Women & Thyroid Health – What You Need to Know

Woman with a thyroid issue

Many women of all ages are afflicted with an improperly functioning thyroid gland and are more likely not aware they have a serious health issue. As many as 20 million Americans have a thyroid disorder, with more than half of those afflicted unaware of their condition.

The causes of thyroid problems are not known; however, if those afflicted don’t get treatment, they can face increased risks of osteoporosis, cardiovascular disease, infertility issues and improperly functioning endocrine systems.

It is estimated that women are around 8 times more affected by thyroid health issues than men, with key triggers for thyroid issues in women directly related to puberty, pregnancy and menopause.

January is Thyroid Awareness Month and your Capital Women’s Care team shares important knowledge concerning proper thyroid balance as it relates to functions of the body it helps to control; various types of thyroid inefficiencies, including hypo- and hyperthyroidism, and symptoms; types of thyroid cancers; vital information on the importance of thyroid functionality in pregnant and menopausal women; and diagnosis and treatment of thyroid disorders.

What Is the Thyroid and Its Importance?

Your thyroid is a butterfly-shaped gland located in your neck, just above your collarbone near your esophagus. It’s one of the body’s endocrine glands responsible for making hormones that:

  • control heart rate
  • regulate the speed at which your body burns calories
  • oversee and regulate breathing
  • regulate body weight and temperature
  • and control muscle strength and blood cholesterol levels.

There are many thyroid dysfunctions which can occur. The thyroid may:

  • produce too many thyroid hormones, known as hyperthyroidism.
  • produce not enough thyroid hormones, also known as hypothyroidism.
  • become enlarged, producing a goiter.
  • may become inflamed, known as thyroiditis.
  • develop thyroid nodules.
  • develop growths indicative of thyroid cancer.

Thyroid disease in women is difficult to pinpoint as the varying associated symptoms oftentimes are subtle, as most women experiencing symptoms tend to think they can be attributed to everyday life stresses, hormone changes connected to premenstrual syndrome and/or monthly menstrual cycles, or hormone fluctuations associated with menopause.

It’s important to monitor and record any symptoms you experience so you can be proactive and voice concerns to your gynecologist or physician. A simple blood test can determine if your thyroid is functioning properly by producing the correct amount of thyroid stimulating hormones.


Also known as overactive thyroid disease, this condition occurs when your thyroid gland produces excess hormone levels.

Symptoms can include:

  • increased body metabolism
  • weight loss
  • nervousness, anxiety, irritability and restlessness
  • hyperactivity (difficulty staying still and having abundant nervous energy)
  • mood swings
  • panic attacks
  • hair loss
  • tremors
  • abnormal protrusion of eyes or puffy-looking eyes
  • excess sweating and/or warm skin
  • irregular menstruation or short-term, light menstruation
  • excessive eating
  • sleep difficulties (insomnia or difficulty falling asleep)
  • constant tiredness
  • being sensitive to heat
  • muscle weakness
  • irregular heart rate and/or palpitations
  • and diarrhea, among others.

Graves' disease is an immune system disorder resulting in overproduction of thyroid hormones. With this disease, your immune system attacks the thyroid, causing it to make more thyroid hormones than your body needs.

Although several disorders may result in hyperthyroidism, Graves' disease is a common cause, affecting nearly 3 million Americans each year. It is the most common cause of hyperthyroidism in the U.S., affecting about 1 in 200 people.

Graves' disease may affect anyone, but it's more common among women and in people younger than 40 years. Those with family history of thyroid or autoimmune disorders are more likely to be diagnosed.

Graves’ disease is 7 to 8 times more common in women than men. Those with other autoimmune disorders are more likely to develop Graves’ disease than people without these disorders. Conditions usually linked with Graves’ disease include:

Those diagnosed with Graves’ disease may also have Graves’ ophthalmopathy (GO), which occurs when the immune system attacks muscles and other tissues surrounding the eyes. Inflammation and tissue and fat buildup behind the eye socket occurs, causing bulging of the eyeball. It’s rare that inflammation is severe enough push upon the optic nerve that leads from the eye to the brain, an action that causes vision loss.

Other GO symptoms include:

  • dry, gritty, and irritated eyes
  • puffy or retracted eyelids
  • double vision
  • light sensitivity
  • pressure or pain in the eyes
  • and trouble moving the eyes.

About 1 in 3 people with Graves’ disease develop mild GO and about 5% develop severe GO. The condition usually lasts 1 to 2 years and often improves on its own. GO can occur before, at the same time as, or after other symptoms of hyperthyroidism develop. Eye problems sometimes develop long after Graves’ disease has been treated in rare instances. GO may even occur in people whose thyroid function is normal. Smoking makes GO worse. Eye drops and steroid medicines are common therapies used to alleviate GO symptoms.

