Most Common Thyroid Problems In Women

The thyroid can cause a lot of problems for women, including weight changes and depression. Lifescript asked thyroid expert Elizabeth Pearce, M.D., to explain why. She talks about the difference between hyperthyroidism and hypothyroidism and answers questions about risk, diet, pregnancy, testing and more.

Ever wonder why you don’t hear much about guys and thyroid problems? Although men have the gland, they’re less likely to develop problems with it. In fact, about 1 in 8 women will develop a thyroid problem in their lifetime.

So what issues should women watch out for? Lifescript asked Elizabeth Pearce, M.D., a clinical endocrinologist and associate professor at Boston University School of Medicine, for answers.

Read on to find out how diet, pregnancy and smoking can all affect your risk of thyroid disease.

What’s the biggest thyroid problem women face?
The most common is hypothyroidism, when the thyroid doesn’t make enough thyroid hormone. Without this hormone, your metabolism slows and you may gain weight, feel sluggish and tired, and get depressed. Your periods may become irregular and you may have dry skin and nails.

About 10% of all women have an underactive thyroid; the condition affects about only 3% of men.

What increases the risk of thyroid disease?
The types and frequency of thyroid disease's forms vary around the world, based on the amount of iodine in the diet.

Smoking also increases risk.

Don’t we get enough iodine in our diets from iodized salt?
Overall, Americans have been getting enough iodine since salt iodization was started in the 1920s. But the amount in the American diet has decreased by about half since the 1970s. That’s partially due to a decline in the amount of [iodized] salt we eat.
But there’s also less iodine in certain foods than before, particularly cow’s milk and bread. That’s because iodate dough conditioners are used less often by many bread manufacturers.

Also, federal legislation in the 1980s limited the amount of iodine in cattle feed, which may be one reason why milk has less iodine.

In fact, 30% of the salt we purchase for household use in this country isn’t iodized. Most sea salt, for example, doesn't contain iodine. In addition, most of the salt we eat is in commercially processed foods and many commercial food processors use non-iodized salt.

Why is iodine deficiency a concern?
Iodine deficiency is a huge problem in some countries, especially for pregnant and breastfeeding women. Because iodine is needed to make thyroid hormone, which is needed for brain development, iodine deficiency can cause brain damage in unborn babies.

In the U.S., the American Thyroid Association has recommended that all pregnant or breastfeeding women take a prenatal vitamin that contains 150 mcg of iodine daily.

Why do some women have thyroid problems after pregnancy too?
As many as 1 in 10 women develop postpartum thyroiditis – inflammation of the thyroid within several months after giving birth.

When the thyroid gets inflamed, it can leak out hormone, so you become a little hyperthyroid [when the gland overproduces thyroid hormone]. Then, when you run out of thyroid hormone, you may become hypothyroid until your gland heals.

Symptoms can be very subtle. Some women lose weight; others feel anxious. You might blame these things on being a new mom. But if the diagnosis is missed, it’s not usually critical. If it’s really mild, you just watch it. The whole thing resolves within several months in most women.

If it’s severe, you may need treatment for the symptoms.
In most women, the hyperthyroid and hypothyroid phases last several weeks. But not all women experience both phases. About 5% of women will be left with permanent hypothyroidism.

It tends to recur in subsequent pregnancies and it’s also more common in women with autoimmune diseases.

So should all pregnant women get a thyroid test?
The concern is that low thyroid hormone in pregnant women may be associated with lower IQ in their children.

Universal thyroid screening in expectant women has been controversial. The American Association of Clinical Endocrinologists suggests that all pregnant women should be tested. The American Congress of Obstetricians and Gynecologists says that asymptomatic women should not be tested. The Endocrine Society recommends testing if a woman has symptoms of hypothyroidism or if she has anti-thyroid antibodies, a family history of autoimmune disease or other risk factors for hypothyroidism.

Why the controversy?
There are three reasons: One, getting your thyroid tested is costly.

