Question: What are symptoms of thyroid problems in females?

Short Answer: There is a wide variety of thyroid symptoms in women. Some of the more common are fatigue, weight gain, constipation, and dry skin. Based on our experience, we have noticed many other hypothyroid related symptoms as well. These symptoms include heavy periods, infertility, anxiety, low libido, hair loss and low mood.

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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki

Dr. Davidson: And I am Dr. Davidson. 

Dr. Maki: So it is officially a little bit past the beginning of summer in Washington, although looking out the window right now, it certainly does not look like summer. It is raining kind of heavy right now. 

Dr. Davidson: I would say even though it is supposed to be summer, it seems like spring has officially started because it is really beautiful with the little deer out and the flowers are blooming, and I think it will clear up a little bit later. 

Dr. Maki: Yes, you know that I sent you the picture you saw but for the listeners, I was sitting here, you were upstairs and I was looking out the window and I saw a female deer and then she just took a picture of it. You know, that is great. A deer walks through the yard all the time and then she moved and there is a little, literally like a little fawn, a little Bambi right next to her and kind of following along and she hit the little white spots on the side and there. Eating little weeds in the yard and they walked over to the little garden over there and ate some things out of the garden. 

Dr. Davidson: I was so happy to see that picture because I saw that little fawn a couple. I think a couple of weeks ago right after it was just born with its mom walking through the driveway and then I did not see them again and well, little baby still. Okay, so it is really neat to see him or her a little bit bigger with those little white spots on the bum. 

Dr. Maki: Yes, right. That was that was nice. You know, we do not see the deer hardly at all winter long and then it seems like June, I remember where we lived. Now we moved in here lack last year and June came literally like June first I will send, the deer came almost every day. We are having deer come through the yard and sure enough, here is June again. I do not know where they go.

Dr. Davidson: Only because we do not cover up our garden beds. So we basically are growing a garden to feed deer. [laughing] Which is fine. 

Dr. Maki: That is okay. 

Dr. Davidson: They need to it. 

Dr. Maki: That is all right. Make sure the little one gets the gets a meal here and here and there. So on today’s episode, we are going to talk about thyroid. This is a question, this is actually a specific question from somebody but it is something that comes up all the time that we get answer or people send us questions. So we just thought we would kind of do this a little bit more of a– if you are curious or if you are wondering about your thyroid or if you already have a thyroid problem, some of these things that we are going to talk about will make some sense. This is really based on our experience. This is not something from Google or anything like that or any of the websites. This is just from our experience and what we have noticed, that depending on their lab work and all that clinical data. These are the situations and the symptoms that tend to improve once they have been on the right medication for them.

Dr. Davidson: Exactly, because you know, gosh, we have been in practice since you were 2003 and I am 2004, and me being a female, I have mainly worked with females. So when it comes to thyroid, I have a lot of women, wondering about their thyroid, wondering well, what are the symptoms of thyroid? Because my conventional doctor just tells me it is about being tired and looking at my lab work. When really there are so many other symptoms involved with having a lower thyroid or having lower thyroid function or hypothyroidism with women that sometimes people do not really connect. 

Dr. Maki: Yes, right. There are some basic ones, certainly, we are going to talk a little bit about weight gain, certainly you said being tired, maybe the third one would be constipation.

Dr. Davidson: Not even constipation. A lot of people are not even aware that constipation is an issue with hypothyroid with females. Not so much that I noticed with the men but you know, like I said, with our own experience, I probably have seen more women than men. But if you want to just jump right into it, I would say constipation is one that people just look at you kind of starry-eyed when you ask them. Well, how are your bowels and the women say, well, I have a bowel movement every other day or twice a week or it just does not feel complete. That really can be impacted from a low thyroid. 

Dr. Maki: Yes, right. Well, if you think about it, the thyroid kind of controls everything. It has an impact. It is one of those major metabolic hormones that has an impact on every functioning system in the body. So if your thyroid is a little bit under functioning then the potential, as we are going to talk about the list, that is going to have an impact on how you feel and how everything else functions. So when you think of it in that context it would make sense that– and certainly you look at some of the textbooks that constipation certainly on the list, but I think you are right. I think that nowadays when it comes to thyroid in general, if your TSH is normal then nothing can be related to your thyroid if your TSH is below 4.5 and I do not really agree with that whatsoever. I think there is a limitation to the testing because we see it all the time. We see people that have reasonable numbers, kind of high normal TSH but they have a whole list of hypothyroid symptoms and I think that testing a lot of times, you know people they go underdiagnosed and all that happens on a regular basis.

Dr. Davidson: I mean wonderfully there are more online forums, more blogs, more videos, more books written about thyroid. And so I am glad that it as a real talking piece in the last few years, but you are right conventionally, they are just looking at medication and your levels. Unfortunately with women, because I do think with low thyroid, women have not the typical– I know I say not the typical but they are not common signs that you would kind of relate with thyroid. When you are looking at women and trying to work on their thyroid function because we have so many other hormones going on in our bodies. Yes, we are complicated but we are so worth it. But we have so many other hormones going on in our bodies that when that thyroid function is starting to drop, you will see manifestations in the female reproductive system, you will see other manifestations that you would not necessarily say “Hey, you know what that is coming upstream from the thyroid.”

