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The Many Clinical Faces of
Hypothyroidism in Gynecology
Robert Filice, M.D.
For years I have been aware of
the unreliability of standard thyroid blood tests, including the TSH in
making the diagnosis of hypothyroidism…an underactive thyroid gland.
Generally characteristic symptoms, low body temperature, and response to
thyroid medication clinches the diagnosis: sub-laboratory (not
subclinical…the patient has the corresponding symptoms!) hypothyroidism.
The significance of this hugely common disorder is that many individuals
who need thyroid replacement therapy are not getting it, and individual
with frequently associated conditions are not being given the help they
need. I wanted to discuss several clinical disorders which are commonly
associated with hypothyroidism in women, and which dramatically respond
to thyroid replacement therapy.
Polycystic Ovary Syndrome (PCOS): This disorder can begin before the
menses have started, but usually is seen in young women associated with
very irregular periods, failure to ovulate, unwanted body hair, and
multiple ovarian cysts. There are blood sugar, sex hormone, and other
abnormalities as well in PCOS, but resolution of the cysts and
re-establishment of regular ovulatory periods can be the result of
proper thyroid hormone replacement therapy.
Infertility:
Because routine laboratory work is not sensitive enough to
diagnose all cases, and because orthodox physicians do not take
the time for a careful history of related symptoms,
hypothyroidism (HT) is a very common undiagnosed underlying
cause of infertility. I have had numerous successes helping my
patients achieve conception by diagnosing and treating
sub-laboratory hypothyroidism.
Recurrent Miscarriages: Very common in the histories of
women with hypothyroidism. Thyroid therapy helps them carry on
to full term deliveries.
Menorrhagia, oligomenorrhea, and hypermenorrhea: These
problems refer to long and heavy, sparse and infrequent, and
abnormally frequent menstrual periods. In a great proportion of
these cases, undiagnosed HT is the answer to the problem.
PMS: Certainly there are many other factors in
PMS, but
HT frequently contributes to this problem.
Fibrocystic Breast Disease: Next to the thyroid itself,
the breasts are the glands which concentrate iodine to the
greatest degree. Iodine is necessary to the production of
thyroid hormone. Lack of iodine, and its associated deficiency
of thyroid hormone deficiency contribute to the formation of
breast fibrocysts. Fibrocystic breasts are lumpy in consistency
and often cause pain at various times in the menstrual cycle.
Thyroid replacement consistently provides relief for mastalgia
(breast pain) patients.
Alopecia: No one wants to lose their hair, especially
women. In my experience stress affecting the adrenal gland is
the most common cause of hair loss among women. However,
autoimmune thyroid disease, hypothyroidism, and over activity of
the thyroid all can cause this problem as well. Plus, HT causes
a very characteristic pattern of loss of hair on the outer one
third of the eyebrow. This is so characteristic of HT that it is
almost diagnostic, regardless of what the TSH blood test may
say.
Weight Problems: It is actually not true that the woman
with hypothyroidism is always overweight. Many of these women
have been slim all their lives, and when they do gain weight it
is mostly around the middle, seldom below the thighs, and the
hands, feet, neck and face, and calves retain a slim character
making it seem that this is a thin person who somehow became
fat. The patient whose thyroid gland has dominated their
metabolism tends to choose foods that stimulate the thyroid
(sugar, carbs, caffeine, Eventually, however, the gland weakens,
the metabolism crashes, and the weight piles on. A low carb diet
that includes avoiding fruit, pushing eggs, attention to
supporting the adrenal gland, and a possible trial of thyroid
replacement therapy can be very helpful in getting these
patients losing weight and feeling more energetic again.)
Patients should be aware that there is a difference between the
art and the science of medicine. Anyone can read a lab test and
compare the results with the normal reference range, and
unthinkingly declare you “normal”. But it takes a physician with
a lot of clinical experience and a firm commitment to help his
patients to read between the lines and do the right thing when
the lab tests seem to be missing the mark. This should not come
as a surprise to us. Just compare the science and art of
medicine to the science and art of aeronautics. It’s one thing
to know how we can fly, and quite another to actually know how
to fly a plane. Similarly it’s one thing to know anatomy and
physiology, pathology and endocrinology, and quite another to
know how to get patients well.
Being a patient of Caring Medical
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