Thyroid SOS Optimizing Thyroid Health In Women

THYROID SOS

Optimizing Thyroid Health in Women

Felice Gersh, MD

Bestselling author of the PCOS SOS series and Menopause: 50 Things You Need to Know

Health Disclaimer This book contains advice and information relating to health care. It should be used to supplement rather than replace the advice of your doctor or another trained health professional. If you know or suspect you have a health problem, it is recommended that you seek your physician's advice before embarking on any medical program or treatment. All efforts have been made to assure the accuracy of the information contained in this book as of the date of publication. The publisher and the author disclaim liability for any medical outcome that may occur as a result of applying the methods suggested in this book.

Copyright 2024 by Felice Gersh, M.D. and Alexis Perella All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

Printed in the United States First printing, 2024 Integrative Medical Press 4968 Booth Circle, Suite 101 Irvine, CA 92604 United States of America

Felice Gersh, MD An integrative approach to women's health

I’m here for you. How can I help?

I’m a full time, practicing physician in sunny Orange County, CA. Go to the Integrative Medical Group of Irvine for an appointment.

You can also find me on Youtube, Instagram, & Facebook.

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Table of Contents Introduction

The importance of thyroid health in women

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Why does your thyroid matter?

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Common thyroid conditions in women

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Common symptoms of thyroid dysfunction

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Thyroid, estradiol and progesterone

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The thyroid-menopause connection

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Testing for thyroid disorders

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Traditional and integrative treatments

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Fasting protocols and thyroid

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Hormone Replacement Therapy and thyroid

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Lifestyle and diet for thyroid optimization

Conclusion

Taking charge of your thyroid health

Felice Gersh, MD An integrative approach to women's health

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THE IMPORTANCE OF THYROID HEALTH IN WOMEN

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Introduction

The importance of thyroid health in women The thyroid gland may be small, but it plays a crucial role in women’s health. Located in the front of your neck, this butterfly-shaped gland produces hormones that regulate your metabolism, energy levels, body temperature, and even mood. When it functions properly, you likely don’t even notice it. But when it’s out of balance, the effects can be farreaching, touching nearly every aspect of your well-being.

Felice Gersh, MD An integrative approach to women's health

THE IMPORTANCE OF THYROID HEALTH IN WOMEN

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Thyroid dysfunction is surprisingly common in women and can often go undiagnosed or overlooked, especially since its symptoms—like fatigue, weight fluctuations, brain fog, and mood changes—are often mistaken for other conditions.

These symptoms may overlap with stress, metabolic issues, polycystic ovary syndrome (PCOS), or menopause, making it easy to feel unheard or dismissed by doctors who may not be looking for the root cause.

A proactive approach to thyroid health For women, particularly during life transitions such as pregnancy, perimenopause, and menopause, maintaining thyroid health is essential for overall well-being. A proactive approach to managing thyroid function can help you feel your best and prevent long-term health problems.

Understanding how your thyroid works, recognizing the symptoms of dysfunction, and exploring effective treatments, including hormone replacement therapy (HRT) and integrative strategies like fasting, are key to achieving optimal health.

In this guide, we’ll dive into the thyroid’s role in your body, common thyroid problems, and how they intersect with women’s hormonal health. We’ll also discuss practical ways to manage thyroid dysfunction and improve your overall vitality.

Felice Gersh, MD An integrative approach to women's health

WHY DOES YOUR THYROID MATTER?

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Why does your thyroid matter?

Your thyroid gland, a small butterfly-shaped organ located at the base of your neck, might not look like much, but it is one of the most important players in maintaining your body’s overall balance.

The key to energy and metabolism The thyroid gland produces hormones, chemical messengers that travel through your bloodstream to organs and tissues, directing various bodily functions.

Hormones help regulate everything from your mood to your immune response, and in the case of thyroid hormones, they play a key role in maintaining your body’s energy metabolism.

Your thyroid produces two key hormones— triiodothyronine (T3) and thyroxine (T4)— that control your metabolism, the process that converts food into energy, which your body can then either use immediately or store for later.

Felice Gersh, MD An integrative approach to women's health

WHY DOES YOUR THYROID MATTER?

The role of thyroid hormones in the body Thyroid hormones, T3 and T4, are released into your bloodstream and delivered to tissues throughout your body.

They help regulate how quickly or slowly your body uses energy, a process known as metabolic rate. When your thyroid is balanced, you feel energetic and in sync. But when there’s an imbalance— whether you produce too much or too little of these hormones—everything from your digestion to your emotional well-being can be disrupted.

