thyroid

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What exactly is an underactive thyroid? Hypothyroidism is commonly described as an underactive or sluggish thyroid, but there is more to it than just thyroid activity. Sometimes the problem is thyroid hormone imbalance, primarily underproduction of the thyroid’s main hormone, thyroxine (T4). But T4 also has to be converted into its active form, triiodothyronine (T3), by the liver. It then has to be efficiently utilized by the body. Disruption in any one of these processes can contribute to hypothyroidism symptoms. Notably, women are far more likely than men to be afflicted with thyroid problems. The great majority of these women suffer from hypothyroidism, which leads to fatigue, weight gain, depression, high cholesterol and other symptoms. A fraction suffer from hyperthyroidism, which is an overactive thyroid. The connection between thyroid hormone imbalance and menopause is often overlooked. Over 20% of menopausal women in the US are diagnosed with thyroid dysfunction. Recent studies suggest that millions more suffer from sub-clinical problems but are undiagnosed. For women in their late 30’s or 40’s, hypothyroidism is often a good indication that they are in perimenopause — the five, ten, or even 15 years of hormonal change preceding menopause. What accounts for this epidemic of thyroid problems? And what’s the connection between thyroid hormones and menopause? Before answering these questions, let’s remember that the thyroid can’t be viewed in isolation from the rest of your endocrine system. On the contrary, it sits at the very center of action. And it is just as vulnerable to stress and lack of support as every other part of your body. Understanding how those stressors create illness and thyroid disease will also show us how to create balance and wellness. It will also illuminate why problems with your thyroid gland are so likely in menopause and perimenopause. What causes hypothyroidism in women? Hypothyroidism is more common in women than in men, probably because hormonal imbalance acts as a trigger for thyroid problems. Women’s bodies have a delicate balance of hormones such as estrogen and progesterone, which can be upset when your body is under stress and not receiving enough support. Perimenopause, menopause, and pregnancy are times in a woman’s life when hormonal imbalance is particularly common, and are also associated with hypothyroidism. Dr. John Lee long argued that an excess of estrogen combined with low progesterone — the estrogen dominance typical of early perimenopause — is also a major trigger. Strong synthetic estrogens, such as those in Premarin, may exacerbate estrogen dominance. Dr. Lee also argued that curbing estrogen dominance prevents many problems in perimenopause, including hypothyroidism. Our take is a little different; we belive that it is more about imbalance in the ratio between estrogen and progesterone. Supplemental progesterone can offset this imbalance, but women taking prescription–strength estrogen will generally need prescription–strength bioidentical progesterone as well. Testing salivary or blood levels of progesterone during the luteal phase of the menstrual cycle may also be of great value, so that gentle replacement can be implemented if needed to reduce the negative impact of excess estrogen on the thyroid. Is it really just a thyroid problem? In addition to hormonal imbalance, other conditions often cause or contribute to hypothyroidism. This is why it is so important to look at the body as a set of interconnected systems, rather than isolating the thyroid as a single entity. There are so many symptoms of adrenal fatigue that are similar to thyroid disorders that this often leads to confusion in distinguishing between the two. There is speculation that adrenal stress impairs thyroid function because it causes overproduction of cortisol, blocking the efficient conversion and peripheral cellular use of the thyroid hormones at many levels. We don’t have data on this, but this seems to be what we observe in clinical practice. For this reason we evaluate and, if appropriate, test for adrenal function in combination with thyroid testing.