heart, muscles, and body weight. Known as T3 (triiodothyronine) and T4 (thyroxine), these hormones are produced when the pituitary gland in the brain tells the thyroid, via the hormone TSH (thyroid stimulating hormone), how much to make. If the pituitary senses that levels of T3 or T4 are low, it gooses up production of TSH in the hope that the thyroid will get the message. An estimated 20 million


Americans are thought to have some form of thyroid disease—and up to 60 percent don’t know it, according to the American Thyroid Association. A woman’s lifetime risk of developing a thyroid disorder is the same as her lifetime risk of breast cancer: one in eight. Most sufferers make inadequate amounts of the hormones, typically because their immune system has mistakenly attacked the thyroid gland, damaging its cells—a condition known as Hashimoto’s thyroiditis. The paradox is that blood tests show high TSH numbers. A much smaller number of people—from 1 to 2 percent of Americans—make too much of these hormones, typically from Graves’ disease. As Glueck observes, symptoms


of hypothyroidism mimic those of perimenopause, or a number of other conditions. They commonly include fatigue, joint or muscle pain, depression, constipation, thinning hair, and weight gain. Those for hyperthyroidism include restlessness, heart palpitations, and weight loss. But not every woman follows the textbook. Robert W. Rebar, MD, executive director of the American Society for Reproductive Medicine based in Birmingham, AL, recalls one midlife woman with hyperthyroidism who found herself packing on pounds; her condition not uncommonly exacerbated her appetite, but because she owned a bakery she was able to indulge her craving all day long.


What’s In a Number? When a woman reports these symptoms, her doctor should order a blood test to evaluate the level of TSH. Most also test T4, or, alternatively, “free T4,” which is the amount available to the cells. (Some doctors also test “free T3” and evaluate antibodies against the thyroid, but this is less common.) The biggest challenge for


women is that the medical community has not fully settled on what numbers warrant treatment. “There is great debate within the medical community about what is the level where treatment should begin,” Rebar says, noting that some doctors treat when the TSH


50. If you have certain risk factors, such as a strong family history of thyroid disease, or you have diabetes or other autoimmune disease, you may need to be screened earlier or more often. Caren Marshall, a stay-at-home mom in Midland, TX, got caught in the cross-hairs of the lack of diagnostic consensus. Over the years, the now 43-year-old had periodically queried her doctors about whether her obesity might be caused by a faulty thyroid, because Marshall worked out daily and severely restricted her calories but continued to gain weight. She was also exhausted, losing hair, and having trouble sleeping. After


“The symptoms associated with thyroid problems—especially mood changes, sleep issues, and cognitive functions—are the same as for perimenopause.”


AGE50


is 3, others 4 or 5, while others say a TSH up to 10 is fine so long as T4 levels are normal. Adding to the confusion, he says, is the fact that thyroid function changes over time, so what might be ideal in your 20s is probably not a realistic target at 50. As part of your annual well


woman exam, your ob-gyn manually examines your thyroid gland to detect any enlargement or problems. The American Congress of Obstetricians and Gynecologists recommends regular TSH screening for thyroid disease every five years beginning at age


ACOG recommends regular TSH screening for thyroid disease every five years beginning at age 50


several doctors brushed off her request to test her thyroid, one finally acquiesced. Her TSH came back just under 4, and he declared she didn’t warrant treatment. Two years ago she found another physician and showed him her lab results. “He said he would have treated me with those numbers. I was so angry when I heard that,” she says. A new test revealed that her TSH had risen above 7. But despite a prescription for the T4 replacement drug Synthroid®, her symptoms didn’t improve much. Another physician put her on the T3 drug Cytomel®; she is finally sleeping


FALL / WINTER 2011 pause 19


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44