At 52, Cindy Vogel started to feel more tired than usual. Even after a full night of sleep, her brain felt foggy, and she was so exhausted that it interfered with everyday household tasks. At first, she ignored it.
“I thought I was just getting older, and things were changing,” said the now-53-year-old administrative coordinator from Richfield, Wisconsin. She said she hoped it wasn’t dementia, and after expressing her concerns to loved ones, they told her not to worry; she was probably just going through perimenopause. “I even did therapy because my husband thought I was just depressed. But I wasn’t,” Vogel said.
She finally got bloodwork done and learned she had Hashimoto’s disease, an autoimmune condition that causes hypothyroidism, or underactive thyroid.
The thyroid is a butterfly-shaped gland in your neck. It produces hormones that help regulate important physiological functions including your metabolism, energy, heart rate, body temperature and mood, said Ruchi Gaba, associate professor of endocrinology at Baylor College of Medicine.
When the thyroid doesn’t work as it should, either producing too little or too much of these hormones, you can end up with a variety of vague but potentially severe symptoms affecting many different parts of your body and brain.
About 20 million people in the United States have thyroid problems, and 12 percent of the population will develop one in their lifetime, according to the American Thyroid Association. Thyroid dysfunction is much more common — five to eight times as likely — in women than men, and 1 in 8 women will have a thyroid problem at some point in their lives. The prevalence also increases with age: Up to 25 percent of adults 65 and older may have some type of thyroid dysfunction, although not always severe enough to cause symptoms.
While experts say thyroid dysfunction is generally simple to diagnose and treat, it’s also easy to dismiss symptoms or blame them on other causes, including aging-related health changes, as Vogel did.
Common signs of thyroid dysfunction
Think of your thyroid as your body’s speed control. Hyperthyroidism happens when the thyroid releases too much thyroid hormone, which Gaba said can cause anxiety, diarrhea, weight loss and insomnia. Hypothyroidism is the opposite, stemming from too little thyroid hormone. This is what can be easily confused with aging-related changes.
“It slows down the entire body,” said Huda Al-Bahadili, an endocrinologist at WashU Medicine. With hypothyroidism, she said, people may experience fatigue, weight gain, feeling cold or sensitivity to cold, constipation, difficulty concentrating, brain fog, and dry skin and hair.
As Vogel described, these symptoms can often be debilitating. “I’m a morning person, and I had no motivation,” she said. “I’d get eight to nine hours of sleep, and by noon I was ready for a nap, and I’m not a napper.” The cognitive effects made it hard to retain information. “I’d have to listen to something three or four times before I got it.”
The most common type of hypothyroidism, Al-Bahadili said, is Hashimoto’s disease, a.k.a. Hashimoto’s thyroiditis, which occurs when the body (for unknown reasons) creates antibodies that attack the gland, impairing thyroid function.
Thyroiditis, or inflammation of the thyroid, can have other causes including viral or bacterial infections, radiation therapy for head and neck cancers, or certain medications such as amiodarone, which treats irregular heartbeat and contains a large amount of iodine.
“It’s inflammation that causes a transient increase in thyroid hormone, and as that process resolves, it can lead to hypothyroidism,” said Beth Lalande, an endocrinologist with the Froedtert & the Medical College of Wisconsin health network.
Rarely, Lalande said, problems with the central nervous system — such as a tumor in the pituitary gland in the brain — can trigger hypothyroidism.
How to know if it’s your thyroid or something else
Many symptoms of hypothyroidism come on gradually and might start around the same time as a stressful life event or big change, Gaba said. “So people usually adjust to how they are feeling and assume it’s part of getting older.”
Add in the fact that the risk of hypothyroidism increases with age, according to Lalande, and it just makes it even more difficult to sort out what’s going on.
While the wide range of age-related changes and hormonal shifts can have overlapping symptoms with thyroid dysfunction, Gaba said, there are some key differences. “You have to think about the patterns to help you realize if it’s out of proportion to just aging,” Al-Bahadili said.
Here are a few questions to ask yourself to figure out if your thyroid is to blame:
- Do your symptoms come and go, or are they chronic? According to Lalande, thyroid dysfunction symptoms are typically persistent, while symptoms due to other issues may ebb and flow over time. Estrogen fluctuations during perimenopause, for example, can cause ups and downs in energy and mood (though these may become more constant as perimenopause progresses). Other age-related factors, such as inconsistent sleep, increased stress or changes in activity level and exercise recovery, can also cause fatigue and brain fog that varies from day to day.
- Are you still tired after a good night of sleep? Lalande said thyroid-related fatigue generally causes constant sluggishness. You may sleep well at night but still feel tired, and find that nothing helps boost your energy. Hormonal-related fatigue, on the other hand, is often related to interrupted sleep, which Lalande said doesn’t tend to happen with hypothyroidism. Other age-related changes, health conditions and even medications can make you more likely to experience insomnia, which can make it hard to fall asleep or go back to sleep if you do wake up in the middle of the night.
- Where are you noticing most of your weight gain? Menopause-related weight gain often centers on the midsection, according to Lalande, while thyroid weight gain is often more distributed throughout the body. Thyroid problems may also cause a feeling of fullness or visible swelling in the front of the neck, Al-Bahadili said.
- Do you have a higher risk of thyroid problems? Medical history is another differentiating factor, Al-Bahadili added: You’re more likely to develop thyroid dysfunction if someone in your family had it, or if you have a personal history of another autoimmune disease.
If you think you may have a thyroid problem — or you have bothersome symptoms but aren’t sure what’s going on — Lalande suggested making an appointment with your primary care provider. Thyroid dysfunction is generally easy to diagnose with a blood test, and your provider can rule out any other conditions or hormonal imbalances at that time, too.
If you indeed have a thyroid problem, treatment is usually straightforward and affordable. Hypothyroidism is usually managed with a daily prescription medication that replaces your thyroid hormone.
After more than a year of brushing her symptoms aside, Vogel eventually saw an endocrinologist, who prescribed her levothyroxine, a synthetic thyroid hormone. “Within 24 hours, I slept through the night, I got up, and I felt like I could run a marathon. Now I feel like me again. I can stay focused. It’s perfect.”
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