Thyroid Disease and Menopause

Thyroid disease and menopause often coexist in women, particularly those in their late reproductive years. This overlap can lead to similar symptoms, presenting diagnostic challenges and complicating treatment decisions. Here's a comprehensive overview based on the European Menopause and Andropause Society (EMAS) statement.

Symptom Similarities

Menopause and thyroid dysfunction share several symptoms, including:

• Menstrual irregularities: Common in both perimenopause and thyroid disorders.

• Mood disorders: Including anxiety and depression, which can also be indicative of thyroid dysfunction.

• Sleep disturbances: Affects women experiencing menopause and those with thyroid dysfunction.

• Increased sweating: A symptom shared by both conditions, often making diagnosis challenging.

Diagnostic Challenges

Given these overlapping symptoms, it can be difficult to distinguish between menopause and thyroid dysfunction:

• Lack of Specific Signs: Without signs like goiter or orbitopathy, diagnosing thyroid disorders can be challenging.

• Comprehensive Assessment: Healthcare practitioners are encouraged to have a low threshold of suspicion for thyroid disorders in menopausal women, ordering hormonal assessments when necessary.

Influence on Clinical Conditions

Menopause and thyroid dysfunction can impact a variety of clinical conditions:

• Thyroid Nodules and Cancer: The incidence of thyroid nodules increases with age, particularly in women. Surgical menopause is associated with an increased risk of thyroid cancer, while natural menopause correlates with a decreased incidence.

• Metabolic Disease: Thyroid hormones play a key role in metabolic regulation, with hypothyroidism contributing to insulin resistance, dyslipidemia, and cardiovascular risk.

• Infertility: Thyroid disorders occur in 30–40% of women with premature ovarian insufficiency, potentially due to thyroid autoimmunity.

Therapeutic Challenges

Managing thyroid disease during menopause poses unique challenges:

• Treatment Impact: Subclinical hypothyroidism can exacerbate menopause-related symptoms and increase cardiovascular risk. Overtreatment can lead to bone density loss and increased osteoporosis risk.

• Menopause Hormone Therapy (MHT): MHT can effectively treat menopausal symptoms, including vasomotor issues and vaginal atrophy, and has been shown to lower all-cause mortality in women within ten years of menopause.

Summary Recommendations

• Increased Awareness: Healthcare professionals should be aware of the overlap between menopause and thyroid dysfunction symptoms to ensure accurate diagnosis and treatment.

• Biotin Caution: Women taking biotin-containing supplements should discontinue use for 2–3 days before thyroid hormone assessments to avoid skewed results.

• Personalized Approach: Clinical decisions should be made with a personalized approach, considering individual characteristics and preferences.

• MHT and LT4: Both can safely manage menopausal symptoms and thyroid conditions, and may also prevent non-alcoholic fatty liver disease (NAFLD).

Conclusion

The coexistence of menopause and thyroid disease presents diagnostic and therapeutic challenges. Healthcare professionals must consider both conditions when treating women in this age group, adopting a personalized approach to achieve overall well-being.