Richard Shames, M.D. graduated Harvard and University of Pennsylvania, did research at the National Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for twenty five years. Dr. Shames practices holistic medicine -- with a focus on thyroid and autoimmune conditions -- out of Boca Raton, Florida, and has for twenty years been engaged in the search for answers about thyroid
disease. Karilee Halo Shames R.N., Ph.D., Dr. Shames' wife, is herself hypothyroid, and is a Clinical Specialist in Psychiatric Nursing and a Certified Holistic Nurse with a PhD. in Holistic Studies. The Shames have a book called Thyroid Power, published in June of 2001, talking about thyroid disease.
Mary Shomon: Is there a significant relationship between low thyroid and
increased menopause difficulties?
Drs. Shames: Yes, most certainly. Low thyroid is often the ignored factor in
far too many women who are simply treated with estrogen and/or progesterone.
Despite increased awareness in the medical community about the issues and interventions surrournding menopause, a disturbing number of women still suffer menopause difficulties despite hormone replacement therapy.
This misery is, of course, in addition to whatever increased risks are involved to women taking HRT, which are mainly endometrial and breast cancer, but also include increased risk of gall bladder disease and stroke.
The women involved expend a great deal of time, money, and heartache on hormone replacement, which frequently does not provide complete relief, because the underlying problem is not fully addressed.
This underlying problem is commonly coexistent hypothyroidism. Not only does low thyroid become more common as women mature, but in addition, menopause
and perimenopause are transition situations which require more than the
amount of thyroid hormone.
A borderline low thyroid woman might be well-compensated for most of her
and 40's, and then slip into overt hypothyroidism with the onset of
menopause. Moreover, administration of estrogen causes an increase in
thyroid-binding globulin, which "ties up" in the blood stream more thyroid
hormone than ever before. The bound thyroid is now not as free to enter
cells, and perform the needed metabolic work, however, it still exists in
the bloodstream, and therefore the standard tests for it (T-3 uptake,
T-4, Total T-3, and even the sensitive TSH) will be normal.
Mary Shomon: Just how common is low thyroid in women of menopausal age?
Drs. Shames: It happens to be extremely common, unfortunately. The doctors
the Thyroid Service of Harvard Medical School, and surveys done by University
of Colorado Health Sciences Center, have estimated that by age 50, one out
every ten-twelve women has some degree of hypothyroidism. By age 60, it is
one woman out of every five or six! This is clearly a runaway epidemic.
Furthermore, it is striking these women at a time when they can least
afford any loss of energy or decrease in coping mechanisms.
Mary Shomon: Are low thyroid symptoms being confused with menopausal symptoms?
Drs. Shames: Yes, but it's a complex issue. The symptoms of hot
flashes, insomnia, irritability, palpitations, and the annoying "fuzzy
thinking" so common in menopause can sometimes be the result of
thyroiditis, the most common cause of hypothyroidism. But the real
comes when actual symptoms of menopause are simply magnified and
because of the low thyroid situation that is now coexistent with
As many thyroid sufferers are aware, low thyroid makes any illness worse.
while menopause is not an illness, it can certainly begin to feel that way
when symptoms of low thyroid exacerbate the already annoying laundry list
female hormone symptoms.
Mary Shomon: What can a woman do when she has both hypothyroidism and menopause together?
Drs. Shames: First of all, find out to what extent menopause might have
playing havoc with your thyroid balance. In our Boca Raton practice, we
seen many women whose previously normal TSH levels begin to rise in their
early 50's. Sometimes this occurs well in advance of the rise in FSH
(follicle stimulating hormone test, usually ordered by one's
which confirms the metabolic onset of menopause.
Thus, for significantly symptomatic menopausal women, we recommend thyroid
testing, even though -- as we have said -- there are frequent false
This means that your tests may be normal but you may still be low thyroid.
The diagnosis is, in this situation, not generally helped by the basal
temperature test, because menopausal women obviously have higher than
temperatures with wide fluctuations.
One way out of this testing dilemma is to have your doctor order thyroid
antibodies tests in addition to the free T-3 and free T-4 tests, which may serve
a better indicator of your actual status. Anything suspicious with these
three tests, in our opinion, warrants a trial of thyroid hormone. This is our
opinion regardless of whether the woman in question is already on hormone
replacement therapy or is simply contemplating it.
Another maneuver is to consider a trial of thyroid hormone, especially if
there has been any incidence of thyroid disease in the extended family or
anytime prior in the individual's life. In fact, if the person has had
symptoms of low thyroid for many years, she would also be a candidate for
simply trying out the addition of thyroid hormone or some non-prescription
thyroid booster to her regimen.
Frequently, the underlying hypothyroidism is such a controlling factor
simply correcting it, sometimes even with homeopathic thyroid or over the
counter thyroid glandular, returns the whole system to fairly normal
function. Menopause continues, but it is a more mild, gradual, and
comfortable process. This is because thyroid is the energy throttle for
whole body, and especially the gas pedal for all of one's coping
Once you have the energy to go through the change more gracefully, life
become more normal.
