Is it Your Thyroid—or Menopause?

“I wonder if I have a thyroid problem.” That’s something we hear frequently at Midi, and we aren’t surprised that patients are concerned. When your health goes awry—maybe you’ve been feeling sluggish, gaining weight, or noticing that your ponytail is skimpier—it’s easy to blame our hormones (and, real talk: it often is our hormones). But that doesn’t necessarily mean your thyroid hormone is to blame. The more common reason: menopause.  

Read on to learn why thyroid disorder and menopause are so easily confused, and how to find the care you need to be screened, and sometimes treated, for both.

What is the thyroid? 

Your thyroid is a small, butterfly-shaped gland located in the front of your neck. It’s part of the endocrine system—a network of glands and organs that make hormones and release them into your circulatory system. 

The two main hormones produced by the thyroid— thyroxine (t4) and triiodothyronine (T3)—control every part of your body at every stage of life, including menopause. These hormones travel to other organs and tissues in your body to regulate metabolism, digestion, heart rate, body temperature, brain development, and more.  

The production of these hormones is controlled by the pituitary gland (also part of the endocrine system). The pituitary releases thyroid stimulating hormone (TSH) into your bloodstream, which activates the thyroid to make more thyroid hormone. Similar to how a thermostat turns on the heat when the room temperature drops, if the pituitary senses that thyroid hormone levels are low, it makes more TSH. And when thyroid hormone levels balance out, the pituitary stops TSH production. 

Different types of thyroid disorder

For the majority of people, this system that regulates the thyroid and release of thyroid hormones operates smoothly. But there are several conditions that can cause the thyroid to make too much or not enough thyroid hormone, leading to thyroid disorder. 

Some of the different types of thyroid disorders are: 

• Hypothyroidism: The most common thyroid disorder, hypothyroidism occurs when the thyroid doesn’t produce enough thyroid hormone. An underactive thyroid may make you feel sluggish, foggy-headed, tired, and cold and can cause weight gain.
  
  An autoimmune disorder called Hashimoto’s disease is the most common cause of hypothyroidism and is most prevalent in middle-aged women. Hashimoto’s progresses slowly, which can make symptoms (such as fatigue, increased sensitivity to cold, sleepiness, dry skin, constipation, and muscle weakness or aches) difficult to notice.
• Hyperthyroidism: Hyperthyroidism occurs when the thyroid produces too much thyroid hormone. An overactive thyroid can cause restlessness, nervousness, fatigue, and increased hunger and you may experience weight loss, a rapid heartbeat, and sweating.
  
  An autoimmune disorder called Graves’ disease is the most common cause of hyperthyroidism. Graves’ symptoms include anxiety, hand tremors, sensitivity to heat, weight loss, and enlargement of the thyroid gland. About 30% of people with Graves’ disease have signs of Graves’ ophthalmopathy, which is marked by bulging eyes or a gritty sensation, pressure, or pain in the eyes. 
• Goiter: An enlargement of the thyroid gland. In addition to swelling, symptoms include coughing and, less commonly, throat tightness or trouble breathing. 

If left untreated, thyroid disorder can cause complications such as high blood pressure, high cholesterol, fertility problems, osteoporosis, eye conditions, and early menopause. 

A near-twin to menopause

The confusion between thyroid disorder and menopause starts with the fact that many thyroid disease symptoms are practically identical to menopause symptoms. The telltale menopause hot flash symptom, for example, can also be experienced by someone with hyperthyroidism. Similarly, fatigue, memory problems, increased sweating, and weight gain are common both during menopause and with hypothyroidism. 

It doesn’t help that the timing of thyroid disorder often coincides with the menopause journey. While thyroid disorders can develop earlier in life (and even be present at birth), women are more likely to develop hypothyroidism after menopause. 

Symptom similarities between thyroid disease and menopause

Because the symptoms are so similar, it’s all too easy to brush off signs of a thyroid condition as menopause side effects or even everyday complaints (who doesn’t feel tired?). In fact, up to 60% of people with thyroid disease are unaware of their condition. And while it’s true that you’re more likely to be going through menopause than dealing with a thyroid issue (one in eight women will have thyroid disorder in her lifetime while 100% will go through menopause), it’s important not to let a thyroid disorder go undiagnosed.

Testing for thyroid disorder

To determine if thyroid disorder or menopause (or both!) is the issue, Midi starts with listening and screening. Clinicians take careful note of a patient’s symptoms and health history and may prescribe a blood test to help rule out a thyroid disorder. Midi recommends thyroid testing for patients with any potential symptoms of thyroid disorder, including fatigue, depression, mood swings, unexplained weight loss or gain, sleep disturbances, palpitations, agitation, or hair thinning.

The blood test most commonly used to check thyroid function is a thyroid stimulating hormone blood test. A high level of TSH suggests that your pituitary’s thermostat is reacting to low thyroid hormone levels due to hypothyroidism. A low level of TSH points to too much thyroid hormone (hyperthyroidism). Other types of thyroid blood tests and imaging tests (including CT scans and ultrasounds) may be used to confirm a thyroid disorder diagnosis or help identify the cause. 

If your test finds normal thyroid hormone levels, it’s likely that your symptoms are due to the hormone changes of menopause. If that’s the case, evidence-based treatments are available to help you feel like yourself again. But if you’re diagnosed with a thyroid disorder, Midi clinicians will help you manage both your thyroid and menopause treatment in an orchestrated way. This typically involves screening and treating for thyroid disorders while evaluating and addressing any remaining menopause symptoms.

Thyroid disorder treatment

Thyroid disorder can’t always be cured, but it can be treated. This often involves taking a daily medication that helps return thyroid hormone levels to normal.

• Treatment for hypothyroidism: In most cases, hypothyroidism is well managed with oral levothyroxine (T4), an FDA-approved formulation that acts like the hormone your body naturally produces. Once normal thyroid hormone levels are restored, symptoms like weight gain or high cholesterol are likely to go away.
• Treatment for hyperthyroidism: Hyperthyroidism requires a specialist (usually an endocrinologist) for care and treatment. Thyroid hormone blockers are commonly prescribed to reduce the amount of hormones the thyroid produces. 

Additionally, radioactive iodine (which destroys most or all of the tissue in the thyroid gland), steroids, and beta blockers may be used. Patients who have severe symptoms or do not respond to medication may need a surgery called a thyroidectomy, which removes a portion of or your full thyroid gland. 

Menopause and thyroid treatment

For women with hypothyroidism, the shift in estrogen levels during menopause can influence thyroid treatment. When estrogen levels start to dip at the start of menopause, levothyroxine dosage may need to be lowered too. 

But if someone starts taking hormone replacement therapy (HRT), which causes estrogen levels to go up slightly, levothyroxine dose may need to be increased. That’s why Midi recommends that patients with thyroid disorder have their levels rechecked in the first few months after starting HRT.

What Midi clinicians want you to know

Menopause and thyroid disorder have many similarities. They are both hormonal disruptions that can—individually or simultaneously—affect women during midlife. And their symptoms tend to overlap, which can be confusing! That’s why it’s important to seek care from a qualified clinician who is familiar with menopause and thyroid disorder. 

Midi clinicians consider menopause symptoms in the context of your whole health to help ensure that a thyroid disorder doesn’t go undiagnosed and guide you to the best treatment plan for your specific health concerns. Whether you’re going through menopause or experiencing a thyroid problem, or both, treatment is available—and effective.