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Crazy Happy Thyroid Dance

Post Published: 24 June 2010
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Category: Guest Bloggers, Sex Hormones Gynecology's impact on Thyroid Function
This post currently has 27 responses. Leave a comment

(Written by, Sara Gottfried, MD)

Dear Thyroidistas;

Somehow I made it through med school, residency and 10 years of medical practice before I figured out a key epiphany: the interdependence of the endocrine systems of the thyroid, sex hormones (estrogen and testosterone, mostly) and the adrenals. Turns out I needed to teach it to myself – it’s not in the medical textbooks or even conventional medicine discourse. One I got “it,” meaning how all these crazy thyroid, adrenal and sex hormones fit together, much of the thyroid chaos fell away, both for my patients and myself. Here’s the memo I never got.

  1. Got estrogen? Got too much estrogen? Estrogen dominance is common with hypothyroidism. Symptoms are: moodiness, cysts (ovarian, breast), weight gain, night sweats/hot flashes, irregular cycles. Too much estrogen raises thyroid-binding globulin, and this in turn can bind your free thyroid hormones, even if they are present in the right amounts. Think see-saw: if estrogen is high, free thyroid hormone is low. And vice-versa.
  2. Conversely, hypothyroidism causes sex-hormone binding globulin (SHBG) to decrease – this raises both free testosterone and estrogen. Note the significant overlap between estrogen dominance and hypothyroid symptoms – there is both redundancy in this system and crossover. Best fix: balance both systems simultaneously or sequentially. Most conventional docs will look at you like you’re nuts if you mention estrogen dominance – find an integrative doc here (acam.net) or test yourself (link = canaryclub.org).
  3. Adrenals operating properly? Adrenal function and thyroid function have a relationship also like a see-saw: when one is up, the other is down. Get both systems balanced so the see-saw is even.
  4. More on cortisol: correct amount of cortisol (not too much, not too little) helps the conversion from T4 (inactive thyroid hormone with 4 iodine atoms) to T3 (active form – 3-4 times more potent than T4, 3 iodines). You can check a questionnaire to assess for this, or even better, get it tested right here (link = canaryclub.org). Another benefit of balanced adrenal hormones is less thyroid inflammation.
  5. Polycystic ovaries? Another key aspect of interdependence is the dance between PCOS, your adrenals and your thyroid.  While the cause isn’t well-delineated, I believe most of PCOS begins with the stress cascade of overtaxed adrenals and too much cortisol in the fight-flight-collapse response, and leading to insulin resistance (typically defined as fasting insulin > 7), which is toxic to the ovary and makes progesterone levels drop. This leads to irregular cycles and imbalanced hormones (high androgens, high estrogens). One treatment is more progesterone, preferably the natural flavor as Chastetree Vitex, progesterone cream or prometrium. But that’s another blogpost for another day. Key point is that high cortisol when stressed can block your progesterone receptors, keeping the progesterone you make from doing its job. Another cause of high cortisol? HYPOTHYROIDISM! Oy, interdependence is a vicious cycle until you understand it. But know this: women with PCOS are four times more likely to have hypothyroidism due to autoimmune thyroiditis
  6. Speaking of inflamed thyroids, have you been tested for thyroid antibodies? Know your titers? Crucial, my friend. More often than not, your under-active or over-active thyroid is a result of autoimmune thyroiditis. What makes autoimmune thyroiditis worse? You guessed it, adrenal dysregulation and estrogen dominance. Oh, and digestive inflammation.
  7. Iodine, as the differentiator between thyroid hormones, is essential to the right balance of thyroid. I find most of my patients are deficient in the Bay Area of California, but too much can cause problems too. Best plan of action is to perform a iodine challenge test, available through Meridian Valley Labs in Washington among other places.
  8. Nutrition – what does that have to do with hormones? A ton. Just going gluten-free reduces estradiol (the key estrogen of our reproductive years and bioidentical hormone therapy in women 40+) by 30-40%. Big help if you’re estrogen-dominance.
  9. Got goitrogens? I’ve never heard a conventional doc talk to patients about foods (called goitrogens) that lower your thyroid function. Tell me your stories of docs who are sharing this info! Yet, as with most things, the info is easy to find online. Raw foods are lightly goitrogenic (cooking inactivates the goitrogenic compounds). Short version: strawberries, pears, peanuts, pine nuts, cassava (yucca), Brassica veggies such as brocolli, bok choy and brussel sprouts. I know, I know – they help your estrogen metabolism but recall the see-saw analogy.
  10. Polyendocrinopathy? Long word, key concept – refers to more than one endocrine gland malfunctioning at a time. Sometimes the thyroid is the first to manifest (or perhaps more commonly, the only one to be tested and/or recognized by your doc), yet one or more endocrine glands is on the wane. This can cause a more complex array of symptoms that are harder to treat. This is where a root cause analysis and step-wise or multi-system hormone treatments can be helpful.

