnant woman can cause stillbirth, miscarriage, and a congenital abnormality known as cretinism. Cretinism is a serious, irreversible condition involving often severe mental retardation and is most common in iodine-deficient areas of Africa and Asia.
Where there is not enough iodine naturally occurring in the food supply, some areas have added iodine to bread or salt to help prevent iodine deficiency. But many people in the world are still iodine-deficient and don’t have access to iodization programs. According to the World Health Organization, iodine deficiency is the most prevalent yet easily preventable cause of brain damage. It’s common, affecting more than 740 million people, or 13 percent of the world’s population. An additional 30 percent of the population is at risk of iodine deficiency-related problems.
About 20 percent of the American public is iodine deficient, but the primary cause of thyroid problems in the United States is autoimmune thyroid disease and is not thought to be iodine-related. In areas like the United States where iodine deficiency is not as common, there is a risk of excessive iodine intake and exposure, from exposure to contrast dye for x-rays or scans, to the use of topical antiseptics like povidone and iodine, to iodine supplements (including bladder wrack, kelp, bugleweed, Irish moss, and seaweed), to the use of the antiarrhythmia drug amiodarone, which contains iodine. In some women, excessive iodine increases the risk of Hashimoto’s disease and hypothyroidism. In other women, being exposed to or ingesting an excess of iodine—and, in some cases, simply being exposed to iodine—can trigger hyperthyroidism. This is sometimes referred to as Jod-Basedow, or iodine-induced, thyrotoxicosis.
OVERCONSUMPTION OF GOITROGENIC FOODS
A particular class of foods known as goitrogens can promote thyroid enlargement (goiter) and cause hypothyroidism. These foods have the ability to block the body from using iodine in the production of thyroid hormone. Goitrogens are a concern only for people who still have a thyroid gland that is functional. They are considered most potent when served raw in larger quantities, and studies show that cooking reduces or eliminates much of the goitrogenic potential. A list of some more common goitrogenic foods includes the following:
OVERCONSUMPTION OF SOY PRODUCTS
Soy is also a common goitrogen, but given its popularity as a “health food,” in particular, for women in perimenopause/menopause, it deserves its own mention. Soy products have definite antithyroid and goitrogenic effects. There is evidence that long-term overconsumption of soy products can promote formation of goiters and development of autoimmune thyroid disease. Concentrated forms of isoflavone-rich soy (in the form of pills and powders) tend to be more of a risk than fermented food forms, such as tofu, miso, and tempeh.
ENVIRONMENTAL TOXINS
A variety of chemicals in the environment have the ability to affect thyroid function.
Fluoride
Added to drinking water and toothpaste, fluoride is a chemical with strong antithyroid properties that increase the risk of hypothyroidism. In the past, fluoride was used as a drug to treat an overactive thyroid.
Chlorine
Found in chlorinated water supplies and swimming pools, chlorine can interfere with proper thyroid hormone conversion and can increase the risk of hypothyroidism.
Mercury
A component that was used in dental fillings and a toxin found in some fish, mercury can disable the thyroid’s ability to convert T4 to T3, resulting in hypothyroidism.
Other heavy metals
Elevated levels of gold, cadmium, and other heavy metals have been linked to an increase in autoimmune thyroid conditions. Heavy metals are sometimes found in water supplies, and some jobs present an exposure risk to these metals.
Perchlorate
This chemical blocks iodine from entering the thyroid and prevents synthesis of thyroid hormone, causing hypothyroidism in some women. Perchlorate is a by-product of rocket and rocket fuel production, and poor disposal, accidents, and use of perchlorate in fertilizers have contaminated water supplies around the United States. Produce grown in those states that use contaminated water for irrigation has reached around the nation.
Dioxins
These chemical compounds are formed through the combination of heat and chlorine and are highly carcinogenic and toxic. They are known to negatively affect thyroid function, and exposure to them increases the risk of hypothyroidism. Dioxins are known to contaminate air and water supplies around the world.
Methyl tertiary butyl ether (MTBE)
This oxygenate is added to gasoline and other chemicals and acts as an “endocrine disrupter.”
