PCOS and Thyroid Health: What you Should Know

It may come as a surprise to learn that PCOS – a hormonal condition often hallmarked by elevated androgens and decreased insulin sensitivity – is associated with thyroid disease  as well. This connection can in turn have both short and long-term implications on your overall physical health. But let’s rewind a little: what does your thyroid even do? And why would PCOS be connected to thyroid conditions? Finally, what are the symptoms of an irregular thyroid, and what can you do about it? These are the questions we’ll be answering in this article. 

What is the thyroid? 

The thyroid is an endocrine gland located at the front of your neck and it produces hormones that are responsible for controlling your body’s metabolic rate. It works with help from something called the pituitary gland, which is located in the center of the skull. This gland helps monitor the amount of thyroid hormones in your bloodstream; if it senses a lack of thyroid hormones, it can adjust the amounts with its own hormone, thyroid stimulating hormone (TSH). TSH will communicate to the thyroid that more thyroid hormones (T3 and T4) are needed , and the thyroid can take this information and – in an ideal world – produce the right amount of hormones that keep your body’s metabolism running at the right rate. 

How does PCOS affect your thyroid health? 

That’s a good question! Frankly, scientists aren’t exactly sure. However, when someone has one autoimmune or inflammatory condition, they are more likely to develop others, due to higher immune system activity in the body, which can attack healthy tissues and systems. They hypothesize that a specific combination of risk factors, such as increased global (meaning full body) inflammation, predisposes individuals to struggle with both PCOS and Hashimoto’s in particular. (For instance, it appears that women with PCOS are more likely to be diagnosed with Hashimoto’s than women who don’t struggle with this endocrine condition). However, other theories include the idea that there could be an autoimmune connection, or even shared genetic predisposition.

There are three thyroid conditions, each with their own unique set of symptoms and implications. 

They include the following: 

  • Hypothyroidism

This is a condition where your thyroid gland doesn’t produce enough thyroid hormone.

Symptoms include: fatigue, feeling cold, hair loss, hair dryness, brittle nails, constipation, dry skin, weight gain, high cholesterol, irregular periods, stiff joints, puffy face, and depression. 

  • Hyperthyroidism

This condition arises when your thyroid gland produces too much of the thyroid hormone thyroxine. 

Symptoms can often include: unintentional weight loss, hair loss, irregular heartbeat, rapid heartbeat, nervousness, anxiety, tremor, sweating, increased sensitivity to heat, increased appetite, and changes to your menstrual cycle. In some cases a goiter (irregular growth of the thyroid gland) can be present. 

  • Hashimoto’s disease

This thyroid condition is one that women with PCOS are especially prone to. In fact, a 2013 study from the Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases suggests that PCOS itself may be considered a type of autoimmune disease and has a close association with autoimmune thyroiditis. This is on the basis of the high rate of thyroid-stimulating hormone (TSH) and thyroid peroxidase (TPO) antibodies. Hashimoto’s – at its core – is best described as an autoimmune condition in which the immune system attacks the thyroid gland. 

Symptoms can include: fatigue, increased sensitivity to the cold, increased sleepiness, dry skin, constipation, muscle weakness, irregular (or excessive) menstrual bleeding, problems with memory, hair loss, brittle nails, and an enlargement of the tongue.

Can you test for thyroid issues? 

If you have a couple of symptoms (or more) that we listed above, don’t panic. That is not necessarily a sure sign of having a thyroid problem; however, it is something that needs to be seriously investigated and understood with the help of a trusted healthcare professional. 

Fortunately, there are several tests that you can take in order to either rule out a thyroid condition, or begin treating it if your doctor gives you a positive diagnosis. 