You maybe wondering with all this complexity and interdependence, which is the chicken and which is the egg? Often we don’t know. That’s where balancing all three systems either simultaneously makes the most sense.

For more info, visit my website, blog and Facebook page, all available at Gottfried Center.

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27 Responses to “Crazy Happy Thyroid Dance”

  1. Prairiesong says:

    I feel hope struggling to the surface.

  2. Melissa Travis says:

    Wow- thank you so much! This is a BUNCH of helpful information. The only time I even asked my endo about T3 levels he told me I was so sick I wouldn’t even NOTICE if he put me on a T3… so I stopped asking…

    but this information is VERY HELPFUL and it makes me feel emboldened to keep seeking information and to HELP MYSELF MORE.

    Thank you!

  3. Sushithyroid says:

    For PCOS – “One treatment is more progesterone”. I SO thought so. I was on progesterone shots for years, went off of them briefly, and wound up with Hashi’s. It took me 2 more years and 60lbs of weight gain to get diagnosed for PCOS and Insulin Resistance. I’m supposed to go back on birth control and am wondering if I should go back on prog. pills or something along that line. When I went on Yaz, it totally screwed up my thyroid levels and sent my TSH through the roof.

    So glad to have read that!

  4. Dear Thyroid says:

    Dr. G. Thank you so much for this incredible post. I keep re-reading it. In fact, I’m printing a copy for my doctor. I wish I was in the bay area, so I could see you. Speaking for myself, some of this I knew about, but certainly not everything. I appreciate the education.

    Love and gratitude,
    DT

  5. Thank you so much for writing this, Sara! This is such an informative post and addresses so many things that so many thyroid patients and even doctors are unaware of. I am lucky to have good doctors who understand the complex (but fascinating) relationships between the hormones of the endocrine system.

    My cortisol is slightly elevated, up until recently my blood sugars were elevated and I have PCOS, but with a bit of luck my androgens have now gone back to normal. I saw my gyno today and he told me my ovaries are looking excellent:-) (I never had polycystic ovaries, but apparently I had a few ovarian cysts, which I am told are also caused by elevated androgens). He also took blood and seeing as last time my androgens were already practically normal, I am going to be optimistic and assume that now they finally are.

    For me the administration of Metformin, which is also used to treat PCOS, is what really kick-started some of my weight loss and started getting my androgens back to normal (of course, it’s a chicken and egg scenario – extra weight can equal extra androgens and vice-versa). From what I have read (and I have read a lot about PCOS and also wrote my own column on it here on Dear Thyroid), the antiandrogen contraceptive merely masks the symptoms of PCOS, but won’t sufficiently lower your androgens on its own.

    I can testify to this because despite the fact that I took the antiandrogen contraceptive since age 24 (when I was diagnosed) and although I didn’t really have any of the visible symptoms such as hirsutism or acne, I still struggled with my weight and was always slightly overweight (but that too was compounded by the Hashimoto’s) and when I finally found a good gyno, he tested my hormones and they were still elevated (years ago, I had been told that the antiandrogen pill normalises them so I believed this).

    My PCP (who works with my gyno) took the initiative and did a glucose tolerance test and found that I have impaired glucose tolerance. I was already on Metformin at the time, as I have read that this is administered even if the patient doesn’t have blood sugar issues, but then they found out that I did anyway. Now, I am prophylactically taking 1 x 450 mg pill Metformin a day for another six to eight months and my blood sugars have normalised.

    Based on my experience, I believe that many PCOS patients may well struggle to lose weight until their PCOS is treated aggressively enough – it wasn’t until my blood sugars were treated (as you will know, blood sugar issues and PCOS are closely linked) that I started to really properly lose weight.

