Your thyroid can worsen when you start going through MENO

[Guest guest]

(I have definitely started the phase of menopause, and I am also

noticing myself feeling sleepy in the afternoon. My gut was telling

me I need more Armour. I will be adding 1/4 grain to my current 3

grains beginning tonite. But I also found the following article

confirming my suspicions. Janie)

Shomon: Is there a significant relationship between low thyroid

and increased menopause difficulties?

Drs. Shames: Yes, most certainly. Low thyroid is often the ignored

factor in far too many women who are simply treated with estrogen

and/or progesterone. Despite increased awareness in the medical

community about the issues and interventions surrournding menopause,

a disturbing number of women still suffer menopause difficulties

despite hormone replacement therapy.

This misery is, of course, in addition to whatever increased risks

are involved to women taking HRT, which are mainly endometrial and

breast cancer, but also include increased risk of gall bladder

disease and stroke.

The women involved expend a great deal of time, money, and heartache

on hormone replacement, which frequently does not provide complete

relief, because the underlying problem is not fully addressed.

This underlying problem is commonly coexistent hypothyroidism. Not

only does low thyroid become more common as women mature, but in

addition, menopause and perimenopause are transition situations

which require more than the usual amount of thyroid hormone.

A borderline low thyroid woman might be well-compensated for most of

her 30's and 40's, and then slip into overt hypothyroidism with the

onset of menopause. Moreover, administration of estrogen causes an

increase in thyroid-binding globulin, which " ties up " in the blood

stream more thyroid hormone than ever before. The bound thyroid is

now not as free to enter the cells, and perform the needed metabolic

work, however, it still exists in the bloodstream, and therefore the

standard tests for it (T-3 uptake, Total T-4, Total T-3, and even

the sensitive TSH) will be normal.

Shomon: Just how common is low thyroid in women of menopausal

age?

Drs. Shames: It happens to be extremely common, unfortunately. The

doctors on the Thyroid Service of Harvard Medical School, and

surveys done by University of Colorado Health Sciences Center, have

estimated that by age 50, one out of every ten-twelve women has some

degree of hypothyroidism. By age 60, it is one woman out of every

five or six! This is clearly a runaway epidemic. Furthermore, it is

striking these women at a time when they can least afford any loss

of energy or decrease in coping mechanisms.

Shomon: Are low thyroid symptoms being confused with menopausal

symptoms?

Drs. Shames: Yes, but it's a complex issue. The symptoms of hot

flashes, insomnia, irritability, palpitations, and the

annoying " fuzzy thinking " so common in menopause can sometimes be

the result of Hashimoto's thyroiditis, the most common cause of

hypothyroidism. But the real complexity comes when actual symptoms

of menopause are simply magnified and exaggerated because of the low

thyroid situation that is now coexistent with menopause. As many

thyroid sufferers are aware, low thyroid makes any illness worse.

And while menopause is not an illness, it can certainly begin to

feel that way when symptoms of low thyroid exacerbate the already

annoying laundry list of female hormone symptoms.

Shomon: What can a woman do when she has both hypothyroidism

and menopause together?

Drs. Shames: First of all, find out to what extent menopause might

have been playing havoc with your thyroid balance. In our Boca Raton

practice, we have seen many women whose previously normal TSH levels

begin to rise in their early 50's. Sometimes this occurs well in

advance of the rise in FSH (follicle stimulating hormone test,

usually ordered by one's gynecologist), which confirms the metabolic

onset of menopause.

Thus, for significantly symptomatic menopausal women, we recommend

thyroid testing, even though -- as we have said -- there are

frequent false negatives. This means that your tests may be normal

but you may still be low thyroid. The diagnosis is, in this

situation, not generally helped by the basal temperature test,

because menopausal women obviously have higher than normal

temperatures with wide fluctuations.

One way out of this testing dilemma is to have your doctor order

thyroid antibodies tests in addition to the free T-3 and free T-4

tests, which may serve as a better indicator of your actual status.

Anything suspicious with these last three tests, in our opinion,

warrants a trial of thyroid hormone. This is our opinion regardless

of whether the woman in question is already on hormone replacement

therapy or is simply contemplating it.

Another maneuver is to consider a trial of thyroid hormone,

especially if there has been any incidence of thyroid disease in the

extended family or anytime prior in the individual's life. In fact,

if the person has had symptoms of low thyroid for many years, she

would also be a candidate for simply trying out the addition of

thyroid hormone or some non-prescription thyroid booster to her

regimen.

Frequently, the underlying hypothyroidism is such a controlling

factor that simply correcting it, sometimes even with homeopathic

thyroid or over the counter thyroid glandular, returns the whole

system to fairly normal function. Menopause continues, but it is a

more mild, gradual, and comfortable process. This is because thyroid

is the energy throttle for the whole body, and especially the gas

pedal for all of one's coping mechanisms. Once you have the energy

to go through the change more gracefully, life can become more

normal.