Blood tests for thyroid conditions include: 

  • TSH 
    • This test measures the level of thyroid stimulating hormone in your blood (this is the hormone that the pituitary gland produces to help regulate your thyroid). 
    • A high TSH level oftentimes indicates hypothyroidism (aka an underactive thyroid), since this means that your thyroid isn’t making enough hormone on its own. As a result, your pituitary gland steps in to release TSH into your blood. In order to understand the root cause, if your TSH test comes back as irregular, you will likely need at least one more thyroid test.
  • FT3 
    • This test measures the levels of total triiodothyronine (T3). T3 is one of two hormones that your thyroid produces and dictates how your body spends its energy, so it’s important to understand whether your levels are in a ‘normal’ range. 
  • FT4
    • This test evaluates thyroxine (T4) total levels; T4 is the second of two hormones that your thyroid produces. A high blood level of T4 may mean you have hyperthyroidism, while a low level of T4 may mean you have hypothyroidism. (Keep in mind that factors such as pregnancy and whether you take oral contraceptives or corticosteroids can impact results). 
  • T3
    • This test measures T3 uptake. T3 test results are often examined alongside T4 and TSH test results to help diagnose thyroid disease.
  • Anti-TPO 
    • This looks at the level of anti-thyroid peroxidase antibodies and thyroglobulin antibodies in your blood (it’s most likely checked if your provider suspects Hashimoto’s or Graves’ disease). 

Your doctor may also, in some cases, order imaging tests if they believe there are nodules on the thyroid gland. 

Can you help manage your thyroid? 

First things first – if you have signs of a thyroid condition, it is critical that you book an appointment with a trusted physician. They can run the proper tests and prescribe you medication and a treatment plan that will help you balance your hormones and manage symptoms. That being said, there are some ways that you can potentially help your body regulate itself: 

  • Engage in physical activity 

Since Hashimoto’s disease and PCOS are both likely to decrease your metabolism, to support a healthy, robust metabolism, it is ideal to exercise regularly. We recommend moderate to vigorous intensity movement 150 minutes or more per week. A mix of strength training and cardio is optimal; consider cycling, running, HIIT, circuits, or swimming to better your heart health and engage in resistance exercise (with weights, or just your body weight) to strengthen your muscles and improve your resting metabolic rate. 

  • Eat frequently and listen to hunger cues 

Aim to eat between 4 and 6 meals and snacks per day. Make sure to listen to hunger and fullness cues, alongside trying to incorporate a variety of all food groups into your diet. Think whole grains, vegetables, nuts/seeds, beans, fruit, fish, and full-fat dairy. All these foods will help you build an anti-inflammatory diet, that also protects your heart health and reduces risk of insulin resistance. Check out our article on the best PCOS diet, as well as this one on balancing your blood sugar for more ideas!

  • Manage your stress (and your sleep!)

Chances are, if you have PCOS, you have higher levels of inflammation (measured via blood tests for C-reactive protein, also known as CRP, a marker for inflammation in the body) than someone without this condition. Though the root cause of this inflammation is unknown, what is known is that stress can trigger further inflammation in the body and negatively impact your thyroid. So how can you reduce stress? 

Well, getting at least 7 hours of sleep per night (but preferably closer to 9 if you can), is thought to be invaluable in reducing how stressed you feel day to day. Beyond that, good habits such as meditation, exercise, eating unprocessed foods, and practicing gratitude are all research-backed ways you can not only lower your stress levels, but also become more resistant to stress and other negative emotions. The best part? None of these practices have to break the bank or dominate your free time. For instance, consider starting out with just one or two of the following: 

  • Meditating for 15 minutes at the beginning of your day 
  • Going to bed an hour earlier (and resting for at least 7 hours)
  • Implementing 30 minutes of exercise per day
  • Avoiding high sugar, low nutrient-dense foods, and opting for high-protein, unprocessed replacements 
  • Writing a list of 3 things you are grateful for at the end of each day 
  • Journaling 

And remember, the key to any of the above isn’t perfection but consistency. Do what you can today, and evaluate after 2 weeks of habit-building how your stress levels have improved. 

  • Build a plan with your healthcare partner 

This may include incorporating foods rich in zinc, selenium, and iodine (such as eggs, cashews, brazil nuts, and pumpkin seeds – to name a few!) to help regulate your thyroid. This also likely includes taking thyroid medications and reducing areas of stress in your life, where at all possible (healthy habits like yoga and meditation can be extremely helpful in improving mindfulness and reducing anxiety and depression). 

Allara provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.