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What Does Hypothyroidism Have to do With PMS & PMDD?
by Dr. Daniel J. Heller
Cindy came in to see me with several health concerns, the biggest of which was "feeling tired all the time." She also had high cholesterol, and wanted to avoid medication for it; she mentioned having trouble with weight gain; had noticed that her moods before her period had been gradually getting much worse; and didn’t have her normal motivation and vivaciousness, which she considered part of her personality.
At Cindy’s first visit, as part of a routine laboratory exam, we ordered a test of Cindy’s TSH levels to check her thyroid function. This test is especially important for women because hypothyroidism in women is common, and too often it isn’t suspected, tested for, or properly diagnosed. Thyroid Stimulating Hormone or TSH is a hormone released by the pituitary gland in the brain. You can think of TSH as giving the thyroid gland its marching orders. In response to TSH levels, the thyroid gland makes thyroid hormone, which controls the body’s metabolism and thermostat. Cindy’s TSH was high, which means that her thyroid function was low. Cindy’s thyroid hormone tests were normal. This combination of high TSH and normal thyroid hormone is actually quite common, and is referred to as subclinical hypothyroidism.
A lack of thyroid hormone can cause depression and fatigue; raise cholesterol, and PMS and PMDD symptoms can become a real problem. We provide a list of common symptoms and conditions caused by an underactive thyroid, many of them among the most common symptoms people experience. Since so many people have these symptoms, and only a small fraction of them have hypothyroidism, it can be confusing for patients and doctors to determine what exactly is causing the symptoms.
What are the Conditions and Symptoms of Hypothyroidism?
- Allergies
- Chest pain
- *Depression
- *Fatigue
- Fibrocystic breast disease
- Heart disease
- Hair loss
- High blood pressure
- High cholesterol
- Hives
- *Hypoglycemia
- Infertility
- Irregular or heavy periods
- *PMS & PMDD
- Polycystic ovary syndrome
- *Poor memory & concentration
- Psoriasis
- Weight gain, difficulty & losing weight
*These symptoms overlap with PMS & PMDD
From Gaby 2004.
There is substantial disagreement between conventional medical doctors and endocrinologists on the one hand, and many patients and holistic practitioners on the other, about the diagnosis of an underactive thyroid and the existence and treatment of a condition called subclinical hypothyroidism (we’ll cover subclinical hypothyroid later in this article). There is another thyroid controversy regarding treatment, with conventional medical doctors believing in the synthetic thyroid hormone medication, levothyroxine, with holistic doctors and many patients preferring natural, or Armour® thyroid medication.
Part of the controversy exists because blood tests for TSH and thyroid hormones aren’t necessarily 100% accurate for detecting underactive thyroid. Another problem is that the symptoms of hypothyroidism are such common ones that they may be caused by many other conditions, so doctors are justifiably cautious in jumping to conclusions and prescribing potentially unnecessary or even harmful medication.
For instance, weight gain and fatigue can both result from a lack of exercise, though they can occur as a result of low thyroid too. Of course weight gain, and difficulty losing weight, is often the result of what we choose to eat, though many believe thyroid is a culprit in weight as well. PMS and PMDD have many causes too, and hypothyroid is certainly not the only or most likely one.
Hypothyroid & Weight Loss
Thyroid hormone rarely helps women lose weight unless they have severe, overt hypothyroidism—the type in which lab tests unequivocally show the thyroid isn’t working properly. Women with this condition will usually have other signs such as fatigue, hair loss, dry skin, and high cholesterol. This means that thyroid problems are a rare cause of weight gain or difficulty losing weight, rather than a common cause as some authors and practitioners suggest.
The same can be said about cholesterol, allergies, infertility, and most of the other conditions and symptoms associated with hypothyroidism. On the other hand, many holistic doctors and practitioners have made a convincing case that the very reason these conditions or symptoms are so commonplace is that there are so many people suffering from undiagnosed hypothyroidism.
Cindy, mentioned above, is a good example of this phenomenon. As soon as she began taking natural thyroid supplementation, her symptoms of hypothyroidism improved, including her mood and energy, and her cholesterol level quickly dropped into the normal range. When she received natural thyroid hormone treatment, her body’s "furnace" immediately started burning up the excess cholesterol, and with her thermostat running at normal, she now had her usual energy. Not surprisingly, the PMS/PMDD symptoms she’d been experiencing improved as well.
Most women with PMS and PMDD are not hypothyroid. Their thyroid is working well. Their PMS symptoms and PMDD symptoms are a result of the more common female hormone imbalances, stress, improper diet, and a range of other causes that don’t have to do with their thyroid.
However, there are women with PMS and PMDD symptoms don’t respond to the conventional medical treatment with antidepressants or birth control. Often these women do better with herbs, nutrition, and a more natural approach. But when a woman has really tried everything, and nothing seems to work, it’s possible that the problem is a type of undiagnosed hypothyroidism that many doctors don’t even recognize: subclinical hypothyroidism.
In overt hypothyroidism, the symptoms are so dramatic, and the thyroid labs are so far out of the normal range, that there can be no doubt that the thyroid is the problem. Women with this type of thyroid condition almost always respond quickly, and well, to treatment. Subclinical hypothyroid, on the other hand, is controversial because the symptoms, the labs, and the response to treatment are not nearly as clear.
In subclinical hypothyroidism, TSH levels are mildly elevated (indicating underactive thyroid) while thyroid hormone levels are normal. However, many practitioners and researchers believe that thyroid lab tests are either inaccurate or simply not sensitive enough. In fact, prestigious medical journals and highly respected doctors and researchers have pointed out that it is a mistake to base the diagnosis and treatment of hypothyroidism on lab work alone. They believe that the symptoms of hypothyroidism are better indication of when someone needs thyroid medication, preferably Armour® thyroid or another natural USP thyroid medication.
Deciding whether or not you have a thyroid problem, and whether it is the source of health problems for you, and then what to do about it, is a highly personal and complex matter. Although it can be hard to find a doctor who will listen to your concerns, let alone one who understands the complexities of subclinical versus overt hypothyroid, and the intricacies of Armour® or USP thyroid medication versus levothyroxine—it is still wise to not try to be your own doctor, and to make these important choices in consultation with a qualified health care provider.
Having said that, it’s helpful to understand that roughly 90% of all people have a TSH level of between 1.0 and 2.5. A TSH below 1.0 indicates possible hyperthyroidism, or overactive thyroid, and the lower the TSH, the more overactive the thyroid function. A TSH in the range of 2.5 to 4.5 is still considered normal by most doctors, though many holistic doctors become suspicious when TSH is in this range, especially if there are hypothyroid symptoms present. As mentioned above, some doctors feel that even a sensitive test like TSH is misleading, and that judiciously prescribed thyroid medication can be a real lifesaver for a woman no matter her test results.
Hypothyroidism is a confusing and difficult area of medicine. Sometimes, all the conflicting views of doctors, researchers, and Internet "experts" make the situation even more unclear for a woman wanting to understand why she doesn’t feel well, and whether her fatigue, depression, and PMS or PMDD may be the result of an underactive thyroid.
It’s important to remember that hypothyroid is just one possible cause of PMS and PMDD, as well as of fatigue, depression, and the other hypothyroid symptoms, so don’t assume your problem is hypothyroidism without investigating other likely possibilities. If, however, you’ve tried everything, and haven’t found relief, and you have several likely symptoms of hypothyroidism, working with your doctor to determine if this might be a problem for you is certainly a path worth taking.
