Women and Thyroid Disease: Know the Symptoms for Proper Diagnosis

Up to 60 percent of those with thyroid disease are unaware of their condition due to misdiagnosis. Knowing the symptoms of thyroid diseases, such as Graves’ disease and Hashimoto’s disease, can help with early detection and proper treatment of thyroid disease reduces associated long-term risks.

When Magdalena Wszelaki was in her late 20s, she was diagnosed with Graves’ disease. Wszelaki knew very little about the disease, other than that it affected her thyroid and she had to take medication to “slow it down,” so she took the medication and went on with life as usual. But then, in her mid 30s, while Wszelaki was living in Shanghai and working a high-powered job in the advertising industry, she was suddenly diagnosed with another mysterious disorder—this time it was Hashimoto’s disease (sometimes called Hashimoto’s thyroiditis), characterized by an underactive thyroid. “That’s when I came down with everything: depression, anxiety attacks, memory loss—I had a total personality change. My life was falling apart,” Wszelaki recalls. Given little information by her doctors, Wszelaki researched her condition and found that what she was battling was actually an autoimmune disorder. “That freaked me out,” she says. “My body was destroying my own thyroid.”

Wszelaki’s story is not all that uncommon. According to the American Thyroid Association, an estimated 20 million Americans have some form of thyroid disease. The thyroid is a butterfly-shaped gland that sits just below the Adam’s apple. Though it’s only about the size of a grape, this little organ affects your entire body. The gland produces hormones that help the body regulate how quickly it uses energy (metabolism), make proteins, and regulate other hormones. In a nutshell: When it’s not working properly, your entire body feels the affects.

Women are five to eight times more likely than men to have thyroid problems, and Hashimoto’s disease is the most common thyroid disorder in women. This autoimmune condition causes your body to produce antibodies that gradually destroy your thyroid, and it causes hypothyroidism, a condition in which the thyroid gland does not produce enough thyroid hormone. As in Wszelaki’s case, Hashimoto’s is sometimes preceded by a hyperthyroid condition, like Graves’. Over time, the thyroid “burns out,” and the individual develops hypothyroidism. Some common symptoms of hypothyroidism are fatigue, a slower metabolism (which can lead to weight gain), constipation, hair loss, and depression.

After her diagnosis, Wszelaki decided to quit her high-stress job and enroll at the Institute for Integrative Nutrition in Manhattan, where she received certification in holistic nutrition. Soon after, she founded the Thyroid Diet Coach in Brooklyn, and at 40, she’s symptom-free. She wishes more women knew about the important role the thyroid plays in the body, though she’s not surprised at the lack of knowledge: “We know about our brain, our gut—why not the thyroid? Because you only know about it when it fails you.”

Thyroid Function After Pregnancy

While the cause of autoimmune-based thyroid disorders is uncertain, it is clear that many more women than men suffer from thyroid problems. The reason, Dr. Liss says, may be the general connection between estrogen and autoimmunity (the attack of immune cells on the body). “There are some studies suggesting that the amount of white cells we make might change depending on levels of estrogen,” she says. “It’s possible that medium amounts of estrogen that women usually have predispose them to TH1 activation, a chemical situation in the body that predisposes them to autoimmunity.”

Changes in estrogen levels after pregnancy play a role in a postpartum thyroiditis, a hypothyroid condition that occurs in approximately 5 to 10 percent of women.

Diagnosis and Treatment

According to the American Thyroid Association, up to 60 percent of those with thyroid disease are unaware of their condition. Polina Liss, M.D., a Manhattan-based doctor who specializes in internal medicine, attributes a good portion of that number to misdiagnosis. “There is a lot of controversy in thyroid measurements, which is why a lot of women and men may be going untreated, even though their symptoms are bothersome,” Dr. Liss says. Doctors test for thyroid problems by measuring the level of thyroid hormones in the body, but there are different views on what level of hormones is considered normal.

The good news, though, is that treatment for these types of disorders are becoming more patient-centered. “If a person doesn’t feel well and the numbers don’t show the diagnosis, it’s not right to disregard the symptoms,” Dr. Liss says.

And for autoimmune disorders like Hashimoto’s, more patients are finding relief in holistic treatments. Traditional medical ideas hold that a thyroid disorder is not curable, but something to be managed with medication throughout a person’s life. “But there is hope that, if it is an autoimmune activity, sometimes you can calm down the immune system and stop it from attacking the thyroid,” Dr. Liss says. One patient of hers had Hashimoto’s as well as celiac disease, but after going on a gluten-free diet she was able to stop taking her thyroid medication. “It’s really an interesting area, where nutrition and supplements help the immune system recover,” Dr. Liss says.

Wszelaki specializes in holistic treatment of thyroid disorders, with a focus on nutrition. “In order to heal, you have to look after the digestive system,” she says. “It’s not coincidental that most people with thyroid diseases—and autoimmune diseases specifically—have a lot of digestion issues: acid reflux, gas, constipation, bloating, feeling lethargic after eating. We grow to believe it’s normal, but it’s not. Those are early signs.”

Food intolerance is a common cause, and gluten is one of the biggest culprits. Wszelaki’s treatment plan includes identifying food intolerances, cutting down on sugar, and adding probiotic-rich foods. “It’s not a diet—it’s a lifestyle change,” she says.

Long-Term Risks

Those with Hashimoto’s and other autoimmune-based thyroid conditions face more than higher numbers on the scale. Misdiagnosis is a concern because, if left untreated, the condition can lead to other serious problems. A higher chance of being overweight means a higher risk of developing heart disease and type 2 diabetes. Additionally, about 50 percent of people with hypothyroidism develop other autoimmune conditions down the road such as lupus and rheumatoid arthritis. And beyond the health risks, there’s the affect on a patient’s everyday life. “The ability to function and the energy level is lower,” Dr. Liss says. “It really affects the quality of a person’s life.”

Know the Symptoms

The following symptoms may indicate a thyroid disorder. If they sound familiar, consider getting tested. And if the results don’t sit well, Dr. Liss says, don’t be shy about getting a second opinion.

Symptoms of hyperthyroidism (overactive thyroid)