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Women's Metabolic Clarity · Topic 8 of 15

Thyroid

Thyroid problems and menopause can look alike. Both are worth checking.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. Could it be my thyroid instead of menopause?
  2. My thyroid test is 'normal.' Why do I still feel bad?
  3. Does hormone therapy affect thyroid medicine?
Question 22 of 45

Could it be my thyroid instead of menopause?

Short answer

  • It could be, or it could be both.
  • Low thyroid can cause tiredness, weight gain, dry skin, feeling cold, and brain fog.
  • These look a lot like menopause symptoms.
  • Thyroid problems are common in women, especially with age.

What to look out for

  • Feeling cold, constipated or very tired.
  • Hair thinning and dry skin.
  • A family history of thyroid disease.

Top 3 things to act on or ask your clinician

  1. Ask: 'Should we check my TSH?'
  2. Ask: 'If my TSH is off, should we check free T4 or thyroid antibodies?'
  3. Ask: 'Could my symptoms be thyroid, menopause or both?'
Sources for this answer
  1. Peer-reviewed Garber JR et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18:988-1028. PMID: 23246686. DOI: 10.4158/EP12280.GL
  2. Peer-reviewed Jonklaas J et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24:1670-751. PMID: 25266247. DOI: 10.1089/thy.2014.0028
  3. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  4. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
Question 23 of 45

My thyroid test is 'normal.' Why do I still feel bad?

Short answer

  • A normal TSH usually means your thyroid is working well.
  • Lab ranges are built from large groups. You can feel unwell for other reasons.
  • 'Subclinical hypothyroidism' means TSH is a bit high but T4 is normal. Whether to treat depends on details.
  • If your thyroid is fine, other causes need a look.

What to look out for

  • Testing just once when symptoms change.
  • Being told 'it's fine' with no next step.
  • Buying thyroid supplements without guidance (some contain hormone).

Top 3 things to act on or ask your clinician

  1. Ask: 'What else could explain my symptoms?'
  2. Ask: 'Should we re-test in a few months?'
  3. Ask: 'Is my TSH in a range that needs a closer look?'
Evidence note: Some experts discuss narrow 'optimal' thyroid ranges. Major guidelines (ATA, AACE) do not support treating normal lab values to reach an 'optimal' number. We go with the guidelines.
Sources for this answer
  1. Peer-reviewed Peeters RP. Subclinical Hypothyroidism. N Engl J Med. 2017;376:2556-2565. PMID: 28657873. DOI: 10.1056/NEJMcp1611144
  2. Peer-reviewed Jonklaas J et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24:1670-751. PMID: 25266247. DOI: 10.1089/thy.2014.0028
  3. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
Question 24 of 45

Does hormone therapy affect thyroid medicine?

Short answer

  • Oral estrogen can change how much thyroid hormone is bound in the blood.
  • Some women on thyroid medicine may need their dose checked after starting oral estrogen.
  • This is a question for your prescriber, not something to change yourself.
  • Tell every clinician every medicine you take.

What to look out for

  • Starting or stopping hormone therapy while on thyroid medicine.
  • New tiredness after a medicine change.
  • Taking thyroid pills with calcium or iron at the same time.

Top 3 things to act on or ask your clinician

  1. Ask: 'Should we re-check my thyroid after starting hormones?'
  2. Ask: 'Do any of my medicines or supplements interact?'
  3. Bring a full list of all pills and supplements.
Sources for this answer
  1. Peer-reviewed Jonklaas J et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24:1670-751. PMID: 25266247. DOI: 10.1089/thy.2014.0028
  2. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed Garber JR et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18:988-1028. PMID: 23246686. DOI: 10.4158/EP12280.GL
  2. Peer-reviewed Jonklaas J et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24:1670-751. PMID: 25266247. DOI: 10.1089/thy.2014.0028
  3. Peer-reviewed Peeters RP. Subclinical Hypothyroidism. N Engl J Med. 2017;376:2556-2565. PMID: 28657873. DOI: 10.1056/NEJMcp1611144
  4. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  5. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  6. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
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All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Insulin Resistance and Blood Sugar · Sleep and Night Sweats · Cortisol and Stress · Brain Fog, Mood and Anxiety · Bloodwork: What to Ask For · Heart and Bone Risk After Menopause · Hormone Therapy Basics · Gut Health · Nutrition and Protein · Alcohol · The Shame and Guilt Cycle, and Identity