As an added benefit to this recommendation, you may find that there

is less need at this point for the estrogen. A lower dose, or a

removal of estrogen from your regimen, will decrease or eliminate

the added risks associated with HRT. This is especially dramatic

with women who are experiencing the unexpected annoyance of " early

menopause " . We have seen, at our office, large numbers of women

whose menopause in their mid-40's completely resolves with the

simple addition of thyroid hormone. They become, instead, women who

have a normal onset of menopause in their early 50's. The entire

syndrome was due to borderline hypothyroidism, and as such, it went

away completely with thyroid hormone treatment.

Early or not, the severe menopausal symptoms of atrophic vaginitis,

unremitting insomnia, and extreme irritability, which do not resolve

adequately with estrogen or natural progesterone, can be

tremendously relieved by the addition of thyroid medication. Once

treated, these women are now pleased to find that their problems of

dry hair, dry skin, and cracking nails often resolve as well. All of

this is why menopause authorities like Lee, MD and Christianne

Northrup, MD, recommend that women with persistent menopause

difficulties be tested and treated for hidden low thyroid.

Shomon: Many women are concerned about thyroid hormone's effect

on their bone density. There is a great deal of controversy over

this issue. What are your thoughts about it. Do you feel there is

really such a problem?

Drs. Shames: In our view, no. Thyroid hormone is not at all the

osteoporosis villain that it has been painted to be in the past. The

controversy started some years ago when research data on bone

density and menopausal women was beginning to be collected. The

results seemed to suggest that thyroid hormonen treatment was

associated with a lowered bone density. Both doctors and patients

alike became fearful of thyroxine, and tried to treat even overt

hypothyroidism with as little medicine as possible. This resulted in

many people receiving a dose too low to relieve their symptoms, but

it was considered a worthy tradeoff. Patients were told they would

have to continue suffering through some low thyroid symptoms now in

order to preserve their bone density for the future.

However, the studies at that time lacked the data available today

from third generation TSH assays and high-resolution bone

densitometers. In addition, the groups of patients then being

analyzed lacked the diversity necessary for accurate study. With

further research now pouring in, it appears clear that thyroid

medication - even in the higher doses some people need to feel best -

does not increase one's fracture risk in later years.

It is now well known that untreated or under-medicated

hypothyroidism is itself a leading cause of osteoporosis. It makes

no sense to soft peddle thyroid hormone treatment in the face of

this new evidence. Careful research in the last few years indicates

that proper doses of thyroid medication do not increase fracture

risk. This is fantastic news for millions of women.

Contrary to what you are likely to be told, you may safely take even

a stiff dose of thyroid medicine, if you need it. All that is

necessary for you to be on the safe side is any measurable amount of

TSH on a third generation (*3 decimal points) TSH assay.

Furthermore, you are at risk for osteoporosis if you are low thyroid

and either don't know it or don't receive adequate treatment. In

addition, of course, it is important to do plenty of weight bearing

exercise, take 1500-2000 mg. of a highly absorbable bone-friendly

calcium product daily, eat mineral rich foods, and consider

supplementing with a trace mineral product.

(Note from Shomon: Remember NOT to take your calcium at the

same time as your thyroid hormone replacement, or you can interfere

with absorption. Take thyroid and calcium supplements at least 2-4

hours apart. For more information, read How to Take Thyroid Drugs.)

Shomon: If a woman suspects hypothyroidism as a factor in her

menopause, but has so-called " normal " test results, what steps do

you recommend?

Drs. Shames: We believe that women who are especially at risk for

the issues we've just described are those who have had decreased

libido with advancing years, a history of difficulty with their

menstrual cycle, experience with miscarriage or infertility, prior

problems with ovarian cysts, or even the hint of endometriosis.

Moreover, if you have been a chilly person in your premenopausal

years, had problems with weight, depression, or chronic recurrent

infections, hard to diagnose digestive or musculoskeletal

difficulties, or even just plain severe allergies, we suggest you

consider yourself a possible thyroid candidate.

Another useful bit of information would be whether any of your

family ever had a thyroid problem, an autoimmune disease (diabetes,

rheumatoid arthritis, colitis, etc), prematurely gray hair, chronic

fatigue, episodic anemia, mitral valve prolapse, carpal tunnel

syndrome, or unexplained episodic hair loss. If so, also consider

yourself a likely low thyroid candidate. You might do well with a

clinical trial of thyroid hormone. Keep in mind that thyroid hormone

is MUCH safer, with far fewer risks in the short and long term, than

estrogen hormone that is so freely being offered.

We wish you every success during what has been, for many, a

challenging time. All women, at every stage, deserve to feel good

and enjoy their life's journey, especially those moving in a new

direction on their continuing path. It can and should be a special

and enjoyable time.