This confirms what I've come to understand, that subclinical thyroid problems can be a major reason why some of us are having such a hellish time with menopause. I am finding it to be true in my case. Although I don't agree with his assessment of the NIH study


Estrogen, Menopause and Your Thyroid

By Richard Shames, M.D. & Karilee Shames, Ph.D, R.N

With researchers discovering that the benefits of estrogen are overrated and dangers underreported, it may be time to focus on your thyroid.

The news is in from the National Institutes of Health: the benefits of estrogen have been overplayed, and its risks have been minimized. Not only have valid studies found that estrogen replacement therapy has less protective value for heart disease, Alzheimer's, depression, urinary incontinence, and especially osteoporosis, but in addition, the latest studies are confirming its increased cancer potential.

In other words, the preventive powers of estrogen replacement therapy are much less than the drug companies have been saying, and its risks are greater. This is especially important information for any woman concerned about her thyroid health. Perhaps the biggest potential for mischief in the whole thyroid field is in the arena of women's health and menopause. Everything from minor vaginal irritations to repeated miscarriages have been shown to be thyroid-related in a certain percentage of sufferers. Menopause is not an illness, but it can begin to feel that way if your thyroid is low or borderline at the time of your change.

Women in this frustrating circumstance are often told "It's just your menopause," as if they should expect to feel awful for years because of a natural reduction in estrogen. Without an accurate diagnosis of low thyroid, these women are simply given estrogen and their symptoms linger. The ovaries and uterus need proper amounts of thyroid hormone as much as any other organ or system.

Despite increased awareness in the medical community about the issues and interventions surrounding menopause, tremendous numbers of women still suffer from menopausal difficulties. They expend a great deal of time, money, and heartache on hormone replacement therapies. Frequently, neither the synthetic nor the natural hormones provides complete relief. This is often because the underlying problem is undiagnosed low thyroid. By age 50, one every twelve women has a significant degree of hypothyroidism. By age 60, it is one woman out of every six.

This runaway thyroid epidemic seems to be striking menopausal women harder than any other group of patients. Fortunately, much can be done to help them. The standard maneuver for perimenopausal patients who consult gynecologists is to provide a handful of estrogen samples. We have heard too many stories of women in their late 40's and early 50's who were given these hormones to take without any blood testing at all. The compliant patient will follow the doctor's advice. But, in those cases where women have been put on estrogen, and the symptoms of hot flashes, insomnia, irritability, palpitations, and "fuzzy thinking" are still quite annoying, the addition of thyroid hormone can be a godsend.


For those symptomatic menopausal women not wanting or benefiting from estrogen, we advocate thyroid blood testing first, perhaps followed by a clinical trial of thyroid hormone, even if their blood tests are in the normal range. Frequently, the underlying hypothyroidism is such a controlling factor that simply correcting it returns the whole system to fairly normal functioning. Menopause continues, but it is a more mild, gradual, and comfortable process. If your thyroid is low, your hot flashes will be much more pronounced, much more frequent, and more disconcerting. This is because thyroid is your energy throttle, and you need energy to go through the change gracefully.

How much energy people have, how well they get up in the morning, how well they sleep, and how much stamina they have for the day is directly related to their levels of thyroid hormone. When your level is too low, you don't have the energy to cope adequately with anything, much less the additional stress and emotional liability associated with the menopausal years.

Consider the following case: a 51-year-old schoolteacher from the Midwest named Sarah. Both she and her mother started menopause at the early age of 46. Sarah knew that her mother had low thyroid, as well as severe menopause problems. Neither the mother, nor Sarah, nor their doctors connected these two situations. When Sarah herself began to have the same severe menopause problems as her mother, she accepted it as her genetic predisposition. She was sometimes so hot and sweaty during a school day that she would need to keep a change of clothes in the teachers' lounge. Needless to say, the kids got on her nerves easily, and she was not enjoying her previously satisfying job.