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which may be subtle at first but can become more serious if not addressed.

In short, your thyroid is the engine behind your body’s energy production, and keeping it healthy is essential for feeling your best.

A well-functioning thyroid also plays a role in heart health, brain function, temperature regulation, and reproductive health. This is why any disruption in thyroid function can lead to a wide array of symptoms, some of

Felice Gersh, MD An integrative approach to women's health

COMMON THYROID CONDITIONS IN WOMEN

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Common thyroid conditions in women

Thyroid dysfunction typically involves the gland producing either too much or too little hormone. Both scenarios can lead to a range of health issues, but the good news is that with modern treatments—ranging from thyroid hormone replacement to surgical interventions—most women can manage these conditions successfully and lead healthy, vibrant lives.

Hypothyroidism and hyperthyroidism Hypothyroidism occurs when the thyroid doesn’t produce enough hormones, which slows down metabolism. This condition is more common in women, particularly as they age, and can lead to symptoms like fatigue, weight gain, hair thinning, and depression. Hypothyroidism is often caused by an autoimmune condition known as Hashimoto’s Thyroiditis, where the immune system attacks the thyroid gland. Hashimoto’s is the leading cause of hypothyroidism in women and requires careful management, often through thyroid hormone replacement therapy.

On the other hand, hyperthyroidism occurs when the thyroid produces too much hormone, speeding up metabolism. This can result in symptoms like weight loss, anxiety, rapid heartbeat, and heat intolerance. The most common cause of hyperthyroidism is Graves' Disease, another autoimmune Felice Gersh, MD An integrative approach to women's health

COMMON THYROID CONDITIONS IN WOMEN

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condition where the immune system mistakenly stimulates the thyroid to produce excessive amounts of hormone. Both Hashimoto’s and Graves’ are autoimmune disorders, with women being disproportionately affected due to the complex interplay between their immune and hormonal systems.

Thyroid nodules and thyroid cancer Not all thyroid conditions are autoimmune conditions.

Thyroid nodules, which are lumps that form on the thyroid, are quite common, especially in women over 50. In most cases, these nodules are benign and don’t cause symptoms.

However, if a nodule produces hormones, it may lead to hyperthyroidism. Doctors often monitor these nodules with regular ultrasounds and, if necessary, biopsies to rule out cancer.

Although thyroid cancer can develop in the thyroid gland, it is relatively rare compared to other thyroid conditions. Most cases of thyroid cancer are treatable, especially when caught early, and the survival rate is very high. Although the word “cancer” can be alarming, thyroid cancer is often slowgrowing and has excellent treatment outcomes when addressed promptly.

COMMON THYROID CONDITIONS IN WOMEN

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Risk factors for thyroid dysfunction Several factors increase the likelihood of developing thyroid conditions, and it’s important to be aware of them, particularly if you're experiencing symptoms that might suggest thyroid dysfunction.

1. Gender and Age: Women are far more likely than men to develop thyroid disorders, and the risk increases with age.

Thyroid problems, particularly hypothyroidism, are more common after the age of 60.

2. Family History: If a family member has a thyroid disorder, especially an autoimmune thyroid condition such as Hashimoto’s thyroiditis or Graves’ disease, your risk of developing a thyroid problem is higher. Autoimmune conditions tend to run in families, so if relatives have conditions like rheumatoid arthritis or lupus, this also increases your risk of thyroid dysfunction.

3. Autoimmune Disorders: If you have an existing autoimmune disorder, such as type 1 diabetes, celiac disease, or vitiligo, you’re at a greater risk for developing an autoimmune thyroid condition.

4. Pregnancy and Postpartum: Hormonal and immune system changes during pregnancy and the postpartum period are known triggers for thyroid dysfunction. Some women develop temporary thyroid problems during or after pregnancy, but these can sometimes become long term conditions if left untreated.

Felice Gersh, MD An integrative approach to women's health

COMMON THYROID CONDITIONS IN WOMEN

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5. Radiation Exposure: Radiation treatment for cancers in the head, neck, or chest, as well as exposure to high levels of environmental radiation, can increase the risk of developing thyroid conditions.

6. Iodine Deficiency or Excess: Both too little and too much iodine in your diet can lead to thyroid problems. Iodine is necessary for thyroid hormone production, but an imbalance can disrupt the gland’s function.

If you fall into one or more of these categories and are experiencing symptoms of thyroid dysfunction, it’s especially important to have your thyroid levels checked regularly. Early detection is key to effective management.

