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Need to Know: Thyroid Health

One of my patients recently summed up her experience succinctly: “I’m just so tired — all the time. I feel like I’m walking through molasses. My get-up-and-go got up and went.”

Sadly, this is the reality for many women. Basically, too little thyroid hormone causes your brain and body to slow down to conserve energy, much like a hibernating bear (but with a job, family, and responsibilities).

Having worked in women’s health care for more than two decades, it has become obvious to me that low-functioning thyroid (hypothyroidism), despite being very common, is sorely misunderstood. The lack of common knowledge can contribute to a sense of being overwhelmed, disempowered, and even resignation in those affected.

According to the American Thyroid Association, 20 million Americans have some form of thyroid dysfunction. Hypothyroidism, however — the most common form of which is Hashimoto’s thyroiditis — affects 5 to 20 times as many women as men. (Hashimoto’s doesn’t start as a thyroid problem per se, rather it’s an autoimmune condition that destroys your thyroid’s ability to make hormones. This type of inflammation appears to be caused by intestinal permeability (leaky gut) from food sensitivities and chemicals such as the herbicide glyphosate, now often found in conventional food.)

Why do these problems affect women more? Well, there’s a perfect storm happening in our bodies.

First, What Is the Thyroid?

To understand what happens when a woman’s thyroid goes rogue, it’s helpful to know a bit about this tireless little gland and all it does for us normally.

Your thyroid sits on the front of your neck, just under your Adam’s apple. It’s made up of a mass of tiny fluid-filled follicles, roughly resembling raspberry jam. It’s the shape of a small butterfly and weighs about the same as a mini box of raisins. Much like a muscle, your thyroid engorges when it has to work harder to get more nutrients.

Your thyroid’s key responsibilities are to maintain your body temperature and regulate your energy and metabolism. To do this, it’s constantly amping up or suppressing body processes based on what’s going on in and around you. You walk into a cold room and your thyroid leaps into action keep you warm. You cut too many calories to lose weight and your thyroid slows your metabolism to preserve energy. Your thyroid is the great regulator. When it’s out of balance, you’ll feel that way, too.

Let’s say you’ve been traveling — navigating different time zones, up later than usual, sleeping in hotel beds, not eating your typical diet. Your body needs extra energy to deal with all this, so it sends a signal to your brain: “more thyroid hormone, please.”


Your thyroid is the great regulator. When it’s out of balance, you’ll feel that way, too.


Your brain’s hormone centers are happy to comply and send a packet of TSH (thyroid-stimulating hormone) to your thyroid to get the ball rolling. With the correct nutrition, the gland promptly releases a cascade of thyroid hormone, T4. There’s a catch though. T4 is just the storage form of thyroid hormone. It must be converted into “active” T3 to be of any use. No worries, because your liver and gut have this covered — as long as they are healthy enough to do their jobs.

Once T3 is activated, it finds its way to VIP parking spaces on all your body cells, plugs in and makes you more energy. Voila! No more brain fog, cold hands, or struggling to get started in the morning.

This is how your thyroid is supposed to work.

When you’re stressed or overworked, however, Reverse T3 (rT3) can upset this whole process. Like an evil twin, rT3 is T3 gone bad. It does nothing but take up T3’s VIP parking spaces, preventing it from making energy. rT3 isn’t the only challenge. If there’s a deficiency anywhere along thyroid’s elegant feedback loop, there will be trouble. This is why for many women, taking outside forms of thyroid hormone (whether natural or synthetic) often works initially but over time seems less effective. If root causes such as mineral deficiencies or poor T4 to T3 conversion aren’t addressed, imbalances will still exist.

Why women?

We have unique body processes that use up more of our thyroid’s resources.

During our reproductive years, we expend tremendous energy building up a thick, mineral-rich uterine lining each month, only to lose it during menstruation. Your thyroid has to bulk up to compensate. Pregnancy also demands more from your thyroid, further diminishing mineral reserves. Giving birth itself can trigger autoimmune thyroid disease. Without specific attention to the gland during pregnancy and after, many women never quite recover hormone balance. 

On top of all that, excess estrogen can provoke an immune attack on the thyroid. This worsens both prior to menopause and when cortisol (our main stress-adapting hormone) is elevated.

Also, because women use on average twice as many personal care products as men, we’re exposed to more toxins. Nail polish and hair dyes contain endocrine disruptors; anti-aging skin care products, perfume, and make-up can contain a certain amount of estrogen legally without including it on the label. 

And finally, our thyroid is part of our immune system. When it detects threats to safety, such as infections, toxins, or extreme stress, our immune system activates and can attack the thyroid. Over the years, I’ve seen numerous patients whose thyroid condition became aggravated following the loss of a loved one, after a difficult move or job change, or after intensifying exercise. In our culture, women are taught early to diet and restrict calories to stay slim. Our body sees all these as threats to survival and slows down both our thyroid and metabolism to compensate.

What can you do?

Comprehensive lab testing is necessary to determine your unique root causes. TSH — which is not a thyroid hormone — is typically the only lab indicator measured. While necessary, it’s nowhere near sufficient to tell you about your actual thyroid health.

I recommend the following be tested: TSH, T3, T4, free T3, free T4, reverse T3, anti-thyroglobulin, and anti-TPO. Consider also testing cortisol, estrogen, progesterone, and iron, which can highlight other factors involved. Your doctor can order all of these, but you may have to ask for them explicitly and by name.

Since most hormone imbalances follow poor liver and gut health, these must also be addressed. This means identifying food sensitivities, making dietary changes to reduce inflammation and rebuild mineral stores, and considering healthier body care products. In my experience, gentle nutritional detoxification, under qualified guidance, can be a great place to start.

Since your thyroid is so dependent on liver, gut, and hormone health, it takes time to fully rebuild and for you to feel good consistently. Be persistent and patient. Your efforts will be rewarded with renewed energy, clearer thinking, emotional resilience/more buoyant emotions, and a stronger metabolism. Work with a qualified functional medicine practitioner who will listen, take your concerns seriously, and help you address contributing issues in the correct order.

Despite hypothyroidism being so common in women and affecting so much of our health, there are numerous ways to support this hard-working gland, even while taking hormone replacement. There is tremendous opportunity for real health changes when our thyroid gets the full support it needs.


Key Signs and Symptoms of Hypothyroidism

  • Lethargy
  • Weight gain
  • Thinning hair
  • Cold hands and feet
  • Difficulty concentrating/mental exhaustion
  • Very dry skin (deeply cracked heels)
  • Low mood and emotional volatility
  • Hoarse voice and trouble swallowing
  • Constipation

Dr. Kimberly Higney has a private practice on the Seacoast of New Hampshire. She helps patients look and feel their best by helping them rebuild hormone health and metabolism through lifestyle.

Photo: Eggeeggjiew

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