Women and Thyroid Disease

Although anyone can develop Graves’ disease, a number of factors can increase the risk of disease, including:⁹

• Family history
• Gender: Women are much more likely to develop Graves’ disease than are men, at a ratio of 7:1.
• Age: Graves’ disease usually develops in people younger than 40
• Other autoimmune disorders
• Emotional or physical stress
• Pregnancy or recent childbirth
• Smoking

Common signs and symptoms of Graves’ disease include:

• Irritability
• Difficulty sleeping
• Fatigue
• A rapid or irregular heartbeat
• A fine tremor of the hands or fingers
• An increase in perspiration or warm, moist skin
• Sensitivity to heat
• Weight loss, despite normal eating habits
• Enlargement of the thyroid gland (goiter)
• Change in menstrual cycles
• Bulging eyes (Graves’ ophthalmopathy)
• Thick, red skin, usually on the shins or tops of the feet (Graves’ dermopathy)

Hypothyroidism is when the thyroid gland is underactive due to improper formation at birth, surgical removal (all or in part), or inability to produce enough thyroid hormone. One of the most common causes of hypothyroidism in women is the autoimmune disease called Hashimoto's disease, in which antibodies gradually target the thyroid and destroy its ability to produce thyroid hormone. Globally the prevalence of Hashimoto’s disease is 1%, but subclinical hypothyroidism affects 4% of the population. Females make up the vast majority of the patients at a ratio of 8:1, female to male.^10,11

Risk factors include:

• Gender: Hypothyroidism is more common in women than men
• Presence of other autoimmune disorders
• Surgical removal of part or all of the thyroid gland
• Radiation treatment for Hodgkin’s disease, lymphoma, or cancers of the head or neck
• Congenital hypothyroidism or hypothyroidism that a baby is born with
• Thyroiditis or inflammation of the thyroid gland, usually caused by an autoimmune attack or viral infection
• Certain medicines such as amiodarone, lithium, interferon alpha, and interleukin-2 can prevent the thyroid gland from being able to make hormone normally
• Too much or too little iodine
• Damage to the pituitary gland
• Rare disorders that infiltrate the thyroid

The rate of hypothyroidism goes up:

• During pregnancy
• After delivery
• Around menopause

Hypothyroidism symptoms in women tend to develop slowly, often over several years. They may include the following:

• Dry, itchy skin
• Dry, coarse hair
• Hair loss
• Mild weight gain, and difficulty losing weight
• Slower thinking, memory loss
• Fatigue
• More frequent and severe muscle cramps and joint aches
• Puffiness around the face
• Heavier and/or more frequent menstrual periods
• Goiter (swelling in the front of the neck, caused by enlargement of the thyroid)
• Slowing of heart rate
• Slightly higher blood pressure
• Higher cholesterol levels

• Gender and age: Women are three times more likely than men to develop thyroid cancer. Women are most often diagnosed at ages 40–50, men in their 60s or 70s.
• Low iodine diet: Increases risk for follicular thyroid cancer.
• Radiation: Exposure may come from certain medical treatments (e.g., neck radiation treatments in childhood) and radioactive fallout from power plant accidents and nuclear weapons.
• Hereditary conditions and family history: Especially medullary thyroid cancer.

Thyroid cancer in women is typically discovered during a routine physical exam. Thyroid nodules are difficult to feel through the skin. If nodules are suspected, ultrasound imaging is required to confirm their presence and for diagnosis. Swelling or a lump in the neck is the most common symptom of thyroid cancer. Left untreated, the size of the tumor may increase and other symptoms may begin to occur, such as difficulty in swallowing and hoarseness.