Felice Gersh, MD An integrative approach to women's health

COMMON SYMPTOMS OF THYROID DYSFUNCTION

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Common symptoms of thyroid dysfunction

Thyroid dysfunction can manifest in many ways, and often, the symptoms are subtle at first. One of the challenges with thyroid-related symptoms is that they overlap with other conditions, including stress, metabolic disease, and menopause. It’s easy to feel like something is off, but hard to pinpoint exactly what. That’s why understanding the signs of thyroid dysfunction is so important.

Subtle symptoms that are easy to ignore When the thyroid is underactive, as with hypothyroidism, your body slows down and you may experience symptoms like persistent fatigue, depression, constipation, unexplained weight gain, cold intolerance, dry skin, hair loss, and brain fog. These symptoms can creep up gradually, making it easy to dismiss them as part of aging or the result of a stressful lifestyle.

On the other hand, an overactive thyroid, or hyperthyroidism, speeds everything up. Common symptoms include unintentional weight loss, rapid or irregular heartbeat, excessive sweating, and anxiety or restlessness. You may also notice sensitivity to heat or difficulty sleeping. These symptoms can be disruptive but often go unrecognized, especially if they appear alongside other life changes like pregnancy or menopause.

Felice Gersh, MD An integrative approach to women's health

COMMON SYMPTOMS OF THYROID DYSFUNCTION

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Thyroid disorders in young women Thyroid disorders can affect women at any age. In younger women, those diagnosed with PCOS have a much higher incidence of autoimmune hypothyroidism, known as Hashimoto’s Thyroiditis. In fact, both PCOS and thyroid dysfunction are often linked to fertility issues. PCOS, hypothyroidism, and hyperthyroidism can all interfere with ovulation, leading to irregular menstrual cycles or difficulty conceiving, and thyroid disorders increase the risk of miscarriage. If you are struggling with fertility, it’s essential to have your thyroid checked as part of your evaluation, especially if you already have a PCOS diagnosis.

Thyroid and menopause For older women, thyroid dysfunction may be missed because many symptoms—such as fatigue, mood swings, and changes in weight—overlap with hormonal shifts related to menopause. That’s why it’s crucial to listen to your body and take these signs seriously at any stage of life. If you’re experiencing a combination of these symptoms, it’s worth talking to a healthcare provider who understands the complexities of thyroid health.

Remember that thyroid conditions are primarily diagnosed through blood tests, which measure levels of thyroid hormones like TSH, Free T3, and Free T4, and not simply through symptoms and medical history. If you suspect thyroid dysfunction, make sure to advocate for comprehensive testing because early diagnosis can prevent more serious complications down the road.

Felice Gersh, MD An integrative approach to women's health

THYROID’S INTERACTION WITH ESTRADIOL & PROGESTERONE

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Thyroid, estradiol and progesterone

The thyroid gland doesn’t operate in isolation. Like many systems in the body, it is closely intertwined with other hormonal processes, particularly those regulated by estrogen and progesterone. These hormones, which are key to a woman’s reproductive system, have a profound impact on how the thyroid functions. This connection explains why thyroid disorders are more common in women and why they often coincide with reproductive milestones such as menstruation, pregnancy, and menopause.

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THYROID’S INTERACTION WITH ESTRADIOL & PROGESTERONE

Estrogen and thyroid function Estrogen plays a vital role in regulating thyroid hormone production. It helps maintain the sensitivity of thyroid hormone receptors, which ensures that your body responds effectively to the thyroid hormones circulating in your blood. When estrogen levels fluctuate—such as during the menstrual cycle, pregnancy, or menopause—it can alter the way your thyroid functions.

For younger, reproductiveaged women, thyroid imbalances can lead to irregular menstrual cycles and fertility challenges.

Hypothyroidism, for instance, can cause heavier or irregular periods and may even disrupt ovulation, making it harder to conceive. Hyperthyroidism, on the other hand, can shorten or lighten menstrual cycles.

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Since the thyroid is so closely tied to the reproductive system, it’s crucial for women experiencing irregular cycles or difficulty with conception to have their thyroid function evaluated.