Another issue associated with Graves’ disease is Graves’ dermopathy, a skin condition commonly affecting shins and upper feet, where skin becomes red and thickened. This associated Graves’ disease condition is not as common as GO.


Having an under-active thyroid is hypothyroidism. This condition occurs when the thyroid gland doesn’t produce enough thyroid-stimulating hormone (TSH).

Hypothyroidism’s deficiency of thyroid hormones can disrupt heart rate, body temperature and all aspects of metabolism, resulting in catabolism taking place within the body to gain energy. Catabolism is the process of breaking down other body tissues (muscle, joint and bone tissues) to acquire energy, causing persistent pain and soreness.

Major hypothyroidism symptoms include:

  • fatigue
  • sensitivity to cold
  • constipation
  • dry, itchy skin
  • increased heart attack risk due to higher cholesterol levels and narrowing of arteries
  • thinning hair on scalp and outer edges of eyebrows
  • decreased sweating
  • slowed heart rate
  • sexual dysfunction
  • puffy face
  • fertility issues
  • heartburn and stomach bloating
  • gallstones
  • muscle weaknesses, aches, pains and soreness
  • joint pain, stiffness and swelling
  • heavy or irregular menstruation cycles
  • depression, sadness and brain fog
  • and unexplained weight gain.

Hypothyroidism is a common disorder, affecting about 3 million people in the U.S. You are at greater risk for hypothyroidism if you:

  • are a woman.
  • are older than 60 years.
  • have had a thyroid problem before, such as a goiter.
  • have had surgery to correct a thyroid problem.
  • have received radiation treatment to the thyroid, neck or chest.
  • have family history of thyroid disease.
  • or were pregnant or had a baby within the past 6 months.

There’s known greater risk of hypothyroidism if you are diagnosed with any of these conditions:

  • Turner syndrome, a genetic disorder affecting females
  • pernicious anemia
  • Sjogren's syndrome, a disease resulting in dry eyes and mouth
  • type 1 diabetes
  • rheumatoid arthritis
  • or lupus.

Because hypothyroidism develops slowly, many who are afflicted don't notice symptoms of the disease for months or even years.

Hashimoto’s thyroiditis is a specific type of hypothyroidism and occurs when the immune system attacks the thyroid gland. Initially, thyroid inflammation causes a leak resulting in excess thyroid hormones; however, over time, the inflammation prevents the thyroid from producing enough hormones. Symptoms include fatigue and unexplained weight gain. Hashimoto’s thyroiditis affects roughly 200,000 Americans annually.

Hashimoto’s thyroiditis is:

  • more common in women than men.
  • usually appears between the ages of 30 and 50 years.
  • and tends to be hereditary.

Hashimoto’s thyroiditis is more likely to develop in people who have other autoimmune diseases, like:

  • certain liver conditions
  • B12 deficiency
  • gluten sensitivity
  • rheumatoid arthritis
  • type 1 diabetes
  • lupus
  • and Addison’s disease.

Hypothyroidism and hyperthyroidism are chronic conditions which may last several years or throughout the rest of a person’s lifetime once it is diagnosed.

Goiter, Thyroiditis and Thyroid Nodules

Physical changes that may result from thyroid disorders include goiters, thyroiditis and thyroid nodules.

A goiter occurs in the front of the neck, just below the Adam's apple and can occur if someone is diagnosed with Hashimoto’s thyroiditis, Graves’ disease, during pregnancy, thyroid cancer, or if someone is exposed to medical radiation treatments (like CT scan) of the head and neck. A small goiter that doesn't cause any symptoms may not need treatment. In some cases, medication or surgery is needed. In most cases, a goiter lasts a few months.

Goiter symptoms include:

  • feeling of tightness in throat
  • hoarseness
  • neck vein inflammation
  • and dizziness when the arms are raised above the head.

Thyroiditis is an inflammation of the thyroid gland and can occur in hypothyroidism and hyperthyroidism disease scenarios.