Dr. Maki: Yes, right. Medicine in general as it has always been is very reductionistic. I think thyroid is kind of looked at even though it is very complex and it affects as I said pretty much every aspect of your being in some in some ways, is looked at in a very kind of narrow lens, so to speak. Even if you have all the symptoms we are going to talk about in a lot of women we deal with, maybe that is why they eventually find us because we have heard the stories over and over. People go to doctor after doctor. Knowing that there is something wrong with them. They know how they feel, but again if their TSH is below 4.5, they are like “Oh you are fine. There is nothing wrong with you.” The patient always know before the doctor does. Nowadays, our philosophy has always been to treat the patient first, the lab tests second. In medicine, not just thyroid, but that is one that we see most often, is that it is lab tests first and the patient second and I do not agree with that at all. 

Dr. Davidson: So let us jump into our list, but before we do, if any of you listeners here kind of a weird like clunky sound and we have said this before like a little clunky clinky sound, It is our, our dog is having a great time putting his bone on top of the base of the table with his little dog hands wrapped around it. So he is having a great time. He is always at our feet. But if you hear that little clunky sound, I am sorry about that. 

Dr. Maki: Like he is literally laying. I am sitting on a stool and he is literally laying on one of my feet as he is chewing on this bone over the side railing of the table. That is pretty typical. If this is a video podcast you could actually see him, it would be really cute but you know, nonetheless if you hear a weird noise in the background, it is always him at our feet.

Dr. Davidson: Always our dog, Bob. 

Dr. Maki: So let us just dive in. So again, this is a list that we kind of just, actually fairly quickly, just kind of ran through and we did research if you want to call it that quote-unquote but as we said this is really just from clinical experience. The things that we see over and over so why do we not just start with the, maybe the most common one that is not just thyroid but certainly the thyroid can play a role in it if it is present. 

Dr. Davidson: Yes, like you said, fatigue and weight gain. That is the first thing people think of when they think of thyroid whether it is females or males, fatigue and weight gain are definitely number one. I guess you could say one and two but what I think is not noticed as much because this is why this funded to this on the podcast, is try to give you some pearls that would say “Oh my gosh. Yes, that is a thyroid issue” especially in females, but with women, they will notice it is not just weight gain, but it is like water weight and bloated. They will wake up and be one weight in the morning and by the end of the day, they could be easily up between three and six pounds for really no dietary reason.

Dr. Maki: Now, I do not think that that is related to the thyroid necessarily. I think you and I could beg to differ about that. You are right. Your weight is going to fluctuate day to day, from one day to the next. It is going to bounce all over the place. So using that as a gauge, I do not think it is necessarily a valid point.

Dr. Davidson: But I do think it is. An important symptom point out because–

Dr. Maki: Oh sure.

Dr. Davidson: Because everybody wants to fit in their pants at the end of the day and I do not want to go run off their stretchy pants or unbutton the top button.

Dr. Maki: I do not have actual numbers, but I would say the average person probably gains casually from the time they are in high school or even in college, until the time they are in their forties. They probably gained really, I think statistically like to 5 pounds a year. They gained like 20 pounds by the time they get to their twenty-year reunions something like that. So a little bit of that weight gain is going to be year by year is going to be somewhat normal, but if someone is putting on a large amount of weight in six months, something is going on there that is driving that extra amount of weight loss, especially if you know caloric intake does not necessarily meet that. Now if you are in COVID lockdown and you have been eating like crazy, which I know a lot of people have been doing, you might have put on some weight. But then once we get out of lockdown, whatever now some of that weight should come right back off relatively easy. But if you have seen this kind of, either a three-six or even a twelve-month time span, a considerable amount of more weight than that, the thyroid certainly does need to be considered in that respect.

Dr. Davidson: Yes, because that metabolic activity drops down and then of course, if you are tired, the last thing you want to do is let us go work out or let’s go exercise granted we know a lot of people that force themselves to and are very unhappy when they notice they are not losing weight. So definitely that weight gain and that fatigue and like I mentioned feeling puffy and bloated. Us as girls, we know when we are puffy. We are like, “I feel puffy today, why?” That can you know, the thyroid does hold onto water that is one of the things when little babies are born with myxedema or their thyroid dysfunction or they do not have a thyroid. Not that common but you can find that in the history books of medical history books. These little babies come out of the womb and their little faces are so puffy. You cannot even see their eyes or it is just so puffy and that is because of a thyroid issue. So that water weight and that puffiness is truly just happening. You are right. It can come from other issues, with your adrenals, with free more hormones, where you are in your cycle, but you know that thyroid being low will put on some water weight.

Dr. Maki: Yes and we could kind of parse out stress-related weight gain and tiredness or fatigue, thyroid-related weight gain and stress and fatigue or fatigue. But in reality because the thyroid and the adrenals are somewhat connected, there is an access there between those two, you cannot really have one without the other. If you have a thyroid issue, you are going to have an adrenal issue and vice versa. And let us talk about 2020 so far, it has been stressful. It has been a stressful year to say the least wherever the entire country. So it is really hard to relate both of those, just a tired but it is on the list of the things that you are going to see for sure.