Insecticides
Several insecticides used to treat airplanes and to eradicate mosquitoes carrying West Nile virus have been shown to have a negative effect on thyroid function. Among these pesticides are resmethrin (brand name Scourge) and sumithrin (brand name Anvil).
X-RAYS, RADIATION, AND RADIUM TREATMENTS
A variety of medical tests and treatments that involve radiation can increase the risk of hypothyroidism. These include:
NUCLEAR EXPOSURE
Nuclear plants can accidentally release radioactive materials that are damaging to the thyroid. Some nuclear exposure risks:
INFECTION
Various infections are known to be triggers for some thyroid conditions.
Viral infections, including upper respiratory infections, colds, influenza, mumps, measles, adenovirus, mononucleosis, myocardi-tis, cat scratch fever, and coxsackie virus, have been implicated as triggers for thyroiditis that can cause hyperthyroidism.
There is also a relationship between Yersinia enterocolitica and Hashimoto’s thyroiditis. Yersinia enterocolitica bacteria are found in the fecal matter of livestock and domesticated and wild animals. You can be exposed to Yersinia enterocolitica, therefore, via contaminated meats, especially raw or undercooked products, poultry, unpasteurized milk and dairy products, and seafood (particularly oysters), as well as from sewage-contaminated water and produce fertilized with raw manure. Foods can also be contaminated by food handlers who have not effectively washed their hands before handling food or utensils used to prepare food. Improper storage can contribute to contamination.
SEVERE SNAKEBITE
Not too many people will face life-threatening illness due to snakebite, but it’s known that severe snakebite can result in pituitary damage that causes hypothyroidism. This is reported in some people who suffered nearly fatal bites from rare and highly poisonous vipers and rattlesnakes.
MEDICAL/DRUG TREATMENTS
There are certain drugs that are known to cause hypothyroidism in some people who take them. The most common ones are lithium, used to treat bipolar disease and other conditions, and the arrhythmia drug amiodarone (brand name Cordarone). If you are taking these drugs now or have taken them in the past, you are at increased risk for hypothyroidism.
Other drugs that may cause hypothyroidism in some patients are:
A number of medical treatments and drugs can trigger Graves’ disease and/or thyrotoxicosis, including:
Drugs that cause hyperthyroidism as a side effect include the following:
NECK TRAUMA/WHIPLASH
Research has suggested that trauma to the neck, such as whiplash or a broken neck, can result in hypothyroidism in some people. Researchers speculate that this may be due to injury to and subsequent inflammation of the thyroid tissues themselves. In some patients, trauma to the thyroid or neck area can result in thyrotoxicosis or thyroiditis.
The types of trauma that have been linked to an increased risk of thyroid problems include:
ALLERGIES/SENSITIVITIES
A variety of allergies can be risk factors—and possibly triggers—for thyroid problems.
Seasonal allergies to tree pollen can increase antithyroid peroxidase and antithyroglobulin autoantibodies, thus increasing the risk of both Hashimoto’s and Graves’ disease.
Sensitivity or full intolerance to gluten, found in most wheat and many grain products, is a known trigger of autoimmune disease in general, and in thyroid problems specifically. The condition is known as celiac disease or gluten intolerance.
Some nutritional experts believe that sensitivity or exposure to aspartame (brand name NutraSweet), an artificial sweetener, can contribute to hyperthyroidism.
STRESS
Stress is considered a precipitating factor for some autoimmune diseases. There is evidence that severe emotional or physical stress can trigger the development of Graves’ disease. In one analysis, severe emotional stress was seen as the primary precipitating factor in the development of Graves’ disease in 14 percent of the patients studied.
RELATED CONDITIONS
Certain conditions are more common in people with Hashimoto’s disease and hypothyroidism. While the mechanisms aren’t always understood, if you have or have had any of these conditions, you are more likely to develop Hashimoto’s disease and become hypothyroid.
Certain conditions are more common in people with Graves’ disease and hyperthyroidism. Again, how they are connected isn’t always clear, but if you have or have had any of these conditions, you are more likely to develop Graves’ disease and become hyperthyroid.
Thyroid Symptoms
MENSTRUAL IRREGULARITIES
Thyroid problems can cause a variety of menstrual irregularities. Some of the common issues are
INFERTILITY/RECURRENT MISCARRIAGE
Infertility is more common in thyroid patients than in the general population. There are also studies that have shown a linkage between a woman being hypothyroid or hyperthyroid and increased rates of anovulation (failure to release an egg), which contributes to infertility.