THYROID’S INTERACTION WITH ESTRADIOL & PROGESTERONE

Menopause and thyroid health As women approach menopause, hormone levels naturally decline, and this has a direct impact on thyroid function. With the loss of estradiol, the ovarian estrogen, and progesterone production during menopause, the thyroid’s efficiency can be compromised. Lower estrogen levels reduce the sensitivity of thyroid hormone receptors, meaning that even if your thyroid is producing normal levels of hormones, your body may not be utilizing them as effectively. This can lead to symptoms like fatigue, weight gain, and cognitive changes— symptoms that are often attributed solely to menopause but may also signal thyroid dysfunction.

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In women who are already dealing with thyroid issues, menopause can exacerbate the symptoms. For instance, women with hypothyroidism may experience worsening fatigue or more significant weight gain after menopause. It’s essential to monitor thyroid health closely during this transition and to work with a healthcare provider who understands the complex interaction between thyroid hormones and reproductive hormones.

Progesterone’s role While estrogen often gets most of the attention, progesterone also plays a critical role in thyroid health.

Progesterone supports thyroid function by balancing the effects of estrogen. When progesterone levels drop, as they do during menopause or with certain conditions

Felice Gersh, MD An integrative approach to women's health

THYROID’S INTERACTION WITH ESTRADIOL & PROGESTERONE

such as polycystic ovary syndrome (PCOS), the thyroid may become less efficient. Women with low

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progesterone may experience symptoms of hypothyroidism, such as fatigue, mood swings, and weight gain, even if their thyroid hormone levels are technically within the normal range.

Thyroid health is deeply connected to reproductive hormones like estrogen and progesterone. Whether you’re in your reproductive years, transitioning through menopause, or in your postmenopausal years, keeping your thyroid in balance is essential for overall well-being. If you’re experiencing symptoms that could be linked to both your thyroid and your reproductive hormones, it’s important to take a comprehensive approach to your health, addressing all hormonal factors.

Felice Gersh, MD An integrative approach to women's health

THE THYROID-MENOPAUSE CONNECTION

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The thyroid-menopause connection

As women age, the risk of developing thyroid conditions increases. Menopause increases the risk for several autoimmune conditions, including Hashimoto’s thyroiditis.

Additionally, the age-related rise in thyroid disorders is fueled by the overall declining efficiency of the endocrine system combined with the hormonal shifts that occur as the ovaries cease to produce estradiol and progesterone during menopause. According to some studies, as many as 20% of women over the age of 60 may have some form of thyroid dysfunction, with hypothyroidism being the most common condition.

Is it menopause or your thyroid?

The interplay between aging, menopause, and thyroid dysfunction is especially significant because both menopause and thyroid issues can present with overlapping symptoms. It’s easy for thyroid issues to be mistaken for menopausal symptoms—or vice versa. That’s why it’s critical for women to be especially mindful of their symptoms during and after menopause and to advocate for regular thyroid screenings as part of their routine health care.

Felice Gersh, MD An integrative approach to women's health

THE THYROID-MENOPAUSE CONNECTION

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Menopause or thyroid?

You can’t tell by symptoms alone

As you can see, because of the overlap in symptoms and because women can simultaneously be in peri-/menopause AND have thyroid dysfunction, testing is essential to get an accurate diagnosis.

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THE THYROID-MENOPAUSE CONNECTION

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Regular thyroid screening is key Given the complex relationship between aging, menopause, and thyroid health, it’s essential for women to monitor their thyroid function as they age. Regular thyroid screenings— especially during and after menopause—are critical. Even if you’re being treated for menopausal symptoms, undiagnosed thyroid dysfunction could still be contributing to your discomfort. Ask your healthcare provider to check your thyroid levels regularly, including TSH, Free T3, and Free T4, to ensure your thyroid is functioning optimally.

Although aging and menopause increase a woman’s risk for thyroid dysfunction, with awareness and proactive care, thyroid issues can be managed effectively. If you’re experiencing symptoms that seem more severe than typical menopausal changes or that persist despite treatment, don’t hesitate to ask for a thorough thyroid evaluation.

Felice Gersh, MD An integrative approach to women's health

TESTING FOR THYROID DISORDERS

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Testing for thyroid disorders

Diagnosing thyroid disorders can be tricky because the symptoms often overlap with other common health issues like stress, aging, and hormonal changes. That’s why it’s crucial to rely on comprehensive thyroid testing and an understanding of your unique health history to get an accurate diagnosis.

Key thyroid tests to request Thyroid conditions are primarily diagnosed through blood tests that measure your hormone levels. The most important tests to request include: TSH (Thyroid-Stimulating Hormone): This is typically the first test used to assess thyroid function.