Faced with these difficulties, Sarah did what her mother had not done: she began taking Premarin and Provera immediately. The hoped-for relief, however, was only minimal, even when the gynecologist increased her dosage.

Fortunately, Sarah was referred to our office, and we discovered that her previously normal TSH was now, with advancing menopause, 6.2, clearly in the abnormal range. This indicated that her thyroid hormone levels were not keeping up with the extra demands of her changing metabolism. Once on thyroid medication, Sarah began to feel like her old self in a matter of weeks. Her menopause symptoms faded into the background, and her life became more balanced and enjoyable. Best of all, she no longer needed the Premarin and Provera to maintain this more graceful version of menopause. Thyroid hormone alone resolved the problems.

Other menopausal symptoms are equally amenable to treatment with thyroid hormone alone. Atrophic vaginitis, or thinning of the vaginal wall as the result of falling estrogen levels, can lead to itching, discharge, and painful intercourse. All of these symptoms are much more severe when your thyroid is low. Women who have had unremitting vaginal dryness that was unresolved with vaginal creams or estrogen pills are often found to be low thyroid, if checked carefully. In addition to getting an important part of their intimate life back, once treated with thyroid medicine, these women are pleased to find that their problems with dry hair, dry skin, and cracking nails are often resolved as well.

We don't intend to belittle the persistent difficulty that some women have at this time in their life. Not everyone will be helped as quickly or as completely as was Sarah. The dance of the hormones is very complex, so the idea that you can take just one hormone, or even two, and experience total relief, is not always borne out successfully. You need to look at the whole picture. That's what we mean by holistic health.

Contrary to what the pharmaceutical industry and your doctors may be telling you presently, a blue ribbon panel of specialists from around the world have confirmed that estrogen's benefits have been over-rated and its risks minimized. Optimizing your thyroid can be a far better way to achieve the smoother menopause and the preventive health care you may desire.


This articles appears in Share Guide-A Holistic Health Magazine-Issue #71 Jan/Feb 2004 www.shareguide.com

Also, the proper thyroid tests must be done or you risk not getting a real thyroid problem Dx. Unfortunately most docs do not do these, but be assertive and INSIST or it will be a waste of your time and money.

TSH
*free* T4
*free* T3
TPO antibodies
Thyroglobulin antibodies

I stress *free* because this is the actual unbound hormone that is available to your body at any given time. You do not want the other forms of T4 or T3 testing.

Also the range of TSH recommended by the NAACE is 0.3-3. Most docs and labs are using the old ranges which would make it look as though you were normal when you are not. And thyroid docs in the know feel that anything over 2 is suspect.

The antibody tests are critical as they determine whether or not you have Hashimoto's Thyroiditis, an autoimmune condition in which the immune system is slowly attacking and destroying the thyroid gland. This is the most common cause of hypothyroidism today.

If you have Hashi's, then all bets are off as to the accuracy of the other tests, since it's been shown that people with Hashi's can have symptoms before it shows up in the numbers. Which is why it is crucial to have the antibodies tested.

I asked my dr. to include the antibody test and she refused....why would/should she refuse when my insurance would pay for it?And how do i get her to perform the tests that I want?

I've been on thyroid hormones for almost 10 years, and I'm still getting loss of hair and brittle nails. I'm post but not taking any HRT of any kind. I took BCP for a few months to help even out the heavy periods, which was great. I took Estroven for a few months too, but now nothing.

My doctor tests my thyroid, and does all those tests, too, about every 6 months. He said he will adjust the dosage not just on my numbers for these tests, but how I feel. We actually just reduced my thryoid med because the higher dose was giving me anxiety. I feel much calmer now.

Yes, the old thryoid can cause all kinds of problems. I wonder what people did 100 years ago?

WriterMom

You can order your own tests online, which is what I did. You order them through HealthCheckUSA and go to a LabCorp office to get the blood drawn.

Docs who refuse to order all these tests, including antibodies, are obviously not up on the latest research. These days, good clinical assessment skills have fallen by the wayside and instead docs are relying solely on a lab test number and barely glance at the patient or acknowledge that the symptoms themselves are indicative of a thyroid problem.

