Post #26

The Unusual Suspects: Thyroid Issues

Crone Intelligence Briefing · Filed under: Prime Mimics & Hormonal Imposters

The Unusual Suspects

In this series I’ll be investigating the common culprits that mimic peri/menopause. Unfortunately, these imposters make it hard to navigate hormonal changes and to even discover whether you’re actually in peri/menopause in the first place.

First in the dock is…

THYROID ISSUES: Hyper or Hypothyroidism

Let’s start with the basics. The thyroid gland is a small butterfly-shaped gland that sits in the lower neck (over the throat) and releases hormones that control metabolism (and energy use). When it’s overactive we get Hyperthyroidism, when it’s underactive we get Hypothyroidism.

Both conditions suck and cause a large number of issues for those who suffer from them.

Hyperthyroidism

Hyperthyroidism results in body functions speeding up. Symptoms include:

Weight loss
Rapid or irregular heartbeat
Difficulty sleeping
Irritability
Fatigue
Muscle weakness
Sweating and sensitivity to heat
Enlarged thyroid gland

Hypothyroidism

Hypothyroidism on the other hand slows everything down. Symptoms include:

Fatigue
Weight gain
Feeling cold
Joint and muscle pain
Thinning hair
Dry skin
Heavy or irregular periods
Depression
Constipation

I know what you’re thinking: hang on a minute, some of these sound dangerously familiar! We peri/menopausal women have quite a few of these going on already and that’s why I crown Thyroid Issues Perimenopause Unusual Suspect #1. Prime mimic!

Between them both, thyroid issues and perimenopause cover the gamut of symptoms such as fatigue, mood changes, depression, difficulty sleeping, concentration issues, muscle and joint aches and pain, hot flashes, weight gain, low libido, palpitations and irregular periods.

Don’t take my word for it. The supporting research articles listed below are well aware of the crossover between thyroid and hormonal status.

In this series I’ll be investigating the common culprits that mimic peri/menopause.

Unfortunately, these imposters make it hard to navigate hormonal changes and to even discover whether you’re actually in peri/menopause in the first place.

So just in case you’re suffering from any of the conditions I delve into, you can understand a bit more about where you stand. I have also taken the liberty of listing some relevant reading material, and yes, your humble Crone set aside opinion and ranting in favor of facts. I read everything. My mind boggled and I killed off more brain cells than I possess since I’m a mere lay-Crone, not a brainiac! But I find myself more informed than before and I hope you will too.

How do you know if it’s thyroid issues or peri/menopause?

Since we’re dealing with a major overlap, no wonder it’s hard for doctors (who don’t need any excuse to be useless and ill-informed) to struggle with diagnosing patients and happily foist patients onto an endocrinologist who might know better (we live in hope!).

The best way to check if your thyroid gland is to blame for your symptoms is to have a blood test. Usually getting tested for hormone levels during perimenopause isn’t accurate because they shift so much. But the thyroid is a LOT more predictable, hence the testing.

If your doctor is listening to you (a rose in the manure!) and takes your concerns seriously they will factor in the overlap and do baseline tests for both. The most common tests for thyroid are TSH and T4 and sometimes T3.

TSH and T4

If TSH (thyroid stimulating hormone) is too low or too high it shows whether you’re hyper or hypothyroid. T4 tests check how much thyroxine the thyroid gland is producing.

Free T4 shows how much unbound (to proteins) thyroxine is available to the tissues. Total T4 measures both bound T4 (attached to proteins and inactive) and free T4.

T3

A T3 (triiodothyronine) test is most useful for diagnosing hyperthyroidism. Like T4, T3 also comes in two forms: Free T3 that enters tissues as needed and bound T3 which attaches to proteins. Total T3 measures both free and bound T3.

Bottom line, too much TSH, T3 or T4 = hyperthyroid, too little = hypothyroid.

Any doctor serious about diagnosis will actually perform a few more thyroid tests: reverse T3, TPO (thyroid peroxidase) and Tg (thyroglobulin) antibodies. But generally, they usually only perform TSH and T4 tests.

Symptom overlap summary

🤝 Shared

Brain fog, dry skin, fatigue, hair loss, heat intolerance, menstrual irregularities, mood swings, muscle/joint pain and weight gain.

