Quick menopause quiz: midlife menopause or thyroid problem?

  1. Fatigue or exhaustion
  2. Heart palpitations
  3. Dry skin
  4. Trouble sleeping
  5. Hair loss
  6. Weight gain

Actually, it’s kind of a trick question: all of these symptoms can be caused by menopause OR thyroid dysfunction.*

Because menopause and thyroid disease can look a lot alike, all too often women who are dealing with thyroid problems like hypo- or hyperthyroidism are told “it’s just menopause” or “you’re just getting older.” To make matters even more complicated, women in midlife are more prone to thyroid disease, increasing the chances that “it’s just menopause” is actually “just an incomplete diagnosis.”

Yes, it might be “just menopause.” But what if it’s not?

If you would like to discuss your functional thyorid medicine options, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

Chat about functional medicine thyroid with Dr. Kate Kass

Thyroid disease can have serious and lasting health impacts if left untreated. So we asked Dr. Kate Kass, a functional medicine physician who specializes in hormonal health, to talk about the differences in symptoms, how to test for thyroid disease, and what we can do to optimize our health under any circumstances.

Jill: First of all, thank you, Dr. Kate, for joining us today for a deeper conversation about I think, functional medicine. Why don’t you just explain a little bit about your practice and what you do, because I think it’s really unique, especially around functional medicine and age management.

What is functional medicine?

Kate: Sure. I have a functional medicine practice, and for maybe those who aren’t familiar with that term, ‘functional medicine,’ it is really pretty congruent with naturopathic medicine, which I think maybe people in the Northwest are a little bit more familiar with. But, it really just means that, you know, we’re using all the best science, and data, and lab testing from conventional medicine and really combine that with a whole-body, whole-person approach, and an individualized approach. So, really we’re trying to find the root cause of disease and what’s going on. And rather than just treat a symptom, really trying to help people find harmony, figure out why they might be experiencing some constellation of symptoms and get to the root cause of those problems. And oftentimes that’s a pretty individualized approach too, it’s not a one-sized-fits-all.

Jill: Within functional medicine, you’ve got a few specialties. You specialize in women’s health and aging, you specialize in sexual wellness, you specialize in men and aging. Can you talk a little bit about how you landed on these specialties and why these?

Kate: You know, hormones were something that I was fascinated with, and I was fascinated between that connection between hormones and gut and brain symptoms. And, you know, the population that has most hormone imbalance are men and women that are sort of over the age of 40-45, and with those hormone changes came sexual dysfunction, whether that be erectile dysfunction or women having sexual changes as they got older. It was a necessary area that I needed to understand better, and also just so important to quality of life. So, that became something that I specialized in also; it’s great, adjunctive care.

Jill: Can you share a little bit about your own personal story? Because I think that’s what has sparked your passion and your interest in this part of medicine.

How did you get into the functional medicine field?

Kate: Yeah, I was … probably at the end of high school and the beginning of college, and through my mid-twenties—I was struggling with some sort of a strange constellation of symptoms myself. I was diagnosed with the beginnings of osteoporosis, or osteopenia. I had stopped having my period, and I was having all this fatigue, and anemia, and anxiety, sort of this strange constellation of symptoms that I think at the doctor’s office no one really thought was connected. And I really wasn’t getting a lot of support, honestly. I think I had seen probably three or four doctors by the time I was in my, you know, early twenties, and really they just put me on birth control and some osteoporosis medication, and just sort of band-aiding these symptoms that I was experiencing. And I was pretty miserable, and pretty strange symptoms to be experiencing for someone so young.

It wasn’t until I was, I think twenty-six, when I ended up seeing a functional medicine doctor who sort of put it all together for me. I had what they believe was an auto-immune gut issue that was related to foods that I was eating. What happened was most of my symptoms resolved, and I know that sounds sort of wild to think that just healing your gut is going to resolve things like osteoporosis, and anemia, and hair loss, and anxiety, but it really was pretty profound for me, changing those symptoms and figuring out what was going on in my GI tract. At that point I decided, you know, that I needed to go into a more integrated medical practice. I needed to find an integrated medical school, and so I ended up switching. I had originally thought I was going to go to a conventional medical school, but I ended up switching. I just, I had to. It was what …. My personal beliefs at that point really aligned with integrated medical school.