TSH is produced by the pituitary gland and signals your thyroid to produce more or less thyroid hormone. If TSH levels are too high, it indicates hypothyroidism; if they’re too low, it suggests hyperthyroidism.

Free T3 and Free T4: These tests measure the levels of thyroid hormones circulating in your bloodstream.

Free T4 (thyroxine) is the primary hormone produced by the thyroid, while Free T3 (triiodothyronine) is the more active form that affects your metabolism and energy levels.

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TESTING FOR THYROID DISORDERS

Anti-TPO Antibodies: If autoimmune thyroid disease is suspected, this test looks for anti-thyroid peroxidase antibodies that indicate your immune system is attacking the thyroid gland. This is a common marker for Hashimoto’s thyroiditis and Graves’ disease.

Thyroglobulin Antibodies: This test can also help diagnose autoimmune thyroid diseases.

While these are the primary tests used in diagnosing thyroid disorders, a comprehensive evaluation often includes checking other factors that influence thyroid health, such as adrenal function.

Another useful assessment is a micronutrient panel to assess key micronutrient levels. Certain nutrients—such as iodine, selenium, and zinc—are essential for thyroid hormone production and utilization. If you’re deficient in any of these, your thyroid may not function properly, even if your hormone levels appear normal on standard tests.

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TESTING FOR THYROID DISORDERS

When to ask for testing Given how common thyroid dysfunction is in women, it’s important to know when to ask for testing. If you experience symptoms like fatigue, weight changes, mood swings, hair loss, or temperature sensitivity that persist despite lifestyle adjustments, it’s time to get your thyroid checked. This is especially true if you’re also dealing with irregular menstrual cycles or fertility issues, as thyroid imbalances can play a role in reproductive health.

Additionally, women over 40, especially those approaching menopause, should consider regular thyroid screenings as part of their routine health care. As we’ve discussed, thyroid symptoms and menopausal symptoms often overlap, making it hard to distinguish between the two without testing.

Take charge of your thyroid health Getting a comprehensive diagnosis is the first step toward managing thyroid dysfunction effectively. Be proactive about your health by requesting these tests and working with a healthcare provider who understands the complexities of thyroid function. Early detection can make a big difference in your treatment options and overall well-being.

Felice Gersh, MD An integrative approach to women's health

TRADITIONAL AND INTEGRATIVE TREATMENTS

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Traditional and integrative treatments

When it comes to treating thyroid disorders, there are several approaches available, from conventional pharmaceuticals to integrative methods that focus on lifestyle, diet, and hormone balance. The key is to find the right treatment plan that works for you, taking into account your overall health, age, and personal preferences.

Traditional treatment therapies For hypothyroidism, the most common and effective treatment is thyroid hormone replacement therapy. This usually involves taking levothyroxine, a synthetic form of the T4 hormone.

Levothyroxine is designed to

replace the thyroid hormone that your body is not producing enough of, helping to normalize metabolism, energy levels, and other bodily functions.

Thyroid hormone therapy is typically well-tolerated, but it can take time to find the correct dosage. Regular blood tests are necessary to monitor your hormone levels.

Felice Gersh, MD An integrative approach to women's health

TRADITIONAL AND INTEGRATIVE TREATMENTS

Although most women with hypothyroidism just take levothyroxine, some do better with a combo of T4 (levothyroxine) and T3 (liothyronine), the active form of thyroid hormone.

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Limitations of traditional treatments

Desiccated thyroid extract (DTE), made from pig thyroid, is an older form of thyroid replacement medication, but it is no longer preferred because its T4 to T3 ratio is not ideal for humans and it isn’t timereleased.

Conventional therapies are highly effective, but there can be challenges, especially in fine-tuning the treatment to your specific needs and adjusting it if your needs change. Some women may not absorb synthetic hormones well, or they may experience side effects like anxiety, rapid heartbeat, or difficulty sleeping if the dosage is too high.

For hyperthyroidism, treatment may include medications like methimazole or propylthiouracil (PTU), which work to reduce the production of thyroid hormones. In some cases, radioactive iodine or surgery may be recommended to remove or destroy part of an overactive thyroid gland.

Additionally, most thyroid conditions will get worse over time. Left untreated, nodules and cancer may grow. And with autoimmune thyroid conditions, if you don’t reduce autoimmunity and lower inflammation, your body will continue to attack the thyroid gland and your thyroid function will deteriorate.

Felice Gersh, MD An integrative approach to women's health

TRADITIONAL AND INTEGRATIVE TREATMENTS

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An integrative approach can complement traditional treatments by addressing underlying causes, optimizing hormone balance, and supporting overall thyroid health.