    I’m assuming that some PCOS sufferers – like myself – also have elevated cortisol levels, which could also explain a lot as elevated cortisol is known to raise blood sugars and is the first stage of adrenal fatigue. I also read that when the thyroid is malfunctioning, the adrenals tend to take over and work at top speed to keep us going, as our thyroid sure isn’t, but this can of course ultimately lead to them burning out altogether and cases such as Addison’s).

    Another thing that helps with any hormone balancing is regular exercise, which is a true motivation for me to go to my personal training sessions, which I am really enjoying right now.

    Looking forward to your future posts! There is a definite link between say PCOS and hypothyroidism, but many doctors sadly fail to realise this. Thyroid disease can indeed cause a whole host of reproductive problems.

    Thank you again for posting!

    Sarah

  6. Melanie says:

    I think I got very lucky with my obgyn, he is a conventional doc and we have talked about me having estrogen dominance. He first wants me to go see and endo he recommends to get my levels under control and then if I still feel the same we will approach the topic again. I am doing the same thing and printing this out to give to my new endo.

    Thank you

  7. Wendy Curtis says:

    Very detailed, very informative!! Thank you for taking the time to write this, and educate us 🙂 Wonderful information!!

  8. Faren says:

    Great article. I have been trying to figure out what set my thyroid off years ago and this makes me even more sure that it was when I stopped oral contraceptives to have my first child. I had been on the pill for about 10 years by that time with no evidence of thyroid issues that I was aware of. My goiter/nodules were dx’d at my first prenatal appt and a year later I had a TT with papillary cancer confined to one nodule. My Mom and her identical twin sister were also dx’d w/goiters after they had their children (each had one daughter) and have also had surgery. They both took oral contraceptives, also. Coincidence? I’m not so sure. At least not in my family! My best friend went hypo after she stopped taking the pill. No hx of thyroid disease in her family.

    After 10 years of seeing an endocrinologist and still feeling awful I recently found a wonderful women’s practice run by nurse practitioners. I am now being treated for adrenal stress and will be adjusting my thyroid med in the next few months. My FT3/rT3 (which my endo NEVER tested) ratio is extremely low so we will see if that improves as my adrenals improve. My TSH level would have any endocrinologist believing I was hyper yet my symptoms were quite the opposite. I will also be stopping oral contraceptives permanently later this year. I’m finally feeling like I’m on the right road to getting my health back.

  9. Dr. G, thank you SO much for sharing this wonderful, educational piece! It’s such great information to have. THANK YOU!

  10. Lori says:

    Thank you so much, this is great information. You explain it all so well but I’m sure I’ll be reading it several more times. I can’t wait to read the next column as well. I will definitely be bringing a copy of this to the next appointment with my hormone specialist because I now have several new questions for her, but I will also provide my primary care with a copy in hopes this might help other patients be diagnosed much earlier than I was.

    Now how to get the male version of this hormone balancing game. Actually maybe you know the answer to a question I have regarding adrenal gland problems in a male who has pretty extensive stretch marks around the waist and on the thighs. This person has not lost significant weight to cause this. He has recently lost 30 lb and is in the process of being worked up for thyroid disease but never had large weight changes before this and has had the stretch marks for several years. His primary care mentioned it could be related to a “cortisol” problem but has not done any testing for that. Have you seen this as a result of adrenal fatigue?

    Thanks again for doing this column.

  11. DAT says:

    Dr. G, you are wonderful and I thank you for taking the time to help us. It really makes me think. I have been lucky, never any gyno problems but I only took the pill for one year, I resented being a slave to it so I just stopped. I never got pregnant until I was 37 and will admit that I did not always practice safe sex. I trusted my partners and had this thought that if I was meant to get pregnant I would. Ironic that I am now a slave to levo to stay alive I think. I am 47 and believe I am peri-menopausal. My gyno is a great guy and I think he would be open to anything but better yet I see a new internist this coming Tuesday and she sounds a lot like you. Willing to put all the pieces of the puzzle together. Thank you again. I look forward to reading all your upcoming installments. We are lucky to have you 🙂

  12. Brenda says:

    Okay, color me confused. I have hypothyroidism and Hashimoto’s, complete with its fashion accessory a/k/a a multinodular goiter, and I was rocking along pretty well UNTIL I hit another roadblock – menopause. Yipes! Since then, some days I feel like I should just put orange barrels and crime scene tape around the couch and cry “Uncle!” Or maybe just cry.