Dr. Davidson: While stress can make you lose your hair, having lower thyroid function will definitely cause hair loss and that is a scary thing for a lady. We do not want to lose our hair. It is scary and what they notice is it is not so much androgen derived, like you would see with male pattern baldness, but with a low thyroid, a woman will notice their hair is everywhere. I mean, they are terrified to wash their hair because there are just coming out in handfuls and it and what it is, is it is not breakage, but it is coming out at the root. So sometimes you can even see that little punctum at the end of the hair shaft because it should not, I mean we are supposed to lose hair everyday. That is common but it definitely seems like an extraordinary amount of hair loss. 

Dr. Maki: Yes, right. And we hear that is a big complaint. We hear the hair loss issues. And really there is, conventionally, there is not really a lot of good treatments for it. Now, it is funny. They relate a lot of– and men they relate a lot of hair loss to testosterone. But why do women lose their hair when they do not have any testosterone. So I do not– I think that for women I think the androgen, certainly DHEA testosterone can drive some of that hair loss. I think for men it is a little bit more on the cortisol side than it is on the androgen side. Maybe if you are getting–

Dr. Davidson: And the genetic side. 

Dr. Maki: And genetics too, of course, I mean certainly it does get passed down. You see it kind of in the family tree, there is a certain–

Dr. Davidson: Look at my dad. 

Dr. Maki: Yes, yes. I have never seen your grandfather. But does he have hair?

Dr. Davidson: It was not on my dad’s on the father’s side. It was more on his grandfather. So I guess you could say my grandmother’s dad. That is it. It came from the from the female side, with the hair loss but definitely his brothers, all my uncles. 

Dr. Maki: Yes, there is a little bit of a trend there. 

Dr. Davidson: So yes, it came from his mother or my grandmother’s side, the maternal side. 

Dr. Maki: Something is going on. My grandfather on my mom’s side, he was I remember, my dad had actually decent hair, but my dad my grandfather on my mom’s side actually had hair kind of like your dad’s. You had the crown in the middle.

Dr. Davidson: Well you have gorgeous hair. You have lots of hair and your mom and dad both have lots of hair. So nobody feels sorry for them. 

Dr. Maki: Yes, but hair loss is a tricky one. Certainly, the thyroid can play a big role there again, it helps things grow, you start to notice if you get the thyroid right that you start to get some of that undergrowth at the base of the scalp and where the hair meet and that can be very encouraging for someone that has been struggling with hair loss issues. I have had quite a few people that go to all these different hair specialist and they want to do inject steroids and do all these things and I am not really sure how effective some of those treatments really are. 

Dr. Davidson: I think a lot of them are based for females. More on those androgen derived. So doing the steroid injections into the scalp around the temples in the top of the head is supposed to downregulate that testosterone that might be accumulating in the follicles, they say. I am saying a lot of doctors will say, “Well, just go, wash your hair with Rogaine.” And Rogaine does have an effect. But the thing is it only works when you are using it. If you stop using those hair loss formulas for shampoo and conditioning, then the hair just goes back to where it was originally. So the whole goal is to get that hair growth because in hypothyroidism, the hair follicle is not dead. It is alive, it is just in some ways kind of dormant or that the hair does not want to stay in the follicle. So definitely like Dr. Maki said is once we kind of get that thyroid balance and balancing some hormones, that hair does grow in and it is cute. They get bangs because it is growing in and around the hairline, it is different lengths but like you said people are very encouraged by that. 

Dr. Maki: Yes, you get the thyroid if functioning right you reduce some of the stress hormones and for a female’s case, get rid of some of the androgen certainly if she has PCOS so she has higher testosterone higher DHEA, you know certain that would want to be addressed in some respect as well, but thyroid tends to be kind of a foundational piece to that process. All right moving on. Next one of course, we kind of mentioned it, constipation. It used to be kind of on the list of all the classic hypothyroid symptoms. Now, I think constipation kind of gets– maybe because it is really common. Everyone is somewhat constipated to some extent or has some kind of digestive issues that it kind of gets reclassified as either as IBS or some other kind of digestive issue when sometimes it can just be a sluggish thyroid. 

Dr. Davidson: And you think, like you would mentioned earlier, the thyroid has a role in everything. So if things are moving well, hey things down south with the colon are moving well too but if things are moving slowly then you will see that constipation and then to what I also noticed with hypothyroid more so with females than men is one of the amazing things about the large intestines or the colon is its ability to draw water out of the stool. So if I did not have water around and so I would not die from dehydration. It will pull the water out of my stools to try to supply me with some hydration, even though in hypothyroid what you will see is, even though I am down in the water, the colon, for some reason still has an ability to do that that it pulls the water out and then that is why the stools end up being dry. So a lot of women with hypothyroid will complain, not only am I constipated it but it is almost like this stool is, sorry if this is too much TMI, but like rabbit pellets, they are hard and they are dry and that is because of that dehydration. So working on the thyroid is great and we have got a lot, there are so many other tricks and tools for constipation because it is really common in females just in general. 

Dr. Maki: Yes, yes. You do not see her too many men that have constipation problems–

Dr. Davidson: No, do not. 

Dr. Maki: But a lot of women have that problem. I think the liver function plays a big role in that and we can expand on constipation later.

Dr. Davidson: We could talk about. I could talk about it forever because it is so important. You know you are an adult when you want to go to the bathroom every day. 