Integrative, whole-person approaches Integrative medicine looks beyond treating symptoms and focuses on restoring balance to the entire system. For women with thyroid dysfunction, this approach includes addressing diet, lifestyle, and hormonal health to support the thyroid and improve overall well-being.

One powerful lifestyle change that supports thyroid health is adopting fasting methods, such as time-restricted eating, intermittent fasting, and longer fasts. These strategies help improve gut and liver function, which are essential for optimal thyroid hormone production. Fasting supports better digestion and gut health, which can enhance nutrient absorption. Specifically, fasting can increase the diversity and balance of the gut microbiome and restore gut barrier integrity to heal leaky gut, which may help reverse autoimmune thyroid conditions.

For women in perimenopause or menopause, Hormone Replacement Therapy (HRT) can also play a critical role in supporting thyroid function. Estrogen and progesterone are key players in regulating thyroid hormone activity, and when these hormones decline, thyroid dysfunction can worsen. HRT can help restore hormonal balance, which in turn supports more efficient thyroid function and reduces symptoms like fatigue, weight gain, and mood swings.

Felice Gersh, MD An integrative approach to women's health

TRADITIONAL AND INTEGRATIVE TREATMENTS

Beyond medications and hormone therapies, lifestyle changes can have a significant impact on managing thyroid disorders.

Eating a nutrient-dense diet that includes key micronutrients like iodine, selenium, zinc, and iron is essential for thyroid health.

Regular physical activity, stress management techniques like yoga or meditation, and adequate sleep can also improve thyroid function.

By combining traditional treatments with integrative strategies such as fasting protocols, HRT, and lifestyle modifications, you can create a more comprehensive plan that addresses not just your thyroid but your entire body.

Felice Gersh, MD An integrative approach to women's health

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FASTING-MIMICKING DIET AND THYROID HEALTH

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Fasting protocols and thyroid health

One of the most exciting integrative approaches to managing thyroid health is the use of various fasting regimens, including time-restricted eating, alternate day fasting, 5:2 intermittent fasting, modified fasts, and fasting mimicking diets. Each variation has its own specific benefits and challenges, but they all can help support optimal metabolism, gut function, and thyroid health.

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How fasting supports thyroid health The thyroid gland is highly sensitive to the body’s metabolic state. Prolonged stress, inflammation, and poor diet can all negatively affect thyroid function. Fasting regimens work by creating a short term rejuvenative state that promotes cellular repair, reduces oxidative stress, and supports a healthy metabolism—all of which are essential for optimal thyroid function.

In women with hypothyroidism, periods of fasting can help improve the body’s sensitivity to thyroid hormones. For women with autoimmune thyroid conditions like Hashimoto’s thyroiditis, certain fasting regimens may help reset the immune system to produce fewer thyroid antibodies and may lower chronic inflammation, thus reducing the immune system’s attack on the thyroid.

Additionally, fasting regimens can improve overall hormone balance, making the thyroid more efficient at producing and utilizing hormones. Specifically, by promoting a healthier metabolic state and reducing inflammation, periodic fasting helps improve the body’s ability to regulate estrogen, progesterone, and thyroid hormones. For women in perimenopause and menopause—stages of life when hormone levels fluctuate and thyroid dysfunction is more common—fasting practices can offer an effective strategy to support both metabolic and hormonal health.

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Fasting’s impact on weight and metabolism For women with thyroid dysfunction, weight management can be a significant challenge. An underactive thyroid often slows metabolism, which can promote weight gain and make it harder to lose weight or maintain a healthy weight.

Fasting helps regulate metabolism by shifting the body into a state where it efficiently burns fat for energy. This metabolic reset can be particularly beneficial for women with hypothyroidism who struggle with weight gain.

Implementing fasting in your thyroid health plan It’s important to remember that while fasting can be a powerful tool for supporting thyroid health, it should be implemented as part of a broader, individualized treatment plan. Always consult with a healthcare provider before starting any fasting regimen, especially if you have an existing thyroid condition, are taking medications for thyroid management, or if you have a pre-existing metabolic disease such as diabetes. Your doctor can help tailor your fasting practice to your specific health needs, ensuring that it complements your current treatments.

Overall, fasting regimens are a valuable addition to the treatment landscape for women with thyroid dysfunction. By supporting metabolic health, lowering autoimmunity, reducing inflammation, and enhancing hormone balance, fasting can improve overall well-being and make it easier to manage thyroid-related symptoms.