    On the bright side, I have an excellent endocrinologist who has worked with me for almost two years now. He listens, he talks to me like I actually do have two brain cells that occasionally fire simultaneously, has never put me down or blown off my symptoms as unrelated, and did I mention he listens?! In fact, he actually suggested adding Cytomel (T3) before I had a chance to ask him about it.

    I think it’s highly likely that my hormonal status has instigated most, if not all, of the symptoms I have been having, including suddenly not being able to tolerate most thyroid meds. I have also piled on the pounds, despite eating right (gluten-free) and exercising, but he doesn’t seem to be nearly as concerned about that as I am. {Sigh}

    At this point, after numerous tests, all systems are in “normal” range including: TSH, Free T3, Free T4 (in normal ranges for the first time in 18 months), adrenals, and parathyroid (despite having a “notation” about a parathyroid gland on the last ultrasound report which I will be discussing with him tomorrow.)

    Cutting to the chase, I would like to know how being in a menopausal state is contributing to my thyroid problems and symptoms, and how can that be corrected to get everything working harmoniously again? Preferably before I grow to the couch.

  13. DrGottfried says:

    hi friends, i so appreciate your warm comments about the pose. i want to transfer your superb questions into future blog posts, especially the rather meaty topics of how menopause messes with the thryoid, as well as more details on PCOS and metformin – how insulin and leptin fit into this whole dance. please keep your queries, suggestions, comments and wish for clarification coming and i promise to keep track and respond. wish i could write more but my younger 5-year-old daughter is demanding attention at the moment – more soon after polly pockets!

  14. DrGottfried says:

    i meant “post” not pose. can you tell i’m also a yoga teacher? ha ha ha

  15. Amanda says:

    Thank you so much, great information. I will re-read this and try to absorb as much as I can. I feel so blindsided by this thyroid issue, I don’t want to be caught off guard again.

  16. DrGottfried says:

    Love the image of hope rising to the surface — it’s our birthright. For my friend Melissa – keep asking for a free T3. If your doc declines, you can also order that from canaryclub.org (last i checked it was $60). Sushithyroid, were you on depo-provera? Is there a worse toxin? Most women gain weight on it, lotsa lotsa weight. Have you ever tried bioidentical progesterone? I can’t give medical advice here, only coaching and suggestions, but you might want to check out John Lee, MD’s books on natural progesterone. I prefer it orally or transdermally but there’s lots of ways to get it. Birth control pills correct estrogen dominance (there’s more progesterone than estrogen in birth control pills) but with synthetic hormones. Birth control pills will decrease your thyroid hormones, meaning if you start the birth control pill, you’ll probably need higher doses of your thyroid meds. Make sense? For Sarah, hurray that you got your hands on metformin. As you probably know, it’s an insulin-sensitizing agent; that is, it makes your cells more sensitive to insulin. Exercise does the same thing and even 5 pounds of weight loss if you’re overweight can dramatically improve your numbers (such as glucose tolerance test or fasting insulin or fasting glucose). But for many of us losing 5 pounds is a major feat – more on why this is coming in future posts! More soon and thanks again for your loving feedback! Such a lovefest here on Dear Thyroid!

  17. Thanks for your in-depth responses to everyone, Sara. The sad thing about my PCOS is that nobody actually bothered to perform a glucose tolerance test until recently when I met my new gynecologist who was concerned about the weight issues I was having, although to be fair they weren’t as bad as they sound (I was a Size 14 at my biggest), but he is rather weight-obsessed. That was for the best though because I know that even a little bit of extra weight can cause blood sugar issues. I was on quite a monster dosage for a few months (1000 mg 3x a day!) and sadly my B12 levels were depleted by it (a known side effect that is even listed on the packaging instructions) and I think it made me pretty tired too because of the gastrointestinal issues and the horrible pregnancy-like bloating. I told myself it was worth it though if it was going to lower my blood sugars and enable me to lose some weight. Now that I’m down to just one pill a day, it’s so much easier, the bloating has gone down and my energy levels are starting to go up. I’m very lucky I have such a proactive gyno. Funnily enough, I never thought I’d feel comfortable with a male gyno, but he’s been the best yet. Sadly, many of the female ones I had in the past were pretty evil and bitchy. He was moody with me once, but since that one little episode he has been just fine and I get the feeling that he is one of those docs who truly cares. He also performed an operation on my VJ to cut away a flap that was causing sexual pain. I think this may be similar to what is known as Fenton’s Release. Currently, the hope is that my androgens will have normalised. If that is the case, I really will have a lot to thank him for. I do believe that taking the meds alone was not the answer, but I starting paying more attention to the sugars I was eating and also tried to work out more, which definitely helps when you have PCOS. It’s such a fascinating but horrible illness, isn’t it?

