It is tough to be a thyroid patient with all the symptoms that befall us like a ton of bricks, but then add to that struggle the number of doctors that are miserably misinformed about thyroid disease.
When a woman thinks of getting pregnant, thoughts of having her thyroid hormone levels checked doesn’t even come to mind. Her doctor may not even suggest it. In fact, many infertility doctors are unaware of how thyroid function can impact a woman’s ability to conceive. Thyroid hormones directly affect the uterine lining, causing infertility or miscarriages to occur. Unfortunately, obstetricians and gynecologists are the doctors women look to when dealing with fertility issues or pregnancy. Arming more women with accurate information regarding the importance of thyroid function may prove helpful in educating more doctors working in other fields of medicine. In both excess or deficiency, thyroid hormones can negatively impact fertility.
2. Low Libido
Patients more often reporting loss of libido are those with hypothyroidism. Those with hyperthyroidism can also experience this symptom, but they can also experience episodes of increased sex drive, due to the sped up metabolism hyperthyroidism can cause. With hypothyroidism, the metabolism is slowed down, which means the reproductive organs are slowed down as well. The adrenal glands that produce hormones that convert into the sex hormones are also slowed down. Both men and women can see decreased testosterone and estrogen levels.
“Go see a psychiatrist,” your thyroid doctor advises. Hold on a minute. Inadequate levels of thyroid hormones T4 and T3 are most often the culprit of poor mood and mental wellness. With over 4000 patients, the Star*D study is the largest trial comparing antidepressant effectiveness for depression. It found that 66% of patients fail to respond to antidepressants or have side-effects severe enough to discontinue use. Of those who do respond, over half will relapse within one year. The trial found that T3 thyroid medication was effective even when other medications-such as citalopram (Celexa), bupropion (Wellbutrin), sertraline (Zolft), venlafaxine (Effexor), or cognitive therapy were not. Thyroid replacement with T3 was shown to be 50% more effective, even with the less than optimal dose of 50 mcg, under direct comparison with significantly less side effects than commonly used therapeutic approaches with antidepressants.
Have you tried all kinds of healthy diets and followed exercise routines religiously? Have you put all your efforts into losing that stubborn, extra weight and still can’t get the desired outcome? One big lie that your thyroid doctor may tell you is “hypothyroidism doesn’t cause weight gain”. When a person is overweight, everyone blames them for eating too much and not exercising enough. However that’s not the whole story. Despite the vast number of weight loss programs in existence today, many overweight individuals are not successful at their valiant attempts to exercise more and eat less. Even if they do lose weight initially, many do not keep it off long-term. The overwhelming majority of times, there are metabolic abnormalities including low thyroid making it very difficult to lose weight. According to researchers, “Thyroid hormone maintains basal metabolic rate, facilitates adaptive thermogenesis, modulates appetite and food intake, and regulates body weight.”
5. Anxiety & Panic Disorders
One day you wake up with overflowing physical energy, even feeling severely anxious, with a rapid heartbeat, profuse sweating, trembling hands, and diarrhea, and you can’t stop losing weight. Then soon enough, without warning, your energy plummets. You feel like a slug, are constipated, your hair starts falling out, you gain weight no matter how little you eat, and you are severely depressed. You may have difficulty swallowing, sound hoarse, and feel like you have swallowed something that wont go down. And then, suddenly, your old symptoms return, and you feel anxious, sweaty, trembling, and panicky. This cycle can repeat itself again and again. While your symptoms resemble a mental health issue, they could be signs of Hashimoto’s disease, one cause of hypothyroidism.
Hashimoto’s disease, also known as autoimmune thyroiditis or simply Hashimoto’s, is caused by an autoimmune disorder. In this case, the body’s immune system sees the thyroid gland as a foreign body and begins to attack, damage, and kill thyroid cells along the way. As the cells are damaged or destroyed, they release their stored thyroid hormone, causing classic hyperthyroid symptoms such as anxiety, panic attacks, shaking hands, sweating, and a racing heart. Each autoimmune attack causes more and more damage to the thyroid gland until, ultimately, the gland is no longer able to produce adequate thyroid hormones. Every cell in the body needs thyroid hormones, so a deficiency can wreak havoc on the entire system, causing depression, weight gain, severe fatigue, brain fog, memory loss, and even overall body aches. With such a dramatic swing in symptoms, it’s easy to see how Hashimoto’s disease could be misdiagnosed as a mental illness like manic depression or bipolar disorder. And it happens much too often.
Both hypothyroidism and hyperthyroidism can present with mental health symptoms.
6. Carpal Tunnel Syndrome
Carpal tunnel syndrome, a condition where pressure on the median nerve causes pain, numbness, tingling and weakness in the hand, fingers, wrist, and forearm, is a common complaint. Some thyroid patients, in particular those with hypothyroidism, struggle with carpal tunnel syndrome, but don’t realize that there is a key connection between this painful nerve problem and their thyroid function. Hypothyroid patients often find themselves with CTS because those who have thyroid dysfunction tend to retain excess fluids in their connective tissues. Accumulation of musopolysaccarides, another common occurrence in hypothyroid patients, promotes swelling around the median nerve which increases pressure and compression of the carpal tunnel.
