The thyroid is a small, butterfly-shaped gland at the front of the neck. Though small, the hormones it produces have major effects on the body. The thyroid hormones thyroxine (T4) and triiodothyronine (T3) regulate energy use, body temperature, body weight, skin growth, hair growth, nail growth, and sexual organ function. Both women and men can have thyroid problems that disrupt the production of thyroid hormones. However, women are five times more likely to have thyroid disorders than men. Thyroid conditions disrupt thyroid hormones in one of two ways. The thyroid produces too little thyroid hormone (hypothyroidism) or too much (hyperthyroidism).
Underactive thyroid and overactive thyroid have nearly opposite symptoms. While an underactive thyroid makes people tired and sluggish, an overactive thyroid makes them restless and energetic. People gain weight with an underactive thyroid but lose weight when there’s too much thyroid hormone. Women have unique symptoms because thyroid hormones affect the female reproductive system. Thyroid problems disrupt menstruation, ovulation, fertility, and pregnancy.
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Thyroid problems in females are a common health condition that can affect anyone regardless of age, race, or ethnicity.
Early signs of thyroid problems in females include tiredness, depression, sluggishness, restlessness, nervousness, and menstruation changes.
Serious symptoms of thyroid problems in females, such as pregnancy problems, slow breathing, racing heartbeats, high fever, low body temperature, confusion, severe agitation, or coma, may require immediate medical attention.
Thyroid problems in females are usually caused by autoimmune disorders. Other causes include excessive iodine intake, iodine deficiency, thyroid enlargement, thyroid nodules, thyroid cancer, pituitary gland problems, and medication side effects. You may be at risk for developing thyroid problems if you are between the ages of 30 and 45, have an autoimmune disorder, have had thyroid surgery or radiation therapy to the neck, have thyroid cancer, or have given birth.
Thyroid problems in females require a medical diagnosis.
Thyroid problems in females generally require treatment. Symptoms of thyroid problems in females typically resolve with treatment, but the timeline will vary based on the underlying cause.
Treating thyroid problems in females may include thyroid hormone replacement, prescription medications, surgery, or radiation therapy. Read more about treatments for thyroid symptoms here.
Untreated thyroid problems in females could result in complications like infertility, pregnancy problems, postpartum thyroiditis, ovarian cysts, early or late puberty, early onset of menopause, goiter, osteoporosis, blood clots, stroke, heart disease, and eye problems.
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At first, thyroid problems may have no symptoms. When symptoms in females start, they may be minor and difficult to interpret. These symptoms are non-specific to the thyroid, and they may be dismissed as being caused by another issue. The most common early signs of thyroid problems in females are:
Low energy
Mood swings
Sluggishness
Sadness or depression
Restlessness
Agitation
Irritability
Difficulty falling asleep
Menstrual changes
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Symptoms of thyroid problems will depend on whether the thyroid disorder causes too much or too little thyroid hormone.
The most common effect of thyroid conditions is to lower thyroid hormone levels, a condition called hypothyroidism. Symptoms of hypothyroidism include:
Low energy
Depression or sadness
Tiredness or fatigue
Sensitivity to cold
Slow pulse and heart rate
Weight gain
Constipation
Slowed reflexes
Puffy face
Dry skin
Dry, thinning hair
Muscle aches
Joint pain
Hypertension (elevated diastolic blood pressure—the bottom number)
Decreased sweating
Additionally, hypothyroidism can affect a woman’s menstrual cycle causing symptoms like:
Irregular menstrual periods or absent periods
Heavier menstrual bleeding
Longer periods
An overactive thyroid has the opposite effect. It speeds up the body, so common symptoms of hyperthyroidism include:
High energy (restlessness)
Nervousness
Anxiousness
Irritability
Hand tremor
Trouble sleeping
Weight loss
Increased appetite
Feeling hot when other people aren’t
Frequent bowel movements
Fast or irregular heartbeats
Overactive reflexes
Hypertension (elevated systolic blood pressure—the top number)
Bulging or red eyes
Excessive sweating
Nail separation
Again, menstruation is often affected by elevated thyroid hormones:
Infrequent or absent periods
Light periods
Shorter periods
Both hyperthyroidism and hypothyroidism affect fertility in women, including:
Ovulation changes
Anovulation (no egg released during a woman’s cycle)
Difficulty conceiving
Infertility
Development of cysts in the ovaries
Complications during pregnancy are also possible signs of thyroid problems. These include:
Severe morning sickness (hyperthyroidism)
High blood pressure
Postpartum bleeding (hypothyroidism)
Postpartum enlarged thyroid
Some thyroid problem symptoms in females resemble perimenopausal symptoms and vice versa. For women experiencing menopause, thyroid conditions can worsen some of their perimenopausal symptoms. Thyroid problems are easy to miss, but menopause may make it more difficult to determine if there’s an underlying thyroid problem. The main difference between thyroid problems and menopause is that a blood test can quickly diagnose thyroid conditions.
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Thyroid symptoms are based on whether the thyroid produces too much or too little thyroid hormone. Low levels of thyroid hormones slow down the body. People feel tired, down, sluggish, and easily worn out. They feel cold when other people don’t. The heart slows down, breathing slows down, and people can have problems with constipation, weight gain, dry skin, brittle nails, and hair loss. Too much thyroid hormone speeds up the body. People feel energetic, but it’s not pleasant. They’re agitated, restless, anxious, and nervous. Their hands shake, and they sweat more. Fast heartbeats, weight loss, and heat sensitivity are common. For women, underactive and overactive thyroid changes the menstrual cycle and the size and duration of periods. Some women may stop menstruating altogether.