Dr. Maki: Yes. Sure. Well, when I was a little growing up in Minnesota, Wisconsin. I had a lot of older relatives and they are always talking about Auntie Bibi and Auntie Fanny, Auntie Helen and all the people, they are always talking about their bowel movements. It is like “Geez really,?” and their whole day was ruined if they did not have a bowel movement. At that time, I was a little boy, they were probably already in their 70s and 80s, so they were definitely considered to be now by today’s standards some of them would not be considered elderly, right? We have patients that are in their 70s and 80s that are just amazing, still working and still doing some, living a very active lifestyle. When you and I were little, seventy and eighty was– they were considered old people at that point. I mean they were definitely geriatric and that is just kind of what they talked about. They all had prune juice in the fridge and some of those little tricks they needed because their whole day in some ways revolved around going to the bathroom and it was not easy. Sometimes it was a little bit of a miracle or a happy day when those things happen.

Dr. Davidson: Well, I would say its a happy day for those of us not in the 60s or 70s or 80s to have a bowel movement. 

Dr. Maki: Well sure but it was just something that I noticed when I was little. It was just this, they would all be sitting around and crocheting and knitting and doing other things and that was the topic of conversation. I mean, maybe not like the entire conversation but they would certainly be sharing their little tricks and tips and what would work and it just kind of was kind of like a running joke so to speak but they are always talking about it for sure. 

Dr. Davidson: Well, you see my parents, they are between seventy and eighty and they do not stop and they go everywhere. 

Dr. Maki: Yes, right. 

Dr. Davidson: They run circles around me. 

Dr. Maki: Yes, right. So comparing your parents to when I was little, it is striking contrast. And really I think that is the good thing about their quality of life in America is that we are kind of pushing back that envelope, life is a lot. We have a lot more conveniences and now the aging process does not hit us as hard as it used to. I think that is good. I think that so what we are all trying to do live a really high quality of life for as long as possible and not have the– we are not really old for thirty or forty years. We were robust and vital and healthy for as long as possible. 

Dr. Davidson: All right, so moving on to some more symptoms. So one thing that a lot of people really are not aware of, especially with females with low thyroid function, is their periods. Women that have hypothyroid or a low thyroid function, they actually will have heavier periods, longer periods, which then makes them more crappier and painful periods. But that is one thing that a lot of people do not really try to kind of talk about. I mean granted having heavy periods can run in the genetics like “Hey, you know, my mom had heavy periods la la la.” But a lot of times once you can work on that thyroid, get that thyroid level to an optimal level, you will notice that the periods are not quite as heavy. And everyone always says day two and day three are usually the heaviest when you are having your period. I mean I have some women they do not leave the house without wearing white. Do not go on a road trip, go make sure you know where the bathroom is for every hour. So it is really great for a quality of life for a female to be able to work on their thyroid, get it an optimal arranges and then make those periods be tolerable as opposed to all the different conventional medications birth control pills and all that jazz for trying to work on– or hysterectomies for trying to work on heavy periods because it is a symptom. Hey, someone is having heavy periods. Sure there might be a genetic component to it but let us look into it a little bit deeper to find out why are they so heavy? 

Dr. Maki: Yes, sure. It could be a progesterone problem, really high stress. It seems like it always affects the female cycle and there are some actual pathways and how that is. We do not need to get into that. But I am certainly, just like we said, as you improve thyroid function, then everything tends to get better and that is something that we have seen time and time again that once their thyroids optimize, their periods kind of fall back into alignment and they kind of ease out a little bit. Another one that you would not necessarily connect, low libido. Libido for a woman is well, you should be talking about that. I mean, that is a really–

Dr. Davidson: You can talk about it too. 

Dr. Maki: That is a really complicated one, just in general, right? There is not really any conventional treatments for that at all like there is for men.

Dr. Davidson: Yeah, female libido is truly complicated. I wish it were easy, but it is not. It is really more the collection or the balance of hormones. But I do find with lower thyroid, there is a low libido. It has an effect on the female hormones. So thyroid is always upstream from the reproductive hormones. So when thyroids off then you can see those reproductive hormones off, like the estrogen and progesterone, like Dr. Maki had mentioned about the progesterone which then could contribute to the heavier periods. So there is a lot of aspects with that but also too, I think with thyroid, women are tired and we have a lot to do. We have a lot to do. Twenty-four seven that by the end of the day, they are just tired. They would rather go to bed than have sex. 

Dr. Maki: Yes, sure. Well the stress level, just like we talked about with the weight gain and some of the fatigue and lethargy certainly stressed. What you gain was we said kind of the thyroid, the adrenals are kind of connected in that respect. The higher their stressed, the lower the libido is, in almost across the board. Like you said women are busy they are working. They are taking care of the kids, they are taking care of the house, they are trying to do it all and the last thing that is on their mind at that point literally is– 

Dr. Davidson: More work.

Dr. Maki: Yes, yes. Any kind of sex drive of any sorts–

Dr. Davidson: And then too, we will talk about it a little bit as well as thyroid has an effect on your mood. So if your mood is not great the last thing you want to do is have fun and fun in the sack. 

Dr. Maki: Yes, sure. Mood, definitely, there is definitely a correlation between, maybe not clinical depression, but certainly a depressed state. A lower mood, little melancholy, kind of like the sky is ill but cloudy and gray all the time. Thyroid kind of help, kind of uplift that a little bit when it gets optimized for sure. 

