Thyroid Dysfunctions and Your Fertility: How FAMs Can Help You Get to the Bottom of Hypothyroidism

PART I 

Some women live with constant fatigue, very irregular cycles, and insomnia, but are never told that thyroid dysfunction could possibly be the cause of their problems. However, an estimated 20 million Americans have some form of thyroid disease; one woman in eight will develop a thyroid disorder during her lifetime.

Up to 90% of hypothyroidism is subclinical, meaning the level of thyroid stimulating hormone found in the blood is normal, and the diagnosis is often missed. Watching for the symptoms of thyroid dysfunction, in addition to knowing how to interpret your Fertility Awareness Method (FAM) chart could help provide a diagnosis of this elusive disease, and a path towards effective treatment if caught early enough. 

This is the first article in a three-part series for Natural Womanhood dedicated to thyroid dysfunction, and its relationship to fertility. In this article, I hope to explain thyroid physiology, signs and symptoms of thyroid dysfunction, and the diagnostic labs that search for the root cause of thyroid dysfunction. In Part Two, I will explain treatment not only of hypothyroidism, but of its root causes as well. In Part Three, we will take a deep dive into Hashismoto’s thyroiditis; an autoimmune disease that is the most common culprit of thyroid dysfunction in young women. 

My goal in writing this series is that you will be empowered to better know your body, and to have confidence in speaking with your medical provider in order to get the necessary testing and treatment to heal thyroid dysfunction. 

Now, without further ado, let’s start with a crash course in thyroid physiology…  

Thyroid hormones and their functions 

First, Thyroid Stimulating Hormone (TSH) from the pituitary gland (in the brain) signals the thyroid gland (in the front of the neck) to produce mostly thyroxine (T4), and a little triiodothyronine (T3). T4 is not a usable hormone, so it must be converted into T3 in the liver and intestines. Then, T3 is bound to proteins and distributed throughout the body to trigger and maintain numerous functions. 

There is also a “stop” hormone called Reverse T3. Reverse T3 stops the transfer of T4 to T3 when the body has enough T3 to function. This allows a supply of T4 to be stored in case of need (high stress, illness, or injury). Finally, a low amount of T3 and T4 in the body will trigger Thyrotropin Releasing Hormone (TRH) in the hypothalamus (in your brain) to tell the pituitary gland to release TSH, and the cycle continues. 

The functions these thyroid hormones perform in the body are quite extensive. Thyroid hormones are involved with: regulation of heart rate and cardiac output, regulation of respiratory rate and oxygenation, temperature regulation, muscle contraction, mood stabilization, food metabolism, regulation of cholesterol levels, regulation of skin, hair, and nail growth, and the regulation of intestinal movements. In addition, thyroid hormones have an impact on the sexual hormones that regulate ovulation and menses. Thyroid hormones also work together with the adrenal gland to support the immune response and maintain neurotransmitters to provide energy.

Symptoms of low thyroid function, aka underactive thyroid or hypothyroidism 

The fact that thyroid hormones have such far-reaching impact across the body explains why signs and symptoms of low thyroid function (hypothyroidism) are so varied. The myriad symptoms of hypothyroidism can include: fatigue, muscle weakness, long recovery time after exercise, requiring more sleep than most, insomnia, depression, PMS (not improved after a trial of progesterone replacement), anxiety, feeling cold, acid reflux or heartburn, poor appetite (especially in the morning), constipation, thin eyebrows (especially the outer third), dry skin, acne, dry eyes, headaches or migraines, puffy face, fingers or feet, easily broken or peeling fingernails, thinning hair, sparse eyelashes, foggy head, inability to concentrate, poor memory, difficulty losing weight, heavy long, and/ or irregular periods, and poor immune function/ getting sick frequently. 

Measurable biological signs of hypothyroidism can include: low body temperatures, a slow resting heart rate, elevated LDL (bad cholesterol) and low HDL (good cholesterol).

If a woman has several of these signs or symptoms, she may have low thyroid function.  

Detecting signs of hypothyroidism in your fertility chart

Using a Fertility Awareness Method (FAM) to chart your cycle of fertility can be very helpful in identifying a thyroid disorder. Charting with a FAM helps a woman identify the approximate date of ovulation, and thyroid disorders can “show up” in a chart in telltale ways relative to ovulation.   

For example, the follicular phase (which is the first day of the cycle up until ovulation) should be approximately 11-23 days long.  While the length of the follicular phase can vary across cycles, the length of the luteal phase (which is the time between ovulation and the beginning of the next period) should be nearly constant from month to month (the average length of the luteal phase is 11-17 days).  

Hypothyroidism can show itself in a long follicular phase and a variable luteal phase. A woman with underactive thyroid function may also notice a heavy period, and brown bleeding at the end of her period (lasting for more than 2 days).  Also, if she is charting temperatures, she will note that they are consistently low, even after ovulation/during the luteal phase, which is supposed to show a temperature rise due to the presence of progesterone.   

How hypothyroidism (and Hashimoto’s thyroiditis) is diagnosed

If hypothyroidism is suspected due to these signs and symptoms, it’s time to ask a medical provider for a thorough lab work-up to determine the root cause of the symptoms.

A complete thyroid panel includes tests to determine the levels of TSH, Free and Total T4, Free and Total T3, Reverse T3, and thyroid antibodies in the blood. The two antibodies that can affect your thyroid gland are called Anti-TPO (Anti-Thyroid Peroxidase Antibodies) and TgAb (Anti-Thyroglobulin Antibodies). These antibodies attack the thyroid gland, making it less effective at performing its job. 

A positive test for these antibodies yields the diagnosis of Hashimoto’s Thyroiditis, which is condition that must be treated whether the other thyroid labs are normal or not, to prevent further damage to the thyroid. (Note: We will be taking a deeper dive into Hashimoto’s in part three of this series on thyroid dysfunction.) 

If the diagnosis of hypothyroidism or Hashimoto’s Thyroiditis is made, your provider’s work is not over. As a medical provider myself, I believe that it is not enough to simply give a patient a diagnosis and to merely manage their symptoms. I am a firm believer that the source of thyroid dysfunction must be found and treated in order to restore a patient’s health.  

Similarities in the prescription of birth control and Levothyroxine (T4)

I think birth control is a grave injustice to women because it merely masks symptoms of disorders like endometriosis, PMS, and polycystic ovary syndrome, instead of treating the underlying disorder. Levothyroxine (T4) can be used in the same way to mask symptoms of thyroid disorder instead of actually treating the root cause of the dysfunction. If we simply replace the thyroid hormones without searching for and treating the underlying disorder, we will only further increase the dysfunction.

In order to diagnose the root cause of thyroid dysfunction, additional labs could be very useful: 24-hour salivary cortisol and DHEA and serum DHEA-S (for adrenal function), Complete Metabolic Panel (including liver function), Complete Blood Count (CBC for anemia), iron and ferritin, B-12, zinc, vit D 25-OH, selenium, iodine (first-morning urine), prolactin, FSH and LH, Sex Hormone Binding Globulin (SHBG), cycle day 3 estrogen, and 7 days post-ovulation estrogen and progesterone. In addition, an ultrasound is necessary if there is a thyroid enlargement or nodule. 

If any of the symptoms described in this article sound familiar, it is worth taking your concerns to your provider. It is also a great idea to start charting your cycles, as the information contained within a cycle chart can be a valuable tool aiding in the detection of potential thyroid dysfunction.  

In part two of this article, I will explain the treatment of hypothyroidism. Please stay tuned! 

Click here to read Part II of our series on thyroid dysfunction, “Beyond Synthroid: Seeking Complete Treatment for Hypothyroidism.”