Thyroid symptoms should be evaluated by a doctor. Most people who see a doctor won’t suspect they have a thyroid problem but something else. If the symptoms are mild enough, people may dismiss them as inconsequential. They aren’t. Thyroid conditions can worsen over time. Symptoms can usually be minimized with treatment.
Severe symptoms of thyroid disorders require immediate treatment. Call 911 or go to an emergency room if the heart is beating very fast, breathing has slowed markedly, the skin is cold, or a person is confused or unresponsive.
Healthcare professionals will start by taking a medical history and physical examination, but thyroid problems are primarily diagnosed through a blood test that measures thyroid stimulating hormone (TSH). Depending on the results, the clinician will order further blood tests to measure thyroid hormone levels and the presence of thyroid antibodies. These results determine the best course of action in terms of treatment.
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Complications of thyroid problems will depend on whether the thyroid gland is underactive or overactive. The most common complications of thyroid problems in females include:
Menstruation changes
Difficulty or inability to conceive
Early menopause
Goiter
Irregular heartbeats (arrhythmias)
Breathing problems
Thyroid eye disease (TED)
Stroke
Myxedema coma (a life-threatening condition caused by severely low thyroid hormone levels)
Thyroid storm (a life-threatening condition caused by severely high thyroid hormone levels)
RELATED: Thyroid eye disease: causes, symptoms, and treatment
Thyroid problems in females are especially important if a woman gets pregnant. During pregnancy, the thyroid needs to produce more thyroid hormones to meet the increased needs of the mother and the fetus. For the first 20 weeks, the fetus depends entirely on the mother’s circulating thyroid hormones. Abnormal thyroid hormone levels can cause serious adverse effects in both the mother and baby. To avoid complications, pregnant women are routinely instructed to take iodine supplements.
Hypothyroidism can cause pregnancy complications for the mother’s body such as:
Preeclampsia
Miscarriage
Spontaneous abortion
Early labor and birth
Placental separation
Anemia
Heart problems
Postpartum bleeding
Postpartum thyroiditis (swollen thyroid)
Hypothyroidism in the mother can cause complications for the baby, such as:
Premature birth
Low birth weight
Stillbirth or neonatal death
Congenital problems
Delayed neurological development
Pregnancy problems for the mother due to hyperthyroidism include:
Preeclampsia
Miscarriage
Placental separation
Infection
Preterm delivery
Heart failure
Thyroid storm
The fetus or the baby can also have complications including:
Fetal death
Premature birth
Small birth size
Neonatal goiter
Neonatal hypothyroidism
Women with thyroid problems require treatment. Hypothyroidism is treated with thyroid hormone replacement. Levothyroxine, a synthetic version of T4, is the first-line treatment. Hyperthyroidism has several treatment options. For mild to moderate cases, women will take antithyroid drugs that block thyroid hormone production and beta blockers to blunt the effects of thyroid hormones. In severe cases, doctors surgically remove the thyroid gland (thyroidectomy) or kill it with radioactive iodine. Once the thyroid is gone, women must take levothyroxine or other thyroid hormone replacement for the rest of their lives.
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Thyroid conditions in females are most often caused by chronic and lifelong conditions. The most common cause of hypothyroidism is an autoimmune condition called Hashimoto’s disease. Not surprisingly, the most common cause of hyperthyroidism is also an autoimmune disease called Grave’s disease. In both cases, the immune system attacks thyroid tissues. Treatment may be lifelong, but it does work. See a doctor, get tested, and take the medications as prescribed. Lifestyle changes such as diet and exercise can also help.
Compliance with your thyroid medication is a key factor to the success of your treatment. Levothyroxine and its equivalents are best taken on an empty stomach one to two hours before any other medication, food, or drink. For this reason, most females take it first thing in the morning when they wake up. It's important that you try not to miss a dose. Use reminders such as an alarm on your phone to help you remember your dose every day. If you are non-compliant, you may not see the symptom improvement you wanted, and you may still be at risk for the more serious adverse effects of thyroid disorders.
Thyroid symptoms are subtle and confusing. They aren’t always obvious and don’t clearly point to a specific health problem. For this reason, regular visits to healthcare providers can help spot thyroid problems early. If you’re not feeling right, even by just a little, tell the clinician about your symptoms and ask about a thyroid screening. A simple blood test can quickly identify thyroid problems. In most cases, the appropriate treatment can quickly improve symptoms and make you feel normal again.
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How to understand thyroid panel results, SingleCare
Hyperthyroidism: diagnosis and treatment, American Family Physician
Hypothyroidism: diagnosis and treatment, American Family Physician
What is a TSH test and what do the results mean?, SingleCare
Hyperthyroidism: diagnosis and treatment, American Family Physician
Hypothyroidism: diagnosis and treatment, American Family Physician
Managing thyroid dysfunction in selected special situations, Thyroid Research
Thyroid function testing in pregnancy and thyroid disease: , Therapeutic Drug Monitoring
Gender in endocrine diseases: role of sex gonadal hormones, International Journal of Endocrinology
The impact of thyroid disease on sexual dysfunction in men and women, Sexual Medicine Review
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