🔥 Peri/menopause only

Hot flashes, high anxiety, night sweats, palpitations, sleep issues and vaginal dryness.

🦋 Thyroid only

Cold intolerance, brittle hair and nails, constipation and slower heart rate.

Self-diagnostic test for peri/menopause vs thyroid issues

Cold to the bone?

Do you feel a deep cold to the core of your being?
Is the cold constant?
Do you have cold hands and feet?
Are your hands dry, cold and rough?

If the answer is yes, then the chances are you may be hypothyroid.

Frozen fingers?

Do you have frozen fingers?
Is the cold sudden and intermittent?

If the answer is yes, then it’s likely perimenopause is the culprit.

Watch your neck

Watch the ‘V’ shape in the middle of your neck where the collar bones meet. When you swallow is there a swelling?

If the answer is yes, then you may be hyperthyroid and have an enlarged thyroid gland.

⚠️ These don’t take the place of actual blood tests so get those too.

The gray area

We’ve looked at overlap, and testing, what next? Now we enter a tricky gray area.

Thyroid problems can coincide with peri/menopause. The timing certainly is curious. That doesn’t mean they trigger it, but they do affect each other. You may have a hidden thyroid problem that has been camouflaged by peri/menopause due to the many shared symptoms.

Low estrogen especially can make your thyroid problem worse so there’s a fine dance between these two sets of hormones. But why?

They’re both regulated by the pituitary gland, a pea-sized gland that sits under the hypothalamus at the base of the brain. It’s a very busy gland and in this case it makes:

TSH — thyroid stimulating hormone
FSH — follicle stimulating hormone, which stimulates the ovaries to produce estrogen
LH — luteinizing hormone, which controls ovulation

So now you can see how entwined the thyroid hormones and estrogen are.

Why do thyroid issues arise during peri/menopause or after?

Hormones — declining estrogen impacts thyroid gland function due to its interaction with TBG (thyroid binding globulin). Thyroid hormones attach to TBG resulting in less active thyroid hormones being available. Estrogen signals the liver to make TBG.
Physiology — like all organs, the thyroid gland ages and becomes less effective. It shrinks and moves lower down into the neck.
Autoimmune risk — the risk of the immune system attacking the thyroid gland is higher and leads to conditions such as Hashimoto’s Disease that cause hypothyroidism. It can also be triggered by hormonal changes.

Is peri/menopause a danger to the thyroid gland?

During peri/menopause fluctuating/declining and/or absent hormones can cause issues. It’s no coincidence that a lot of thyroid problems appear to dominate in women over 60. But is there danger to the thyroid gland as such?

I would say extra vigilance is required because of hormonal vulnerability. Low estrogen levels disrupt the delicate dance it’s doing with thyroid hormones. This is well-documented.

If you happen to have thyroid issues and are on HRT to treat perimenopause symptoms studies show that more thyroxine is needed. The same applies for hypothyroid women who are post menopause. Standard supplementation comes in the form of LT4 (levothyroxine), a synthetic form of T4.

Bottom line: during hormonal flux or absence, thyroid monitoring is wise. While peri/menopause doesn’t cause thyroid problems, it brings them to light if there are underlying antibodies indicating high or low levels.

I mentioned autoimmune risks that occur during perimenopause. The gut-immune connection has been a hot topic for some time but it seems that the gut biome has an impact on estrogen, progesterone and other hormones. It’s a mutually beneficial arrangement.

When hormones decline the health of the gut biome suffers leading to inflammation, immune weakness and a leaky or permeable gut. Researchers admit (in the documents below) that more studies are needed but ask if the gut biome could be used to improve menopause symptoms and effectiveness of hormone therapy.

Can HRT and thyroid issues work together?

Yes, it just takes more care and monitoring. But for HRT to work properly the thyroid needs to be performing at its best.

A tandem approach is needed and a doctor who doesn’t just want to push HRT alone. They also need to perform the wider set of thyroid tests to see how everything interacts.

They also need to bear in mind that oral estrogen behaves differently to transdermal (gels, patches and sprays). It increases TBG (thyroxine binding globulin) production in the liver, which binds to free T4 leaving less active hormone available to the tissues. This means in people with thyroid issues, monitoring is essential.

So, there we have it. Plenty to mull over.

THE CRONE'S VERDICT UNUSUAL SUSPECT #1:
GUILTY AS CHARGED!