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Thyroid Complications in Women: Hypothyroidism & Hyperthyroidism

Doctor checking thyroid glands of senior woman

The thyroid gland produces the hormones triiodothyronine (T3) and thyroxine (T4). These hormones control many activities in the body, including how fast the heartbeats, energy levels, internal temperature, hair/skin/nail growth, and more. Thyroid diseases either cause the thyroid to make excessive or not enough of these hormones. Depending on if the thyroid is over or underactive, the patient can often feel restless or tired, or they can rapidly lose or gain weight. Studies have shown that women are more likely than men to have thyroid diseases, especially right after pregnancy and menopause.

What is the thyroid? 

The thyroid gland is a small butterfly-shaped gland, a part of the endocrine system, found at the base of the neck. This gland creates the thyroid hormones, T3 and T4, that travel through the blood to all the parts of the body. The thyroid hormones control the body’s metabolism in many ways, such as the rate they burn calories and the rate of their heartbeat.

How do thyroid problems disproportionately affect women?

According to the American Thyroid Association, 1 in 8 women will develop thyroid problems during their lifetime, and women are 5-8x more likely than men to have thyroid disease. In women, thyroid diseases can lead to:

● Problems with their menstrual period. The thyroid helps control the menstrual cycle in women. Imbalanced thyroid hormones can make periods very light, heavy, or irregular. Thyroid diseases also can cause a condition called amenorrhea where periods stop for several months or longer. If the body’s immune system causes thyroid disease, other glands, such as the ovaries, may be involved and this can lead to premature menopause (before age 40).

● Problems getting pregnant. Thyroid disease can affect the menstrual cycle, when it does it also impacts ovulation and this can make it harder to get pregnant.

● Problems during pregnancy. Thyroid complications during pregnancy can cause health problems for the pregnant mother and her unborn child.

Symptoms of thyroid problems are sometimes mistaken for menopausal symptoms. Thyroid diseases, particularly hypothyroidism, is more likely to occur after menopause.

Who should get tested for thyroid disease?

A patient would want to talk to their doctor about getting tested if they:

● Have had a thyroid problem in the past

● Have had surgery or radiotherapy that affected the thyroid gland

● Have a health condition such as goiter, anemia, or type 1 diabetes

According to the U.S. Preventive Services Task Force, screening for thyroid disease is not recommended for most people.

Which types of thyroid diseases disproportionately affect women?

These thyroid diseases disproportionately affect more women than men:

● Disorders that cause hypothyroidism or hyperthyroidism

● Thyroiditis, especially postpartum thyroiditis

● Goiter

● Thyroid nodules

● Thyroid cancer

What is hypothyroidism?

Hypothyroidism (underactive thyroid) is when the thyroid does not make enough of the thyroid hormones. Not producing enough of these hormones slows down many of the body’s functions, like the metabolism.

The most common cause of hypothyroidism in the United States is Hashimoto’s disease where the immune system mistakenly attacks the thyroid. The attack damages the thyroid and it no longer makes enough hormones.

Hypothyroidism also can be caused by:

● Hyperthyroidism treatment (radioiodine)

● Radiation treatment for some cancers

● Removal of the thyroid

What are the signs and symptoms of hypothyroidism?

Symptoms of hypothyroidism progress slowly, often over the course of several years. At first, the patient may feel tired and sluggish. Later, they may develop other signs and symptoms of a slowed-down metabolism, including:

● Feeling cold when other people do not

● Constipation

● Muscle weakness

● Unexplained weight gain

● Muscle or joint pain

● Feeling depressed

● Feeling fatigued

● Dry, pale skin

● Thinning, dry hair

● Slow heart rate

● Decreased sweating

● Puffy face

● Hoarse voice

● Increased menstrual bleeding

The patient can also develop high LDL or “bad” cholesterol, which can increase their risk of heart disease.

How is hypothyroidism treated?

Hypothyroidism is managed with medicine that gives the body the hormones it needs to function normally. The most common medications are synthetic forms of the hormones that the thyroid naturally makes. Unfortunately, most patients need to take thyroid hormone pills for the rest of their life. When a patient takes the pills as directed, the pills are typically very safe.

What is hyperthyroidism?

Hyperthyroidism, or an overactive thyroid, causes the thyroid to make excessive hormones. This speeds up many of the body’s functions, like heart rate and metabolism.

The most common cause of hyperthyroidism is Graves’ disease, which is an immune system disorder.

What are the signs and symptoms of hyperthyroidism?

Symptoms of hyperthyroidism usually begin slowly so patients might not notice them at first. However, over time, a faster metabolism can cause symptoms like:

● Unexplained weight loss

● Eating more than usual

● Irregular or rapid heartbeat

● Feeling anxious or nervous

● Feeling irritable

● Having trouble sleeping

● Trembling of the fingers and hands

● Increased sweating

● Hot flashes

● Muscle weakness

● Diarrhea or an increased number of daily bowel movements

● Lighter and fewer menstrual periods

● Eye symptoms like bulging, redness, or irritation

Unfortunately, hyperthyroidism also increases a patient’s risk of developing osteoporosis. Osteoporosis is a condition that weakens bones and causes them to break easily. Hyperthyroidism can impact a patient’s bones before they notice any other symptoms and this is especially true of women who are post-menopausal or are already at high risk of osteoporosis.

How is hyperthyroidism treated?

The treatment chosen will depend on the patient’s symptoms and the cause of their hyperthyroidism. Treatments include:

● Medication.

○  Antithyroid medications block the thyroid from making new hormones without creating lasting damage to the thyroid.

○  Beta-blockers block the effects of thyroid hormones on the body but they don’t reduce the number of hormones that are made. These medications can help slow the heart rate and manage other symptoms. Beta-blockers are typically only used temporarily until another form of treatment can take effect.

● Radioiodine. This treatment destroys the thyroid cells that produce thyroid hormones. Usually, this causes permanent hypothyroidism.

● Surgery. Thyroid surgery removes the majority or all of the thyroid. This may also cause permanent hypothyroidism.

Come back next week where we will be discussing the second part of this series on thyroid complications; thyroiditis, goiter, nodules, and cancer.

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