Back before the 'infallible' TSH came into being, docs went by symptoms only to Dx thyroid problems and were correct most of the time. They would give the patient a trial of thyroid meds to see if the symptoms resolved and they usually did. Now docs only see numbers on a sheet and seem to have forgotten the important of clinical assessment as a major part of the picture.

Could you possibly post your last test result numbers, including antibodies, along with the lab ranges? And what type of thyroid meds are you on?

Have you had your serum ferritin checked? Low ferritin can also cause loss of hair and brittle nails.

I'd have to go look up my last test results, but they were within the normal ranges, and the T3 and T4 were good. I take Levothroid, I think 125 mg. the 150 mg was too much for me. I did not know about ferritin. I don't think I've had that tested. I will ask about that next time I'm at the doctor's. I have also heard that stress, and good old age, can also cause nails to get brittle. Mine get ridges in them, but if I keep nail polish on them, it helps a lot. It protects them. I also pound on a keyboard almost all day long. No wonder my nails are hurting!

WriterMom

Even if your results were in the 'normal' range, unless they are near the top they can be too low, especially if there are symptoms. And the med you are on is a T4-only med and you may not be converting it to the active T3, which is what give the best symptom relief. Many people who have switch from the T4-only meds to a natural T4 plus T3 med (Armour thyroid) are amazed at how much better they feel.

I'd love to see your lab results if you come across them. And be sure to post the lab ranges with it, since different labs have different ranges.

Definitely agree with Sariah here... I know a number of people who did not feel optimal on T4 only after years of taking it. They finally switched to Armour after really having to twist their doctors arms or find new ones in some caes...and felt terrifically. That said just getting your doc to add some T3, which could be the reason you are still having the problems, would make you feel much better because it sounds like you are not converting it properly. I would also suggest adrenal testing since you have had the thyroid disorder for so long. You can also get that online, saliva testing is best for the adrenals!

Wishing you the best!

TJ

P.S. I found a great article that speaks to what has been said here that a friend took to her doctor who is finally switching her meds... It is great for anyone trying to get their doctor to listen and understand the complexity of the thyroid and the fact that it is underdiagnosed, especially in women. He also stresses the importance of T3 and T4, he is a naturopath, however! He also discusses "normal" versus "optimal" for the thyroid....

TJ

OK, a couple of questions:

1. What happens when your T3 and T4 test w/in normal range but THS goes down? My MD tells me that THS can bite the dust because hypo is being addressed and that the main risk is brittle bones. W/O thyroid, my T3 and T4 are low and I am a barely-walking cretin.

2. Can a person be 'cured' of hypo, as Ms. Winfrey recently claimed on her show? I thought that, once hypo, you were 'treated', not 'cured'. That once levels were w/in normal range, you were monitored via symptoms, clinical exam, and regular labs. In my 20's, the MD got my levels into normal range and then took me off it. I nosedived within a month, but he never put me back on. No one did until my late 40s. Not pleasant.

Thanks for all the good & helpful info.

GK

Another thing to consider with thyroid replacement therapy - is WHAT DO YOU REPLACE IT WITH? The traditional approach, taught to physicians by pharmaceutical companies, has been with Sythroid. However, Synthroid is T4, an inactive form of thyroid that must be converted into T3 by the body with certain enzymes. T3 is formed from the breakdown of T4 in the peripheral tissues. In comparing the two hormones, T3 is the more active, therefore T3 plays the primary role in regulating metabolic activity within the body. The thyroid’s growth and function is maintained by TSH (thyroid stimulating hormone). The thyroid is regulated by several mechanisms. First the anterior pituitary gland secretes TSH which regulates the thyroid hormones. Also the process of removing iodine from T4 and T3 is regulated by many factors which include nutrition, drugs, illness, and other non-thyroid hormones.

