Menopause Discussion > Other Health Discussion

Thyroid issues & support

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dibradley:
Hi Wrensong,
Thanks for your reply on a different thread. I’m not sure how to PM you. So thought I would just reply here. I appreciate the information and like the idea of this thread. Thanks to everyone who is so knowledgeable - am learning a lot. And I love how none of you are negative or have scary responses like on some Facebook groups - which I have now unfollowed as they are just too scary and too unhelpful.

Wrensong:
Hi dibradley.  I think you'd have needed to reach 10 posts before you could send a PM but now you have reached that number so hopefully if you want to use that facility in future you will now be able to.  You can click on the blue "my messages" tab, then "messages" & select "new message", entering the member's name in the "to" box, then typing your message in the text box as you would a post.  Sorry - not being in messages option at the mo there are probably stages I'm missing out, but don't worry about remembering how now, you can ask anyone on the forum if/when you want to send a PM & they'll tell you how.  I also only use the forum on my laptop so not familiar with any differences that may apply using it on a phone.

We all know how unnerving & frightening a time menopause can be, so we try to give reassurance, support & strike the right balance in exchanging accurate info & personal experience with as little ambiguity as possible, in the hope this will help empower others, while avoiding causing unnecessary worry.  Nothing that is passed on here can be a substitute for expert medical help, but sometimes a snippet from those who are living with menopause can shed a little additional light that helps someone progress.  Please never be afraid to ask about anything, we are all learning from each other, there is a wealth of experience & wisdom here & nothing is too trivial, nothing taboo.

I don't do FB, but sounds as though you are better off avoiding any groups that are not what you need right now.  Keep posting as you are far from alone with it all & there is always someone here to hold out a hand.
Wx

FAB-jellybean:
Thank you so much @Wrensong for your help with such comprehensive information. Having finally got to grips with my complex thyroid situation (there's now not much I don't know about it), I've been completely thrown by perimenopause. I've been finding it really difficult to find good, reliable information about complex cases, so greatly appreciate your knowledge and expertise as well you taking the time to share it with me. I'm delighted to have found you. My GP is very supportive and I'll speak to her next week about everything that's been going on. I didn't mention the mild, intermittent side-effects at the review and am now wishing I had. Finally after 6 days without a patch, my oedema went down and the crippling anxiety I was feeling has gone (those were my most unbearable symptoms). I put half an Evorel 50 patch back on last night to see how I get on with a lower dose of just the oestradiol so I can report that back to the GP and so far so good (mild swelling but no worse than yesterday). I think you're completely right about the slow release products being better for me so I'm hoping to stick with the oestradiol patches (although perhaps might be better with the Estradot that has 25, 37.5 and 50 doses) and now that my thyroid levels are better, it would appear I don't need as high a dose of oestrogen?? I'm actually wondering if my symptoms to start with were low progesterone rather than oestrogen. My body is so sensitive to minor fluctuations in hormones it's a total nightmare (I have to do minor tweaks in my T3/T4 to get where I need to get to because of side effects from big swings). I vaguely remember having some issues with the combined contraceptive pill (pre-hypothyroid diagnosis) and saying at that point that I really wasn't looking forward to the menopause, when in actual fact it's perimenopause that's being the biggest pain (so far!). I have found that splitting my T3 and T4 doses has helped me balance my thyroid hormones (much reduced dips in energy through the day and not taking 2 hours to come to of a morning). I take half my T4 at 6am (set my alarm and go back to sleep when I'm not feeling anxious) and the other half before bed at 11pm, my T3 I split in 3, taking ~1/3rd at 6am, 11am and 4pm. This lets me fit in my supplements without causing any absorption issues (B vitamins, probiotic and ashwagandha at 9am, Vit C and iron at 1-2pm and Fat soluble vits, magnesium glycinate and co enzyme Q10 at 7pm). And having just written that, the only recent addition has been the ashwagandha which I started 2 weeks before I had my review and was changed to the Combi patches. I'm now wondering if that has been causing issues as it's an adaptogen. I'll cut it back out for a while until I get myself on an even keel and then I can reintroduce it without having to wonder what is doing what. I tested my iron, vitamins and magnesium in August too with mixed results (magnesium was extremely low and everything else was sub-optimal so room for supplementation for maximum T4 conversion).

I'm hoping the bladder issues are just being caused by the constipation (I am also taking max Tramadol doses daily for a back issue that I've been referred for and although they haven't caused constipation before, I know they have the potential to so are probably adding to that. I'm hoping they can give me a nerve block or something that will let me keep functioning without them. The testosterone being normal one week and then so high the next is really confusing. I was ready to ask for testosterone gel after the first result as it was expected given my complete lack of libido and poorer function at the gym but now I'm totally thrown. I certainly don't have symptoms of high testosterone and suspect that's because my FAI is still low with most of it being bound. This is from the GP Notebook webpage "SHBG may be increased via thyrotoxicosis, oestrogens and liver failure. This increase in SHBG levels leads to an increase in total testerone concentrations. Despite changes in the SHBG, free testosterone levels generally remain within the normal range because of feedback adjustment of gonadotrophin secretion. There is an increase in SHBG capacity with age." I've started using senna to try to help things stay moving naturally and I'll discuss the vulval pain/tampon issues with the GP next week.