Dr. Davidson: Oh, yes. If you want to go ahead and jump right down the list to the low mood. Low mood is like one of the biggest things I see with hypothyroid that people are not aware of. I do not want to jump into all the different clinical words and depression and all that jazz, but definitely that lower mood people, they are sad. They can be sad. They are still doing everything they need to do and they get things done, but they can be sad which that is a huge impact on that. You know with that mood. I do not think it has to do necessarily with energy because when you are tired, and I am sure your mood might not be great, but a lot of times once you get that thyroid up, especially that freeT3, their mood is so much better. 

Dr. Maki: Yes, right. And it is not again, we do not follow a TSH. We are not even really, I mean we are concerned about TSH. We do test it. But really it comes down to that free T3 level. That is the active hormone, the active thyroid hormone, the T4 which is what most of the conventional medications are really the body does not do anything with it except convert it to T3. T3 is where the attention needs to be put and that does not really happen on the conventional side very much. But you know, there is some research to support that between T3 and mood, that there is a definitely a correlation between those two. Now again, we could make that correlation between low mood and stress, there is a little bit of a theme there that those two are definitely are intertwined and just like we said going from low libido, the low mood, as you said too, those things are definitely related. The lower your mood, the lower your libido. What is the common denominator there? Of course, it is kind of the busy stressful fast-paced society. And now some of our emotions are kind of blunted in that respect and we just maybe have a little bit of a flatter affect or just do not have the emotional up and down. that is normal, right? We are supposed to have highs and lows but just making sure that those highs and lows are positive highs and lows if there is such a thing as a positive low so you are not too high, you are not too low and you are actually able to find some joy on a daily basis.

Dr. Davidson: And we are not saying the thyroid is completely compartmentalize, like when you are treating somebody with the thyroid, we definitely want to look at what you had been talking about with stress in the adrenal glands. We are looking at the reproductive hormones, we are looking at the neurohormones, but definitely on, you know, if I were to just kind of give a broad statement is that when I see low levels of free T3, and low thyroid function, that mood is impacted.

Dr. Maki: Yes, for sure. Now, if you are saying someone is depressed, the one thing that goes along with the depression a lot is anxiety. Depression anxiety kind of like brother and sister, they kind of run together in some respects. You have one you are going to have the other. And anxiety, certainly we see that a lot in the Hashimoto’s people. The ones that actually have the antibodies, the anti-TPO, the anti-thyroid, and the anxiety tends to kind of rear its head a lot and it can be one of those kind of key symptoms that people notice when they have a thyroid problem. 

Dr. Davidson: And anxiety, you would not really picture to go along with hypothyroid. You think “Oh, well, maybe hyperthyroid they would be anxious. But hypo are they not just tired and lethargic?” But I do find that and I do not want to call or label it anxiety, but there is this angst or this wound up, stressed out feeling when you have this in congruency of the things you need to do in the day and the energy that you have to expend for that is less. So there is like, they know they are just not going to get what needs to get done today. And it creates this level of angst that always seems to be perpetuating around. So a lot of times when you can raise their energy and they feel better, then that anxiety or that stress level does drop down. 

Dr. Maki: Yes. That is something that, in some ways that becomes, that anxiety becomes almost like a barometer. Like they can kind of tell where things are and they can kind of navigate and manage their stress level based on that. What exacerbates it? What makes it better?, all those things and you are right. That is something that you would not, and we are not really big fans of anti-anxiety medications at all. That is in some ways, it is kind of like a rule that the last thing we would ever do, that we prescribe those things, anyways. But we do certain, basically talking about benzodiazepines. The last thing you want to do is prescribe something like that for someone that actually has anxiety. Even though that is what they are intended for, It only causes–

Dr. Davidson: It is the thyroid. Because really it is about the thyroid 

Dr. Maki: At least in this context.

Dr. Davidson: In this context. That is why did not want to label it quote-unquote anxiety, but you see that level when it comes to somebody when their thyroid is low. 

Dr. Maki: Yes, sure. So moving on, the other ones that these are again going back to female issues certainly fertility, a woman is having a hard time conceiving. Certainly the thyroid has to be optimized. A lot of times, I know that we have seen it with some of our patients and we co-manage them with OBGYNs that they are concerned about that once the woman is already pregnant, they want to make sure that TSH stays low. They are very concerned about thyroid function, maybe not in exactly the same way that we are and they do not look exactly at the same numbers, but they are certainly concerned about that. If a woman is trying to get pregnant, let us say maybe she has got PCOS or something, part of increasing her fertility is optimizing that thyroid. 

Dr. Davidson: Oh, absolutely. When you have that thyroid optimized, it is great for helping with ovulation, it helps with the female reproductive hormones particularly the progesterone and then on that flip side, like Dr. Maki had mentioned. Yes, once somebody is pregnant, your OBGYN is very concerned about your thyroid and rightly so because when your thyroid is low being pregnant, it actually increases up your risk of miscarriage.  Mainly more in that first trimester before the placenta implants and your hormones are going skyrocketing, but usually in that first beginning part, especially even up to week 10 is, I think I am super concerned about making sure that that thyroid is level, is optimal in the very beginning part of pregnancy. I always say as soon as you find out you are pregnant, you let me know because I am going to make sure that those levels are good and that we are optimizing that thyroid because of that, because yeah low thyroid does increase up the risk for miscarriage. 

