A tiny butterfly-shaped gland at the base of your neck has an important role in overall well-being; it helps regulate body temperature as well as metabolism (how fast you burn calories). When the thyroid is under-performing or over-performing, issues start to crop up and women, who this mostly affects, begin to feel off, gaining weight, feeling more tired or listless than usual.

An interesting study on subclinical hypothyroidism alerts us to issues such as weight gain and hair loss that may be symptoms of the thyroid being overactive or underactive. However, before jumping to a self-diagnosis, you should consider your family’s genes and inherited traits related to weight and hair, because these also show up at middle age, just simply as a factor of getting older. If you have eliminated those as family traits as possibilities, it may be time to consider some blood tests to see what is going on.

The confounding factor about the thyroid is that the range of normal levels of most hormones is very wide. Because of this, a person may have thyroid hormone levels on the threshold for needing treatment, but still in the “official” normal range. Getting too much thyroid medication to optimize one’s blood results, can lead to other serious medical complications such as heart attacks and cardia arrhythmias (irregular beats), as well as bone loss, osteoporosis, and fractures. So, it is imperative to get the dosage just right. An expert in medical endocrinology or reproductive endocrinology (like me), understands these issues and can make slight adjustments to optimize thyroid replacement or supplementation, which often results in the patient feeling much better, with less fatigue, while minimizing the risk of side effects such as cardiovascular and skeletal disorders.

I always try and look at the whole patient, not just their symptoms or their laboratory values. I take into account the other medications that patients may be taking, which could have an impact on well-being. For example, if a patient is taking an oral hormone therapy to mitigate menopause symptoms, this can upset the normal thyroid balance, so it is vital to find the right balance of both these hormones. Similarly, younger women on birth control pills may experience excessive weight gain because their contraception has thrown off their thyroid. Once the optimal thyroid treatment is determined, the patient can stay on that dosage for a long time. Like butterflies, each patient is unique and a personalized approach works best.

Key Points

  • There is no “one size fits all” thyroid treatment.
  • Most women should be screened around the onset of menopause, if there they are considering going on hormone treatment, to find the thyroid’s baseline levels.
  • Women with rapid and excessive weight gain should be tested.
  • If there is a family history, patients should be screened at age 35 or if other signs of hyper or hypothyroidism are present.
  • Heart attacks, cardiac arrhythmias, and bone loss – occur later in life and are asymptomatic until they occur. Over-treatment with thyroid medication can causes these disorders down the road.
  • To learn more please call the office at (202)293-1000 or email the practice at info@intimmedicine.com.


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