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Latest Update:

The Thyroid/Menopause Connection
Information from Richard and Karilee Shames

by Mary Shomon

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 usual amount of thyroid hormone.

A borderline low thyroid woman might be well-compensated for most of her 30's 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 the cells, and perform the needed metabolic work, however, it still exists in the bloodstream, and therefore the standard tests for it (T-3 uptake, Total 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 on 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 of 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 Hashimoto's thyroiditis, the most common cause of hypothyroidism. But the real complexity comes when actual symptoms of menopause are simply magnified and exaggerated because of the low thyroid situation that is now coexistent with menopause. As many thyroid sufferers are aware, low thyroid makes any illness worse. And 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 of 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 been playing havoc with your thyroid balance. In our Boca Raton practice, we have 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 gynecologist), 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 negatives. 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 normal 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 as a better indicator of your actual status. Anything suspicious with these last 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 that 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 the whole body, and especially the gas pedal for all of one's coping mechanisms. Once you have the energy to go through the change more gracefully, life can become more normal.

As an added benefit to this recommendation, you may find that there is less need at this point for the estrogen. A lower dose, or a removal of estrogen from your regimen, will decrease or eliminate the added risks associated with HRT. This is especially dramatic with women who are experiencing the unexpected annoyance of "early menopause". We have seen, at our office, large numbers of women whose menopause in their mid-40's completely resolves with the simple addition of thyroid hormone. They become, instead, women who have a normal onset of menopause in their early 50's. The entire syndrome was due 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 are now pleased to find that their problems of dry hair, dry skin, and cracking 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 thyroid.

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 osteoporosis villain that it has been painted to be in the past. The controversy started 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 doctors and patients alike became fearful of thyroxine, and tried to treat even overt 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 continue 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 third generation TSH assays and high-resolution bone densitometers. In addition, the groups of patients then being analyzed lacked the diversity necessary for accurate study. With further research now pouring in, it appears clear that thyroid medication - even in the higher doses some people need to feel best - 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 research in the last few years indicates that proper doses of thyroid medication do not increase fracture risk. This is fantastic news for millions of women.

Contrary to what you are likely to be told, you may safely take even a stiff dose of thyroid medicine, if you need it. All that is necessary for you to be 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, eat mineral rich foods, and consider supplementing with a trace mineral product.

(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 chilly person in your premenopausal years, had problems with weight, depression, or chronic recurrent infections, hard to diagnose digestive or musculoskeletal 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. Keep in mind that thyroid hormone is MUCH safer, with far fewer risks in the short 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 time. 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 path. 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.


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.

Sticking Out Our Necks and this website are Copyright Mary Shomon, 1997-2003. All rights reserved. Mary Shomon, Editor/Webmaster
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