Dr. Maki: Sure, yes, and that is not a fun process.

Dr. Davidson: No, it is terrible. Devastating. 

Dr. Maki: Especially if they have a history going in then we are going to take even more, make sure there is more attention to make sure that that thyroid stays that way prior to and then immediately like you say once they find out. And those are the things that you would not really pay a lot of attention to because it is considered to be a female issue. But in our experience, improving fertility and thyroid in some ways, they kind of go hand in hand. It is almost like one of those things that just needs to be done. And for whatever reason it seems like the ones that are having trouble on the fertility side, they always have under functioning thyroid. So there is definitely a correlation there. It is not just magically made it up. And I am sure we have not looked at, you know, really dove into any of the literature. It is more from observation and clinical practice, but I do not know how many times people have had a really tough time getting pregnant and then they– six months, nine months, they are like, “I am pregnant.” I mean, it is always very nice when that happens. 

Dr. Davidson: Yes. It is definitely a joyful time. That is always wonderful to hear that. And then of course, kind of moving on a little bit is the dry skin. People complain, women, I mean it happens to all humans but us, ladies are more concerned about dry skin, but with cellular turnover, the thyroid has such an impact on our cells turning over so you think about are epithelial cells or our skin cells. That turnover process can really be kind of in some ways degraded. So you will see a lot of dry skin. 

Dr. Maki: Yes. I mean that is you know–

Dr. Davidson: And nails too but mainly the skin.

Dr. Maki: Yes, yes. Sure. You can see changes to the nails, certainly the nails maybe not grow or they are not as hard that you know where the hair come in because the hair and nails are pretty much kind of the the same tissue for the most part. You know the skin on the lower limbs, like on your shins and stuff having almost like if you rush the skin and you get this kind of flakiness that comes off.

Dr. Davidson: If you are wearing black and you take off some black leggings and then there is skin, white skin flakes all over it. 

Dr. Maki: Some of that is normal. Like the dust in the house, dust in your house, a lot of that is–

Dr. Davidson: Or winter.

Dr. Maki: –is skin. 

Dr. Davidson: Or dry, you know living in the southwest or midwest winter or the low humidity but definitely, dry skin is really common with low thyroid so I would not rule it out. 

Dr. Maki: Oh, no, I am not saying you rule it out, but you are not going to make a diagnosis of someone with hypothyroid just on that. Usually if they have a thyroid issue, they are going to have a few other things besides just dry skin, but certainly if they have some of the things we talked about and the dry skin now you have this complete picture of what really is going on. You can make an accurate diagnosis that way. Now this is also a little bit more, what would you say, a function–

Dr. Davidson: Subjective? Objective? 

Dr. Maki: Yes, functional, maybe not necessarily, you are not going to bring endocrinologist body temperatures, but certainly looking at core body temperature, there are some protocols and how to take your temperature in the morning and if it is consistently low, in some ways that body temperature 98.6 is normal, right? So if you are always running a little bit lower than that, that can indicate an under functioning thyroid as well. 

Dr. Davidson: And I think it is kind of an interesting symptom or aspect, or even in some ways objective data to take your temperature. Because with hypothyroid though I say, “Oh, yes, they are cold or have a little body temperature.” and then they just blow it off and say “Hey, wear a sweater because you know being cold is not going to kill you. It is not a disease” but it is something to take into consideration saying “Hey, you know my body temp is running always a little bit low, or I am always the coldest one in the room.” It is one way that at least you can say, maybe I should look at some of these other symptoms that I was not aware of and that way, like you said putting it all together. It is not like one symptom. I am going to treat someone’s thyroid because they have dry flaky skin, but putting all the symptoms together give you kind of a picture of what direction you want to go in.

Dr. Maki: Sure. Some of them might be a little bit, you know ambiguous or a little bit convoluted, but then there are some other symptoms that people have, it is just classic.

Dr. Davidson: And I do not– to be honest you and I see the testing all the time, I do not trust the testing sometimes. I really do not. I mean it is what it is. The numbers are there but you know their numbers will come back a certain way and they clearly have all these things going on but yet, you know just because their TSH is under 4.5 and they are technically not hypothyroid. I just, again you have to do it from a clinical perspective and lab testing. It cannot be one or the other. It has to be– not in every case, but someone who has got a TSH 17, it is pretty obvious, but a lot of times it has to be using both parts of that information. You have to use the subjective along with the objective information. Subjective is the patient’s complaints. The object of is data labs or diagnostic imaging or some kind of testing of some sort to really be able to do that effectively. And I think that conventionally it relies more on the the objective than it is on the subjective. Now this one so a little story about that. So when I was in college actually back in Duluth, we had a really great physiology teacher. His name was Doctor Czalo[?]. They call him Dr. C and he used to teach all the anatomy physiology classes, all the pathophysiology and this guy was just, he was like a biker right? He had long hair, used to wear Harley Davidson T-shirts or sweatshirts all the time and big biker boots and it was like a private catholic school and you know in Northern Minnesota. He did not really fit the mold necessarily, but he was just an amazing teacher and he was talking about thyroid function and that the Army used to do some studies on body temperature and they would put soldiers in cold weather to try to stimulate thyroid because the thyroid is very sensitive to body temperature. And if you think about it on an annual basis our temperature than our environment is really the same all the time whether we are in the summer time, in the winter time, our temperature that we are exposed to does not really change that much.  

