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Your thyroid gland is a butterfly-shaped gland just in front of your windpipe. Its job is to control your metabolism. When your thyroid gland doesn’t work properly, you may notice symptoms such as palpitations and weight loss (caused by an overactive gland) or depression and hair loss (caused by an underactive gland). Two in every 100 people in the UK will suffer from a problem with their thyroid gland, and 3% of women aged 50 or over are taking thyroid hormones.

This article was included in issue 84 (spring 2020) of The Menopause Exchange newsletter.

Thyroid hormone levels
Two hormone levels are usually checked in a thyroid function blood test (TFT): TSH and T4. TSH (thyroid stimulating hormone) is released by the pituitary gland in your brain and triggers your thyroid gland to release two more hormones, thyroxine (T4) and triiodothyronine (T3), into your bloodstream. Your T3 levels are usually only checked on special request.

Underactive thyroid gland
If your thyroid gland is underactive, it makes too little thyroxine; a condition called hypothyroidism. This can be present when you’re born (congenital) or develop in later life (acquired). Acquired hypothyroidism can occur after you’ve had treatment for thyroid cancer or an overactive thyroid, or may occur naturally.

The symptoms of an underactive thyroid gland include tiredness, weakness, putting on weight, dry skin and hair, low mood, poor concentration and memory and constipation. A raised TSH level and low T4 shows that your thyroid gland isn’t responding to the TSH and is producing too little thyroxine.

Treating an underactive thyroid gland involves replacing the missing thyroid hormone with levothyroxine tablets. You’ll need to have regular blood tests every three months or so until your TSH and T4 levels are back in the normal range, and then every year. Even though blood tests may show the thyroid gland to be back to normal, some women still feel unwell, but it’s very important not to self-medicate as levothyroxine is a very powerful medicine.

Subclinical hypothyroidism
Subclinical hypothyroidism is when your T4 level is normal but your TSH level is higher than normal. Current guidelines advise taking thyroxine for up to three months to normalise your TFT levels. If your symptoms don’t disappear, you may be able to stop taking thyroid hormone, as there’s no evidence that this type of underactive thyroid damages your health. Treatment with T3 replacement or animal-derived thyroid products isn’t recommended as there’s no evidence that these remedies work and not enough is known about their long-term safety.

Overactive thyroid gland
An overactive thyroid gland is less common; this is called hyperthyroidism. The two main causes in the UK are autoimmune thyroid disease (Graves’ disease) and non-cancerous thyroid nodules (lumps).

If you have hyperthyroidism, your body’s metabolism speeds up, causing tiredness, sweating, problems with tolerating heat, weight loss, difficulty sleeping, palpitations and anxiety. Patients with Graves’ disease can develop eye problems and, if not treated early enough, this can result in bulging eyes and problems with vision. Blood tests show a low TSH and a higher-than-normal T4 level.

Hyperthyroidism is usually treated by an endocrine specialist in a hospital, although your GP may start some treatment, such as propranolol, to slow your heart rate and avoid heart problems while you’re waiting for the hospital appointment. Subclinical hyperthyroidism is a relatively new diagnosis. This is when your T4 levels are normal alongside a persistently low TSH.

At the menopause
An underactive or overactive thyroid can cause similar symptoms to the menopause. Some women only have one or two symptoms with highly abnormal blood tests. A TFT blood test is therefore one of the most-often requested GP tests, as it can be so difficult to accurately diagnose thyroid disease, despite someone appearing to ‘tick all the boxes’. As thyroid problems increase with age, and most occur over the age of 60 in the UK, women are more often diagnosed during and after the menopause. You can take thyroid replacement with HRT. But if your thyroid is underactive, your dose of levothyroxine may need increasing, due to the hormones in your HRT.

Your diet and your thyroid gland
With vegan diets becoming more popular, it’s worth noting that most plant-based milks have very low levels of iodine, about 2% of the level in cow’s milk. Iodine is essential for the normal function of your thyroid gland. People living in areas of the world where natural iodine levels are low can get enlarged underactive thyroid glands (a ‘goitre’). Some manufacturers are starting to add iodine to their products.

The same situation can occur with soy products known as phytoestrogens. There appears to be no problem with these if your thyroid gland is working normally, but if your thyroid is slightly underactive, soy foods may increase your risk of hypothyroidism. So it’s a good idea to check you have a good dietary intake of iodine. Women taking levothyroxine and using phytoestrogens may need to have a higher dose of levothyroxine, as there’s evidence these foods may block the absorption of thyroid hormones.

An overactive or underactive thyroid can cause your bones to become thinner and prone to osteoporosis, resulting in an increased risk of a hip fracture. There’s no evidence that subclinical hyperthyroidism has similar dangers.

Thyroid disease can mimic many symptoms but is easily diagnosed with a blood test through your GP. Don’t be misled by non-medical specialists offering unproven treatments; thyroid disease can be dangerous and potentially life-threatening if it’s not treated properly by a qualified healthcare professional.

About the author
Dr Jeni Worden is a GP in Christchurch, Dorset, with a special interest in Women’s Health and particularly the menopause.

Created Spring 2020 

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