Jill: One thing that when you talk about what you do that really intrigues me is you say it’s the relationship between the gut and the mind. Can you talk a little bit more about the mind and how that connects into people’s health? Because I don’t think we naturally think about anything controlled by our head or our mind.

What is the gut/mind connection when it comes to our health?

Kate: Yeah, this is a really hot topic of medicine right now, actually. And even in the conventional world and you know, big medical journals, there’s so many studies coming out connecting the gut and microbiome to our cognitive function. It really impacts it in several ways. One, we need to absorb nutrients properly to make neuro-transmitters, right? For our cognitive function and for, you know, even things like mood and anxiety. You know, and I think the statistic that gets thrown around a lot, you know, they say that 80 percent of our serotonin for instance starts at the gut level. So, it really is imperative for our gut to be operating well for us to have good neuro-transmitter function. But now there’s even more literature around leaky gut and inflammation, and inflammation’s impact on things like dementia, and depression and anxiety. Really, depression and anxiety in particular, inflammation’s been closely tied to that. And so, I think we’ll probably get into this later in the podcast, but if you have leaky gut, or gut issues going on, you’re going to have more inflammation which is going to then potentially impact things like depression, anxiety, even things like dementia. It was interesting because I think a lot of patients come in they think, “oh, this is just an alternative medicine kind of idea.”

But a couple docs that I generally will refer patients to, one is named Dale Bredesen: he’s a researcher at UCLA. He’s one of the head researchers on Alzheimer’s disease, and he recently came out with a book called The End of Alzheimer’s Disease, and he talks specifically about dietary changes and the ability to change your diet and actually reverse symptoms of dementia and Alzheimer’s disease, which no drug has ever been able to do. And I would say also even a couple of days ago I was reading the journal of neurology at Neurology Times, which is a very conservative journal, and they posted an article about the connection between microbiome—which is our gut bacteria—and Parkinson’s disease. So, they said that the microbiome had specific changes that increase your risk for Parkinson’s disease. So, this gut-brain connection, the gut-brain axis, is a really exciting area of medicine. And I would say also empowering for people too, especially people that might suffer from depression or anxiety, or even have a family risk for Alzheimer’s disease, so it’s just a really cool area of medicine, and something you have control over too.

Jill: So, you use the term ‘leaky gut,’ and this is also kind of a new term. Can you just explain to the listeners what that means, because it’s a really important thing that I think consumers are beginning to understand.

Can you explain “leaky gut”?

Kate: Yeah, leaky gut is actually something that was really established by a Harvard medical doctor, so again kind of a conventional doc. His name is Alessio Fasono, he’s a Harvard gastroenterologist that focuses on pediatric care. Leaky gut is when the lining of our gut gets compromised and it allows things to pass through when they’re not supposed to pass through. So, we’re supposed to have really tight little sections in the gut that only selectively let things through when they’re broken down properly, or selectively let through molecules or particles when they’re meant to go through into our bloodstream. The lining of our gut can become compromised for a lot of reasons, from chemicals or pesticides in our food, from even certain types of foods that are aggravating or inflammatory to people. And that lining of our gut starts letting through particles, and chemicals, and proteins that it’s not supposed to let through. And this is really important because it can actually create systemic inflammation and it can trigger the immune system to react, to overreact I would say, and this is important as it pertains to thyroid dysfunction too.

hear holistic health coach Amanda Giralmo’s thoughts on food, stress, inflammation and feeding a healthy gut

Jill: Why don’t you talk a little bit about thyroid, because how does thyroid fit into all of this? January happens to be thyroid awareness month. Can you explain how thyroid fits into head, gut biome, and your overall functional health?

How does the thyroid fit into all this?