I don't seem to have symptoms of high prolactin (tender breasts [other than just before my period starts] and leaking nipples) but the GP notebook says the following:
"This is a hormone produced by the anterior pituitary gland. Prolactin is a polypeptide hormone composed of 199 amino acid residues.
Synthesis: synthesised by cells of the pituitary (lactotrophs) and only small amounts of prolactin are stored in the pituitary gland
Release: under inhibitory dopaminergic control and stimulatory thyroid releasing hormone (TRH) control
-increased release at night
-in females - increased release during puberty
-androgens may have a modest inhibitory effect on release
-released in response to stress e.g. exercise
-prolactin levels are high during pregnancy - oestrogen causes an increase in numbers of lactotrophs
-during lactation, suckling of the breast results in an increased release of prolactin
Actions:
-breast - milk protein synthesis and excretion in ducts and lobules
-contraceptive effect - seen with high levels of prolactin
-has no established function in males
What level of prolactin is significant?
-mildly increased prolactin levels (400-600mu/L) may be physiological and asymptomatic but higher levels are usually pathological
-very elevated levels (above 5,000mu/L) usually imply a prolactin-secreting pituitary tumour
Note that reference ranges vary between laboratories.
Notes: prolactin secretion varies with time, resulting in serum levels being 2-3 times higher at night than during the day. The levels of prolactin in
normal individuals also tend to rise in response to physiological stimuli, including sleep, exercise, pregnancy and surgical stress."

Blood samples were taken on waking at 8am so I'm guessing this will have increased the amount and that it's been caused by a mix of high oestrogen and my thyroid levels not being quite optimal for me. The higher testosterone in the 2nd sample helps to explain the prolactin reduction. Possibly a feedback reaction with my body trying hard to stay balanced. 

The endo who prescribed my T3 is a diabetes specialist and I'm not sure how much help he would be with menopause (if he hasn't already retired). I will ask to be referred to the local menopause clinic if my GP feels out of her depth. I suspect this is going to be another journey of trial and error, then repeat. My GP was happy for me to start the continuous treatment because I had been on the cyclical for 2 years so hopefully she'll be happy for me to try a natural progesterone on continuous with a lower dose slow release oestrogen which will let my body adapt more easily I feel. I would rather use it vaginally too to help reduce the side effects so hoping she will prescribe one of the other brands that doesn't have the soya in them. I saw someone on a thread here mention Lutigest as an option. I'd rather try that before going down the oral Bijuve route as I think you're right in that it will probably cause me more issues with my thyroid, as it is well recognised as affecting thyroid dosing. Tbf there is a warning on the Evorel that it will interact with levothyroxine and liothyronine so unsure why endos believe that it's only oral preparations that affect them. I realised on reading the Menopause Matters page on the different preparations after posting that 1mg oral is considered lower than the 50mcg transdermal and I certainly seem to absorb well by the transdermal route, and not sure about how well I'd absorb the oral preps. I'm also not sure how I'd manage taking the oral preparations away from my thyroid meds given my split dosing so would rather avoid that if I can.

You really need to have the mindset of a detective when you have thyroid problems, never mind adding the complications of (peri)menopause so thanks again for your help. I'm much clearer now in what I think I need to do moving forward and what to discuss with my GP next week. All the research that I have done with regards to my health spurred me to start an MRes in Health Research. I'm currently completing my last module before I start my dissertation so I'm on the home straight providing I can keep the brain fog symptoms at bay. The link between fibromyalgia and hypothyroidism has been my topic of particular interest (and probably what my dissertation topic will be around) up to now but I'm now I'm thinking that I should be looking at menopause in amongst that too.     

FAB-jellybean:
Just found more info about prolactin and maybe that has actually been causing some of my issues. https://labs.selfdecode.com/blog/prolactin-blood-test/ Main symptoms here include Irregular cycles, Vaginal dryness and Fatigue. Autoimmune conditions are associated - Hashimoto’s disease, Lupus, Rheumatoid arthritis, Psoriasis and psoriatic arthritis. I have had active psoriasis for 4+ years now (diagnosed first when I was 12) and as far as I know haven't had high enough thyroid antibodies to diagnose hashimoto's but 20% of patients never have hgh enough antibodies. I'm waiting for copies of medical records to try to work out what was tested and found 20+ years ago. So maybe my vaginal issues haven't been low oestrogen at all. OMG it's all so confusing. Am I actually perimenopausal??? Or was I just suffering from undermedicated hypothyroidism back in Aug 2020 and thereafter dealing with the side effects of hyperprolactinaemia with the increased oestrogen and I shouldn't be touching HRT yet?? Arrgh!!!! Then again, why the increase in menopausal symptoms when I stopped the patches for a month. Being stuck between a rock and a hard place doesn't come close...

Kathleen:
Hello ladies.

I just wanted to say that this thread is a great idea given how many of us have thyroid issues. Excellent suggestion Wrensong!

I look forward to keeping up with all the posts on this topic. Given all the information that has appeared so far we will all have science degrees soon alongside fabbellybean lol!

Take care ladies.

K.

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