Why EVERY woman with PCOS needs to have her thyroid tested thoroughly.

cycles, very heavy or very light periods. Thyroid hormone is necessary for the production of estrogen and progesterone. Both of these may have a big impact on your menstrual cycle and fertility. Hypothyroidism is the most common thyroid disorder. In this article I will focus on hypothyroidism for this reason.

Hypothyroidism affects both sexes, but women are up to eight times more likely to develop the condition. Hypothyroidism is the most common thyroid disorder in Australia, affecting around 1 in 33 Australians. This does not take into account the many undiagnosed people with hypothyroidism. Some sources estimate that one in 20 people will experience a thyroid disorder in their lifetime. I used to see this in my fertility clinic every day. I estimate that 70% - 80% of women I treated for fertility problems had an underactive thyroid or suffered from subclinical hypothyroidism and 90% of them were undiagnosed.

What are the symptoms?

The symptoms of hypothyroidism may include:

Depression Fatigue Sensitivity to cold

Unexplained weight gain

Lower body temperature

Dry skin

Hair loss

Dry and brittle hair

Hoarse/deep voice Constipation Heavy or irregular periods Infertility

Low libido Impaired memory

Poor concentration Muscle aches, pains and cramps

Weakness

Pale appearance

Fluid retention – swollen face, hands, ankles and/or feet

Difficulty falling or maintaining sleep

Breathlessness

Low heart rate

Testing for hypothyroidism

The standard Thyroid Function Tests which are performed in Australia is TSH (Thyroid Stimulating Hormone).

The Medicare protocol for screening patients who have not yet been diagnosed with a thyroid function problem is to test TSH. Generally, only if the result of this test is outside the reference range will free T3 (fT3, triiodothyronine) and free T4 (fT4, thyroxine) be tested. Medicare will only fund screening tests which satisfy this protocol. (there are some exceptions)

A typical (statistical) reference range for thyroid-stimulating hormone (TSH) in many laboratories is around 0.3-5.5 mU/L. If TFH is lower, this indicates Hyperthyroidism (overactive thyroid) and if it is higher, it indicates Hypothyroidism (underactive thyroid).

However, a study published in The Lancet 2002 has shown that individuals with TSH values greater than 2.0 mU/L have an increased risk of developing overt hypothyroidism over the next 20 years. Further research has indicated that TSH values above 2.0mU/L are already an indication of subclinical hypothyroidism. Despite your TSH levels being “within range”, you may be experiencing symptoms of hypothyroidism, one of which could be irregular cycles or infertility. However, many patients are told, their thyroid is fine, as their TSH levels are in the “normal range”.

When I inquire about thyroid tests, most patients tell me that they were told their thyroid is fine. Once I request a copy of their blood test, more often than not I find that their TSH is well above 2 and no further investigations have been done. Patients with a sluggish thyroid go undetected and are therefore not treated appropriately. This is what I see with 70% - 80% of my patients. Their thyroid has never been tested thoroughly due to Medicare protocol, but also many doctors believe that testing for TSH is enough despite all the studies indicating that this is not the case. Due to the outdated ranges that labs use, most patients are told that their thyroid is ok. Thyroid function is very important for fertility and can often be the underlying cause of unexplained infertility. Thyroid also plays a big part in PCOS and a majority of women who suffer with PCOS also have suboptimal thyroid function.

Thyroid disorders themselves can have negative effects on the ovaries, according to the Indian Journal of Endocrinology and Metabolism. It interferes with other hormones such as prolactin, luteinising hormone (LH), follicle-stimulating hormone (FSH) and dehydroepiandrosterone (DHEA). These fluctuating hormone levels can affect your ovaries and ovulation.

According to the BioMed Research International PCOS is linked with a high occurrence of subclinical hypothyroidism, autoimmune thyroiditis and goiters.

Another study reports that of 107 women with PCOS, 50% of the participants had some kind of a thyroid related disease.

Additionally, many studies have reported that LDL Cholesterol is increased in women with PCOS even thought this is not normally the case in women with just insulin resistance. The reason is not clear, but it is suspected that it may be linked to hyperandrogenism (excess of male hormones)

What can you do to find out if you have hypothyroidism?

You can ask for more tests to be done, but you may have to pay for them yourself. These include the following: TSH, free T4, free T3, reverse T3, TPO (Thyroid peroxidase antibody) and TGAb (Thyroglobulin antibody). Alternatively, you can test your thyroid with this simple test (according to Dr. Wilson)

Test your temperature by mouth, every 3 hours, 3 times a day, starting 3 hours AFTER waking. Do this for several days, but not the 3 days prior to your period, since it’s higher then. For each day, add the 3 temperatures together and divide by 3 to get the average. If your temperature consistently averages below 37 degrees Celsius, then you may be suffering from an underactive thyroid.

Treating hypothyroidism Thyroxine replacement therapy is the mainstay of medical treatment for hypothyroidism and is usually lifelong. According to conventional medicine, there is no cure for hypothyroidism, and therefore most people will remain on medication for the rest of their lives.

Factors that adversely affect thyroid function include nutritional deficiencies such as selenium, zinc, iodine, chromium, insulin resistance, toxicities such as heavy metals and environmental toxins. Food intolerances and your gut microbiome may also be the cause for hypothyroidism, as is stress.

Hypothyroidism can be treated naturally in most cases without needing lifelong medication. Thorough thyroid investigation should be part of the treatment plan for EVERY woman with PCOS. It is an absolute must, but unfortunately overlooked by many health care professionals.