Case Study - Perimenopause / Thyroid Health

• Sally is a 42-year-old business owner and a divorced mother of 2 teenage boys
• Struggling with constant fatigue, steady weight gain, muscle aches and tenderness, and disrupted sleep - she assumed it was 'just' the perimenopause.
• Sally came to seek my help after trying to eat better and investing ￡300 in premium menopause supplements and seeing no improvements.

The first thing we did was carry out a full health screen to find out exactly what was happening. The tests showed Sally had very low vitamin D, iron and high TSH levels (thyroid stimulating hormone), which can indicate an underactive thyroid.

It's worthwhile noting that whilst targeted menopause supplements, like the ones Sally bought, can help alleviate some symptoms, it's important to get the basics checked if you're struggling with your health, as there could be something else going on that needs attention.

In Sally's case, the vitamin D and iron needed supplementing to bring them back to optimal levels. Without measuring her exact nutrient status, it's impossible to know this and to do it accurately. The TSH result needed further investigation to determine whether she did have hypothyroidism and, if so, what was the root cause.

Thyroid Health

Thyroid issues are quite common in women over 40, and the symptoms can easily be dismissed as perimenopause. The risk increases with age, and it's about 10 times more common in women than men. It's estimated that 12–20% of women over 60 have an underactive thyroid.

The thyroid – a butterfly-shaped gland located in the neck – is the body’s internal motor, effectively setting the speed at which the body works. If it’s not up to scratch, you might experience a whole host of uncomfortable or annoying symptoms (see below).

The hormones it makes affect most cells in the body by increasing the basal metabolic rate, as well as augmenting heat production. That’s why people with an underactive thyroid often struggle to lose weight, feel the cold more easily and have low energy – imagine a record player playing a record at reduced speed.

Do any of these sound familiar?

• I feel tired all the time
• My hands and feet are always cold
• I’m putting on weight for no reason
• I can’t seem to lose weight whatever I do
• I’m often constipated
• My muscles ache
• I get muscle cramps more often
• I feel irritable
• Generally, I’m feeling a bit low
• My periods are heavier than usual
• My hair and skin feel so dry
• My sex drive is flagging or non-existent
• I’m losing hair at the outer edge of my eyebrow.

If more than a few symptoms resonate with you, contact your GP to discuss symptoms and ask to get your thyroid tested.

GP testing

One of three things will happen after you have a blood test at the GP. The doctor may tell you your results look normal, in which case no further action will be taken*. Or you might be sent for further testing, if the result looks a little off, either immediately or for a retest in a few months.

It’s much more common to have an underactive thyroid than an overactive one, and more common still for the underactive thyroid to be an autoimmune condition called Hashimoto’s, where the immune system destroys the thyroid gland to the extent that it can no longer function normally.

However, even with a diagnosis, many people still experience symptoms despite treatment. ?

What actually gets tested?

In the UK, the first thing doctors test is Thyroid Stimulating Hormone (TSH) levels. TSH is the hormone that tells your body to produce the actual thyroid hormones. If TSH is within range, your GP is unlikely do any further tests on the assumption that the rest of the thyroid hormone-producing cascade is working correctly.

If TSH is raised, your body is working harder than necessary to produce the right levels of thyroid hormones. At this point, your doctor may repeat the TSH test in a few months in order to compare levels.

Alternatively, they might test your Thyroxine (T4) levels to determine whether or not you’re producing the right levels of this hormone.

If this level is below range, you’ll likely be prescribed a synthetic form of thyroxine to supply the body with what it is not making itself. If the levels are above range, which suggests an overactive thyroid, you may be prescribed carbimazole and perhaps a beta-blocker.

*Still feeling tired and ‘rubbish’ despite treatment?

This a common problem. Initially, you may start to feel better, but many patients report sliding back into their previous pattern of symptoms.

The reasons why you’re not feeling better can be complex.

1. Supplementing with T4 might not work, as what’s going on in your body might be more complicated and involve several issues.
2. Some people produce enough TSH and T4, but T4 isn’t actually the hormone that does the work.
3. Triidothyronine (T3) is the ‘work horse’ that needs to be converted in the liver from T4. Some people, for various reasons, simply don’t convert it very well.
4. In other cases, you might produce enough TSH, T4 and T3, but the body negates the effects of the usable T3 by making reverse T3 (rT3) –literally reversing the action of T3.
5. Everything may ‘look normal’, but if you’re still dragging yourself through the day, you could have sub-clinical thyroid problems. GP ranges are quite broad, so it’s easy to fall outside the limits.

It’s worth knowing that regular GP testing does not cover T3 or rT3, so if you’re still feeling below par, it’s worth getting a full thyroid blood screen done privately. I work with all major private laboratories and can arrange this for you.

Do you have an autoimmune thyroid problem?

Another vital piece of information, which isn’t often covered by the standard GP test, is for the presence of autoimmune thyroid antibodies (thyroid peroxidase and thyroglobulin). This indicates your immune system is attacking your thyroid.

The autoimmune disease Hashimoto’s Disease (a form of underactive thyroid) is incredibly common but unless your GP tests for the antibodies, you won’t know that you have it.

GPs generally don’t test for this as it doesn’t affect their clinical management of you – whatever the diagnosis, you’re still going to be prescribed thyroxine.

However, this test is important to nutritional therapists, as the diagnosis requires an entirely different treatment protocol.

You may have high levels of these antibodies, but no symptoms of an underactive (or overactive) thyroid. The autoimmune element always comes first.

Hashimoto’s (underactive) and Graves’ (overactive) Disease affect the thyroid, but they are actually immune system disorders.

Adrenal stress - the missing link in thyroid treatment

Thyroid health is closely connected with your adrenals (two walnut-shaped stress glands located on your kidneys). If you have had any significant stress, your adrenal glands may not be performing optimally – and this is very bad news for thyroid health.

Adrenal stress disrupts the complex network of interactions needed to make the right amount of thyroid hormones, suppressing the thyroid function.

There are tests available privately for this. Unfortunately, adrenal problems are not recognised by UK GPs.

Addressing adrenal problems is important because the effects of stress affect energy production, fat storage (storing fat around the middle) and female hormone health.?

The importance of iodine

The mineral iodine is essential for the manufacture of thyroid hormones triidothyronine (T3) and thyroxine (T4)? Thyroid hormones contain three or four iodine atoms respectively. If you’re serious about fixing your thyroid for once and for all, you could consider a urine test to determine whether or not you have sufficient levels of iodine.

Ready to get that thyroid back into shape?

There are several different tests, which we can use to measure your thyroid levels. These include a full blood draw, finger prick blood spot test and a urine test. I take a full medical history and evaluate my clients before deciding on the best option.

If you have an underactive thyroid and are feeling below par, despite medication, I can help. Medication is just a piece of the puzzle. If you would like my input drop me a DM.