Felice Gersh, MD An integrative approach to women's health

HORMONE REPLACEMENT THERAPY AND THYROID HEALTH

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Hormone replacement therapy and thyroid health

For women in perimenopause and menopause, hormone replacement therapy (HRT) can play a vital role in maintaining both thyroid function and overall well-being. The hormonal changes that come with menopause—particularly the decline in estrogen and progesterone—can directly impact thyroid function and thyroid-related symptoms.

The estrogen, progesterone, thyroid connection Estrogen and progesterone are key hormones that regulate much more than just the reproductive system. They also influence the body’s sensitivity to thyroid hormones. As estrogen levels decline during perimenopause and menopause, the thyroid receptors become less sensitive to thyroid hormones like T3 and T4. This reduction in sensitivity can mimic or worsen the effects of hypothyroidism, leading to symptoms like fatigue, weight gain, and cognitive issues.

For women already managing hypothyroidism, the drop in estrogen can make it harder for thyroid hormone replacement therapy (such as levothyroxine) to work effectively. This is where HRT can make a significant difference. By restoring hormonal balance through estrogen and progesterone therapy, HRT helps improve thyroid receptor sensitivity, allowing the thyroid hormones to function more efficiently in the body.

Felice Gersh, MD An integrative approach to women's health

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Supporting thyroid health with HRT In women with normal thyroid function, the hormonal shifts of menopause can trigger the onset of thyroid dysfunction, particularly hypothyroidism. HRT can help mitigate these effects by maintaining a healthier balance of reproductive hormones, which in turn supports thyroid function. Estrogen replacement helps the thyroid work more efficiently, while progesterone aids in balancing estrogen’s effects and maintaining overall hormonal stability.

HRT must be prescribed by a physician or other healthcare provider with prescribing authority. Be wary of anyone in the wellness space who encourages you to take supplements, estriol formulations, or extremely low dose hormones instead of typical or physiologic doses of estradiol and progesterone.

It’s important to work with a healthcare provider experienced in managing both thyroid and menopausal health to create a treatment plan that addresses your specific needs. For women using both thyroid hormone replacement therapy and HRT, careful monitoring of thyroid levels is essential because adjusting one treatment can affect the other.

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HRT benefits beyond thyroid health In addition to supporting thyroid function, HRT offers broader benefits for women in menopause. It helps alleviate many of the common symptoms of menopause, including hot flashes, night sweats, mood changes, and vaginal dryness. HRT has also been shown to improve bone density, heart health, and overall quality of life, making it a valuable option for women navigating both thyroid and menopausal changes.

When used in combination with lifestyle adjustments, diet, and thyroid hormone replacement, HRT can be a powerful tool for women looking to optimize their health during menopause and beyond.

Felice Gersh, MD An integrative approach to women's health

LIFESTYLE AND DIET FOR THYROID OPTIMIZATION

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Lifestyle and diet for thyroid optimization

Managing thyroid health isn’t just about medications and hormone therapies—your daily lifestyle choices and diet play a critical role in optimizing thyroid function. By adopting key habits and incorporating thyroid-supportive nutrients into your diet, you can help your thyroid function more efficiently, support your overall well-being, and reduce the severity of thyroid-related symptoms.

Key nutrients for thyroid health Certain nutrients are essential for the production and regulation of thyroid hormones. Without the proper intake of these nutrients, thyroid function can suffer, even if hormone levels appear normal in blood tests. The most important nutrients to focus on include: Iodine: This is a key building block for thyroid hormones. Without enough iodine, the thyroid can’t produce adequate amounts of T3 and T4. Seaweed, iodized salt, and seafood are excellent sources of iodine, but too much iodine can also cause problems, so moderation is essential.

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Selenium: This mineral plays a vital role in converting T4 to T3, the active form of thyroid hormone.

Brazil nuts, sunflower seeds, and fish are great dietary sources of selenium.

Zinc: Like selenium, zinc is important for thyroid hormone conversion. It also supports the immune system, which is especially important for women with autoimmune thyroid disorders. You can find zinc in shellfish, pumpkin seeds, and legumes.

Iron: Iron deficiency can impair thyroid hormone production and disrupt metabolic function. Women, particularly those who are menstruating, should ensure they get enough iron through foods like lean red meat, spinach, and legumes.