In addition to Hashimoto’s thyroiditis, there are 3 additional types of thyroiditis:

  • De Quervain's thyroiditis – the thyroid gland becomes inflamed rapidly and becomes very tender, resulting in too much thyroid hormone released into the blood. Hyperthyroidism generally resolves after several weeks or months, with patients usually experiencing hypothyroidism as a result.
  • Silent thyroiditis – is a combination of Hashimoto and Graves’ symptoms and usually occurs in young women following pregnancy. It usually requires no treatment, and 80% of patients show complete recovery, with return of the thyroid gland to normal size after 3 months. Symptoms resemble those of Graves’ disease except milder, with the thyroid gland becoming only slightly enlarged.
  • Acute thyroiditis - One of the most common reasons someone might experience thyroiditis is following surgery in the neck or involving the thyroid gland. Having any surgery carries some risk, and in the case of parathyroid surgery, a common result is temporary post-operative thyroiditis.

An inflamed thyroid may also occur due to a viral infection (viral thyroiditis) or a bacterial infection (bacterial thyroiditis), following radiation or in response to certain medications.

Thyroid nodules are solid or fluid-filled lumps and are very common occurrences. Most thyroid nodules don't cause symptoms and the majority don't require treatment. More than 95% of thyroid nodules are noncancerous.  If concern arises about cancer possibility, your doctor may simply recommend monitoring to see if growth occurs. Ultrasound can help evaluate a thyroid nodule and determine if biopsy is necessary.

Thyroid Cancer

There are 3 main types of thyroid cancer:

Differentiated (including papillary, follicular and Hürthle cell)

1. Papillary cancer (also called papillary carcinomas or papillary adenocarcinomas) -- About 8 out of 10 thyroid cancers are papillary cancers.

These cancers tend to grow very slowly and usually develop in only one lobe of the thyroid gland. Even though they grow slowly, papillary cancers often spread to the neck lymph nodes. Even when these cancers have spread to lymph nodes, they can often be treated successfully and are rarely fatal.

2. Follicular cancer (also called follicular carcinoma or follicular adenocarcinoma) -- Follicular cancer is the next most common type, making up about 10% of thyroid cancers.

It is more common in countries where people don’t get enough iodine in their diet. These cancers usually do not spread to lymph nodes, but they can spread to other parts of the body, such as the lungs or bones.

The prognosis for follicular cancer is not quite as good as that of papillary cancer, although it is still very good in most cases.

3. Hürthle (Hurthle) cell cancer (also called oxyphil cell carcinoma) -- About 3% of thyroid cancers are this type, which is harder to find and to treat.

Medullary thyroid cancer (MTC) -- accounts for about 4% of thyroid cancers. It develops from the C cells of the thyroid gland, which normally make calcitonin, a hormone that helps control the amount of calcium in blood.

Sometimes this cancer can spread to lymph nodes, the lungs, or liver even before a thyroid nodule is discovered.

This type of thyroid cancer is more difficult to find and treat.  There are 2 types of MTC:

  • Sporadic MTC -- accounts for about 80% of MTC cases and is not genetically inherited. It occurs mostly in older adults and often affects only one thyroid lobe.
  • Familial MTC -- is inherited and 20% to 25% can occur in each generation of a family. These cancers often develop during childhood or early adulthood and can spread early. Patients usually have cancer in several areas of both lobes. Familial MTC is often linked with an increased risk of other types of tumors.

Anaplastic (undifferentiated) thyroid cancer -- Anaplastic carcinoma (undifferentiated carcinoma) is a rare, aggressive form of thyroid cancer, making up about 2% of all thyroid cancers.

It is thought to sometimes develop from an existing papillary or follicular cancer. This cancer is called undifferentiated because the cancer cells do not look very much like normal thyroid cells. This cancer often spreads quickly into the neck and to other parts of the body and is very difficult to treat.

Thyroid Cancer Risk Factors

Thyroid cancers, like almost all diseases of the thyroid, occur about 3 times more often in women than in men.

Thyroid cancer can occur at any age, but the risk peaks earlier for women (who are most often in their 40s or 50s when diagnosed) than for men (who are usually in their 60s or 70s).

Having a first-degree relative (parent, brother, sister, or child) with thyroid cancer, even without a known inherited syndrome within the family, increases your risk of thyroid cancer. The genetic basis for these cancers is not totally clear.

People with family history of the following face increased thyroid cancer risk:

  • Medullary thyroid cancer
  • Familial adenomatous polyposis (FAP)
  • Cowden disease
  • Carney complex, type I
  • or Familial non-medullary thyroid carcinoma.

If you have family history of any of the aforementioned health issues, refer here for genetic information to see if you would benefit from genetic testing and/or counseling.

Thyroid Dysfunction and Pregnancy

Proper thyroid function of pregnant women is particularly crucial during the early stages of pregnancy, as babies are dependent upon the mother’s thyroid during the first trimester of pregnancy.

Your thyroid hormones are critical to normal development of your baby’s brain and nervous system. Babies who don’t get enough of these hormones in the first trimester, when they’re dependent on the mother’s supply, can be born with neurological development problems.