Thyroid problems can also increase your risk of miscarriage. Therefore, miscarriage, in particular, recurrent miscarriage, can be considered a “symptom” of thyroid conditions as well.
TEMPERATURE CHANGES: FEELING COLD/HOT
Frequently, an underactive thyroid can cause low body temperature and make you feel cold when it’s in fact warm. In particular, hands and feet may feel cold. With hypothyroidism, some women perspire less than normal.
In hyperthyroidism, because of the increase in metabolism, women find themselves feeling warm, or extremely hot, even when it’s cold. Some people who are hyperthyroid become intolerant of any warm or hot temperatures and experience hot flashes and excessive sweating.
SLEEP PROBLEMS
Problems with sleep are fairly common in people with an overactive thyroid. Symptoms can include difficulty falling asleep, waking up frequently, and finding it hard to fall back asleep. You may have insomnia and not be able to sleep at all. In both hypothyroidism and hyperthyroidism, some patients are less able to reach deep, restorative stage 4 sleep, so they may wake up feeling tired and unrefreshed. Hypothyroidism also increases the risk of sleep apnea, which can cause frequent waking and can disrupt sleep and cause morning tiredness.
WEIGHT CHANGES
Inappropriate weight gain and the inability to lose weight are very common symptoms of an underactive thyroid. Even mild hypothyroidism, including “normal” TSH levels that are on the higher end of the normal reference range, is associated with weight gain. If you find yourself suddenly gaining weight or unable to lose weight following a reasonable diet (and I don’t mean cutting out dessert once a week and expecting to drop pounds and inches!), this may be a symptom of hypothyroidism.
When the body is in a hyperthyroid state, the excess thyroid hormone raises metabolism—enhancing the body’s ability to break down fat and muscle—which causes weight loss. Some people don’t eat more and haven’t changed their exercise habits, yet they lose weight rapidly. Others feel constantly hungry and eat substantially more, yet they either don’t gain or lose weight. Some women with hyperthyroidism stop eating or eat very little due to a loss of appetite and are misdiagnosed as being anorexic.
One unique change in hyperthyroidism is an increased appetite for carbohydrates. Researchers have documented that brain chemistry changes in hyperthyroidism actually do increase the appetite, but specifically for carbohydrates far more than for protein and fat.
While the mechanisms aren’t well understood, a small percentage of people who are hypothyroid lose weight inappropriately, and a small percentage of people who are actively hyperthyroid gain weight.
MOOD CHANGES
One of the most common symptoms of hypothyroidism is feeling sad or even depressed. You may have feelings of worthlessness, difficulty concentrating, or it may seem as if your mind is “in a fog.” You may lose interest in normal daily activities or be more forgetful and have a tougher time keeping up with work, schedules, or details.
Hypothyroidism may also be the reason why your antidepressant doesn’t seem to be effective. As many as 80 percent of people on antidepressants may suffer from unresolved symptoms—such as weight gain, lethargy, and loss of libido—that are also very common symptoms of thyroid disease. A significant percentage of people on antidepressants may actually be suffering from undiagnosed thyroid problems.
Some people with hypothyroidism experience increased anxiety. Moods may also change easily, and you might feel restless.
Patients with hyperthyroidism also experience changes to mood and feelings. You may experience swings in mood and emotions, even to the extent that you are behaving erratically or overemotionally. You may have feelings of uncontrollable or irrational anger or feel aggressive for no reason.
Anxiety is even more common in hyperthyroidism, given the elevated heart rate, blood pressure, and racing metabolism. Symptoms can include feeling restless, irritable, on edge, nervous, or inexplicably frightened. You may be worrying all the time and find that you can’t stop. You may find yourself jumpy and easily startled and have fast reflexes, tremors, or shaky hands. You may find that you can’t sit still and are always moving, jiggling, tapping a foot, or drumming your fingers.
