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.
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The Link Between Hypothyroidism and Gynecological Systems 