Experiencing symptoms of either hypothyroidism or hyperthyroidism conditions during pregnancy can cause complications to both mother and baby.

Be sure to mention any symptoms to your OB/GYN practitioner so you may be tested with a simple blood test to check your thyroid to make sure it is functioning properly and creating the appropriate level of hormones.

Untreated hypothyroidism during pregnancy can lead to:

  • premature birth
  • preeclampsia (a severe increase in blood pressure)
  • miscarriage
  • low birth weight
  • anemia for the mother
  • stillbirth
  • or rare instances of congestive heart failure for the mother.

Hypothyroidism is easy to diagnose with a blood test to check proper thyroid hormone levels. Treatment is usually a synthetic hormone, which is completely safe during pregnancy as well as vital to both you and your baby.

If you have a pre-existing hypothyroid condition prior to pregnancy, you may need an increase in synthetic hormone as your body needs more of the hormones to share with baby during the first trimester of pregnancy.

During pregnancy and postpartum, your thyroid hormone levels will be monitored every 6 to 8 weeks to see if your dose needs further adjustment. In addition to medication, be sure to eat a healthy balanced diet and take a prenatal vitamin.

Untreated hyperthyroidism during pregnancy can lead to:

  • congestive heart failure in the mother
  • preeclampsia
  • miscarriage
  • premature birth
  • and low birth weight.

As with hypothyroidism, hyperthyroidism is easy to diagnose with a blood test. If your condition is mild, you likely won’t need any treatment. More severe cases require antithyroid medications called propylthiouracil (PTU) in the lowest effective dose during your first trimester.

After the first trimester, if necessary, your doctor may switch you to the antithyroid medication methimazole. Either way, you’ll need to check with your doctor regularly to make sure the medications and dose are still right for you. In rare cases (if you don’t respond to medications or experience severe side effects), you may need surgery to remove part of the thyroid.

Your Thyroid During Pregnancy

Your body’s need for thyroid hormone fluctuates during pregnancy. If you have ever been diagnosed with any thyroid problems in the past or are currently taking medication for a thyroid condition, be sure to let your practitioner know. It’s possible you may require medication again or need to adjust your dose.

Also be aware that after pregnancy, many symptoms of a thyroid disorder are like those symptoms associated with postpartum depression (PPD). If you’re experiencing any symptoms, be sure to let your doctor know so you can receive appropriate diagnosis and subsequent treatment.

Your Thyroid and Menopause

Menopause usually occurs in women who are in their late 40s and 50s, with perimenopause symptoms beginning as early as 10 to 15 years prior to its onset. There is a direct link between the drop in women’s estrogen levels as menopause commences and thyroid function.

Menopause and thyroid dysfunction share many of the same symptoms, making it especially difficult to distinguish between the two scenarios based on symptoms alone.

Untreated hypothyroidism can worsen menopause symptoms and lead to increased risk of cardiovascular disease and osteoporosis.

Untreated hyperthyroidism also contributes greater osteoporosis and cardiovascular disease risks.

It’s important to speak with your OB/GYN practitioner about your symptoms. A simple blood test can determine if you are experiencing thyroid dysfunction. Based on test results, your doctor may prescribe medication with regular follow-up blood tests every 6 to 8 weeks to monitor your thyroid hormone levels and modify medication dose if necessary. Once your thyroid hormone levels are successfully treated, annual follow-up testing is recommended to monitor thyroid function and health.

Diagnosis and Treatment

For proper diagnosis of all types of thyroid diseases, your doctor will ask your medical and family health histories, perform physical exam, prescribe thyroid tests and sometimes recommend biopsy to evaluate and diagnose your condition. Appropriate treatments include medication, regular blood screenings, radioiodine therapy or surgery, depending upon diagnosis.

There are things you may do to control your thyroid cancer risk:

  • Be mindful of radiation exposure to the head and neck area, especially with children.
  • Maintain a healthy weight.
  • Monitor dietary iodine intake for proper thyroid function and adjust your diet accordingly, especially if you are afflicted with hyperthyroidism.

Your Capital Women’s Care team is here should you have any questions or concerns about symptoms which may indicate thyroid dysfunction. Our family of knowledgeable, compassionate professionals are here for focused discussion with you concerning your symptoms and devise and implement appropriate diagnoses and treatment to optimize your overall health and well-being.


20 Signs Your Thyroid Isn’t Working Right - The Surgical Clinic (thesurgicalclinics.com)
What Is Thyroid Cancer?
Thyroid Cancer Risk Factors

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