Dr. Maki: So actually when I was in college at the time, I was probably what, my early– late teens early twenties and I used to in Minnesota, I used to go as long as I could in the winter, or the fall into the winter without wearing a jacket so I could stimulate thyroid function. Now, I never did any testing or anything because it was not really available back then but it would have been interesting to see and sometimes I get into like November with no jacket, be you know, lower, thirty degrees or less and I would not have a jacket on because I was trying to do what he said in class and trying to stimulate my thyroid function. 

Dr. Davidson: Oh my goodness. Growing up in Washington with our temperate weather. I wear a jacket in November. [laughter] 

Dr. Maki: Well now that we lived in Las Vegas for so long and what would happen when I did that come January, February when the temperatures got really cold and I was never really that cold. I mean, I never really had that bone chill cold where now people it will be even in Washington where it is pretty mild for the most part and people are freezing all the time. But when we lived in Vegas, we kind of, we got re-acclimated to– now I cannot tolerate, I probably could now we have been in Washington for a little bit. 

Dr. Davidson: I do not think you could tolerate your hometown, in the midwest. That gets cold. 

Dr. Maki: Well, yes. I mean if we were there for a little while we certainly could but you are right, your body does adapt and I would imagine if we mapped out thyroid issues, there would be probably proportionally, and I am sure this, I think I have heard this somewhere that there is proportionally more hypothyroid in the southwest, in the warmer climates than there is in those cold climates because of the weather change. I think there is something to that. That is where I think even like cryotherapy, hydrotherapy, using hot and cold, saunas and cold soaks, I think you can stimulate thyroid function that way because of the contrast. That cold temperature taken an ice bath. I do not know if anyone has ever taken an ice bath before but holy moly talk about invigorating or I am a big fan of saunas, all the rule is always after the sauna is you have to take a cold shower. Not a warm shower, not a lukewarm shower, but a cold shower, and that contrast, it gets your heart racing, your breathing increases and I guarantee you that that is having an impact on thyroid. We could probably go find some studies that would actually say exactly that thing that TSH levels are going to go down because of that contrast in temperature. And in our society because of houses and furnaces and ways to heat ourselves or cool us off, we do not really have that temperature fluctuation like we used to.

Dr. Davidson: Well then I think we should definitely go outside without jackets on. Granted it is July but it is kind of cold out. 

Dr. Maki: Yes. I know it is a little nerdy but hey, he was a really good teacher. I think he is still teaching there. He teaches the nurses and he teaches that the medical school and pre-med and all that kind of stuff. He was a really, really good teacher. That is kind of what where all this nerdy science stuff came from because he was really that good. All right moving on, but that was just a little digression where I kind of learned about thyroid even well before you and I were doing anything medicine related. Another one that– this one is kind of known about at least on the doctor side maybe not so much on the patient side is high cholesterol. 

Dr. Davidson: Oh, yes, absolutely. High cholesterol. In fact more so, with cholesterol, you have your total cholesterol, you have your HDLs, your good cholesterol, your LDLs, your bad cholesterol, the lower the better and then your triglycerides. What I notice with thyroid is when you optimize someone’s thyroid, ensure they might be feeling better. So they are not eating the comfort food or whatnot, but their cholesterol does go down. Particularly I noticed more the triglycerides than the LDLs but over all the LDLs and the triglycerides go down, but I noticed the triglycerides go down much more significantly than the LDLs. 

Dr. Maki: Yes. And I think there is a of confusion I think about cholesterol. We have been doing some CT coronary calcium scores lately, particularly when people that are having these abnormally high cholesterol levels and a coronary calcium score basically looks at the plaque formation in your coronary arteries and using that as a way to look at someone’s cholesterol levels to say is this, do they need lipid management or cholesterol management and using a CT score like that coronary calcium score to kind of help make that decision and time and time again. I have had a couple of carnivore patient’s doing in the carnivore diet. Their cholesterols are off the chart, but they have these CT scores come back and they virtually have no atherosclerosis whatsoever. Even though like their cholesterols are on the high 300s or the low 400s which we listen to conventional advice, that would be super dangerous and they should have plaque in their arteries all over the place and they really do not. That is not every case. I have seen it the opposite way where someone has actually good numbers, good cholesterol, do not need any lipid management and now their cholesterol scores are off, their CT scores are off the chart. And then I have seen some that would kind of, they got high numbers and high score, low numbers, low score. So you see kind of a few different profiles there but there is no real reason to it. You cannot predict based on someone’s cholesterol who has– this is the part that I think people need to be aware of. You cannot predict based on their cholesterol who has the higher, the higher the score the worse it is. You cannot predict based on their cholesterol who is going to have the plaques, worse plaque score, than who does not. That is where I think the disconnect is. So I think that the argument or the claim for using Statin therapy or lipid management in general, I think it is going to change a lot over the next ten to fifteen years. If not in the next few years because there is this discrepancy, especially with this new imaging type of study. 