Some people with hyperthyroidism have panic attacks, including the full list of symptoms, such as palpitations, sweating or chills, difficulty breathing, terror, nausea, feeling as if you are going to die, tingling or numbness, dizziness, and faintness. Some patients are incorrectly diagnosed as having panic disorder, when their panic attacks are actually triggered by their hyperthyroid state, and the attacks go away once the thyroid is normalized.
LOSS OF SEX DRIVE
A low sex drive (low libido) is a common symptom of hypothyroidism. Typically, patients with hypothyroidism who have sexual symptoms have low or no desire, problems with arousal, or difficulty having an orgasm. For some people, a sexual problem, in particular, a lack of desire, may be the first noticeable symptom of an underlying thyroid condition.
HAIR LOSS
Hypothyroidism, hyperthyroidism, and autoimmune thyroid disease are all associated with loss of hair—both on the head and on the body. Typically, hair falls out at the root faster than normal and can become brittle, breaking more easily when handled. A unique and noticeable hypothyroidism symptom is loss of the hair from the outer part of the eyebrow.
Your hair can also look and feel very coarse, rough, and dry. In Graves’ disease and hyperthyroidism, hair may become thinner, finer, and softer. Women with hypothyroidism and hyperthyroidism often complain that their hair can no longer hold a curl or a perm.
Having autoimmune thyroid problems also puts you at higher risk of developing hair loss due to the autoimmune condition alopecia.
SKIN CHANGES
Changes to the skin associated with hypothyroidism include
Interestingly, because the increased metabolism causes more rapid turnover of skin cells, women with hyperthyroidism may find their skin smoother, younger looking, even velvety.
More often, however, people report a variety of skin problems, including worsening acne; bruising; spider veins on the face and neck; blisterlike bumps on the forehead and face (called “miliaria bumps”); a flushed appearance to the face, throat, palms, and elbows; and sometimes a yellowish cast to their skin.
Hives and itching are frequent symptoms of people with Graves’ disease and thyrotoxicosis.
A loss of skin pigmentation, known as vitiligo, can also be a symptom.
One unusual skin condition seen in people with Graves’ disease is pretibial myxedema (also known as dermopathy, infiltrative dermopathy, or sometimes Graves’ dermopathy). If you develop pretibial myxedema, you may notice waxy, red-brown lesions on your shins and lower legs that are itchy and inflamed. These lesions typically heal into rough, leathery patches. Occasionally, pretibial myxedema can affect the tops of your feet, as well as your toes, arms, face, shoulders, or trunk.
BONE LOSS
Women who had lengthy periods of untreated hyperthyroidism due to Graves’ disease are at risk of lower bone mineral density, which increases the risk of osteoporosis.
Some practitioners believe that chronic hypothyroidism, because it slows the metabolism and impairs bone formation, may also be associated with risks of lower bone mineral density.
ELEVATED CHOLESTEROL LEVELS
Elevated cholesterol levels, in particular, elevated cholesterol that does not respond to cholesterol-lowering medication, is a common symptom of hypothyroidism.
Less commonly, hyperthyroidism can cause unusually low cholesterol levels in some women.
FATIGUE, LACK OF ENERGY
However you describe it, fatigue, exhaustion, weakness, lethargy, or feeling run down, sluggish, overtired is one of the most common thyroid symptoms. You may find yourself needing a nap in the afternoon just to make it to dinnertime. You may sleep ten or twelve hours a night and still wake up exhausted. You may find yourself less able to exercise, and your endurance drops because of weakness or lethargy. Or you just walk around feeling exhausted on the same amount of sleep that used to leave you feeling refreshed.
ACHES AND PAINS
Many thyroid patients, both hypothyroid and hyperthyroid, experience chronic pain, aches, and stiffness in various joints and muscles, particularly the hands and feet. The aches and pains can sometimes be so severe that doctors mistake them for arthritis symptoms, and there is a higher incidence of fibromyalgia in thyroid patients.
Carpal tunnel syndrome (which causes pain and weakness in the forearms, hands, and fingers), tarsal tunnel syndrome (which causes pain in the calves, shins, and feet), and plantar fasciitis (which causes pain in the soles of the feet) are all associated with untreated or undertreated hypothyroidism.
In hyperthyroidism, you may feel muscle weakness, especially in the upper arms and legs.