  18. Sushithyroid says:

    I really don’t want to go back on birth control… it DID mess up my thyroid medication pretty severely. Since going on Metformin, I have at least been getting my period again… not on a regular schedule, but close enough. After not having it for years, anything is better than nothing.

    I will look into the natural progesterone, though. All I know is once I went off of it, all hell broke lose. I never gained on Depo. I actually did really well on it till going off of it.

    Metformin = super great as long as you exercise and watch your diet. I’m finally losing a little.

  19. DAT says:

    Okay, this may sound really foolish but I wonder about this. I don’t have a thyroid (follicular thyroid cancer survivor, 4 year mark soon) and have not struggled with weight until recently losing more than I cared to because I am hyper for the first time. I think the levo started to affect me differently because of peri-menopause, am I right? And, I know you will probably address this soon enough but how does being thyroidless affect being in menopause? Do I have the same concerns as those with thyroids or not? I guess I have assumed (bad word) that my levo is my thyroid. I wonder about the nutrition piece too. I want to eat right for the rest of my body and will, but the issues of diminishing your thyroid function, do they apply when you don’t have one? I can’t wrap my head around this. Thank you again and I hope you had fun with your daughter.

  20. DrGottfried says:

    I wanted to thank Faren for mentioning the fT3/RT3 ratio (free T3 to reverse T3). As many of you know, this is an important ratio to track, especially if you continue to have hypothyroid symptoms despite treatment and a normal-ish TSH. Goal generally is fT3/RT3 > 18 (when units ng/dl) or >0.018 (units pg/ml). RT3 (inactive T3) rises when: (1) stressed, as suggested in Faren’s adrenal overload; (2) perceived starvation, often from chronic dieting; (3) and when overweight. Do you know your ratio? More on this in the next post!

  21. Faren says:

    Sara,
    These were my results:
    TSH: 0.18 (0.40-2.50)
    FT4: 1.3 (0.9-1.8)
    FT3: 2.95 (1.80-4.20)
    RT3: 31.4 (9.0-35.0)
    Anti-Tg: <32 (<=40)
    Anti-TPO: <14 (<=34)

  22. Jan says:

    Is it possible to balance one’s adrenals and thyroid via a nutritional approach? For example, if you eat low carb (50gm or less) per day, does that raise adrenaline and exacerbate fatigued adrenals? Should we eat some complex carbs at every meal to prevent adrenaline from getting too high in relation to insulin?

  23. Sarah Downing says:

    Dear Sara,

    I have two questions to you about hyperandrogenemia/elevated male hormones. I realise that you are unable to give medical advice on these forums, but perhaps you can provide me with some basic information to ease my mind because I am very worried right now and can’t get hold of my gyno until tomorrow. Even then, he never explains things in as much detail as I’d like or need, but is still the most proactive gyno I have had to date. This pertains to my case in particular. I was very happy with my gyno, but now I am confused and pissed off because since he has been treating me for elevated androgens, my levels have actually gone up and yesterday they called me and told me that my levels have gone down and I am making good progress …

    I have been on an antiandrogen contraceptive since I was 24 (was on various other contraceptive pills since I was 18) when my androgen levels were first measured as elevated.

    I’ve researched for hours and talked to various gynos, but nobody seems able to give me any answers, so I am hoping you can at least give me some basic information (my questions are at the bottom, but I figured I should tell you about my case first).

    I started out with my gyno in February 2010 about five months after I was diagnosed with Hashimoto’s – he was worried about my elevated androgen levels and told me that the contraceptive pill would only mask the symptoms, but wouldn’t decrease the androgens. The thing is until that time I was blissfully unaware that my levels were even elevated because I don’t suffer from any of the common virilisation symptoms such as polycystic ovaries, hirsutism or acne. The only thing that is possibly a symptom is some extra weight around my middle which has improved since my thyroid diagnosis and could equally be related to this! My gyno however steadfastly claimed that this must be related to the androgens and was very anxious to get my levels down.

