When Your Doctor Tells You It’s Just Age
1 in 6 women have Hashimoto’s thyroiditis. Most don’t know it. Neither did I.
May is both Women’s Health Month and Older Americans Month, and this past week marked National Women’s Health Week. Together, these celebrations offer the perfect moment to focus on the needs of women in midlife, one of the most overlooked, misunderstood, and powerful stages of life.
While younger women’s health often takes center stage, peri- and postmenopausal women are navigating complex changes, from hormonal shifts to increased risk of autoimmune disease, as well as the cultural narratives that too often minimize and dismiss their symptoms as nothing more than “just aging” or “just hormones”. Honoring older and midlife women’s health enables us to rewrite that story.
A Disease Hiding in Plain Sight
Worldwide, the most commonly diagnosed autoimmune disease among women isn’t lupus or rheumatoid arthritis. It’s Hashimoto’s thyroiditis, an autoimmune thyroid disorder in which the body produces antibodies that attack thyroid hormone-producing cells, slowly killing off the cells and destroying the thyroid. Most people have few symptoms during the early stages of the disease, so diagnosis can take place years after the condition has started.
It's estimated that 14 million people in the United States have this autoimmune thyroid disease and the vast majority of them (80 - 90%) are women. That’s nearly 1 in 6 women. Yet, that figure is somewhat misleading, as the condition is often underdiagnosed because symptoms of Hashimoto’s, like fatigue, weight gain, brain fog, cold intolerance, constipation, and hair loss, are often written off as stress, burnout, hormonal imbalance or menopause.
Women are five to eight times more likely to get thyroid disease than men and up to 10 times more likely to develop Hashimoto’s, with the risk peaking between the ages of 30 and 50. The average age of diagnosis, however, starts about a decade later, somewhere between age 40 and 50, which coincides with perimenopause. And, according to data from the American Thyroid Association, it’s estimated that more than 20% of postmenopausal women may have undiagnosed hypothyroidism, mistaking the symptoms for normal aging or menopause. Thyroid diseases in general primarily affect women, with the incidence five to 20 times higher than in men. And the prevalence of most thyroid diseases increases with age.
My Diagnosis
For me, diagnosis was at 42, and finding a doctor that took the disease seriously took some time. I was in grad school, working part-time, and commuting from the suburbs into the city for both school and my job. My days were long, busy, and demanding. And I was finding it impossible to keep up. A simple blood test was all it took to learn I had hypothyroidism. But the doctor said it was mild, my TSH (that’s Thyroid Stimulating Hormone, a hormone secreted by the pituitary gland which tells the thyroid it needs to create more of its own hormone) was only 8.2. The doctor told me not to worry until it hit 40. He told me I wasn’t in need of any medication, that I needed to learn to live with it and understand that my symptoms were probably due to my busy schedule and the fact that I was "just getting older".
When Doctors Don’t Listen
WHAT? Was he for real? I could barely drag myself from the subway to the office, and keeping my head up for an eight-hour day was almost impossible. I don’t know how many times I had to shut my office door and take a short nap. A quick Google search told me a TSH of 8.2 was considered high and a sign that something is definitely wrong. A TSH of 40 was severe hypothyroidism and could lead to serious health problems, including cardiovascular disease, neurological disorders, respiratory failure, organ stress, and a host of other serious and life-threatening conditions. It was time to find a new doctor.
I sought a second opinion from a board-certified endocrinologist, who ran a full thyroid panel and found my thyroid antibodies were over 1,000 (they should be no higher than around 35 on a conventional scale; functional medicine practitioners look for an antibody count closer to zero). My immune system was attacking my thyroid. This was Hashimoto’s. He started me on medication immediately, and, after a few weeks, I felt better. But the deeper question stayed with me: WHY?
Root Causes of Hashimoto’s Thyroiditis
One possibility is genetics and family history: if you have close family members with thyroid disease or autoimmune conditions, you are more likely to develop Hashimoto’s. No one in my family that I knew of had thyroid disease or an autoimmune condition, but my mother had asthma, which, according to studies done by researchers at Chun Shang Medical University in Taiwan, has been linked to an increased risk of hypothyroidism. So, one of the first things my new doctor had me do was get my 71-year old mom tested, and, sure enough, she also had an elevated TSH and elevated thyroid antibodies. Her numbers weren’t as bad as mine, but they were high enough that she too needed to take synthetic thyroid hormones. So, I figured, I was doomed from the start; there was nothing I could have done to prevent this. But that’s not so. There are many other factors that can contribute to Hashimoto’s and thyroid hormone imbalance. Some of these include:
1. Molecular mimicry: this is when an infection, such as a virus or bacteria, is comprised of proteins that resemble thyroid proteins. Because the immune system can’t differentiate between the pathogen and the thyroid’s own tissues, it attacks both.