Two, healthy pregnant women often have thyroid blood test results outside what’s considered normal (due to physiologic changes during pregnancy). Most labs can’t provide normal, trimester-specific reference ranges, so inappropriate interpretation and treatments are possible.

And three, we don’t know if hypothyroidism treatment improves outcomes in babies; that’s being studied.

The American Thyroid Association and Endocrine Society have convened task forces that will update their testing and treatment guidelines pregnancy within the next 1-2 years.
How do you know if you have hypothyroidism?
It’s tricky, because many of the symptoms are vague and can be easily blamed on lifestyle. Fatigue, for instance, may be the result of being busy, not just an underactive thyroid. Weight gain may come from eating too much or not getting enough exercise.

You need to get a TSH test – a blood test that measures the amount of thyroid-stimulating hormone in your blood. If your thyroid isn’t making enough thyroid hormone, your pituitary will make more TSH, which tells the thyroid to make more of its hormone.

How is hypothyroidism treated?
You take a synthetic version of thyroid hormone in a pill to replace what your body isn’t making.

Can your thyroid go in the other direction, becoming too active?
Hyperthyroidism is much less common than hypothyroidism, affecting just 1% of the U.S. population. It’s also more complex and difficult to diagnose and treat.

In hyperthyroidism, the thyroid is making too much thyroid hormone, which can cause shakiness, heart palpitations, insomnia and weight loss.

How do you treat hyperthyroidism?
Depending on the cause, it can be treated with anti-thyroid medications, radioactive iodine or surgery to remove the thyroid.

There are two anti-thyroid drugs that can be used to treat hyperthyroidism: PTU (propylthiouracil) and methimazole. The Food and Drug Administration (FDA) determined that, of the two medicines, methamizole should be the first treatment in almost all cases, because PTU has been implicated in rare cases of liver failure.
Whatever you do, if you have hyperthyroidism, make sure you have an experienced [doctor] taking care of it.

Why are we hearing a lot about thyroid cancer lately?
The U.S. incidence of thyroid cancer rose from 3.6 per 100,000 people in 1973 to 8.7 in 2002. In 2009, estimates show about 37,000 new cases diagnosed and 1,630 thyroid cancer deaths.

A lot more people are getting CT scans and ultrasounds, so maybe we’re catching more thyroid cancer. But the true incidence may be growing. There might be environmental reasons, such as changes in radiation exposure or diet.

Though it’s a common cancer, it tends to be very treatable. Exact treatment depends on your age, the size and type of the tumor and whether the cancer has spread to other organs. Thyroid cancer tends to be more common [as women] age.

If you have thyroid cancer, you may have the thyroid surgically removed and there may or may not be additional treatment with radioactive iodine.

What can women do to keep their thyroids healthy?
Not much, other than not smoke. If you live in the U.S., you can assume you’re getting enough iodine in your diet. Unless you’re pregnant, breastfeeding or planning a pregnancy, you shouldn’t have to do anything.

You should be aware of what the front of your neck feels like. If you feel any new lumps, which could be thyroid nodules, tell your doctor.

Most thyroid nodules aren’t cancerous, but they still need to be checked out. They also don’t always cause symptoms. Many people really have no idea they have one until a doctor feels it or it gets picked up on imaging.
So when you have a check-up, should you ask for a TSH test?
If you have symptoms of hyperthyroidism or hypothyroidism, you should definitely have a TSH test. However, experts disagree about routine testing in people without symptoms.

The U.S. Preventive Services Task Force says there’s no evidence for routine screening. The American Thyroid Association, on the other hand, says every adult should start routine TSH screenings every 5 years starting at age 35.

Do You Have Thyroid Disease?
Always cold or hot? Heart racing a mile a minute? Whether underactive or overactive, a thyroid problem can make your body feel out of whack. Knowing the symptoms can help your doctor diagnose the problem and get you feeling better fast.