Kate: Hypothyroid specifically is a really common issue, particularly for women. I think women are about five to eight times more likely to get thyroid dysfunction than men. And I think it’s about one in, I think it’s one in twelve women are going to have a thyroid issue, so about 12 percent of the population they say. Thyroid symptoms can be anything from fatigue and brain fog, hair loss, weight gain or inability to lose weight, even mood changes like anxiety and depression. It’s a lot of these symptoms that I think sometimes people just attribute to aging, so for that reason I think a lot of times this dysfunction is overlooked. Most thyroid issues for women are actually auto-immune, which in conventional medicine they don’t necessarily distinguish. And part of that is because conventional medicine says if you’ve got a thyroid problem, we just treat you with thyroid medication and it doesn’t really matter that much if it’s an auto-immune thyroid problem or not. I would argue that it is important to know if it’s an auto-immune thyroid problem, because it does change the way we treat thyroid issues.

And so, you know, it’s really two-fold. One, we want to find out if you have a thyroid problem, right, and make sure that you’re being diagnosed properly. And then two, once you’re diagnosed we want to find out if it’s an auto-immune thyroid problem, because that is going to actually change part of the way we treat your thyroid issue. If you do have a thyroid issue and it is auto-immune—which is about 90 percent of women with hypothyroid have this auto-immune thyroid problem called Hashimoto’s—and if it is an auto-immune thyroid problem then we really want to investigate how the gut impacts that auto-immune thyroid issue. Because again, if you have an auto-immune thyroid problem, having compromised gut health is going to really flare that thyroid issue.

Jill: A lot of the thyroid issues that you named off sound like what women experience in menopause, or as their hormones change. How do you differentiate them?

Is it thyroid? Or is it menopause?

Kate: That’s a great question and something I wanted to mention, because all those symptoms I just described—weight gain, brain fog, mood changes, low energy—all these symptoms are so commonly attributed to quote-unquote “aging,” that’s just part of getting older, which is so unfair to women. What I tell women is, you know, be persistent, listen to your gut about these things, figuratively and literally I guess. But listen to your intuition: if you don’t feel right and you don’t think it’s normal, then make sure that you find someone who’s going to help you investigate that thoroughly. And in my clinic what I tell women is, “yes, maybe you have some perimenopause/menopause symptoms going on, but it’s so common to have thyroid symptoms in conjunction with that, that we want to thoroughly investigate whether you have a thyroid issue, because they can be compounding, right?” So, there are two separate issues that need to be addressed, and I would say women, make sure you’re finding someone who’s thoroughly checking your thyroid. And I would say that’s the number one problem is that women are not finding a doc that will look at, you know, this big thyroid panel. They’re only looking at one marker, sometimes two markers for thyroid dysfunction.

Jill: And so, for thyroid you’re taking a panel or a blood test, essentially.

Kate: You want to find a doctor who’s going to look at both of your free thyroid hormones and your TSH, and your thyroid antibodies, and sometimes even something called reverse T3. So, you just want to have a really big, full picture of what’s going on with your thyroid: the TSH is not enough. And I would say most conventional docs, if you’re just seeing your primary medical care doctor, they are only testing your TSH. And so, what I see a lot is that women are suffering from thyroid issues/thyroid symptoms, were like, “oh my gosh, I go online and I read and I’m just like a poster child for thyroid dysfunction, but I’ve gone to my doctor twice and both times they told me “your thyroid looks perfectly fine.” Well, at that point you either need to go back to doc and say, “hey, can you please test these other markers for thyroid?” or find another functional medical doctor somewhere, or a naturopathic physician somewhere. You need as big a picture as possible, and at that point when they get that broader picture, that’s often when we figure out, “oh yeah, actually you do have hypothyroid. You have auto-immune hypothyroid, actually. And so, all of those symptoms you’re experiencing really make sense now.”

Jill: You obviously probably get a lot of patients who have tried a traditional route, haven’t had success, they’ve come to you. After you’ve done this testing and you realize that they’ve got, you know, a hypothyroid issue or the auto-immune version of it, how do you go about like, prescribing a better course to feeling better? What does that look like?