2. Environmental Triggers: diseases or conditions such as Epstein-Barr (aka mononucleosis) can trigger an autoimmune response, as can exposure to heavy metals, pesticides, chemicals, and certain medications. (e.g., lithium) or radiation therapy to the neck.
3. Gut Health: conditions such as leaky gut (where toxins and undigested food particles are able to penetrate the intestinal wall and enter the bloodstream, triggering an immune response) and dysbiosis (an imbalance of gut bacteria) can compromise thyroid function.
4. Nutrient Deficiencies: low levels of selenium, Vitamin D, zinc or iron as well as both an iodine deficiency and excess iodine can all affect thyroid health and immune system regulation.
5. Hormonal Factors: estrogen dominance can influence immune function, potentially triggering autoimmunity, which is why women are more likely to develop Hashimoto’s. And because women undergo so many hormonal fluctuations during pregnancy, after pregnancy, before, during and after menopause or by taking oral contraceptives, it’s no wonder the majority of women experience autoimmune thyroid problems.
6. Stress & Adrenal Health: both chronic stress and poor adrenal function can weaken the immune system, triggering autoimmune responses. Stress hormones like cortisol can disrupt thyroid hormone metabolism, worsening hypothyroid symptoms.
I Thought I was Doing Everything Right
I fit into so many of those categories. Hormonal issues? Check. Environmental triggers? For sure. I had mono in college. Stress? Oh yeah! As for gut health, nutrient deficiencies, adrenal health? Who knew? No one ever checked. I thought my diet was good. I ate organic, steered clear of GMOs, used many “clean” products in my home, avoided dangerous cosmetics, and took a good number of supplements to augment my so-called "healthy" diet. But no one ever told me what to do to protect my thyroid. No one ever tested me to see if my gut was healthy or if my toxin load was high. In retrospect, several doctors over the years did ask if I had a thyroid condition, claiming it looked like I had an enlarged thyroid. But when I told them that no doctor had diagnosed me with a thyroid condition, they dropped it. No blood tests, no lifestyle or diet suggestions, nothing! Probably because most conventional doctors have no idea how to maintain a healthy thyroid. It was the same with my mother. Had I not suggested she get her thyroid checked, she’d have no idea until her symptoms, which she assumed were caused by age or menopause, would have gotten worse.
How I Took Back Control of My Health
As time went by, my body figured out how much thyroid hormone I needed, and I began to feel like my old self again. And, as I started taking my health more seriously, I started exercising more, cleaned up my diet even more, first eliminating all processed foods from my diet, then eliminating meat, drastically reducing the amount of gluten I was consuming, eventually eliminating all dairy products, ensuring I was getting enough of the essential vitamins and minerals, and incorporating stress management practices into my day-to-day life. And, over time, I felt better than I had felt in decades. I lost weight, my blood work improved, and after a few years, the amount of thyroid hormone I was taking needed to be reduced. Although I could never rely on my thyroid to produce its own hormones (too much time had elapsed before I was diagnosed, and the damage could never be reversed) knowing that I was able to have some control over my body made me feel more empowered.
Menopause or Thyroid – or Both?
It’s important to remember that many symptoms of Hashimoto’s and hypothyroidism in women, like fatigue, brain fog, low mood, weight gain, and even hot flashes, overlap with menopause. As a result, countless women in peri- and postmenopause are told their symptoms are “just hormonal” and all a part of the aging process. Most are offered HRT or antidepressants without ever having their thyroid fully tested. But if your thyroid isn’t functioning properly, no amount of HRT will restore your energy, metabolism, or clarity. It’s essential to rule out thyroid dysfunction first or you risk treating the wrong thing.
This experience made me realize how important regular testing and screening are for maintaining optimal health. So, besides the recommended pap smear, mammogram, and colon cancer screening, that means comprehensive blood work, not just for your thyroid, but to check on your gut, adrenals, and the rest of your foundational systems. With Hashimoto’s, catching things early might even enable you to reverse the condition so that you don’t have to be on medication for life. Whether your numbers are off or not, healthy diet and lifestyle patterns are your best long-term protection for thyroid health.
If you’re looking for personalized support for a thyroid condition, menopause symptoms, or any other health-related challenges women face in midlife, let’s chat.