7. Heart Disease
Have you been diagnosed with atrial fibrillation, high cholesterol, or high blood pressure? It is possible your thyroid hormone levels could be responsible. Thyroid hormones have a direct effect on the heart, causing it to speed up or slow way down, creating heart disease. Your doctor, after evaluating the heart disease symptoms, may refer you to a cardiac specialist. Cardiologists may only look at the heart disease symptoms at hand, not considering the possibility that thyroid hormone imbalance could be the cause.
Low Thyroid Hormones
With too little thyroid hormones circulating within the body, your heartbeat slows down and can even cause irregular heartbeats to occur, Bradycardia. Low thyroid hormones reduce the function of the heart, sometimes causing fluid to develop around it, causing pericardial effusion.
Low thyroid hormone levels can also cause high cholesterol for many people. Increased levels of “bad” lipoprotein (LDL) cholesterol are directly related to sub-optimal thyroid function. These hormones not only make cholesterol (good or bad), but they are also responsible for eliminating the cholesterol that we do not need. When the extra cholesterol isn’t removed, plaque develops within our arteries, clogging them. The result can be heart disease, stroke, or even heart attack. In a Dutch study called “The Rotterdam Study”, it was found that elderly women with subclinical hypothyroidism were almost twice as likely as women without this condition to have blockages in the aorta. They were also twice as likely to have had heart attacks. Having autoimmune hypothyroidism with elevated antibodies to thyroid peroxidase increased the risk even further.
Blood pressure can also become high when thyroid hormones are too low. Arterial stiffness, thickening, and decreased elasticity can occur when too little thyroid hormone is circulating within the body, increasing peripheral vascular resistance, causing blood pressure to rise. Many doctors prescribe statin drugs for high cholesterol levels and blood pressure medication without first checking thyroid hormone levels to see if they could be the the underlying cause.
High Thyroid Hormones
When thyroid hormones levels are too high the heart beats faster which can lead to a condition known as Tachycardia. Tachycardia can go unnoticed until palpitations, heart pain (angina), shortness of breath, or dizziness starts to occur. A prolonged fast heart rate can also cause incoordination of the electrical impulses that travel to the heart. The effect on the electrical impulses of the heart can cause a serious condition called atrial fibrillation (Afib) to develop in the right atrium of the heart. Afib causes your heart to beat erratically and can be quite uncomfortable. The constant quivering or irregular heartbeat may lead to stroke, heart failure, and many other serious heart problems.
8. ADD & ADHD
Both hypothyroidism and hyperthyroidism can promote symptoms commonly seen in ADD/ADHD. This isn’t to say that ADD and ADHD don’t exist, nor is it to say that you can’t have these conditions while suffering from a thyroid problem, but due to the lack of knowledge and improper thyroid testing many people are incorrectly diagnosed with ADD or ADHD when really they have a thyroid problem.
When looking at the symptoms of hypothyroidism and ADD, they are eerily similar. Hypothyroidism symptoms include:
- Brain fog
- Short and long-term memory issues
- And many, many, many more
ADD symptoms include:
- Difficulty focusing
- “Zoning out”
- Difficulty remembering conversations/tasks
In addition to the similarities listed above, hyperthyroidism and ADHD have extremely similar symptoms, as well. In the case of Hashimoto’s disease, a person’s TSH can rise and fall with symptoms of hypothyroidism and hyperthyroidism.
Hyperthyroidism symptoms include:
- Difficulty staying still, constantly moving
- Brain fog/lack of attentiveness
- Irritability/mood swings
ADHD symptoms include:
- Constant fidgeting/moving
- Difficulty focusing
- Quick temper/easily angered
These conditions do sound very similar and could be easily confused in children and even in adults. Another, not as well-known thyroid conditions, can also mimic ADHD: thyroid hormone resistance. This is a condition in which the body does not properly respond to the thyroid hormones and instead of the pituitary gland lowering the production of the TSH hormone, it stays the same and the body continues to produce unnecessary thyroid hormones.
9. Gastroesophageal Reflux Disease (GERD)
Do you have Gastroesophogeal Reflux Disease (GERD)? Did you know that that could be an indication of thyroid dysfunction? If not, don’t worry. Most thyroid doctors don’t know that either. Excess stomach acid is often considered the culprit, but looking beyond heartburn commercials reveals the projected public perception can be contrary to the underlying physiology. GERD is frequently treated with proton pump inhibitors (PPIs), which are the most potent suppressors of gastric acid on the market. Digestive medications are a multi-billion dollar industry. With stomach acid at the center of it all, it is easy to see why reducing it might be the answer. Yet delving further clearly illustrates that’s not always the case.
