Hot flashes! Is it my Thyroid or Estrogen?
What is the difference between menopause and thyroid disorder induced hot flashes?
A hot flash caused by menopause is different from the heat intolerance seen in hyperthyroidism or hypothyroidism. Temperature intolerance in hyperthyroidism occurs due to an excess of thyroid hormones, which can be caused by conditions like Graves’ disease or a toxic nodule. In these scenarios, the patient is intolerant to heat and feels hotter than others in the same room. This also leads to symptoms like anxiety, palpitations, and increased sympathetic activity due to the excess release of thyroid hormones, making the entire system metabolically overactive or "hyper."
Menopausal hot flashes, on the other hand, are related to changes in the body’s temperature regulation set point in the brain, particularly around the hypothalamus, due to inadequate or declining estrogen levels. These hot flashes often affect the central chest or upper body, appear suddenly, and are more common at night, though they can happen any time during the day. These episodes are typically transient and can occur frequently or infrequently depending on the individual. They are less likely to be associated with palpitations, anxiety, tremors, or jitters, but those can sometimes be present.
How can one distinguish between the two? It’s important to understand that hyperthyroidism or hypothyroidism will not just present as temperature intolerance. They are usually accompanied by several other consistent symptoms if left untreated.
Q: Are thyroid disorders more common in women?
Autoimmune thyroid diseases such as hyperthyroidism or hypothyroidism tend to occur more commonly during certain phases in a woman's life. These include the preconception period, hormonal treatments for fertility, during pregnancy, the postpartum period, and perimenopause/menopause.
Q: How to get evaluated for a thyroid disorder vs perimenopause/menopause?
Thyroid disorders must be diagnosed through blood tests, including TSH (thyroid-stimulating hormone), free T4, and in some cases free T3, especially in hyperthyroidism. Depending on these hormone levels, antibody testing may also be performed to differentiate between types of thyroid dysfunction.
Menopause, on the other hand, is a clinical diagnosis. It is defined by the absence of menstrual cycles for 12 consecutive months. In cases where patients have had a hysterectomy, endometrial ablation, or use intrauterine devices that affect bleeding patterns, FSH (follicle-stimulating hormone) may be tested. An elevated FSH level suggests menopause. Perimenopause is also largely a clinical diagnosis based on symptoms such as hot flashes, night sweats, brain fog, memory issues, joint pain, and more. Estrogen and progesterone levels fluctuate daily, and random hormone levels are not typically necessary for diagnosis.
Q: What is happening in the body when one has hyperthyroidism or menopause?
Hyperthyroidism results in too much thyroid hormone being circulated in the body. Every cell becomes overstimulated, leading to increased metabolic activity. Common symptoms include restlessness, poor sleep, nightmares, increased heart rate, arrhythmias such as atrial fibrillation, shortness of breath, loose stools, tremors, and increased anxiety. It’s not just about temperature intolerance. Every system in the body is affected.
In contrast, during perimenopause or menopause, declining estrogen impacts the brain’s temperature regulation. The blood vessels tend to dilate inappropriately, leading to a sudden sensation of heat in the chest, face, or body - commonly referred to as a hot flash.
Hyperthyroidism: Causes and Treatments
Hyperthyroidism is a common endocrine condition, often caused by:
Graves’ disease (an autoimmune condition),
Toxic thyroid nodules or multinodular goiter producing excess hormone,
Transient thyroiditis (e.g., postpartum thyroiditis or viral thyroiditis).
Treatment depends on the underlying cause. It may include:
Antithyroid medications
Radioactive iodine ablation
Surgery
For transient conditions like viral thyroiditis, treatment is often supportive. Beta-blockers may be used to control symptoms like palpitations, but antithyroid drugs are generally not required.
Lifestyle Considerations:
There is some evidence that selenium supplementation may help reduce thyroid antibodies (specifically thyroid peroxidase antibodies) and improve TSH levels, but not in hyperthyroidism. In general, hypothyroidism or hyperthyroidism should be thoroughly evaluated and appropriately treated.
For overall health and to help overall health, I advise patients to:
Minimize processed and fried foods, sugar, and high-sodium intake.
Focus on a diverse and nutrient-dense diet including fiber-rich fruits, vegetables, beans, legumes, and lean protein sources.
It’s also essential to remember that if you are diagnosed with hyperthyroidism, you must determine the exact cause and seek specialized medical care. For example, untreated Graves’ disease can lead to serious complications such as atrial fibrillation and hospitalization.
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