Dr. Ron’s Research Review – August 13, 2014

© 2014

This week’s research review focuses on menopause and thyroid.

Thyroid dysfunctions are not uncommon during menopause. Many of the menopausal manifestations; namely hot flashes, mood swings and gastrointestinal and cardiovascular changes, bear a resemblance to those attributed to thyroid hyper-function or even hypo-function.  The incidence of thyroid disease in a population of postmenopausal women is as follows: clinical thyroid disease, about 2.4%; subclinical thyroid disease, about 23.2%. Among the group with subclinical thyroid disease, 73.8% are hypothyroid and 26.2% are hyperthyroid. (Schindler, 2003)
A study compared the symptoms of menopause and symptoms of thyroid disease in Japanese women aged 35-59 years. 'Facial flushing', 'sweating', and 'thyroid tumor' were all positively related with age and menstrual status. 'Breathlessness and palpitations' were positively related to Grave's disease. Moreover, 'sweating', 'irritability', and 'stiff shoulders, low back pain, and joint pain' were related to thyroid tumors. 'Insomnia' decreased with age. (Oi and Ohi, 2013)
A study published in the Journal of Obstetrics and Gynaecology involved 350 women with different menopausal symptoms.  The study showed that 21 women (6%) had hypothyroidism (all were due to autoimmune thyroiditis) and 18 (5.1%) had hyperthyroidism (11 were due to toxic multi-nodular goitre and seven had Graves’ disease). (Badawy et al., 2007)
Patients with hyperthyroidism were treated with anti-thyroid drugs, while patients with hypothyroidism were treated with thyroxin (T4) replacement. Women with normal thyroid function had estrogen replacement therapy when appropriate. Women with proven thyroid dysfunction were treated properly and this led to relief of most of their complaints apart from sexual dysfunction. Although their complaints did not disappear completely as they are partly due to estrogen deficiency, most women were not in need of any estrogen replacement in conjunction with the thyroid therapy.

 

Dr. Ron


 

Articles

Can thyroid dysfunction explicate severe menopausal symptoms?
(Badawy et al., 2007) Download
Many of the menopausal manifestations look like those accredited to thyroid hyperfunction or hypofunction. Can thyroid dysfunction explicate severe menopausal symptoms? The study comprised 350 women with different menopausal symptoms. All women had serum TSH, T3 and free T4 estimated. Women with thyroid dysfunction were appropriately treated and other women were treated with ERT. The study showed that 21 women (6%) had hypothyroidism and 18 (5.1%) had hyperthyroidism. Marked improvement in the menopausal-like symptoms occurred after treatment of the thyroid dysfunction. Elderly women with severe or resistant menopausal symptoms can be offered TSH, T3 and T4 assays to rule out the thyroid disturbances before attempting hormone replacement therapy.

Comparison of the symptoms of menopause and symptoms of thyroid disease in Japanese women aged 35-59 years
            (Oi and Ohi, 2013) Download
OBJECTIVE: In this study, we surveyed thyroid function abnormalities and menopausal symptoms in young as well as in menopausal women. METHODS: We conducted a random survey among outpatients at our facility from September 2008 to June 2011. The study included 853 women aged 35-59 years. We assessed the subjects according to the Simplified Menopause Index, menstrual status, thyroid hormone measurements (thyroid stimulating hormone, free thyroxine, free triiodothyronine), the presence of Hashimoto's disease antibodies (anti-thyroid peroxidase antibody or anti-thyroglobulin antibody), the presence of Grave's disease (anti-TSH receptor antibody), markers of thyroid tumor (high thyroglobulin), and thyroid ultrasonography studies. The data were analyzed by means of the statistical program JMP version 8.0. RESULTS: 'Facial flushing', 'sweating', and 'thyroid tumor' were all positively related with age and menstrual status. 'Breathlessness and palpitations' were positively related to Grave's disease. Moreover, 'sweating', 'irritability', and 'stiff shoulders, low back pain, and joint pain' were related to thyroid tumors. 'Insomnia' decreased with age. Patients with Hashimoto's disease were very rare because they were usually treated at other hospitals that specialize in thyroid disease. CONCLUSION: The symptoms of thyroid function abnormalities were shown to be very similar to menopausal symptoms and were found to occur in younger women before the onset of menopause. This study shows the need to differentiate menopausal symptoms from those of thyroid diseases.


Thyroid function and postmenopause.
            (Schindler, 2003) Download
There is an increasing prevalence of high levels of thyroid stimulating hormone (TSH) with age - particularly in postmenopausal women - which are higher than in men. The incidence of thyroid disease in a population of postmenopausal women is as follows: clinical thyroid disease, about 2.4%; subclinical thyroid disease, about 23.2%. Among the group with subclinical thyroid disease, 73.8% are hypothyroid and 26.2% are hyperthyroid. The rate of thyroid cancer increases with age. The symptoms of thyroid disease can be similar to postmenopausal complaints and are clinically difficult to differentiate. There can also be an absence of clinical symptoms. It is of importance that even mild thyroid failure can have a number of clinical effects such as depression, memory loss, cognitive impairment and a variety of neuromuscular complaints. Myocardial function has been found to be subtly impaired. There is also an increased cardiovascular risk, caused by increased serum total cholesterol and low-density lipoprotein cholesterol as well as reduced levels of high-density lipoprotein. These adverse effects can be improved or corrected by L-thyroxine replacement therapy. Such treatment has been found to be cost-effective. With time, overt hypothyroidism can develop. Therefore, routine screening of thyroid function in the climacteric period to determine subclinical thyroid disease is recommended. Hormone replacement therapy (HRT) in women with hypothyroidism treated with thyroxine causes changes in free thyroxine and TSH. Increased binding of thyroxine to elevated thyroxine-binding globulin causes an elevation of TSH by feedback. Since adaptation is insufficient, there is an increased need for thyroxine in these women taking HRT. TSH levels should be controlled at 12 weeks after the beginning of therapy. At higher age the need for iodine and thyroxine is decreased. Therefore, therapy has to be controlled. For bone metabolism thyroid hormones play a dominant role. While there are only marginal differences between hypothyroid patients and euthyroid controls, there are large differences for hyperthyroid patients. Previous thyrotoxicosis and subsequent long-lasting L-thyroxine treatment are together associated with reduction in femoral and vertebral bone density in postmenopausal women. In these cases HRT is important for the control of bone loss.

 


References

Badawy, A, O State, and S Sherief (2007), ‘Can thyroid dysfunction explicate severe menopausal symptoms?’, J Obstet Gynaecol, 27 (5), 503-5. PubMedID: 17701801
Oi, N. and K. Ohi (2013), ‘Comparison of the symptoms of menopause and symptoms of thyroid disease in Japanese women aged 35-59 years’, Climacteric, 16 (5), 555-60. PubMedID: 23025806
Schindler, AE (2003), ‘Thyroid function and postmenopause.’, Gynecol Endocrinol, 17 (1), 79-85. PubMedID: 12724022