How do you help patients feel better?

Kate: If you just have this, you know, very beginnings of a thyroid dysfunction, if you’re really mild, sometimes even just by changing some lifestyle and diet things, we can reel you back in without needing medication. But, however, in a lot of circumstances women do need some thyroid medication supplement. Let’s say that you find out you have hypothyroidism, and then you find out also that you have auto-immune hypothyroidism, right? That means that you have antibodies, so your body’s little immune system is attacking your thyroid tissue, right? You not only potentially need to supplement with some thyroid medication, but you also need to stop your body from attacking its thyroid tissue, right? The coolest part about having an auto-immune hypothyroid condition is that you can actually reverse some of that auto-immunity, or at least slow it down.

One of the main ways that you can slow down auto-immunity, or have your immune system sort of calm down, is through diet and gut repair. So, two foods that most commonly flare hypothyroid/auto-immune hypothyroid are gluten and dairy. Those two actually stimulate your immune system to attack your thyroid tissue through something called molecular mimicry. I think if you went online you could go dive a little deeper there if you want to learn more.

Another thing that you want to do is lower your toxic burden because again, auto-immune thyroid is all about allowing your immune system to rest again so it’s not on high alert. In auto-immune thyroid your immune system’s gone rogue, so we’re trying to reel things back in, allow your immune system to relax again. So, what flares your immune system? Foods like gluten and dairy, but also toxins in our environment flare your immune system, right? So, that means toxins in our water like chlorine, and fluoride, and bromide. That means toxins from skin care products that we put on our body flare our immune system. Pesticides in foods flare our immune system. So, what I tell patients is, you know, in addition to changing your diet, you also want to reduce that toxic burden the best you can. Now, we live in an environment where we can’t live in a bubble. We’re always going to be exposed to these things on some level, but you can make some decisions and choices about how to reduce that load by eating organic when you can, being cognizant of the body care products you put on your body, you know, drinking filtered water, things like that. At the end of the podcast I’ll give you a couple of resources of books that I think can help women arm themselves with more details on this.

So, you know, summarizing here: you want to repair your gut, remove those foods that aggravate auto-immunity. You want to reduce your toxic burden. And then you also want to relieve stress, because our thyroid is really puppeted by our brain, right? So, our brain, and our pituitary and hypothalamus gland actually tell our thyroid what to do. So, if we’re under a lot of stress, our body actually will signal our thyroid to slow down, because it says, “hey, we’re under a lot of stress.” Whether that’s physiological stress or psychological stress, your brain doesn’t always know the difference. It just says, “hey body, start conserving, slow down. And we don’t know what’s going on, but we’re under a lot of stress so we don’t our thyroid, we want to conserve things.” And our thyroid’s our engine, our thyroid is what, you know, makes our metabolism work faster, what allows us to utilize energy and burn fuel, and burn fat. So, if you’re under a lot of stress, your brain tells your thyroid to slow things down, right? So, you know, you could be on the perfect diet and the perfect medication, but if you’re under an incredible amount of stress that thyroid isn’t going to work optimally, right? So, you want to relieve stress.

And then lastly–this is a little trickier, maybe stuff you can’t do quite as well on your own, you might need a functional medicine doctor to do this—but lastly is you want to treat infections or viruses. So, this sort of goes back to the optimizing the immune function. A lot of women with thyroid or hypothyroid issues have some concomitant infections going on, and some of those are gut infections, like candida or SIBO, and sometimes those are viral infections like Epstein-Barr virus or even some of the herpes viruses. So, again going back to immune system’s impact on the thyroid, if you have these other infections going on, it can actually cause immune compromise and affect your thyroid also. So, you know, just to summarize again, five things: repair your gut, optimize your diet, reduce or lower your toxic burden, relieve stress, and then figure out if you have any of those infections going on.

can an unhealthy thyroid make your ears ring? why, yes. yes it can. and so can menopause.

Jill: And that’s all something you can get done with a functional medicine doctor. Obviously, that’s something that you’re doing for your patients every day.