    First of all, my gyno switched me to another antiandrogen pill (Valette), which is supposed to be even more effective.

    In addition, he also had me on 5 mg Androcur a day for about a month, but I couldn’t tolerate it as it made me horribly tired and, I believe, was also responsible for migraines I started getting (I think my testosterone levels went down during this time, but once I stopped taking it, they seem to have gone back up).

    Furthermore, my gyno started me out on Metformin and after a glucose tolerance test was done and I was found to have impaired glucose tolerance, I continued on that. Up until recently, I was taking 1000 mg three times a day, but about a month ago the doctor reduced it to 425 mg once a day because my levels had gone down. I was very glad because other than losing a few pounds, the Metformin made me feel worse than ever in terms of tiredness and bloating – probably because of the high dosage, which I have read is the highest dosage a doctor should administer. Thanks to the the damn Metformin, my B12 levels are now depleted too, which I’m unsurprisingly a bit pissed off about. I’m taking B vitamins though to hopefully get these back up.

    Anyway, so my blood sugars are now normal, I’ve lost a bit of weight, but not a ton (I went down from a Size 14 to about a Size 12). According to my last blood results, my triglycerides have also gone back to normal – for those reading this, high triglycerides can be a symptom of PCOS/elevated male hormones.

    Well, my gyno’s receptionist called me yesterday and told me that my levels were decreasingly nicely and we were on the right track so that I should come back in in three months (before then, my gyno had insisted on seeing me every two weeks, which was getting too much and too expensive. My insurance pays my gyno bills 100% thankfully, but still. I believe my gyno has good intentions and wasn’t doing it for the money, but rather because he is so damn impatient).

    Anyway, today I decided to look back at the lab results only to find to my horror that the testosterone level measured in February (before I started out on the gyno’s treatment) was higher than the latest one, as were some of the other levels. Interestingly, my SHBG (Sex Hormone Binding Globulin) is always elevated, which I suspect is why my free androgen index is in the normal range, which I suspect is in turn the reason why I don’t display symptoms of androgenisation.

    Anyway, to get to my two questions:

    – I know that most doctors seem to think hyperandrogenemia has an ovarian cause, but if that were the case with me, surely my levels would have gone down since I’ve been on the contraceptive pill (well, they haven’t – my testosterone levels at age 32 are pretty much the same as they were at age 24!) Furthermore, I thought that when my blood sugars went back to normal, so too would my androgens as one cause of PCOS is deemed to be the high blood sugars stimulating the ovaries to produce more androgens. Well, the Metformin doesn’t seem to have helped much with my androgens either!

    The conclusion that I am starting to draw is that maybe my hyperandrogenemia has nothing to do with my ovaries and much more to do with my adrenals, particularly as I have elevated cortisol (but not to the extent where they are worried about Cushing’s or anything like that).

    So my question is: what forms does adrenal hyperandrogenemia take and how is it treated?

    My second question is based on a past medical report that claimed that there are women who naturally have higher levels of androgens without them being pathological. Is this possible? Frankly, I’m sick and tired of my two doctors harping on about getting my androgens down when at this point it doesn’t even seem possible. Either that, or I’m on the wrong damn treatment because these androgens seem pretty resistant to therapy. As I mentioned above, I haven’t had any of the typical signs of androgenisation – is it possible that I just have naturally high androgens and that there is nothing they can or need to do about this?

    Thank you so much for any information you can provide me with. At this point, I am desperate for information because I am pretty worried.

    Cheers,

    Sarah

  24. victoria says:

    Excellent post. You’ve synthesized it all. It took me years to get this info. All on my own. With useless doctors. And I’m still not better. I will look you up.

  25. Kristy says:

    I am not able to tolerate thyroid medications since being off birth control pills. Does a hormonal imbalance contribute to this? I’ve had my hormones checked and my estrogen and progesterone are low.

  26. John Veteran says:

    Of course crappy Sleep Hygiene (light proof, sound proof, precise temperature controls) produces high stress levels and the body’s inability to properly replenish Cerebral Spinal Fluid due to lack of Mutagenic D and low Prolactin Levels from an exhausted pituitary gland and HPA axis cause the thyroid to tank in the first place.

  27. […] – PMS is a real issue for hypothyroid women. Sex hormone levels are intricately connected to thyroid hormones. Be sure to have your sex hormones including […]

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