Lisa Haber, now 41, struggled with weight issues, fatigue, and dry skin as a teenager. She visited an endocrinologist, who said her thyroid was not to blame. But in 2013, when she was 37 and trying unsuccessfully to get pregnant, she went to her internist and had her thyroid retested. She found out that it wasn’t functioning well and could be contributing to her inability to have a baby. Lisa, a social worker who lives in Chicago, went on medication that relieved some of her symptoms, and she got pregnant with her son a few months later.
Thyroid problems can take a toll on well-being, and as Lisa found out, they can be difficult to pinpoint. Often the symptoms mimic signs of other issues like depression and menopause. About one in eight women will develop a thyroid disorder during her lifetime, yet up to 60 percent of people with thyroid disease don’t realize they have it.
What’s more, the diagnosis of hypothyroidism, one of the most common thyroid problems, can be controversial: Some think test results don’t always offer a definitive answer. That’s why you should educate yourself to stay healthy. Here, what all women need to know.
The butterfly-shaped gland, which lives in the base of your neck, is frequently associated with everything from fatigue to excess pounds—for good reason. “Thyroid hormones affect nearly every organ and process in the body,” says Angela Leung, M.D., assistant clinical professor of medicine in UCLA’s Division of Endocrinology. How it works: Thyroid-stimulating hormone (TSH), released by the brain’s pituitary gland, tells the thyroid to produce and release thyroxine (T4). You metabolize T4 into a more usable form, T3, which goes out into the body to accomplish its mile-long to-do list.
About 10 percent of women have some form of hypothyroidism, in which the thyroid gland can’t make sufficient thyroid hormones to keep the body humming smoothly. Women are up to eight times as likely to experience it as men, and those over 60 are at even higher risk. Less frequent (affecting about 1 percent of Americans) is hyperthyroidism, in which excess thyroid hormone is produced.
When the thyroid slows down, you slow down. Your metabolism loses steam, your energy slumps, you feel colder and weaker, your heart rate drops, and your brain fogs. Hypo- thyroidism has also been linked to an increased risk of type 2 diabetes and infertility. (The opposite happens with hyperthyroidism, which causes bodily functions to speed up.)
Your risk of thyroid issues increases with age, and perimenopause usually starts in your 40s. Since hypothyroidism shares many of the same symptoms, such as fatigue, erratic periods, and weight gain, it can be hard for women to tease the two issues apart initially, says Dr. Leung. Clues that your symptoms might be thyroid-related instead of menopausal: You have a family history of thyroid disease (ask your mother or a female relative if you’re not sure) or you have an autoimmune problem such as type 1 diabetes or celiac disease. (Inflammation caused by an autoimmune disease—when your immune system attacks the thyroid—is the most common cause of hypothyroidism.)
The first step in investigating a problem is to check your TSH level with a quick blood test. If your TSH is high or abnormal, it could mean your thyroid isn’t functioning well and your body is trying to release more TSH to tell your thyroid to get moving. Yet what’s “normal” can be subjective. Many experts consider the normal range for TSH to be from 0.5 to 5 mIU/L, so if your test results come back within this window, your doc might not suggest treatment. Other experts, typically integrative or holistic-minded physicians, might consider treatment if your levels are technically in the normal range (say, 2.5 to 4 mIU/L) but you’re experiencing symptoms. Your doctor may also want to test your T3 or T4 level to get a better sense of your thyroid health.
Levothyroxine—synthetic T4—is one of the most prescribed drugs in the U.S., more common than amoxicillin or Lipitor. It’s relatively inexpensive (about $13 per month for the generic form) and has few side effects. Most patients notice a difference in how they feel within a month. Although the medication is safe, you need to take it at the same time every morning on an empty stomach, an hour before eating. If it works, you need to be on it in some form for the rest of your life, says Juan Brito, M.D., an endocrinologist at the Mayo Clinic, and thus experts caution against the pills unless you truly have a thyroid disorder.
It’s true that symptoms like weight gain, fatigue, and low sex drive are sometimes wrongly blamed on the thyroid. That’s why it’s important for doctors to look at everything—test results, symptoms, and risk factors—in context rather than as stand-alone issues, says Melinda Ring, M.D., executive director of Northwestern Medicine’s Osher Center for Integrative Medicine in Chicago. Knowing what’s typical for your body and working with a doctor to sort through concerns will help provide answers. An internist or a primary care physician is a great person to start with. Along with conducting blood tests, he or she will look for other issues that might be masquerading as hypothyroid symptoms: Fatigue, for example, could indicate a vitamin deficiency. From there, you may be referred to an endocrinologist if necessary.
Eating smaller, more frequent meals throughout the day may have a positive impact on T3 levels, perhaps by increasing levels of insulin, which helps the body turn T4 into T3, suggests new research from Rush University Medical Center in Chicago.
One study found that selenium might help prevent thyroid damage in people with Hashimoto’s thyroiditis, an autoimmune condition that can lead to hypothyroidism. (Selenium is needed to make thyroid hormones.) The recommended daily amount of the mineral for women is 55 mcg per day; you can find it in seafood, Brazil nuts, and eggs.
While most medical organizations do not endorse routine thyroid screening for healthy individuals, it’s a good idea for pregnant women. “Thyroid hormone is important for the developing fetus,” says Shanti Serdy, M.D., a staff physician at Boston’s Joslin Diabetes Center specializing in thyroid health and an instructor of medicine at Harvard Medical School. You may also want to get screened if you have risk factors such as a family history of thyroid disease or a personal or family history of autoimmune conditions.
Finally, if you know something is off, go with your gut. Exercising her voice and working with different medical practitioners was critical for Mary Shomon, 56, of Gaithersburg, MD, who was diagnosed with hypothyroidism in 1995 and tried numerous medications before finding a combination that worked. (In addition to T4, she needed a daily boost of T3 before her symptoms of weight gain, fatigue, and the blues finally subsided.) Now a thyroid-health activist and author, she encourages women not to give up. “What’s normal for one woman may not be normal for another,” she says. “I’m thankful I found someone to treat me as a patient, not a number. It changed everything.”