Kate: That’s right. And some of that you can actually have your conventional doc do for you. Some are more amenable than others to testing, you know, doing a broader test for thyroid, it just sort of depends on your relationship with your primary care doctor. But, a functional medicine doctor or a naturopathic physician could definitely do those things for you. And I would say a lot of those things you could even do on your own, you know, like the gut, the diet, the lowering the toxins, the stress piece, those you can all do on your own. You might need a little bit more support when you start diving into the testing for infections piece.

Jill: I have to ask the question around gluten and dairy, because it’s a fad, it’s everywhere. If a woman suspects she’s maybe got some thyroid issues, or she’s just not feeling very good, is lowering the amount of the intake good enough? Or do you have to completely take it out of the diet for it to have an impact?

Tell us about inflammation, gluten, and dairy?

Kate: This is a question that I sort of dread getting, honestly, but it’s an important question. If you know for sure you have auto-immune hypothyroid symptoms, if you know you for sure you have Hashimoto’s, which is the auto-immune thyroid issue, right—or even Graves’ disease which is an auto-immune thyroid issues also–unfortunately eating gluten and dairy actually flares those antibodies that attack your thyroid tissue, right? And it takes three months for those antibodies to go away. So, that means if you’re someone who just eats gluten or dairy once a week, or you know, once every couple of weeks, you’re never giving your body’s antibodies a chance to lower. So, I hate to say it, but it is true. I think at least in the very beginning you need to be really strict and allow your immune system to go off that red alert, to calm down and for those antibodies to come down. Would reducing those things help on some level? Of course. Do I think it’s important to strictly avoid those at least for three months? I think that’s important, and if you are someone with an auto-immune thyroid condition, it’s probably something you’re going to have to steer away from pretty strictly indefinitely.

And what I tell patients to, is once we get them really stable and on medication–you know if they’re on a thyroid medication and we’ve also got their thyroid stable, and they have done a diet for three months or something where they’ve avoided gluten/dairy strictly and they’re feeling much better—then I say if you want to dip your toe in the water and see how you feel…. Once in a while someone can eat a little bit of gluten or dairy once in a while and they’re okay, but people figure out what their threshold is pretty fast. So, you know, I would say some people, some women will say, “even a little bit of gluten or dairy is going to throw me over the edge and I’m going to feel crappy for a couple of weeks or more.” But I would say from an antibody standpoint, you’ve got to avoid pretty strictly: again, it takes three months for those antibodies to come down.

Jill: We’ve been talking about thyroid in particular, and gut, and how your mind works with your body, but you also talk a lot about, in your practice, age management, which is such a huge sphere. Can you just talk to that a little bit? And how even what we’ve been talking about factors into that, because everybody wants to stay as young as they can and manage the speed at which they grow older. What do you mean by age management?

What do you mean by “age management”?

Kate: Well I hate that term ‘anti-aging,’ I really don’t like it. I think it’s sort of become a buzz word and ultimately, I think it has sort of a negative connotation in my mind, ‘anti-aging.’ But age management just simply means allowing us to sort of feel our best at any age. It means, you know, we come up against different health challenges as we get older, and it’s about figuring out what those health challenges are and overcoming them. And replacing what needs to be replaced when it needs to be replaced. And allowing you to have freedom to do all the things you love to do. And really that’s what it’s about for me, is freedom I think, it’s patience. Especially as someone who has struggled with health issues before I would say, you know, when you’re struggling with health or changes in the way you feel, or energy, or brain fog, or mood, you know, you’re losing your freedom. You’re losing your freedom to be present with your family, to do your job, to go out for a jog, you’re losing the freedom to do the things you love to do. And so, what I mean by age management is just tackling those problems that come up as we get older, optimizing hormone health, optimizing thyroid function, optimizing gut and immune system, and allowing you to have the freedom to do what you want to do as you get older.