In some people, there is a problem converting T4 to T3. In normal thyroid function, T4 converts to T3 in the active form and reverse T3 (RT3) in an inactive form. The enzyme that is used to convert T4 to T3 is inhibited by stress, acute and chronic illness, fasting and the stress hormone cortisol. In times of stress, the body produces more T4 to RT3 to conserve energy for stress. A vicious cycle then occurs with more RT3 than T3 being produced.

While there are several approaches to treating thyroid disorders, Sustained release T3 is one that is well tolerated in twice daily dosing. Immediate release T3 is marketed under liothyronine (Cytomel), but does not appear to work as well as sustained release T3, which a compounding pharmacy would have to prepare. Dessicated thyroid (Armour thyroid) has also been used since its main constituent is T3 although it has T4 as well. Levothyroxine (Synthoid) is not as good of an option because it is only T4. Still another option is custom compounding of the combination of T3 and T4 as extended release capsules.

Paul Hueseman, Pharm.D.

It depends in what part of the 'normal' range they test in. Bottom or top of range? If you are using a natural dessicated whole thyroid, such as Armour or NatureThroid, then your TSH will go down and look 'hyper' to an uninformed doc. It all depends on the *frees*--free T3 and T4. Do you know what those actual levels are and the lab ranges?

I've not heard of anyone being cured, but I suppose it's possibly unless one has hashi's in which case the gland is being destroyed and it wouldn't be possible. Do you have hashi's? Again, it's depends on how a doc is interpreting your actual numbers in the the range. If he/she thinks anything is fine in that range even if it's on the low end, then they do not understand thyroid very well.

Can you post your last results along with the ranges?

I tried a T3 med without the T4 and hated how it made me feel. Not everyone does well on T3 meds, compounded or not. It could be indicated if you have a reverse T3 problem, but you should get tested for rT3 levels first.

Sometimes if you are not converting T4 to T3 well then adding nutrients that assist with that conversion can be very helpful, such as iron and selenium.

Two combo T4/T3 products are Armour and NatureThroid. And they are quite cheap and even my awful insurance pays for them. Even if it didn't it's $5-6 per month. Much cheaper than synthetic or compounded.

Oprah recanted the "cured" comment and said she is just stable at the moment. I certainly haven't heard of anyone being cured. In fact, what I have heard is some doctors going by the range and stopping treatment once you get in the range and refusing meds after that...talking about uninformed! Once you're on meds, you're usually on them for life!

TJ

Can you post your last results along with the ranges?

Sariah,

Here's my info, from last November.

TSH: <.0.004 uIU/mL, range 0.460 - 4.980

Free T4: 1.00 ng/dL, range 0.71 - 1.85

Free T3: 3.70 PG/ML, range 2.00 - 4.00

The weird units are as they appear on the lab sheet.

I take Cytomel 25 mcg, 2x day in split doses and Synthroid 100 mcg 1x day. I stick them under my tongue. The MD is an endo and the practice does not like to use Armour, for reasons known only to god and the MD.

Once I get ferritin checked, I'll definitely supplement with iron and selenium. Thanks for those suggestions.

Your TSH is low, your fT4 should be in the upper 1/3 of the range, so that's low also. But your fT3 looks OK. Weird. For some reason you do not have enough T4, even though you are on Synthroid. Have you tried adding some iodine? Do you like the Cytomel? I hated that stuff.

Thanks, Sariah. The MD has told me that when thyroid is supplemented (if that's the right word), TSH can poop out and that's why it's low - sort of like it's been decommissioned.

What happened with you and Cytomel? With me, I don't notice much either way. In my twenties, the MD put me on thyroid in grains and then when I felt better and my #'s got within range, took me off. Felt fairly lousy until I got back on it in my late 40s. No, haven't tried iodine & will check it out on-line. Forgot to mention earlier, don't believe it's Hashi. I'm glad for all this info & will take it with me to my appt next week.

Yes, your TSH is fine as long as the frees aren't over range. It's just odd that your T4 is low, yet your T3 is fine. Must be the Cytomel could be masking any conversion problems you might have, since it's a T3 med. But you aren't producing enough T4. The iodine may help, but be sure to also get at least 50 mcg of selenium with it.

