When discussing thyroid problems in women, especially during menopause, hypothyroidism is the one people typically mention most often. However, a few other thyroid issues we need to consider are hyperthyroidism, goiter, thyroid nodules, and thyroiditis.

Before we delve into these different thyroid conditions, let’s take a closer look at the thyroid and the hormones involved.

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The thyroid 101

The thyroid gland, located at the base of the neck below the Adam’s apple, is part of the endocrine system, which is a key player in numerous bodily activities. For the thyroid gland, the activities include making hormones responsible for regulating the metabolic rate, controlling digestive and muscle function, bone health, heart function, and brain development. Those hormones are thyroxine (T4) and triiodothyronine (T3). T4 is primarily inactive, while T3 is active. When the thyroid gland releases T4, it is transformed into T3 so your cells can use it.

How do you know if your body is transforming your T4 to T3? If your conversion rate is low, you may experience fatigue, constipation, depression, weight gain, dry skin, hair loss, and feel puffy or bloated.

If you are experiencing these symptoms, you may want to get a blood test to identify your thyroid function. However, a thyroid test may not tell you everything you need to know, as discussed below.

Testing thyroid function

The traditional thyroid test is a blood test that measures levels of the following:

• Thyroxine (T4), which is converted into T3. It influences how the heart and other organs function in the body.
• Triiodothyronine (T3), the active thyroid hormone.
• Thyroid stimulating hormone (TSH), which is released by the pituitary gland to stimulate the thyroid to make its hormones and to help burn calories.

However, there are other factors that can provide important information about thyroid function as well:

• Free thyroxine (FT4) identifies how much T4 is free (unbound) to enter and impact the body’s tissues.
• Free triiodothyronine (FT3) is used to help uncover thyroid conditions, especially hyperthyroidism.
• Reverse triiodothyronine (RT3) is a byproduct of thyroid hormone metabolism.
• Thyroglobulin antibodies (TGAB) is a protein made and used by the thyroid to make T3 and T4.
• Thyroid peroxidase antibodies (TPAB), which may indicate thyroid damage and detect autoimmune thyroid disease.

There are “normal” ranges for each of these factors, yet there are numerous problems associated with relying on these numbers and what is being tested, according to thyroid expert, scientist, and health coach Danielle Meitiv. She notes that “we use the word ‘normal,’ but it actually statistically just means average.” Since the average person is not well, she says, having average thyroid levels is not necessarily healthy.

She notes other problems with thyroid testing. For example, doctors will test TSH and report normal levels. Yet, “why are we using a hormone made by the brain to decide the complete health of the thyroid?” Another thing to consider regarding thyroid testing is a factor known as reverse T3, which is an indication that the body is under a great deal of stress. You likely will not see this marker on your test results because it is not commonly measured, yet it can be an important indicator for your health.

Given all of these caveats about thyroid testing, what should women do? If possible, have your results reviewed with a thyroid specialist who understands that “normal” is not necessarily healthy for you, and who can analyze your symptoms and your test results based on your unique situation. 

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What is hyperthyroidism?

While hypothyroidism is characterized by a thyroid gland that is underactive and thus associated with weight gain, the other side of the coin is hyperthyroidism, in which the thyroid gland is overactive. Although both of these common thyroid conditions are usually caused by an autoimmune condition, the antibodies involved and the part of the thyroid affected are different.

The most common cause of hyperthyroidism is the autoimmune disease called Graves’ disease, affecting about 70 percent of people with an overactive thyroid. Hyperthyroidism also may be caused by consuming too much iodine, overactive thyroid nodules, inflammation of the thyroid (thyroiditis), or taking too much thyroid hormone medication. Low TSH and high T4 indicate an overactive thyroid.

What are thyroiditis, thyroid nodules, and goiter?

Thyroiditis, or thyroid inflammation, can cause either very high or very low levels of thyroid hormones. The most common form of thyroiditis is the autoimmune disease called Hashimoto’s thyroiditis. Another form is silent or painless thyroiditis, which is also an autoimmune condition.

Thyroid nodules are abnormal growths of cells on the thyroid. In most cases, the nodules are benign, but they may still be an indication or cause of thyroid disease. Over-functioning thyroid nodules may result in hyperthyroidism, while they also may be associated with low thyroid function and hypothyroidism.

Various factors can cause thyroid nodules, including iodine deficiency and Hashimoto’s thyroiditis. They are four times more common in women than in men and can be fluid-filled or solid. If they grow large enough, they may interfere with breathing and swallowing, as well as cause pain and lead to goiter.

Goiter is a noncancerous enlargement of the thyroid. It is most often caused by an iodine deficiency, but it also may develop if you have thyroiditis, Graves’ disease, or pituitary gland tumors.

Eating for healthy thyroid function

Specific vitamins and minerals are suggested to support and promote healthy thyroid function. These include:

• Iron, necessary to convert T4 into T3
• Iodine, critical for thyroid function. Both T4 and T3 contain iodine
• Selenium, a mineral that protects the thyroid from oxidative stress damage
• Zinc, necessary for thyroid hormone production. Optimal levels of zinc are needed for healthy levels of T3, T4, and TSH

Other nutrients that are helpful for optimal thyroid function include:

• Magnesium: Low levels may worsen symptoms of Hashimoto’s by raising thyroid antibody levels.
• Inositols: These compounds play a role in hormone signaling. The type of inositol especially helpful for the thyroid is Myo-inositol.
• B vitamins: Of this group, vitamin B1 is especially useful for healthy thyroid function, although be sure to get all your Bs.
• Vitamin A: This vitamin works with zinc and other nutrients to convert T4 to T3.
• Vitamin D: Healthy levels of this hormone can support lower TSH and thyroid antibody levels. Vitamin D is also involved in many bodily processes involving the thyroid.
• Copper: This mineral helps produce T4 and regulates how much is absorbed by your cells. It’s important to maintain a good copper-to-zinc balance for this to occur.
• Black Seed Oil: A study showed improvements in hypothyroidism with black seed oil supplements.

When choosing foods for optimal support, promotion, and maintenance of your thyroid function, including the following:

• Avocados
• Beans and legumes
• Berries
• Eggs
• Fermented foods
• Leafy greens
• Nuts and seeds
• Olive oil (extra virgin)
• Seafood

Bottom line

Healthy thyroid function is essential for many critical processes in the body. When thyroid hormones and other related factors are disrupted, various thyroid issues can arise, such as hyperthyroidism, thyroid nodules, goiter, and thyroiditis. In depth, thyroid testing can help identify problems with this gland, and selected nutrients and foods can support and promote healthy thyroid function.