And it’s sort of depressing to me that I think a lot of patients go into their doctor’s office with symptoms like fatigue, or weight gain, or even you know, low mood or brain fog, and doctors often say, “oh you’re just getting older, or you’re stressed, those are just normal symptoms.” I really don’t accept that. It really irks me, I don’t accept that. Not from a personal level, and I don’t want to accept that for my patients either. And I would say clinically speaking, if people find the right answers and they really advocate for themselves and find the right doctors, they don’t have to accept that.

Jill: I think that’s so encouraging because, you know, people want to feel as great as they can, especially—I know the women that we work with, specifically with Gennev and the community—everyone’s looking for ways to not be subject to the things that are impacting their bodies as they do age. And so, managing that I think is just really incredibly important.

What is the benefit of working with a functional medicine doctor?

Kate: A lot of women that have auto-immune thyroid, or hypothyroidism in general, when they finally get it figured out and they find the right formula and they heal their gut, women will tell me they’ve felt better than they’ve felt in decades and decades. So, you know, women oftentimes have been struggling with thyroid issues that are sort of sneaky thyroid issues that A: haven’t been treated properly or B: haven’t been discovered, for decades, and they just thought, “oh this is just me.” And when you get it really dialed in, women will feel better than they’ve felt in, you know, in decades they’ll say, which I think is really inspiring.

Jill: You mentioned earlier a few resources that you often recommend for patients, or for women and men to read. What are those resources?

What resources can you recommend for our listeners?

Kate: I often recommend patients go to Dr. Amy Myers. She’s a doc out of Texas, she’s a functional medicine doc. She doesn’t see any more patients, but she has written two books: one called The Auto-Immune Solution and one called The Thyroid Connection, and she is very in alignment with everything I just said and those books really dive into detail, and actually even help guide you to find doctors that put your needs and teach you how to ask for what you need to ask for. So, again The Thyroid Connection and The Auto-Immune Solution by Dr. Amy Myers. Her website also has got great blogs on it, but I think that information is empowering. And, you know, you can find a functional medicine doctor in your area, or even a naturopathic physician doctor in your area. Both of those kinds of docs are going to be more equipped to do kind of deeper testing.

Jill: Dr. Kate, do you take patients from all over the United States, or just particularly local to the Pacific Northwest where you’re located?

How can someone work with you?

Kate: I do. I have patients from all over the place, you know, I have patients in Boston, I have patients in Mexico, Canada, all over the place. I need to establish care physically with a person face-to-face first, once. And then at that point I can often do tele-medicine, and I try to get patients in once a year to see them face-to-face.

Jill: Well, it has been a pleasure having you. There’s so much more I know we could go into, but you’ve given, I think, us a wonderful education specifically on thyroid health. But people can find you at Dr. Kate Kass. That’s Kate: K-A-T-E and Kass is K-A-S-S, correct?

Kate: Yup, that’s it, it’s really simple. Yeah, they’re welcome to find us there, and yeah, I think those resources are helpful too. So, yeah, I would just say be your own advocate, that’s sort of the takeaway message. And, trust your gut. If you don’t feel right, you’re not feeling like yourself, you know, persevere and keep trying figure it out or find someone who’s going to help you.

Jill: Thank you.

Kate: Yeah, my pleasure. Nice chatting with you.

Jill: You too.

As Dr. Kate says, “trust your gut.” If you feel something isn’t right, look for help and keep looking until you find the health care professional who resonates best with you. Menopause symptoms generally resolve after hormones level out and reach their new normal. Thyroid issues generally don’t and can worsen with time.

Next up on the Gennev podcast: heart health with Dr. Sarah Speck. The Seattle-based cardiologist and internist is going to share with us some very important information, just in time for American Heart Month. Be sure to subscribe to Gennev on iTunes, Stitcher, or Google Play so you never miss an episode!

*The information in this blog is for educational purposes only is not intended to replace consultation with your medical professional. If you think you’re dealing with thyroid issues or any other serious health concern, please seek medical attention right away.

Have you dealt with a thyroid issue or worked with a functional medicine doctor? We’d love to hear what you have to say about your experience. Please share in the comments below, on Gennev's Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group.


Shannon Perry

January 30, 2018
Director of Programming & Media

Medically Reviewed By

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