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The role of gut health in thyroid function Gut health is deeply interconnected with thyroid health. The gut microbiome plays a role in the absorption of nutrients that support thyroid function, and imbalances in gut bacteria can lead to inflammation and hormonal disruptions that affect the thyroid. Maintaining a healthy gut through a diet rich in fiber, fermented foods, and probiotics is an important part of thyroid optimization.

Avoiding processed foods, excess sugars, and artificial ingredients can also help reduce inflammation and improve thyroid health.

Stress management and thyroid health Chronic stress can wreak havoc on the thyroid. Stress triggers the release of cortisol, a hormone that, when elevated over long periods, can suppress thyroid function.

Incorporating stress-reducing activities such as yoga, meditation, deep breathing exercises, and regular physical activity can help balance cortisol levels and support overall thyroid function.

Exercise for thyroid support Regular physical activity helps maintain a healthy metabolism, improves mood, and supports cardiovascular health—factors that are all important for those managing thyroid disorders. However, it’s essential to listen to your body and avoid overexercising, especially if you’re dealing with

Felice Gersh, MD An integrative approach to women's health

LIFESTYLE AND DIET FOR THYROID OPTIMIZATION

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fatigue or other thyroid-related symptoms. Moderate, consistent exercise, like walking, swimming, or yoga, can improve energy levels and boost metabolic function without putting too much strain on your system.

Sleep and thyroid health Good sleep is essential for hormone regulation, including thyroid hormones. Poor sleep can lead to imbalances in cortisol and other hormones that impact thyroid function.

Aim for 7 to 9 hours of quality sleep each night to support thyroid and overall health.

Making lifestyle changes work for you Integrating these lifestyle changes—balanced nutrition, regular exercise, stress management, and quality sleep—into your daily routine can significantly enhance your thyroid function. These changes not only support your thyroid but improve your overall health and vitality, helping you feel your best no matter what stage of life you’re in.

Felice Gersh, MD An integrative approach to women's health

TAKING CHARGE OF YOUR THYROID HEALTH

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Conclusion

Taking charge of your thyroid health Your thyroid health is an essential part of your overall wellbeing, and taking proactive steps to support it can make a world of difference in how you feel. Whether you’re navigating the challenges of infertility, approaching menopause, or simply want to optimize your health, it’s important to prioritize your thyroid and make thoughtful, informed choices about your health.

Diet, lifestyle, and regular check-ups with your healthcare provider are all crucial in keeping your thyroid functioning at its best. Eating a nutrient-rich diet that includes iodine, selenium, and zinc, managing stress, getting regular exercise, and ensuring quality sleep all contribute to a healthier thyroid. It’s equally important to schedule routine check-ups and request thyroid-specific tests to stay on top of any potential issues, especially during life transitions like pregnancy and menopause.

Above all, it’s vital to listen to your body. If you feel off— whether it’s persistent fatigue, unexplained weight changes, mood swings, or simply not feeling like yourself—don’t dismiss it as just part of getting older or being stressed.

Felice Gersh, MD An integrative approach to women's health

TAKING CHARGE OF YOUR THYROID HEALTH

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Feeling "not quite right" isn't something you should settle for, and it's not a normal part of any life stages.

Yes, life stressors and aging can cause shifts in energy, mood, and weight, but these changes still warrant a thorough check-up to rule out any underlying thyroid issues or other health concerns.

Don’t be afraid to advocate for yourself. You know your body better than anyone else, and if you feel like something is wrong, it’s important to find a trusted healthcare provider who listens to your concerns and takes them seriously. Your health is worth the effort, and you should never settle for feeling less than your best.

Be your own health champion. Proactive care, early detection, and a commitment to your well-being are the keys to thriving, no matter your age. When you understand and support your thyroid health, you give yourself the opportunity to live with vitality, confidence, and energy.

ABOUT THE AUTHOR

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About Dr. Gersh Felice Gersh, M.D. is a multi-award winning physician with dual board certifications in OB-GYN and Integrative Medicine.

She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidencebased therapies from conventional, naturopathic, and holistic medicine.

For 12 years, she taught obstetrics and gynecology at Keck USC School of Medicine as an Assistant Clinical Professor, and she now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine through the University of Arizona School of Medicine. Felice is a prolific writer and lecturer who speaks globally on women’s health and regularly publishes in peer-reviewed medical journals.

She is the bestselling author of the PCOS SOS series and her latest book, Menopause: 50 Things You Need to Know.

Follow her on YouTube, Instagram, and Facebook.

Felice Gersh, MD An integrative approach to women's health

Felice Gersh, MD An integrative approach to women's health