When it comes to the thyroid, your thyroid doctor must understand the importance of gut health in a treatment protocol. Not only is the majority of the immune system located in the gut, but the thyroid relies on healthy gut bacteria to convert thyroid hormone T4 to active T3 as well. Another consideration is the close relationship between stress, thyroid and the digestive tract. We all know that pit in our stomach or lump in our throat that can come with stress. Other effects of stress on the digestive tract aren’t as noticeable however. For instance, stress can contribute to “leaky gut“ (intestinal permeability), which is associated with autoimmune disease and symptoms that come with it. The thyroid is part of the HPAT-axis (Hypothalamus-Pituitary-Adrenal-Thyroid-Axis). The thyroid and its symphony of hormonal functioning are also affected by stress since adrenals regulate stress response.
“I’m not sleeping at all. But maybe I’m just stressed.” I hear this from many women in their forties. It’s true, the stressors have seemed to multiply and attack from all sides – kids, marriage, aging parents, bosses, coworkers, employees – all just look like hungry mouths screaming to be fed. But the difference now, is that hormonal changes are making it difficult to handle these inevitable life challenges. In the perimenopausal years – usually when a woman is in her forties – ovarian production of hormones starts to shift. Insomnia is one of the most common symptoms of perimenopause. What disturbs me most about hearing women describe their insomnia that has been occurring for months, is that women are not sharing this with their friends, nor mentioning this to their doctor. They seem to just accept it as inevitable, an effect of living a full life, or just a natural sign of aging. If this is only happening sporadically, or only after a rare, particularly stressful day or after too many glasses of wine, then there is no real cause for concern and the best approach is to minimize the stress at hand. However, any symptom you are having is a signal from your body that it is out of balance and some intervention is necessary. The primary culprit during perimenopause and menopause is a hormonal imbalance or deficiency.
Progesterone and Sleep
Progesterone declines first during the perimenopausal years. Progesterone is only produced during the second half of the menstrual cycle: from ovulation until bleeding occurs. So if you’re bleeding more often, spotting between periods, having heavier periods or not ovulating at all and skipping periods, your progesterone levels are low. Progesterone has a direct, sedative effect on the brain, by stimulating the brain’s production of the neurotransmitter GABA and stimulating benzodiazepine receptors. Yes, progesterone is nature’s Valium! In turn, progesterone deficiency causes insomnia, irritabililty, anxiety and even panic attacks. Progesterone also is a respiratory stimulant, meaning that it deepens breathing and can prevent sleep apnea. Many untreated perimenopausal women gain weight, causing sleep apnea, which in itself destroys sleep quality.
Estrogen and Sleep
Hot flashes and night sweats are one of the most disturbing symptoms of perimenopause and menopause, mainly caused by estrogen deficiency and fluctuations in estrogen levels. Although estrogen doesn’t always decline first in perimenopause, if you’ve started skipping periods, that’s a clear sign that you have an estrogen deficiency, because you didn’t make enough estrogen to ovulate. The most common symptoms of estrogen deficiency are hot flashes, night sweats, vaginal dryness, missed periods, lighter bleeding, and depression. If you’re not having any problems falling asleep, but you wake every night at 2:00 AM drenched in sweat, or you feel hot just as you awaken every morning, then you’re most likely feeling the effects of low estrogen. Estrogen is both a serotonin agonist as well as a GABA agonist, two neurotransmitters that promote good mood and a sense of calm. Insomnia and depression are inextricably linked, so if you’re suffering from both of these and you’re perimenopausal, estrogen deficiency might be the cause.
Cortisol and Sleep
Cortisol is the adrenal hormone that wakes us up in the morning and helps us combat stress throughout the day, then declines at nighttime, allowing us to sleep. When we’re stressed, whether from external sources like the economy, or internal sources like infections or hormonal changes, our adrenals pour out massive amounts of cortisol initially, then often crash if the stress is insurmountable. During menopause, cortisol levels can spike during the night, causing those nighttime awakenings and disturbed sleep. Optimizing adrenal function is another key to that perimenopausal insomnia.
Thyroid and Sleep
The typical hypothyroid patient is so steeped in fatigue that they can sleep all day long. However a small subset of hypothyroidism causes insomnia. It’s as if the body doesn’t have enough energy during the day, then finally spikes at night, preventing the body from recharging and perpetuating the vicious cycle of fatigue. This may also be due to cortisol spikes at night, as mentioned above, but optimizing thyroid function is essential for healthy energy production and sleep-wake balance.
11. Headaches & Migraines
Headache is one of the most common symptoms in hypothyroidism. According to a study published in The Journal of Headache and Pain, patients with subclinical hypothyroidism have a higher risk of lifetime migraines. Another recent study found that headache disorders may be a risk factor for the development of new onset hypothyroidism. It is also believed that decreased levels of estrogen and progesterone, which occurs before/during menstruation and during perimenopause and menopause, may cause blood vessels to spasm at the base of the neck. Low adrenal function or an imbalance of brain chemicals, such as serotonin and dopamine, may also play a role but are often completely overlooked.