Thyroid Problems in Midlife

Patient Information |
June 24, 2014

Thyroid Problems in Midlife

  1. Diane Judge, APN/CNP

Symptoms of hypo- or hyperthyroidism are similar to changes that occur during the menopause transition, sometimes making them difficult to interpret.

  1. Diane Judge, APN/CNP

Your thyroid gland is part of your endocrine system, a group of organs that produce hormones to control your body's many functions. When your clinician presses on the front of your neck and asks you to swallow, he or she is examining your thyroid. You might be able to feel your own thyroid gland by putting two fingers on one side of your larynx (voice box) and the thumb on the other side, pressing gently. A normal thyroid is smooth and butterfly shaped, with each half on either side of your larynx and connected by a thin band of tissue. A larger-than-usual thyroid gland is called a goiter.

The Thyroid's Balancing Act

Thyroid hormones have far-reaching effects on features such as weight, muscle strength, skin texture, memory, heart rate, menstrual periods, and energy levels. Thyroid disease can be difficult to diagnose in midlife (around ages 40–60). Symptoms that your thyroid is not working normally include menstrual cycle changes, fatigue, problems sleeping, and changes in mood, hair, and skin. You may recognize these as some of the changes that also go along with the menopause transition.

The most common thyroid problems are hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid). These conditions can be diagnosed with a blood test to measure thyroid-stimulating hormone (TSH). When the thyroid is underactive, the pituitary gland releases more TSH to signal the thyroid to produce more thyroid hormone. If the thyroid is overactive, the pituitary releases less TSH, therefore signaling for less thyroid hormone. So with an underactive thyroid, your TSH level will be high — and with an overactive thyroid, your TSH will be low.

Because thyroid problems are common in midlife women and the symptoms often confusing, some experts suggest routine TSH testing in this age group (although studies have not yet shown this to be beneficial). However, if your parents, siblings, or children have thyroid problems, or if you have had thyroiditis (thyroid inflammation) after a pregnancy, previous hyperthyroidism treatment, or type 1 diabetes or other autoimmune diseases, you are more likely to develop thyroid problems. Make sure your clinician knows your health history, and ask whether you should be tested.

Hyperthyroidism (Overactive Thyroid)

Symptoms of hyperthyroidism include unexplained weight loss, irritability or nervousness, shakiness, disturbed sleep, vision problems, rapid or irregular heart rate, diarrhea, and feeling too hot when others are comfortable. The most common cause of hyperthyroidism is Graves disease — a condition in which your immune system fools the thyroid into overworking.

Women with hyperthyroidism are usually referred to an endocrinologist to discuss treatment options. Choices include oral antithyroid medications to decrease the amount of hormone your thyroid produces, surgery to remove most or all of the gland, or radioactive iodine to destroy the thyroid tissue. While tests are being done and treatment decisions made, you may be prescribed medication to control uncomfortable symptoms such as rapid heart rate and shakiness.

Hypothyroidism (Underactive Thyroid)

Hypothyroidism is more common than hyperthyroidism and is most often caused by a condition called Hashimoto thyroiditis. With this condition, your body thinks that your thyroid doesn't belong there and attacks it. In trying to protect you, your body damages the thyroid tissue, sometimes causing a goiter and reduced thyroid hormone production.

Symptoms of hypothyroidism include unusual fatigue, constipation, unexplained weight gain, mood swings, forgetfulness, change in voice quality, not being able to tolerate cold temperatures, and coarsening of the hair, skin, and nails. Hypothyroidism also can cause high cholesterol levels and heavy, infrequent periods.

Hypothyroidism is easy to treat. Your clinician will prescribe thyroid hormones in pill form to replace what your thyroid gland can no longer make. You will need to take the pills daily for the rest of your life. Especially when the medication is first prescribed, you should have regular blood tests to make sure the dose is correct. The first test is done 6 to 8 weeks after you start medication. Before each blood test, tell your clinician if you've been skipping pills. If you have missed some, don't take extras to “catch up” right before your test. Skipping pills or taking too many gives a false picture of whether your thyroid medication dose is correct, too low, or too high. It's better to let your clinician know and postpone the test until you've been taking the medication regularly for 6 to 8 weeks — and then you can also discuss why you were not taking the medication.

If you start or stop estrogen therapy for menopause symptoms, your TSH blood test should be redone 6 to 8 weeks later. Estrogen can interfere with the amount of thyroid hormone that gets into your bloodstream, so your thyroid medication dose may need adjustment.

Subclinical Hyperthyroidism

Some women have an abnormally low TSH, but when their actual thyroid hormone level is checked to confirm a diagnosis of hyperthyroidism, that result — which would ordinarily be high in hyperthyroidism — is normal. This condition, called subclinical hyperthyroidism, is associated with osteoporosis (bone thinning, which also occurs in women after menopause), irregular heartbeat, and possibly a higher likelihood of developing heart disease. If you are healthy and have low TSH but normal thyroid hormone levels, your clinician will likely repeat both tests in 3 to 6 months to see if they return to normal. If not, or if you already have health problems that contribute to a high likelihood of bone fractures and heart problems, treatment with antithyroid medication may be recommended and carefully monitored.

Thyroid Nodules

When your clinician is examining your thyroid gland, he or she may feel one or more firm swellings, or nodules, in the usually smooth tissue. About 5 of every 100 women have thyroid nodules. Usually the clinician will order an ultrasound to get a picture of the nodules, which will determine whether or how they should be treated. For instance, a fluid-filled nodule might be a cyst that can be treated by withdrawing the fluid with a tiny needle. If you yourself feel a lump in your neck, have it checked by a clinician. And don't jump to the conclusion that it's cancer; few nodules (about 5 to 15 of every 100) are malignant. Thyroid cancer is most commonly found in women aged 40 to 60, and most of these cancers can be treated successfully.

In Summary

Thyroid problems are common in midlife women. Symptoms of hypo- or hyperthyroidism are similar to changes that occur during the menopause transition, making them difficult to interpret. Blood tests to detect thyroid problems are not recommended for everyone, but make sense if you have a family or personal history that makes hypo- or hyperthyroidism more likely, or if you have symptoms or exam findings (for example, goiter) that suggest a thyroid abnormality.


Office on Women's Health


Editor Disclosures at Time of Publication

  • Disclosures for Diane Judge, APN/CNP at time of publication Nothing to disclose

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