GASTROINTESTINAL/DIGESTIVE DISTURBANCES
Constipation is a common symptom of hypothyroidism. Often, this type of constipation does not respond to increased dietary fiber, increased water consumption, laxatives, and fiber products like Metamucil.
It’s common for people with hyperthyroidism to report having more frequent bowel movements, looser bowel movements, or even diarrhea. You may also find that you have to urinate more frequently. A smaller percentage of people experience nausea and/or vomiting as a symptom.
Ascites, an abnormal accumulation of fluid in the abdomen, can be a sign of hypothyroidism. Symptoms of ascites include rapid weight gain, abdominal distention, shortness of breath, and swollen ankles.
Some thyroid patients also report pain in the upper right abdominal area, which may be due to adrenal inflammation or costochondritis, an inflammation of the cartilage that connects rib to breastbone.
DRYNESS
Dry eyes and dry mouth can be symptoms of thyroid disease. Because thyroid disease is frequently autoimmune in nature, thyroid patients have a higher incidence of Sjögren’s syndrome, which can cause severe dry mouth and increased cavities, and dry eye symptoms, including pain, light sensitivity, and irritation.
BREAST CHANGES
Some people with hypothyroidism have imbalances in prolactin, the hormone that controls breastfeeding. One symptom that can signal hypothyroidism is lactation, or milk leaking from breasts, in a woman who otherwise is not breastfeeding.
HEART/BLOOD PRESSURE-RELATED SYMPTOMS
Heart and blood pressure changes are often symptomatic of both hypothyroidism and hyperthyroidism.
In hypothyroidism, some women have palpitations (irregular heart rhythms). Some women with hypothyroidism have a slowed heart rate and low blood pressure, but paradoxically, others actually experience high blood pressure when hypothyroid.
In hyperthyroidism, women may experience flutters, noticeable skipped beats, or a strange pattern or heart rate rhythm. You may have a headache and feel breathless, even dizzy. Some people feel a twinge of pain, specifically pain in the chest. Typical symptoms include a feeling that your heart is racing and pounding. If you take your pulse, you may find it over one hundred beats per minute. You may feel as if you can “hear” your heartbeat in your head.
CONCENTRATION AND MEMORY PROBLEMS
Many women with thyroid disease notice changes in thinking as a symptom.
Some of the most commonly reported symptoms are difficulty concentrating, difficulty making decisions, confusion, memory problems, and feeling as if your thinking is disorganized. You may have dyslexia or difficulty with reading, calculating, and thinking. You may have memory problems, find yourself forgetting things more frequently, or feel that your mind is going blank all the time. You may also feel as if your mind is always racing and you can’t shut your thoughts off.
Some people refer to it as “brain fog,” that fuzzy feeling that makes it difficult to concentrate.
HEADACHES/MIGRAINES
Worsening of chronic headaches and/or migraine disease can be a symptom of thyroid disease.
INABILITY TO TOLERATE MEDICINES, DRUGS, AND TOXINS
Because hypothyroidism slows down the metabolism and the liver’s ability to process toxins, some people find that they are unable to tolerate medicines, alcohol, coffee, and toxins without experiencing side effects. Alexandria, Virginia, physician Donna Hurlock, who works with many thyroid patients, has said that she notices that many of her thyroid patients find that even small doses of medication have greater side effects, even small amounts of caffeine make them jittery, and they feel that alcohol has a stronger effect.
PULSE AND BLOOD PRESSURE CHANGES
Pulse, or heart rate, varies depending on age, level of fitness, and other factors. But, generally, an average heart rate/pulse runs around sixty to eighty-five beats per minute. Athletes and those taking some medications may have a slower heart rate, but a slowed heart rate can also be a symptom of an underactive thyroid. An elevated pulse rate can be a sign of an overactive thyroid.
Similarly, lower blood pressure can be a sign of an underactive thyroid, and high blood pressure can be a sign of hyperthyroidism.
EYE PROBLEMS
The eyes are a frequent target for thyroid symptoms. The majority of problems are in women with Graves’ disease and hyperthyroidism, which can cause a variety of eye-related symptoms, including sensitivity, swelling, and blurred vision. Some Graves’ patients have an additional, related problem, thyroid eye disease, which is also known as Graves’ ophthalmopathy or thyroid-associated ophthalmopathy (TAO). Thyroid eye disease is an inflammation of the eyes and bulging or protrusion of the eyeballs (the medical term is exophthalmos), blurred or diminished vision, red or inflamed eyes, and double vision.
