Thyroid Thursday Episode 13: Thyroid Hormones and Your Cycle
Hi, its Dr Eric Balcavage. I am back for another edition of Thyroid Thursday and today we are going to talk about thyroid hormones and your menstrual cycle. So, I am often asked by some of my patients if thyroid hormones fluctuate during the month? The answer to that is no. It should be pretty consistent from day to day. The vast majority of the thyroid hormones production occurs in the morning and the conversion occurs throughout the rest of the day, but from day to day, the amount of thyroid hormones you make should be pretty consistent. You can have an increase in thyroid symptoms however, right around day 14 and about the week before your cycle starts.
The reason for that isn’t necessarily that there are more or less hormone available, but that there is an elevation of something called thyroid binding globulin during your peak times of estrogen load. Somewhere around day 14, estrogen level is at its highest and somewhere around that week before your menstrual cycle, estrogen levels are also fairly high. As estrogen levels go up, the sex binding proteins, or sex binding globulin levels go up. One of those is thyroid binding globulin.
As thyroid binding globulin goes up, there is less free thyroid hormone floating around the system. You’ll remember from earlier videos, the thyroid hormone that actually binds to the receptors is the free hormone. When you see T4 or T3 that’s bound to the protein, it’s not useable, it has to come off of the protein and become free hormone (free T4, free T3) to actually do its work. I may have used an example before about the thyroid binding globulins being like taxi cabs. If you wanted to go shopping in New York city, you would take a taxi ride into the city. But to do the shopping, you have to get out of the taxi cab. It’s the same with thyroid hormone. You need the thyroid binding globulins to carry the thyroid hormone around the system. But, you’ve got to have the thyroid binding globulins give up the thyroid hormone so it can become free hormone and so it can get into the cells and do its magic.
One of the big challenges I see is that people go to their doctor complaining of these symptoms around their hormonal cycle. Doctors will run a TSH and maybe a T4. They won’t run a full thyroid panel, they’ll just run a TSH and T4. They’ll find out that the TSH levels are normal and the T4 levels are normal, and they’ll look at a woman and say, “well, you’re a mom and you work, you’ve got multiple kids, you’re just stressed out, you’re fatigued…”. They prescribe a medication, like an SSRI, that will help you feel better.
That’s a good news/bad news scenario because initially the medication can make you feel better, but it hasn’t addressed the real issue. Besides that, while it may initially make you feel better, there are side effects that occur as a result of taking the medication. Had you not taken the medication, your symptoms probably would have dissipated as soon as the estrogen levels dropped and you wouldn’t have the symptoms. But, you wind up taking the medication and you felt good maybe initially when you took it, but then you get the side effects of the medication, which could be headaches, migraine, insomnia, fatigue, GI problems, many of the same symptoms you originally took it for and now you don’t know what is really causing this symptomatology.
The better option is to address what’s going on. Do you have excessive elevations of estrogen? Is there an estrogen dominance issue? Are there problems with thyroid binding globulin? What else is going on with the thyroid physiology that may be causing this to be more significant or more severe?
If your estrogen physiology is really good, if your thyroid physiology is really good, you probably don’t even have any symptoms as your hormones or estrogen peaks. But, if you have estrogen issues or thyroid issues going into those peak estrogen periods, you are probably going to see more significant symptomatology. The real solution isn’t taking an SSRI, it’s finding out why you may have those problems with estrogen and thyroid physiology that are exacerbated during the peak times of estrogen levels, right around ovulation and that week before your menstrual cycle.
What do you do if you have headaches or fatigue or symptoms right around day 14 or that week before your menstrual cycle? You need to find a functional medicine practitioner like myself who understands hormone physiology, thyroid physiology, can do a more thorough evaluation of what’s going on, determine what’s causing the estrogen imbalances or the thyroid physiology problems and help you fix it naturally through diet, lifestyle and nutrition versus being put on an SSRI, which is not really going to address the underlying cause of the problem.
Short term, you may feel better, but long-term, you are going to have more symptoms as a result of being on the medication. If you have questions, put them below the video and I’ll be sure to get back to you. If you have some more significant questions or challenges and you want to contact me, you can always call my office, 610-558-8920. I look forward to doing another video for you next Thursday.