Dr. Davidson: Well, I would never hang my hat on cholesterol being the marker for a cardiovascular event or cardiovascular risk, but I am definitely, I will have patients that maybe decided they did not want to take their thyroid anymore and they “hey I can do without it” or maybe they forgot to take their thyroid medication or ran out or something and then we will run their blood work and I will see their cholesterol go up and I will say that I did not change my eating, I will say that was because your thyroid went up so you definitely see that clear correlation. Like I said more so I find between the triglycerides and thyroid but you are right. We would never, I mean, cholesterols just one marker to look at when you are looking at any kind of objective value. I would never base that on any kind of risk for future cardiovascular events. 

Dr. Maki: Yes, but everyone has been kind of led to believe, even doctors believe if your cholesterol is over two hundred it needs to come down and I do not think that is the case at all. I think you cannot, like you said you cannot base that decision on that one number of your total cholesterols two twenty-five or two-fifty or two seventy-five, is that really enough to put somebody on a Statin drug? And I do not really think that it is. I think there needs to be more information than that because the correlation between that and having a heart attack or having a stroke, the correlation is not very good and the CT scans that I have been having patients do lately, as kind of proving that out and it is almost random. You cannot tell between the two and I think that you know, creates a little confusion. All right, so–

Dr. Davidson: And yes, and before we finish up here, I definitely want to talk about joint pain and thyroid. I know if you Google, hypothyroid you will see muscle weakness and pain, but really I do not think doctors really kind of correlate that that low thyroid really truly causes joint pain. 

Dr. Maki: Yes, sure. I know that we have seen it happen kind of in the reverse way. Like someone does not take their thyroid medication all of a sudden they get this kind of bone fatigue, that you just kind of get bone tired and it hurts. They go back on their medication and they are osteoarthritis or whatever their joint pain was. It just kind of miraculously goes away. 

Dr. Davidson: And that is the interesting thing about the joint pain in hypothyroid or low functioning thyroid is it is not really osteoarthritis. It is more like “Hey, I am just achy, like my shoulders are hurt, my neck and then a different day, my hips and my low back is kind of achy. I just feel achy.” And it definitely is the joints, “My wrists. I do not know why I did not do anything but it is just achy” and it moves around as opposed with osteoarthritis, you are looking at through, the little parts of their joints and they are enlarged or they are hurting or they are red or osteoarthritis in the hip, it is going to be there every time you get up and you move. Where it is, with the low thyroid it creates that kind of joint irritation. I do not think it is really so much inflammation. It is probably a combination between the muscles and the nerves, the innevations, but it really is that achiness and when you get that thyroid optimized they really feel good. 

Dr. Maki: Yes, sure. Their pain level or their discomfort, like you said you and I are in our mid-forties, certainly by the time you get to your forties, you definitely have some aches and pains, usually a lot more you did when you are in your twenties and thirties, maybe it is a little progressive to some extent but you are right. It is just kind of like this– and I have noticed it in patients, not so much beforehand, but really when they stop it for some reason or they run out and all the sudden that discomfort kind of comes roaring back and kind of gives them a good reference point to say “Hey, my thyroid this is important and that is not fun to live with, pain on a daily basis” 

Dr. Davidson: And we do a lot of supplementation with thyroid. So when you are looking at optimizing thyroid, like, Dr. Maki had mentioned earlier, it is not just “Oh just one pill fits all, here take some medication.” There are so many different types of medication. There are so many different types of supplementation. Depending on someone’s goals. So with all the list that we went over here. You think somebody might have, four out of all of them and those are their main goals they want to work on. I have lots of patients with low thyroid and they have no weight issues but at the same time they have a very low mood or their hair is falling out and they have constipation but they do not have any weight issues. I have had other hypothyroid patients that actually have lots of energy, but they have really high cholesterol, that kind of related to that low thyroid, they have joint pain so everybody is a little bit different on how we manage and treat this so it is not just medication. Like I said supplementation, there is lifestyle, there is dietary, there are types of exercise, there are so many different ways to kind of embrace working on optimizing someone’s thyroid. 

Dr. Maki: Sure. Even we have talked about before, even caloric intake, being on a perpetual diet is going to lower your thyroid function, even some of the keto and intermittent fasting, some of those things people drop their calories too low, and your thyroid function is going to go down. So maintaining an appropriate amount of calories, not maybe not on a daily basis, but certainly over time. So you are not at a chronic deficit for too long. That can actually have a major effect because we cannot over supplement or sometimes over prescribe or whatever, a diet that has too few calories in it. Then that becomes a really big deal. Thyroid is very sensitive to temperature and food that is why I was telling the story about not wearing a jacket in Minnesota, and certainly caloric intake. That is what the body is trying to protect us against sometimes. So this was kind of a long list. Usually this one usually were at about thirty minutes. This one is running a little long. 

Dr. Davidson: We kind of got out on some little tangents but they were important but we just wanted to let you all know that with hypothyroid, there are so many other symptoms that come and play with it and there is a lot of kind of symptoms you would not expect especially with females when you are trying to look into thyroid function optimizing the thyroid and what goals we are going to have moving forward. 

Dr. Maki: Absolutely. So I think that this gives everyone if you are concerned or you are questioning or you are not really sure, you keep getting different answers, you are looking on different resources online. Hopefully this will give you more insight as to what we see as the real common thyroid problems. As always you have any questions you can send us an email helpatprogressyourhealth.com. Check out our website progressyourhealth.com. Until next time. I am Dr. Maki. 

Dr. Davidson: I am Dr. Davidson.

Dr. Maki: Take care. Bye-bye.