Karen's story 

'I was told I was "too young" for menopause so I asked for investigations into my thyroid.'

Back in 2019, I felt my anxiety levels rising and I seemed to be losing weight. After a few months, I went to my GP and they requested some blood tests to check a whole load of things. I was told nothing was wrong, but having checked the results myself online, my TSH level was showing as lower than the normal range (around 0.07) and was flagged as ‘abnormal’ in a bold red font.

I queried this with the receptionist and was initially fobbed off. I called the surgery again and insisted it be investigated. I had a second blood test a month later and the TSH was still low (around 0.06, but T3 and T4 were normal). 

I continued to feel unwell, but nothing specific. I was having problems with my marriage and in the midst of a job change at work and so put it down to stress. My GP suggested I try the FODMAP* diet, but I'd started losing so much weight (down to 7st 11lb at 5ft6in) that I insisted there must be more going on (and blood tests showed I didn’t have coeliac disease).

My marriage ended at the start of 2020, just before Covid changed the world. I work in the travel industry, so my work life was also turned upside down; everything suddenly stopped and there was so much uncertainty. Both work and home life were stressful and I couldn’t see friends or go out easily due to the Covid lockdown restrictions.

My TSH level was getting lower, I'd stopped sleeping, my anxiety was getting worse, my periods were all over the place and I felt rubbish.

My GP referred me to an endocrinologist but due to the pandemic, I only had a couple of telephone appointments over that year. I was told that they would monitor me, and that if I was still having symptoms and still had a low TSH in my 50s, they'd do something about it then as there were more implications as I got older. The endocrinologist said stress was probably affecting my thyroid.

I managed to move out of the marital home at the start of February 2021 and into a flat on my own. We were still in lockdown and so couldn't go to the office for company. The loneliness was overwhelming and the anxiety was hideous. I was wide awake until past 3 am most nights. I would get up to do jigsaw puzzles or some work during the night and then log on to do a full day's work at 9 am. I was exhausted!

Then I started to get hot flushes. As it was worse in summer it felt like an intolerance to the heat and I put it down to my thyroid. I bought linen shift dresses, and carried around a fan and water all the time. My memory and brain fog were bad, but I put that down to lack of sleep.

That summer I went to my new GP to beg for more investigations. I was told I was ‘too young’ for menopause (45!) so I asked for more investigations into my thyroid as I said I had felt fobbed off in the previous year. I was referred to a different hospital where I had a face-to-face consultation. I was advised I had subclinical (borderline) hyperthyroidism and the doctor put on carbimazole; the consultant told me about the BTF (thank goodness he did!) and booked me in for a scan.

The carbimazole didn't help any of my symptoms because I was on such a low dose so as not to affect the T3 / T4 as these were still normal (my TSH was now <0.01). 

I had a scan in the autumn. This revealed nodules on my thyroid and I was told about radioactive iodine (RAI) and surgery. Having watched the BTF webinar on thyroid nodule treatments, I opted for RAI in January 2022.

Not long after the treatment, I got diagnosed with hypothyroidism (I had been warned that about 30% of patients become hypothyroid). I moved in with my boyfriend in February on a Wednesday. On the Thursday, my mum was admitted to hospital with a brain aneurysm, then I got shingles a week later. My mum was in hospital for a month (she's doing well now though!)

After a few months on levothyroxine, I felt no better, and asked my GP why I still had the same symptoms. She ran some more tests and I was told I was perimenopausal. I was at breaking point by then! I felt like I'd needed at least 6 months of feeling ‘normal’ so that I could distinguish between thyroid disease and menopause. I have no idea if the RAI made me ‘better!’ I don't regret having it, but I sometimes wonder whether all my hormones were so affected by the treatment that it could have triggered perimenopause?

I was signed off work last May having broken down at work. I'd been just about coping for so long that I didn't feel strong enough to carry on working. I ended up having 10 weeks off work (very unlike me).

My GP started me on HRT in May and anti-depressants (for anxiety) in July. I started gaining weight, which I knew I needed to, but I'm now heavier than I've ever been (9st 13lb). I had to buy lots of new clothes, which was depressing when it was a case of having to and not wanting to.

I don't get hot flushes nearly as much (but I don't think mine were menopause related anyway); if anything the cold affects me more. My sleep is still horrendous, as is my memory and the brain fog.

I started exercising in February this year and was doing quite well (nothing massive, just following a fitness app, so 10 mins one day, 20 mins the next), but then physical exhaustion took over - and I had another bout of shingles. I haven't yet found the motivation to start again.

I've just had my HRT dose increased, and I'm hoping that will help me feel better. I've had a couple of blood tests since being prescribed HRT and my thyroid hormone levels have not been affected. I now realise this is due to me having oestrogen via my skin using a patch, rather than as tablets.

Over the past few years I've had different types of CBT (to deal with medical phobias!) and counselling for anxiety. While I was off work I was walking about 3-5 miles a day (until I got shin splints!)

Until 2018/19 I'd been healthy, quite fit and happy with life. Suddenly everything became hard work and a struggle. I think things are getting better, but it's slow progress as my confidence takes a massive hit when I'm tired, and I still have broken sleep.

I would be interested to know whether other people have experience of becoming perimenopausal after starting treatment for thyroid disorders.

*FODMAP diet stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols; commonly known as carbohydrates. This diet is sometimes recommended under supervision of a dietitian to reduce or eliminate symptoms of conditions such as Irritable Bowel Syndrome (IBS). The diet eliminates high FODMAP foods for six to eight weeks. After this period, small amounts of FODMAP foods are gradually reintroduced to establish what levels the individual can tolerate without symptoms returning.

BTF comment

Karen’s experiences show that it can be very difficult to tease out which symptoms are thyroid-related, and which are related to peri/menopause. Karen’s initial symptoms, hot flushes and lack of sleep corresponded with a suppressed TSH, indicating hyperthyroidism. When Karen then became hypothyroid following radioiodine treatment for hyperthyroidism, her symptoms (fatigue, brain fog, feeling colder) all suggested they were related to the hypothyroidism she was now being treated for. Yet her blood tests confirmed she was also perimenopausal, indicating why monitoring thyroid hormone levels during this period is so important. If thyroid hormone levels are optimal, and other causes have been ruled out, then it suggests that peri/menopause could be the cause.

Like Karen, many women ask whether thyroid disorders cause women to start peri/menopause earlier. Treated hypothyroidism is not explicitly associated with early menopause. However, Premature Ovarian Insufficiency (POI) is associated with autoimmune thyroid disease. Thyroid problems can occur in 14–27% of women with POI, so these women should be tested for thyroid peroxidase antibodies and screened with thyroid-stimulating hormone levels at presentation.

Hyperthyroidism does not specifically cause earlier menopause either. Uncontrolled hyperthyroidism can cause stress across your hormone system. For this reason, it can affect and even stop menstrual periods in fertile women and increase perimenopausal symptoms in women who are already nearing or in the menopause transition. Once the overactive thyroid is treated, these effects may subside. They may also continue if your body was already heading towards perimenopause before the thyroid problem began.

Read more about thyroid and menopause

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