Sariah,

I found my labs and realized I forgot to add something to the post I left awhile back on my thyroid numbers.

To save you from having to go find it, I'll repost the original numbers with the added numbers I didn't know would be related to this.

TSH 0.784 (0.300-5.000)
T4 10.3 (5.5-12.0)
FREE T-3 3.3 (2.4-4.5)
FREE T4 1.30 (0.80-1.80)

THYROID PERX AB 18.06 (0.00-100.00)
ANTI THYROGLOB 0.08 (< 1.00)
Ferritin 25 (15-150)
B12 628 (200-1000)

Estradiol 369 (I don't have ranges for this, they didn't include it)
DHEA SULFATE 155 (25-220)
Progesterone 0.90 ( again, no ranges for this)

I have an appointment with a new Dr. in two weeks to go over these, the one who ran the tests refused to help me and said all my numbers were 'normal'. I don't feel 'normal', I feel horrible actually. I have both hypo and hyper symptoms and every day is just getting harder and harder to get through.

Thanks again for any help you can give

Angie

Angie,

Your ferritin levels are pretty low. When mine were that low I also had hyper and hypo symptoms. Work on getting your iron levels up and see if that makes a difference.

Your free T4 is 50% of the range (should be in upper 1/3
Your free T3 is 43% of the range (should be in upper 1/4)

Although your TSH looks low, your actual thyroid hormones are not optimal.

It doesn't look like you have Hashimoto's or Grave's (antibodies neg), so no autoimmune component. Although it's possible for the antibodies to not show up in blood tests yet an ultrasound can tell if it looks like there is lymphocytic infiltration or nodules.

Your B12 could be higher. In Japan they like to see a patient's B12 near 1000.

So in short, try to get your iron levels up (ProFerrin is best for this--it's a heme iron) Also I would add 150mcg of iodine/day, along with 100 mcg of selenium. Those 2 nutrients can both increase T4 (iodine) and increase conversion to T3 (selenium)

And be sure to drink a minimum of 8 glasses of water/day.

Forgot to ask:

Where were you in your cycle when your blood was drawn for estrogen levels?

Also, zinc helps to increase T3 so maybe add 15mg/day

I was at day 7, that's the month that my periods went crazy and I literally had a two day period that you could hardly even call a period. With all my symptoms it's so hard for me to figure out if this is hormones or thyroid, or maybe I'm just going crazy after all this time, either way, I'm pretty much sick and tired of feeling sick and tired.

Thank you for your help!!

A

At first glance your E levels look high, but it was a time when E levels are normally increasing, although that number seems high regardless. Ideally it would be good to test E again on day 3-4 of your cycle and also if possible on days 20-22.

High E can bind thyroid hormone making it unavailable.

Hi Sariah -

Just stumbled on your thread and I'm so glad I did. The article that you posted is very interestng. I've often wondered why some women suffer more than others with peri/menopause and I think the article touches on some very exciting key points. Thanks for posting

GREAT ARTICLE, SARIAH!!!

Is it possible for any thyroid issues to stop once one hits menopause? I believe all my current issues are the result of my hormonal imbalance...one hormone affects another and they all impact each other.

That is an excellent question and one for which I, nor anyone else (it appears) have no answer. I think that it warrants some serious studies, though.

I am 42 and going through what I think are Thyroid issues now. I am having a hard time finding one of those "docs in the know". The one I went to yesterday is clueless and thinks basically all of this is in my head. I guess I'll keep searching for the right doctor. My last TSH was 2.93 with a free T3 of 2.90 and a free T4 of .74 . I have no clue if this is off or not, but from my symptoms, I would guess so. I have low blood pressure, low body temp, sensitivity to hot/cold and many other thyroid symptoms. Do you know if this looks abnormal? You seem to know a lot about this?

Do you have the lab ranges for each value? Were your antibodies tested?