As an added benefit to this recommendation, you may find that there is
need at this point for the estrogen. A lower dose, or a removal of
from your regimen, will decrease or eliminate the added risks associated
HRT. This is especially dramatic with women who are experiencing the
unexpected annoyance of "early menopause". We have seen, at our office,
numbers of women whose menopause in their mid-40's completely resolves
the simple addition of thyroid hormone. They become, instead, women who
a normal onset of menopause in their early 50's. The entire syndrome was
to borderline hypothyroidism, and as such, it went away completely with
thyroid hormone treatment.
Early or not, the severe menopausal symptoms of atrophic vaginitis,
unremitting insomnia, and extreme irritability, which do not resolve
adequately with estrogen or natural progesterone, can be tremendously
relieved by the addition of thyroid medication. Once treated, these women
now pleased to find that their problems of dry hair, dry skin, and
nails often resolve as well. All of this is why menopause authorities like
John Lee, MD and Christianne Northrup, MD, recommend that women with
persistent menopause difficulties be tested and treated for hidden low
Mary Shomon: Many women are concerned about thyroid hormone's effect on
their bone density. There is a great deal of controversy over this issue. What are your thoughts about it. Do you feel there is really such a problem?
Drs. Shames: In our view, no. Thyroid hormone is not at all the
villain that it has been painted to be in the past. The controversy
some years ago when research data on bone density and menopausal women was
beginning to be collected. The results seemed to suggest that thyroid
hormonen treatment was associated with a lowered bone density. Both
and patients alike became fearful of thyroxine, and tried to treat even
hypothyroidism with as little medicine as possible. This resulted in many
people receiving a dose too low to relieve their symptoms, but it was
considered a worthy tradeoff. Patients were told they would have to
suffering through some low thyroid symptoms now in order to preserve their
bone density for the future.
However, the studies at that time lacked the data available today from
generation TSH assays and high-resolution bone densitometers. In addition,
the groups of patients then being analyzed lacked the diversity necessary
accurate study. With further research now pouring in, it appears clear
thyroid medication - even in the higher doses some people need to feel
does not increase one's fracture risk in later years.
It is now well known that untreated or under-medicated hypothyroidism is
itself a leading cause of osteoporosis. It makes no sense to soft peddle
thyroid hormone treatment in the face of this new evidence. Careful
in the last few years indicates that proper doses of thyroid medication do
not increase fracture risk. This is fantastic news for millions of
Contrary to what you are likely to be told, you may safely take even a
dose of thyroid medicine, if you need it. All that is necessary for you to
on the safe side is any measurable amount of TSH on a third generation (*3
decimal points) TSH assay.
Furthermore, you are at risk for osteoporosis if you are low thyroid and
either don't know it or don't receive adequate treatment. In addition, of
course, it is important to do plenty of weight bearing exercise, take
1500-2000 mg. of a highly absorbable bone-friendly calcium product daily,
mineral rich foods, and consider supplementing with a trace mineral
(Note from Mary Shomon: Remember NOT to take your calcium at the same time as your thyroid hormone replacement, or you can interfere with absorption. Take thyroid and calcium supplements at least 2-4 hours apart. For more information, read How to Take Thyroid Drugs.)
Mary Shomon: If a woman suspects hypothyroidism as a factor in her menopause, but has so-called "normal" test results, what steps do you recommend?
Drs. Shames: We believe that women who are especially at risk for the
issues we've just described are those who have had decreased libido with
advancing years, a history of difficulty with their menstrual cycle,
experience with miscarriage or infertility, prior problems with ovarian
cysts, or even the hint of endometriosis. Moreover, if you have been a
person in your premenopausal years, had problems with weight, depression,
chronic recurrent infections, hard to diagnose digestive or
difficulties, or even just plain severe allergies, we suggest you consider
yourself a possible thyroid candidate.
Another useful bit of information would be whether any of your family ever
had a thyroid problem, an autoimmune disease (diabetes, rheumatoid
arthritis, colitis, etc), prematurely gray hair, chronic fatigue, episodic
anemia, mitral valve prolapse, carpal tunnel syndrome, or unexplained
episodic hair loss. If so, also consider yourself a likely low thyroid
candidate. You might do well with a clinical trial of thyroid hormone.
in mind that thyroid hormone is MUCH safer, with far fewer risks in the
and long term, than estrogen hormone that is so freely being offered.
We wish you every success during what has been, for many, a challenging
All women, at every stage, deserve to feel good and enjoy their life's
journey, especially those moving in a new direction on their continuing
It can and should be a special and enjoyable time.
For more information, and for the references upon which these answers are
based, please see our website and Thyroid Power, our June 2001 book.
TO CONTACT THE SHAMES:
Richard Shames, M.D. offers consultations by telephone, online or in person at his holistic health center in Boca Raton, Florida. To schedule an appointment, please telephone 866-468-4979. The same services are available with Karilee Halo Shames, Nurse Health Promotion Specialist, who teaches holistic nursing.