Eye movement can be affected, and one of the characteristic eye changes is called “lid lag.” In lid lag, the upper eyelid doesn’t follow smoothly along when you look down. The appearance of the eyes also can change, and the eyes may appear red, with visible blood vessels. The upper and lower eyelids may look irritated and puffy, and you may have a noticeable stare. The upper eyelids may retract, giving you a wide-eyed, startled look.
While thyroid eye disease is associated with Graves’ disease, both hypothyroidism and hyperthyroidism are associated with a variety of other eye symptoms, including:
NECK AND THROAT COMPLAINTS
Both hypothyroid and hyperthyroid patients can have problems in the neck and throat area, including:
Goiter is one of the most common symptoms in people with Graves’ disease. Some women with Graves’ disease also report a peculiar, “buzzy” feeling in the neck/thyroid area, as if a low current of electricity is running through it or as if the thyroid is vibrating.
HEARING ISSUES
Tinnitus, commonly referred to as “ringing in the ears,” is the perception that you’re hearing hissing, roaring, whistling, clicking, ringing, or other noise when there is no sound. Tinnitus can be a symptom of hypothyroidism in some women.
Hearing loss, including sudden onset of hearing loss and deafness, is reported to be related to hypothyroidism in some people, although it’s considered a very rare symptom.
BREATHING DIFFICULTIES, ASTHMALIKE FEELINGS, SLEEP APNEA, AND SNORING
Sleep apnea involves momentary lapses of breathing while sleeping and is accompanied by loud snoring, snoring and gasping for breath as you sleep, and feeling tired all the time, no matter how much sleep you get. It can be a symptom of hypothyroidism. In fact, undiagnosed and improperly treated hypothyroidism is considered an important but frequently overlooked cause of sleep apnea.
While not reported in patient literature, a hypothyroidism symptom that many people have reported to me—and one I experienced myself—is a feeling of shortness of breath and tightness in the chest. Some people describe this as “feeling like I need to yawn just to get enough oxygen.” Sometimes this can be mistaken for asthma. Some practitioners have speculated that this is due to insufficient oxygen circulation due to hypothyroidism.
NAILS/HANDS
Dry, brittle nails that break easily are more common in people with hypothyroidism.
In hyperthyroidism, nails may be more shiny than usual and break easily because they are softer. The palms may be warm and moist. Two unusual conditions can be seen in some patients with hyperthyroidism. In the first, acropachy, or thyroid acropachy, the fingertips and toes swell and become wider, sometimes even clubbed. This can be accompanied by arthritic damage to the joints in the fingers and/or toes. In the second condition, onycholysis, also called Plummer’s nails, the underlying nail bed separates from the skin.
LOW, HUSKY, HOARSE VOICE
Changes in voice are frequently associated with hypothyroidism. Most typically, the voice becomes hoarse, husky, or gravelly. (Some women have even reported that when hypothyroid, they are mistaken for a man on the phone.)
ALLERGIES
Development of allergies or worsening of existing allergies—including hay fever, seasonal allergies, and food allergies—have all been reported as symptoms of hypothyroidism.
DIZZINESS AND VERTIGO
Vertigo is dizziness with the illusion of motion. When you have vertigo, you may feel you are moving or that things are moving around you. Lightheadedness, dizziness, and vertigo can all be symptoms of both hypothyroidism and hyperthyroidism.
PUFFINESS AND SWELLING
Swelling, bloating, water retention, and puffiness (referred to as edema) of various parts of the body are associated with hypothyroidism. In particular, puffiness and swelling may affect the eyes, eyelids, face, feet, and hands.
SLOWNESS
Slowness in movement and speech is considered a symptom of hypothyroidism.
LOW RESISTANCE/FREQUENT INFECTIONS
Some doctors believe that more frequent infections and less resistance to infection—signs of lowered immunity—are symptoms of hypothyroidism. Many people with thyroid problems also report getting colds, flus, and sinus infections more frequently and have a longer, harder time recuperating from these infections.